Contact: Kelly Connelly
kconnellybaycrest
416-785-2432
Baycrest Center for Geriatric Care (Canada)
Path to recovery at the brain level appears different from drug therapy
Toronto, CANADA -- An imaging study by neuroscientists in Canada has found that patients who recover from depression with Cognitive Behavioral Therapy (CBT) show a pattern of brain changes that is distinct from patients who recover with drug therapy.
It's an important finding because it shows -- for the first time with definitive imaging evidence -- that the depressed brain responds 'differently' to different treatments. It may also help doctors better understand why a particular treatment might work for one patient and not another.
The results are published in the January 2004 issue of the Archives of General Psychiatry. The study was led by The Rotman Research Institute at Baycrest Centre for Geriatric Care, in collaboration with the Centre for Addiction and Mental Health (CAMH), and University of Toronto.
'When treating clinical depression we know that one type of treatment doesn't fit all,' says principal investigator Dr. Helen Mayberg, a senior scientist at The Rotman Research Institute at Baycrest and the Sandra A. Rotman Chair in Neuropsychiatry at the University of Toronto.
'Our imaging study shows that you can correct the depression network along a variety of pathways. Anti-depressant drugs change the chemical balance in the brain through effects at very specific target sites. Cognitive behavioral therapy also changes brain activity, it's just tapping into a different component of the same depression circuit board.'
The most common treatments for clinical depression are CBT or other types of psychotherapy, drug therapy, or a combination of both. It's not unusual for treatment to go through a trial-and-error period until one is found to provide optimal results for a patient, with the least side effects.
With CBT, patients learn to evaluate emotional provocation in their environment in a new way. They are taught cognitive strategies for reducing automatic reactivity to negative thoughts.
Using positron emission tomography (PET) -- multi-colored imaging that pinpoints where maximum changes in brain metabolism occur -- Dr. Mayberg's team, led by CBT expert Zindel Segal, PhD, and graduate student Kimberly Goldapple, generated a detailed picture of what this self-correction looks like.
CBT has theoretically been considered a top-down approach because it focuses on the cortical (top) area of the brain -- associated with thinking functions -- to modulate abnormal mood states. It aims to modify attention and memory functions, affective bias and maladaptive information processing.
In contrast, drug therapy is considered a bottom-up approach because it alters the chemistry in the brain stem and limbic (bottom) regions which drive more basic emotional and circadian behaviors resulting in eventual upstream changes in depressive thinking.
In this current study in Archives, 14 clinically-depressed adult patients underwent a full course of CBT. They each received 15 to 20 individualized outpatient sessions. None were on drug therapy. The patients' brains were scanned prior to beginning treatment and at the end of the full course of therapy.
Investigators found that CBT targets many of the same limbic and cortical regions affected by drug therapy, but in 'different directions'.
With drug therapy, metabolism (blood flow) decreases in the limbic area and increases in the cortical area. With CBT, Mayberg and colleagues identified the reverse pattern: limbic increases (in the hippocampus, dorsal mid cingulate) and cortical decreases (in the dorsolateral, ventrolateral and medial orbital frontal; inferior temporal and parietal). Furthermore, each treatment showed changes in unique brain regions supporting the top-down, bottom-up theories.
What explains this reverse pattern? As CBT patients learn to turn off the thinking paradigm that leads them to dwell on negative thoughts and attitudes, activity in certain areas in the cortical (thinking, attention) region are decreasing as well.
'The challenge continues to be how to figure out 'how to best treat' for what the brain needs,' says Dr. Mayberg. She suggests that brain scans may one day become a useful component of the treatment protocol for clinically depressed patients, helping doctors to determine in advance what treatment will be most efficacious, as well as monitor the effectiveness of a particular treatment strategy.
Dr. Mayberg's research team included Kimberly Goldapple (The Rotman Research Institute), and Drs. Zindel Segal, Sidney Kennedy, Mark Lau and Peter Bieling, and Carol Garson of the Department of Psychiatry (CAMH).
The study was funded by the Sandra A. Rotman Chair in Neuropsychiatry (Rotman Research Institute, University of Toronto), the Canadian Institutes of Health Research, and a University of Toronto Institute of Medical Science Open Fellowship Award.
Dr. Mayberg is now Professor of Psychiatry and Neurology at Emory University School of Medicine in Atlanta, and remains an associate scientist with The Rotman Research Institute at Baycrest.
вторник, 31 мая 2011 г.
Wyeth Affirms The Safety Profile Of Effexor XR
In response to reports regarding Effexor XR® (venlafaxine HCl), an antidepressant approved for the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder and panic disorder, Wyeth Pharmaceuticals, a division of Wyeth (NYSE: WYE), affirms that no causal link between Effexor XR and homicidal thoughts and actions has been established. The Company proactively performs comprehensive reviews of both clinical and post-marketing surveillance data and acts responsibly and in full accordance with regulatory requirements in disclosing safety data regarding its medicines.
"Depression is a serious, complex disease that can be difficult to treat, and patients with depression can have other serious co-morbid psychiatric illnesses," says Joseph Camardo, M.D., Senior Vice President of Global Medical Affairs, Wyeth Pharmaceuticals. "Homicidal thoughts may occur in patients with psychiatric conditions whether or not a patient is being treated with psychotropic medications.
"It is unfortunate that unsubstantiated and irresponsible allegations have been made that may create undue concern and confusion on the part of patients who benefit from treatment with Effexor XR," Dr. Camardo continues. "However, we always encourage patients to discuss any concerns or confusion they may have with their treating physicians."
Other Material Facts
-- As required by regulations, Wyeth documents and reports safety findings from its clinical trials and post-marketing surveillance data to health boards and regulatory agencies around the world. In addition, we conduct periodic safety reviews to ensure the safety profile represented in labeling is current and accurate.
-- The term "homicidal ideation" first became part of the Effexor XR label in the section titled "Other Adverse Events Observed During the Premarketing Evaluation of Effexor and Effexor XR," in November 2005 upon FDA approval of Effexor XR for the treatment of panic disorder. As part of the application for the panic disorder indication, Wyeth provided the FDA with data that included homicidal ideation in a clinical trial for Effexor XR.
-- Homicidal ideation was listed in the approved label in the section titled "Other Adverse Events Observed During the Premarketing Evaluation of Effexor and Effexor XR." Homicidal ideation is noted under a subheading titled "Nervous System," and is categorized as "rare." This section of the FDA-approved label states, "although the events reported occurred during treatment with venlafaxine, they were not necessarily caused by it."
-- Health authorities, including the FDA, recognize an important distinction between Adverse Reactions and Adverse Events. Adverse Reactions are believed to occur as a result of using a medication, whereas Adverse Events have not been proven to occur as a result of using a medication. An Adverse Event may or may not be causally related to treatment.
-- There is no scientific evidence that establishes a causal link between Effexor XR and homicidal ideation. The Company has appropriately communicated the safety profile of Effexor XR through its existing label.
In bringing its medicines to market, one of Wyeth's chief concerns is patient safety. Wyeth is confident that a wealth of clinical data and experience over more than 11 years in over 12 million patients continue to support the appropriate use of Effexor XR in treating adult patients with major depressive disorder, generalized anxiety disorder, social anxiety disorder and panic disorder.
IMPORTANT TREATMENT CONSIDERATIONS
Suicidality in Children and Adolescents
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Effexor XR (venlafaxine HC1) or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Effexor XR is not approved for use in pediatric patients.
-- Effexor XR is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs).
-- Adult and pediatric patients taking antidepressants can experience worsening of their depression and/or the emergence of suicidality. Patients should be observed closely for clinical worsening and suicidality, especially at the beginning of drug therapy, or at the time of increases or decreases in dose. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania have been reported and may represent precursors to emerging suicidality. Stopping or modifying therapy should be considered especially when symptoms are severe, abrupt in onset, or not part of presenting symptoms.
-- The development of potentially life-threatening serotonin syndrome may occur when EFFEXOR XR is coadministered with other drugs that may affect the serotonergic neurotransmitter systems. Concomitant use of EFFEXOR XR with MAOIs is contraindicated. If concomitant use of EFFEXOR XR with an SSRI, SNRI, or a triptan is clinically warranted, careful observation of the patient is advised. Concomitant use of EFFEXOR XR with tryptophan supplements is not recommended.
-- Treatment with venlafaxine is associated with sustained increases in blood pressure (BP) in some patients. Postmarketing cases of elevated BP requiring immediate treatment have been reported. Pre-existing hypertension should be controlled. Regular BP monitoring is recommended.
-- Mydriasis has been reported in association with venlafaxine; therefore, patients with raised intraocular pressure or those at risk of acute narrow-angle glaucoma (angle-closure glaucoma) should be monitored.
-- Abrupt discontinuation or dose reduction has been associated with discontinuation symptoms. Patients should be counseled on possible discontinuation symptoms and monitored while discontinuing the drug; the dose should be tapered gradually.
-- The most common adverse events reported in Effexor XR short-term placebo-controlled depression, generalized anxiety disorder (GAD), social anxiety disorder (SAD), and/or panic disorder (PD) trials (incidence >10% and >2x that of placebo) were anorexia, asthenia, constipation, dizziness, dry mouth, ejaculation problems, impotence, insomnia, nausea, nervousness, somnolence, and sweating.
Wyeth Pharmaceuticals
Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of women's health care, cardiovascular disease, central nervous system, inflammation, transplantation, hemophilia, oncology, vaccines and nutritional products. Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products and nonprescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.
The statements in this press release that are not historical facts are forward-looking statements based on current expectations of future events and are subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. These risks and uncertainties include risks associated with the inherent uncertainty of the timing and success of product research, development and commercialization (including with respect to our pipeline products), drug pricing and payment for our products by government and third party-payors, manufacturing, data generated on the safety and efficacy of our products, economic conditions including interest and currency exchange rate fluctuations, changes in generally accepted accounting principles, the impact of competitive or generic products, trade buying patterns, global business operations, product liability and other types of litigation, the impact of legislation and regulatory compliance, intellectual property rights, strategic relationships with third parties, environmental liabilities, and other risks and uncertainties, including those detailed from time to time in our periodic reports filed with the Securities and Exchange Commission, including our current reports on Form 8-K, quarterly reports on Form 10-Q and annual report on Form 10-K, particularly the discussion under the caption "Item 1A, Risk Factors." We assume no obligation to publicly update any forward-looking statements, whether as a result of new information, future developments or otherwise.
wyeth
View drug information on Effexor.
"Depression is a serious, complex disease that can be difficult to treat, and patients with depression can have other serious co-morbid psychiatric illnesses," says Joseph Camardo, M.D., Senior Vice President of Global Medical Affairs, Wyeth Pharmaceuticals. "Homicidal thoughts may occur in patients with psychiatric conditions whether or not a patient is being treated with psychotropic medications.
"It is unfortunate that unsubstantiated and irresponsible allegations have been made that may create undue concern and confusion on the part of patients who benefit from treatment with Effexor XR," Dr. Camardo continues. "However, we always encourage patients to discuss any concerns or confusion they may have with their treating physicians."
Other Material Facts
-- As required by regulations, Wyeth documents and reports safety findings from its clinical trials and post-marketing surveillance data to health boards and regulatory agencies around the world. In addition, we conduct periodic safety reviews to ensure the safety profile represented in labeling is current and accurate.
-- The term "homicidal ideation" first became part of the Effexor XR label in the section titled "Other Adverse Events Observed During the Premarketing Evaluation of Effexor and Effexor XR," in November 2005 upon FDA approval of Effexor XR for the treatment of panic disorder. As part of the application for the panic disorder indication, Wyeth provided the FDA with data that included homicidal ideation in a clinical trial for Effexor XR.
-- Homicidal ideation was listed in the approved label in the section titled "Other Adverse Events Observed During the Premarketing Evaluation of Effexor and Effexor XR." Homicidal ideation is noted under a subheading titled "Nervous System," and is categorized as "rare." This section of the FDA-approved label states, "although the events reported occurred during treatment with venlafaxine, they were not necessarily caused by it."
-- Health authorities, including the FDA, recognize an important distinction between Adverse Reactions and Adverse Events. Adverse Reactions are believed to occur as a result of using a medication, whereas Adverse Events have not been proven to occur as a result of using a medication. An Adverse Event may or may not be causally related to treatment.
-- There is no scientific evidence that establishes a causal link between Effexor XR and homicidal ideation. The Company has appropriately communicated the safety profile of Effexor XR through its existing label.
In bringing its medicines to market, one of Wyeth's chief concerns is patient safety. Wyeth is confident that a wealth of clinical data and experience over more than 11 years in over 12 million patients continue to support the appropriate use of Effexor XR in treating adult patients with major depressive disorder, generalized anxiety disorder, social anxiety disorder and panic disorder.
IMPORTANT TREATMENT CONSIDERATIONS
Suicidality in Children and Adolescents
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Effexor XR (venlafaxine HC1) or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Effexor XR is not approved for use in pediatric patients.
-- Effexor XR is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs).
-- Adult and pediatric patients taking antidepressants can experience worsening of their depression and/or the emergence of suicidality. Patients should be observed closely for clinical worsening and suicidality, especially at the beginning of drug therapy, or at the time of increases or decreases in dose. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania have been reported and may represent precursors to emerging suicidality. Stopping or modifying therapy should be considered especially when symptoms are severe, abrupt in onset, or not part of presenting symptoms.
-- The development of potentially life-threatening serotonin syndrome may occur when EFFEXOR XR is coadministered with other drugs that may affect the serotonergic neurotransmitter systems. Concomitant use of EFFEXOR XR with MAOIs is contraindicated. If concomitant use of EFFEXOR XR with an SSRI, SNRI, or a triptan is clinically warranted, careful observation of the patient is advised. Concomitant use of EFFEXOR XR with tryptophan supplements is not recommended.
-- Treatment with venlafaxine is associated with sustained increases in blood pressure (BP) in some patients. Postmarketing cases of elevated BP requiring immediate treatment have been reported. Pre-existing hypertension should be controlled. Regular BP monitoring is recommended.
-- Mydriasis has been reported in association with venlafaxine; therefore, patients with raised intraocular pressure or those at risk of acute narrow-angle glaucoma (angle-closure glaucoma) should be monitored.
-- Abrupt discontinuation or dose reduction has been associated with discontinuation symptoms. Patients should be counseled on possible discontinuation symptoms and monitored while discontinuing the drug; the dose should be tapered gradually.
-- The most common adverse events reported in Effexor XR short-term placebo-controlled depression, generalized anxiety disorder (GAD), social anxiety disorder (SAD), and/or panic disorder (PD) trials (incidence >10% and >2x that of placebo) were anorexia, asthenia, constipation, dizziness, dry mouth, ejaculation problems, impotence, insomnia, nausea, nervousness, somnolence, and sweating.
Wyeth Pharmaceuticals
Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of women's health care, cardiovascular disease, central nervous system, inflammation, transplantation, hemophilia, oncology, vaccines and nutritional products. Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products and nonprescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.
The statements in this press release that are not historical facts are forward-looking statements based on current expectations of future events and are subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. These risks and uncertainties include risks associated with the inherent uncertainty of the timing and success of product research, development and commercialization (including with respect to our pipeline products), drug pricing and payment for our products by government and third party-payors, manufacturing, data generated on the safety and efficacy of our products, economic conditions including interest and currency exchange rate fluctuations, changes in generally accepted accounting principles, the impact of competitive or generic products, trade buying patterns, global business operations, product liability and other types of litigation, the impact of legislation and regulatory compliance, intellectual property rights, strategic relationships with third parties, environmental liabilities, and other risks and uncertainties, including those detailed from time to time in our periodic reports filed with the Securities and Exchange Commission, including our current reports on Form 8-K, quarterly reports on Form 10-Q and annual report on Form 10-K, particularly the discussion under the caption "Item 1A, Risk Factors." We assume no obligation to publicly update any forward-looking statements, whether as a result of new information, future developments or otherwise.
wyeth
View drug information on Effexor.
Child's behaviour at 10 years of age may predict risk of depression, violent tendencies and phobias later in life
New research findings suggest that a child's behaviour during the age of 10-11 could predict whether he/she will suffer from depression, have violent tendencies or have social phobia later in life.
The study looked at the data on 765 children 10-11 years of age. They followed the kids up for a period of ten years. Those who at the age of 10-11 were involved in fighting, stealing or had other behaviour problems had four times the normal risk of developing depression or violent behaviour as a 21-year-old adult.
Dr. W. Alex Mason , led researcher, said to the Reuters news agency "The good news is that the findings in this study suggest that parents, teachers, and service providers might be able to identify children with conduct problems at an early age and intervene to reduce those problems as a way to prevent later violence and depression."
Other studies have suggested an association between childhood anxiety and depression and adult depression and anxiety disorders. Most studies seem to agree that behavioural problems (and emotional) during childhood increases the chances of children becoming antisocial adults.
The problem with previous studies is that one could not make conclusions regarding society at large as the children being monitored were all from clinics rather than from the general community.
This latest study has overcome this limitation. Dr. Mason and his team (Washington University) studied Seattle schoolchildren aged 10-11 in high crime neighbourhoods.
A decade later they found that 21% of the children they had been monitoring had committed at least two violent acts during the previous twelve months. 20% had experienced depression while 17% had experienced some kind or social phobia over the previous twelve months.
The researchers found there was link between the children's own records earlier in life and violent behaviour, depression or social phobia as early adults.
You can read about this study in the Journal of the American Academy of Child and Adolescent Psychiatry.
There was also a link, although less significant, between shyness during childhood and increased risk of social phobia later in life.
The scientists found a stronger link between violent behaviour and adult depression from the parental and teacher reports than from the children's reports on themselves.
Mason also stressed that it is normal for children to be involved in some kind of conduct problems during their lives. He said that it was when those problems started earlier than was thought typical that it may be a sign of increased risk of things to come.
When asked why there might be this association between childhood conduct problems and adult depression or violent behaviour, Dr. Mason said "Some have hypothesized that children who engage in aggressive behaviour like fighting, pushing others and other problem behaviours become increasingly socially isolated during adolescence. Their social failures may contribute to the development of depression."
The study looked at the data on 765 children 10-11 years of age. They followed the kids up for a period of ten years. Those who at the age of 10-11 were involved in fighting, stealing or had other behaviour problems had four times the normal risk of developing depression or violent behaviour as a 21-year-old adult.
Dr. W. Alex Mason , led researcher, said to the Reuters news agency "The good news is that the findings in this study suggest that parents, teachers, and service providers might be able to identify children with conduct problems at an early age and intervene to reduce those problems as a way to prevent later violence and depression."
Other studies have suggested an association between childhood anxiety and depression and adult depression and anxiety disorders. Most studies seem to agree that behavioural problems (and emotional) during childhood increases the chances of children becoming antisocial adults.
The problem with previous studies is that one could not make conclusions regarding society at large as the children being monitored were all from clinics rather than from the general community.
This latest study has overcome this limitation. Dr. Mason and his team (Washington University) studied Seattle schoolchildren aged 10-11 in high crime neighbourhoods.
A decade later they found that 21% of the children they had been monitoring had committed at least two violent acts during the previous twelve months. 20% had experienced depression while 17% had experienced some kind or social phobia over the previous twelve months.
The researchers found there was link between the children's own records earlier in life and violent behaviour, depression or social phobia as early adults.
You can read about this study in the Journal of the American Academy of Child and Adolescent Psychiatry.
There was also a link, although less significant, between shyness during childhood and increased risk of social phobia later in life.
The scientists found a stronger link between violent behaviour and adult depression from the parental and teacher reports than from the children's reports on themselves.
Mason also stressed that it is normal for children to be involved in some kind of conduct problems during their lives. He said that it was when those problems started earlier than was thought typical that it may be a sign of increased risk of things to come.
When asked why there might be this association between childhood conduct problems and adult depression or violent behaviour, Dr. Mason said "Some have hypothesized that children who engage in aggressive behaviour like fighting, pushing others and other problem behaviours become increasingly socially isolated during adolescence. Their social failures may contribute to the development of depression."
How Depression And Burden Affect Caregivers Of Those With Sensory Impairment
When a person experiences impairment or declining health, caregiving typically falls to a family member, most often a spouse. This increased burden can cause burnout, stress, and illness in the caregiver. The health care system focuses first on the client and provides little support for the caregiver.
A study just published in the journal Insight: Research and Practice in Visual Impairment and Blindness explores levels of burden and depression reported by caregivers. This Canadian study focuses on people over the age of 65 with blindness, deafness, or both impairments, and the spouse or partner who serves as caregiver.
Nearly 21% of seniors with disabilities in Canada are afflicted with vision loss. More than 50% of Canadians older than 65 have inner ear hearing loss. Among those 70 years and older, 9% to 21% have some degree of dual-sensory loss.
Twenty-five participants, spouses to clients of a vision and hearing loss rehabilitation center, were recruited for this study. Of the clients, six had vision loss, eight had hearing loss, five had dual-sensory loss, and six were control participants with no sensory loss. Participants were ages 65 to 93.
The current study used two survey instruments, the Caregiver Burden Scale and the Geriatric Depression Scale. These surveys address topics such as caregivers' health, psychological well-being, finances, social life, and relationship with the person receiving care.
The hypothesis was that spouses whose partners had sensory loss would report higher levels of both burden and depression compared to the control group. However, the current study did not find this result on a statistically significant level. In fact, the one comparison that did show a significant difference indicated that those in the control group, with no sensory loss, experienced a greater feeling of burden than those in the hearing-impaired group.
These results were somewhat surprising, yet they did show a significant relationship between increased perception of burden and higher levels of depression. Despite the limitation of a small number of study participants, these results could indicate that burden and depression are generally more widespread in older adults and are not specifically linked to a disability or health status.
Full text of the article, "Depression and Burden in Spouses of Individuals with Sensory Impairment," Insight: Research and Practice in Visual Impairment and Blindness, Vol. 4, No. 1, Summer 2011, is available here.
A study just published in the journal Insight: Research and Practice in Visual Impairment and Blindness explores levels of burden and depression reported by caregivers. This Canadian study focuses on people over the age of 65 with blindness, deafness, or both impairments, and the spouse or partner who serves as caregiver.
Nearly 21% of seniors with disabilities in Canada are afflicted with vision loss. More than 50% of Canadians older than 65 have inner ear hearing loss. Among those 70 years and older, 9% to 21% have some degree of dual-sensory loss.
Twenty-five participants, spouses to clients of a vision and hearing loss rehabilitation center, were recruited for this study. Of the clients, six had vision loss, eight had hearing loss, five had dual-sensory loss, and six were control participants with no sensory loss. Participants were ages 65 to 93.
The current study used two survey instruments, the Caregiver Burden Scale and the Geriatric Depression Scale. These surveys address topics such as caregivers' health, psychological well-being, finances, social life, and relationship with the person receiving care.
The hypothesis was that spouses whose partners had sensory loss would report higher levels of both burden and depression compared to the control group. However, the current study did not find this result on a statistically significant level. In fact, the one comparison that did show a significant difference indicated that those in the control group, with no sensory loss, experienced a greater feeling of burden than those in the hearing-impaired group.
These results were somewhat surprising, yet they did show a significant relationship between increased perception of burden and higher levels of depression. Despite the limitation of a small number of study participants, these results could indicate that burden and depression are generally more widespread in older adults and are not specifically linked to a disability or health status.
Full text of the article, "Depression and Burden in Spouses of Individuals with Sensory Impairment," Insight: Research and Practice in Visual Impairment and Blindness, Vol. 4, No. 1, Summer 2011, is available here.
Little Convincing Evidence That Omega-3 Combats Depression
There is no convincing evidence that taking omega-3 fatty acids on their own can alleviate depression, says Drug and Therapeutics Bulletin (DTB).
And there is only limited evidence that they can relieve depression when used in combination with antidepressant drugs, it adds.
Evidence from circumstantial research has suggested links between omega-3 levels and behaviour and mood disorders, such as depression. And the findings have attracted widespread attention.
Omega-3 fatty acids are polyunsaturated fatty acids, or PUFAs, which include ALA, EPA, and DHA. They are involved in chemical messaging in the brain, and help regulate blood vessel activity and aspects of the immune system that affect the central nervous system.
The main dietary sources of EPA and DHA come from oily fish, while ALA is found mainly in nuts, seeds, and leafy green vegetables.
Omega-3 supplements are available over the counter in the form of fish oil.
The DTB review looked at published research on the clinical effectiveness of omega-3 fatty acids, on their own and in combination, as well as overall analyses of these studies (meta-analyses).
It concluded there was little convincing evidence for using the fatty acids alone as a treatment for depression. And it found only limited evidence to back their use as a supplement to antidepressants.
The review found that fish oil supplements are generally well tolerated by people who take them.
But there is evidence that they contain environmental toxins, which may be particularly concentrated in supplements made from fish livers. So it is important not to exceed the maximum recommended doses, says the DTB.
Furthermore, as fish oil supplements contain vitamin A, pregnant women should take only low doses of them, because of the potentially harmful effects of high levels of vitamin A on the developing fetus.
British Medical Journal
BMA House, Tavistock Sq
London WC1H 9JP
United Kingdom
bmj
And there is only limited evidence that they can relieve depression when used in combination with antidepressant drugs, it adds.
Evidence from circumstantial research has suggested links between omega-3 levels and behaviour and mood disorders, such as depression. And the findings have attracted widespread attention.
Omega-3 fatty acids are polyunsaturated fatty acids, or PUFAs, which include ALA, EPA, and DHA. They are involved in chemical messaging in the brain, and help regulate blood vessel activity and aspects of the immune system that affect the central nervous system.
The main dietary sources of EPA and DHA come from oily fish, while ALA is found mainly in nuts, seeds, and leafy green vegetables.
Omega-3 supplements are available over the counter in the form of fish oil.
The DTB review looked at published research on the clinical effectiveness of omega-3 fatty acids, on their own and in combination, as well as overall analyses of these studies (meta-analyses).
It concluded there was little convincing evidence for using the fatty acids alone as a treatment for depression. And it found only limited evidence to back their use as a supplement to antidepressants.
The review found that fish oil supplements are generally well tolerated by people who take them.
But there is evidence that they contain environmental toxins, which may be particularly concentrated in supplements made from fish livers. So it is important not to exceed the maximum recommended doses, says the DTB.
Furthermore, as fish oil supplements contain vitamin A, pregnant women should take only low doses of them, because of the potentially harmful effects of high levels of vitamin A on the developing fetus.
British Medical Journal
BMA House, Tavistock Sq
London WC1H 9JP
United Kingdom
bmj
VNS therapy for treatment-resistant depression proves effective for some patients
Vagus nerve stimulation (VNS) therapy, a treatment recently approved by the Food and Drug Administration for treatment-resistant depression, produced a positive response in more than 25 percent of patients in a national, yearlong study led by UT Southwestern Medical Center psychiatrists.
Sixteen percent to 20 percent of the study group experienced total remission.
Results of the study, led by Dr. A. John Rush, vice chairman for research in psychiatry at UT Southwestern, appear in the September issue of Biological Psychiatry. Findings from two additional related studies also are included in the issue.
VNS therapy, which the FDA approved for treatment of epileptic seizures in 1997 and for depression in July, has been studied in clinical trials for treatment-resistant depression since 1998. VNS therapy includes surgical implantation of a small battery-operated pulse generator - similar to a pacemaker - in a patient's left upper chest. Thin, flexible wires from the device are tunneled into the neck and send mild, intermittent pulses to the neck's left vagus nerve. The vagus nerve in turn delivers these pulses about every five minutes to the areas of the brain involved in the regulation of mood, motivation, sleep, appetite and other symptoms relevant to depression.
Karmen McGuffee, who had the vagus nerve stimulator implanted in 1999 after suffering from severe depression for more than 15 years, said the device has restored her life. A participant in one of the first clinical trials at UT Southwestern, she had taken more than 10 types of antidepressant drugs before the surgery, with little success.
"It was like having the color come back into my world," said Mrs. McGuffee, 35. "Before VNS therapy, I could barely function and only then with a lot of help. At the time, I had nothing to lose.
"Now I feel brighter and lighter. I'm not constantly worried, and I look forward to everyday activities. Things that other people take for granted, such as managing a house, a family and a job all are now possible."
VNS therapy is only indicated for people who have not been helped by other depression treatments, said Dr. Rush. "If you have treatment-resistant depression and need long-term treatment, VNS is an option that should be considered. While it's not going to get everybody into remission, it's doing pretty well in very difficult-to-treat patients," he said.
Two of the three studies in the current journal compared patients with major depressive disorder or bipolar disorder, all of whom were implanted with the vagus nerve stimulator. In the first trial, which included 235 people and only lasted for 10 weeks, patients implanted with the stimulator received either active VNS therapy or no therapy, meaning the device was not activated. There was little change in either group.
Dr. Rush's second multicenter trial, which included 205 of the same patients, provided active VNS therapy for a full year to all participants, measuring their symptoms of depression at regular intervals using several standard rating scales. One rating scale showed a 27.2 percent reduction in symptoms among participants and a 15.8 percent remission rate at year's end - suggesting that long-term treatment with VNS offers a greater benefit than its short-term application. A second rating scale showed reduction in symptoms by 28.2 percent and a 20.3 percent remission rate.
"This is a very good response, given the type of highly resistant depression involved," Dr. Rush said. "Participants in the trials were some of the most treatment-resistant depressed patients ever studied, with at least half having been hospitalized for the disease at least once."
The studies also showed VNS to be well-tolerated, with few serious adverse reactions, he said. Possible side effects, however, can include a slight voice alteration or temporary hoarseness, cough, tickling in the throat or shortness of breath during exertion - symptoms which may occur intermittently when the stimulation is on.
The third study, of which Dr. Rush was a co-author, compared two groups of people with similar degrees of severe depression. One group was implanted with the vagus nerve stimulator as well as given other types of treatments for depression, including medication and cognitive therapy. The second group did not receive the device, but was treated for depression. Results showed a 27 percent reduction in depressive symptoms in the VNS group, compared to a 13 percent reduction in the second group.
Dr. Mustafa Husain, professor of psychiatry and internal medicine at UT Southwestern, said VNS offers "new hope" for severely depressed individuals.
"VNS treatment can be very useful in combination with antidepressants for a particular group of patients who are chronically depressed," he said. "It can provide new hope for a better life to those who are not responding to antidepressant medications."
Dr. Husain and Dr. Rush were involved in all three studies, which included researchers from more than 20 sites around the country. The studies were supported in part by Cyberonics Inc., manufacturer of VNS Therapy.
This news release is available on our World Wide Web home page at utsouthwestern/home/news/index.html
To automatically receive news releases from UT Southwestern via e-mail, subscribe at utsouthwestern/receivenews
Donna Steph Hansard
donna.hansardutsouthwestern
214-648-3404
UT Southwestern Medical Center
swmed
Sixteen percent to 20 percent of the study group experienced total remission.
Results of the study, led by Dr. A. John Rush, vice chairman for research in psychiatry at UT Southwestern, appear in the September issue of Biological Psychiatry. Findings from two additional related studies also are included in the issue.
VNS therapy, which the FDA approved for treatment of epileptic seizures in 1997 and for depression in July, has been studied in clinical trials for treatment-resistant depression since 1998. VNS therapy includes surgical implantation of a small battery-operated pulse generator - similar to a pacemaker - in a patient's left upper chest. Thin, flexible wires from the device are tunneled into the neck and send mild, intermittent pulses to the neck's left vagus nerve. The vagus nerve in turn delivers these pulses about every five minutes to the areas of the brain involved in the regulation of mood, motivation, sleep, appetite and other symptoms relevant to depression.
Karmen McGuffee, who had the vagus nerve stimulator implanted in 1999 after suffering from severe depression for more than 15 years, said the device has restored her life. A participant in one of the first clinical trials at UT Southwestern, she had taken more than 10 types of antidepressant drugs before the surgery, with little success.
"It was like having the color come back into my world," said Mrs. McGuffee, 35. "Before VNS therapy, I could barely function and only then with a lot of help. At the time, I had nothing to lose.
"Now I feel brighter and lighter. I'm not constantly worried, and I look forward to everyday activities. Things that other people take for granted, such as managing a house, a family and a job all are now possible."
VNS therapy is only indicated for people who have not been helped by other depression treatments, said Dr. Rush. "If you have treatment-resistant depression and need long-term treatment, VNS is an option that should be considered. While it's not going to get everybody into remission, it's doing pretty well in very difficult-to-treat patients," he said.
Two of the three studies in the current journal compared patients with major depressive disorder or bipolar disorder, all of whom were implanted with the vagus nerve stimulator. In the first trial, which included 235 people and only lasted for 10 weeks, patients implanted with the stimulator received either active VNS therapy or no therapy, meaning the device was not activated. There was little change in either group.
Dr. Rush's second multicenter trial, which included 205 of the same patients, provided active VNS therapy for a full year to all participants, measuring their symptoms of depression at regular intervals using several standard rating scales. One rating scale showed a 27.2 percent reduction in symptoms among participants and a 15.8 percent remission rate at year's end - suggesting that long-term treatment with VNS offers a greater benefit than its short-term application. A second rating scale showed reduction in symptoms by 28.2 percent and a 20.3 percent remission rate.
"This is a very good response, given the type of highly resistant depression involved," Dr. Rush said. "Participants in the trials were some of the most treatment-resistant depressed patients ever studied, with at least half having been hospitalized for the disease at least once."
The studies also showed VNS to be well-tolerated, with few serious adverse reactions, he said. Possible side effects, however, can include a slight voice alteration or temporary hoarseness, cough, tickling in the throat or shortness of breath during exertion - symptoms which may occur intermittently when the stimulation is on.
The third study, of which Dr. Rush was a co-author, compared two groups of people with similar degrees of severe depression. One group was implanted with the vagus nerve stimulator as well as given other types of treatments for depression, including medication and cognitive therapy. The second group did not receive the device, but was treated for depression. Results showed a 27 percent reduction in depressive symptoms in the VNS group, compared to a 13 percent reduction in the second group.
Dr. Mustafa Husain, professor of psychiatry and internal medicine at UT Southwestern, said VNS offers "new hope" for severely depressed individuals.
"VNS treatment can be very useful in combination with antidepressants for a particular group of patients who are chronically depressed," he said. "It can provide new hope for a better life to those who are not responding to antidepressant medications."
Dr. Husain and Dr. Rush were involved in all three studies, which included researchers from more than 20 sites around the country. The studies were supported in part by Cyberonics Inc., manufacturer of VNS Therapy.
This news release is available on our World Wide Web home page at utsouthwestern/home/news/index.html
To automatically receive news releases from UT Southwestern via e-mail, subscribe at utsouthwestern/receivenews
Donna Steph Hansard
donna.hansardutsouthwestern
214-648-3404
UT Southwestern Medical Center
swmed
Prozac May Be The Most Popular, But Might Not Be The Most Effective Antidepressant
Although Prozac has achieved phenomenal marketing success, it may not be as effective as certain other antidepressants, according to a recent systematic review.
Researchers led by Andrea Cipriani, M.D., compared Prozac (fluoxetine) to other selective serotonin reuptake inhibitors, and to other antidepressants and found that Zoloft (sertraline) and Effexor (venlafaxine) were somewhat better for treating depression.
The review also compared the tolerability of fluoxetine and several other often-prescribed antidepressants. Patients found fluoxetine more tolerable than both Elavil or Endep (amitryptilline) and Tofranil (imipramine).
Cipriani, a psychiatrist at the University of Verona in Italy, said in an e-mail, "Fluoxetine, the most widely studied SSRI, has progressively replaced amitriptyline and imipramine as the standard of comparison for newer medications. We chose fluoxetine because of its long-time position as the market leader and because it has been often used as a reference compound for newer [antidepressants]."
Psychiatrist Xavier Amador, a member of the board of directors for the National Alliance for the Mentally Ill, said, "Prozac was available years before other SSRIs. Since, as a group, the SSRIs were far safer than [earlier antidepressants] the first one, Prozac, became hugely popular. It has tremendous name recognition for this reason."
The review appeared in the latest issue of the Cochrane Library. The Cochrane Library is a publication of The Cochrane Collaboration, an independent international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The review pooled data from 132 published randomized controlled trials, with effectiveness data on 9,311 participants and of tolerability data on 14,391 participants, both inpatients and outpatients diagnosed with depression, without other ongoing medical problems.
The researchers looked at SSRIs, tricyclic and heterocyclic antidepressants, and newer antidepressants. The researchers analyzed participants' scores on several diagnostic scales for depression, comparing measurements on Prozac with other antidepressants.
Results were mixed: Prozac was found less effective than Prothiaden (dothiepin), Zoloft, Remeron (mirtazapine) and Effexor but more effective than the antidepressants ABT-200 and milnacipran. Prozac was better tolerated than tricyclic antidepressants as a group and with other individual antidepressants.
"Although the better effectiveness profile of sertraline and venlafaxine over fluoxetine seems meaningful, it needs further investigation," Cipriani said, noting that studies were short, usually eight weeks or less. "This limits the ability of the studies to show clinically meaningful differences," he said. "We need more robust and pragmatic evidence, free from industry influence."
According to Cipriani, fluoxetine's huge success has occurred despite the fact that "results from randomized clinical trials did not clearly indicate that it offered substantial benefits over conventional agents." Many studies have compared fluoxetine with other antidepressants, but he said a major problem with some of these studies is "that they have analyzed the SSRIs as a group and evidence applicable to this group of drugs might not be entirely applicable to fluoxetine alone."
Until additional, robust, unbiased evidence becomes available, Cipriani said that clinicians ought to base their selection upon considerations of drug toxicity, patient acceptability and cost.
"The great majority of randomized controlled trials have been sponsored by pharmaceutical industry and data have shown a possible relationship between industry sponsorship and trial outcomes," said Cipriani, "We need further analyses on the possible confounding role of sponsorship and new tools to improve the quality of evidence."
The review notes that one of its co-authors has received fees for speaking and research grants from pharmaceutical companies that market antidepressants, and another has received funding and support from two companies that manufacture SSRIs.
Cipriani A, et al. Fluoxetine versus other types of pharmacotherapy for depression (Review). The Cochrane Library 2005, Issue 4.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.
Andrea Cipriani
andrea.ciprianiunivr.it
Center for the Advancement of Health
cfah
View drug information on Effexor; Prozac Weekly; Remeron SolTab.
Researchers led by Andrea Cipriani, M.D., compared Prozac (fluoxetine) to other selective serotonin reuptake inhibitors, and to other antidepressants and found that Zoloft (sertraline) and Effexor (venlafaxine) were somewhat better for treating depression.
The review also compared the tolerability of fluoxetine and several other often-prescribed antidepressants. Patients found fluoxetine more tolerable than both Elavil or Endep (amitryptilline) and Tofranil (imipramine).
Cipriani, a psychiatrist at the University of Verona in Italy, said in an e-mail, "Fluoxetine, the most widely studied SSRI, has progressively replaced amitriptyline and imipramine as the standard of comparison for newer medications. We chose fluoxetine because of its long-time position as the market leader and because it has been often used as a reference compound for newer [antidepressants]."
Psychiatrist Xavier Amador, a member of the board of directors for the National Alliance for the Mentally Ill, said, "Prozac was available years before other SSRIs. Since, as a group, the SSRIs were far safer than [earlier antidepressants] the first one, Prozac, became hugely popular. It has tremendous name recognition for this reason."
The review appeared in the latest issue of the Cochrane Library. The Cochrane Library is a publication of The Cochrane Collaboration, an independent international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The review pooled data from 132 published randomized controlled trials, with effectiveness data on 9,311 participants and of tolerability data on 14,391 participants, both inpatients and outpatients diagnosed with depression, without other ongoing medical problems.
The researchers looked at SSRIs, tricyclic and heterocyclic antidepressants, and newer antidepressants. The researchers analyzed participants' scores on several diagnostic scales for depression, comparing measurements on Prozac with other antidepressants.
Results were mixed: Prozac was found less effective than Prothiaden (dothiepin), Zoloft, Remeron (mirtazapine) and Effexor but more effective than the antidepressants ABT-200 and milnacipran. Prozac was better tolerated than tricyclic antidepressants as a group and with other individual antidepressants.
"Although the better effectiveness profile of sertraline and venlafaxine over fluoxetine seems meaningful, it needs further investigation," Cipriani said, noting that studies were short, usually eight weeks or less. "This limits the ability of the studies to show clinically meaningful differences," he said. "We need more robust and pragmatic evidence, free from industry influence."
According to Cipriani, fluoxetine's huge success has occurred despite the fact that "results from randomized clinical trials did not clearly indicate that it offered substantial benefits over conventional agents." Many studies have compared fluoxetine with other antidepressants, but he said a major problem with some of these studies is "that they have analyzed the SSRIs as a group and evidence applicable to this group of drugs might not be entirely applicable to fluoxetine alone."
Until additional, robust, unbiased evidence becomes available, Cipriani said that clinicians ought to base their selection upon considerations of drug toxicity, patient acceptability and cost.
"The great majority of randomized controlled trials have been sponsored by pharmaceutical industry and data have shown a possible relationship between industry sponsorship and trial outcomes," said Cipriani, "We need further analyses on the possible confounding role of sponsorship and new tools to improve the quality of evidence."
The review notes that one of its co-authors has received fees for speaking and research grants from pharmaceutical companies that market antidepressants, and another has received funding and support from two companies that manufacture SSRIs.
Cipriani A, et al. Fluoxetine versus other types of pharmacotherapy for depression (Review). The Cochrane Library 2005, Issue 4.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.
Andrea Cipriani
andrea.ciprianiunivr.it
Center for the Advancement of Health
cfah
View drug information on Effexor; Prozac Weekly; Remeron SolTab.
Corcept Therapeutics Completes Enrollment In Third Phase 3 Study For Treating Psychotic Major Depression
Corcept
Therapeutics Incorporated (Nasdaq: CORT) announced today that it completed
patient enrollment in Study 06, the third of three Phase 3 clinical trials
in which CORLUX(R) (mifepristone) is being evaluated for treating the
psychotic features of psychotic major depression (PMD). The company expects
to announce the results in late February 2007.
A total of 441 patients have been enrolled in Study 06, a randomized,
double-blind, placebo-controlled trial, at 40 sites in the United States
and 5 sites in Europe. The primary endpoint is the proportion of patients
with at least a 50% improvement in the Brief Psychiatric Rating Scale
Positive Symptom Subscale (BPRS PSS) at both Day 7 and Day 56. The BPRS is
an 18-item rating instrument used to assess psychopathology and the PSS
includes the four items in the BPRS that specifically measure psychosis.
BPRS assessments will be conducted at baseline and Days, 7, 14, 28, 42 and
56. Patients must have at least mild psychotic symptoms (BPRS PSS > or =
12) to enter the studies and will be hospitalized if clinically necessary.
Patients were evenly distributed among three active dose groups (300
mg, 600 mg and 1200 mg) or a placebo group and patients received once daily
dosing for a period of seven days. All patients in the study must not have
taken any antidepressant or antipsychotic medication for at least one week
before the seven-day treatment period. All patients receive antidepressant
therapy starting on Day 1 through Day 56. As with Corcept's two previously
completed Phase 3 clinical trials evaluating CORLUX for the treatment of
PMD, Study 07 and Study 09, treatment with antipsychotic medications or
electroconvulsive therapy is not be allowed at any time during this study.
About Psychotic Major Depression
PMD is a serious psychiatric disorder that affects about three million
people in the United States every year. It is more prevalent than either
schizophrenia or bipolar I disorder. PMD is characterized by severe
depression accompanied by delusions, hallucinations or both. People with
PMD are approximately 70 times more likely to commit suicide than the
general population and often require lengthy and expensive hospital stays.
There is no FDA-approved treatment for PMD.
About Corcept Therapeutics Incorporated
Corcept Therapeutics Incorporated is a pharmaceutical company focused
on developing drugs for treating severe psychiatric and neurological
diseases. Corcept's lead product, CORLUX, is in Phase 3 clinical trials for
treating the psychotic features of PMD. The drug is administered orally to
PMD patients once per day for seven days. CORLUX, a potent GR-II
antagonist, appears to reduce the effects of the elevated and abnormal
release patterns of cortisol seen in PMD. The company has also initiated a
proof-of-concept study to evaluate the ability of CORLUX to mitigate weight
gain associated with the use of olanzapine. For more information, please
visit corcept.
Forward-looking Statements
Statements made in this news release -- other than statements of
historical fact -- are forward-looking statements. These include
information relating to Corcept's PMD clinical development program, FDA
agreements, and the timing of the completion of pivotal Phase 3 trials.
Forward-looking statements are subject to a number of known and unknown
risks and uncertainties that might cause actual results to differ
materially from those expressed or implied here. For example, there can be
no assurances on the efficacy, safety, completion or success of clinical
trials; the regulatory process or regulatory approvals, or commercial
success. In addition, trial timetables may not be accurate. Risk factors
are explained in the company's SEC filings, all of which are available from
its Web site (corcept) or from the SEC's Web site (sec).
The company does not have any intention or duty to update forward-looking
statements made in this news release.
Corcept Therapeutics Incorporated
corcept
Therapeutics Incorporated (Nasdaq: CORT) announced today that it completed
patient enrollment in Study 06, the third of three Phase 3 clinical trials
in which CORLUX(R) (mifepristone) is being evaluated for treating the
psychotic features of psychotic major depression (PMD). The company expects
to announce the results in late February 2007.
A total of 441 patients have been enrolled in Study 06, a randomized,
double-blind, placebo-controlled trial, at 40 sites in the United States
and 5 sites in Europe. The primary endpoint is the proportion of patients
with at least a 50% improvement in the Brief Psychiatric Rating Scale
Positive Symptom Subscale (BPRS PSS) at both Day 7 and Day 56. The BPRS is
an 18-item rating instrument used to assess psychopathology and the PSS
includes the four items in the BPRS that specifically measure psychosis.
BPRS assessments will be conducted at baseline and Days, 7, 14, 28, 42 and
56. Patients must have at least mild psychotic symptoms (BPRS PSS > or =
12) to enter the studies and will be hospitalized if clinically necessary.
Patients were evenly distributed among three active dose groups (300
mg, 600 mg and 1200 mg) or a placebo group and patients received once daily
dosing for a period of seven days. All patients in the study must not have
taken any antidepressant or antipsychotic medication for at least one week
before the seven-day treatment period. All patients receive antidepressant
therapy starting on Day 1 through Day 56. As with Corcept's two previously
completed Phase 3 clinical trials evaluating CORLUX for the treatment of
PMD, Study 07 and Study 09, treatment with antipsychotic medications or
electroconvulsive therapy is not be allowed at any time during this study.
About Psychotic Major Depression
PMD is a serious psychiatric disorder that affects about three million
people in the United States every year. It is more prevalent than either
schizophrenia or bipolar I disorder. PMD is characterized by severe
depression accompanied by delusions, hallucinations or both. People with
PMD are approximately 70 times more likely to commit suicide than the
general population and often require lengthy and expensive hospital stays.
There is no FDA-approved treatment for PMD.
About Corcept Therapeutics Incorporated
Corcept Therapeutics Incorporated is a pharmaceutical company focused
on developing drugs for treating severe psychiatric and neurological
diseases. Corcept's lead product, CORLUX, is in Phase 3 clinical trials for
treating the psychotic features of PMD. The drug is administered orally to
PMD patients once per day for seven days. CORLUX, a potent GR-II
antagonist, appears to reduce the effects of the elevated and abnormal
release patterns of cortisol seen in PMD. The company has also initiated a
proof-of-concept study to evaluate the ability of CORLUX to mitigate weight
gain associated with the use of olanzapine. For more information, please
visit corcept.
Forward-looking Statements
Statements made in this news release -- other than statements of
historical fact -- are forward-looking statements. These include
information relating to Corcept's PMD clinical development program, FDA
agreements, and the timing of the completion of pivotal Phase 3 trials.
Forward-looking statements are subject to a number of known and unknown
risks and uncertainties that might cause actual results to differ
materially from those expressed or implied here. For example, there can be
no assurances on the efficacy, safety, completion or success of clinical
trials; the regulatory process or regulatory approvals, or commercial
success. In addition, trial timetables may not be accurate. Risk factors
are explained in the company's SEC filings, all of which are available from
its Web site (corcept) or from the SEC's Web site (sec).
The company does not have any intention or duty to update forward-looking
statements made in this news release.
Corcept Therapeutics Incorporated
corcept
Depressed Singles Benefit From Marriage The Most
People who benefit the most from getting married are people who suffered depression when they were single, say researchers from Ohio State Unversity, USA. Most previous studies on marriage looked at the benefits for the whole population in general, rather than trying to find out whether certain types of people are helped more than others.
Addrianne Frech, co-author of the study, said "Our findings question the common assumption that marriage is always a good choice for all individuals."
Addrianne Frech, a doctoral student in sociology and Kristi Williams, Assistant Prof. Of Sociology, Ohio State University, say this is the first study to examine the benefits of marriage for depressed and non-depressed people.
Williams said "Those 'average' benefits of marriage may be largely limited to people who are depressed before they entered marriage. There may not be strong benefits for everyone."
They collected information from the National Survey of Families and Households. The survey interviewed people in 1987-88 and then again in 1992-94. Frech and Williams used data from 3,066 people who were single in 1987-88. From 12 questions the survey had, it was possible to measure the people's level of depression. For those who got married during the period, they examined measures of marital happiness and marital conflict.
Frech said "We actually found the opposite of what we expected. We thought depressed people would be less likely to benefit from marriage because the depression of one spouse can put a strain on the marriage and undermine marital quality."
Williams had done a previous research which indicated that levels of marital quality and conflict were key in determining depression levels in people after they got married.
Even this study found that those who reported low prevalence of conflict were less likely to be depressed. Hence, the surprise when they found that single depressed people seemed to benefit from marriage more than people who were not depressed when they were single.
They did find that depressed people reported overall lower levels of marital quality after they got married when compared to non-depressed people. Nevertheless, people who had been depressed when single benefited more psychologically from marriage than people who had not been depressed.
They did not investigate why depressed people gain more from marriage.
Williams said "If you start out happy, you don't have as far to go. But also, depressed people may just be especially in need of the intimacy, the emotional closeness, and the social support that marriage can provide. Marriage may give depressed people a greater sense that they matter to someone, while people who weren't depressed prior to marriage may have always thought that way."
The researchers stressed that this study only looked at people who had been married up to five years. Whether or not the benefits are evident for depressed people over a longer period, when children appear in the scene, or the number of divorces are higher, remains to be seen.
Frech said "We can't focus just on average effects of marriage on well-being. As this study shows, there is a great deal of variability in the benefits of marriage."
sociology.ohio-state
Addrianne Frech, co-author of the study, said "Our findings question the common assumption that marriage is always a good choice for all individuals."
Addrianne Frech, a doctoral student in sociology and Kristi Williams, Assistant Prof. Of Sociology, Ohio State University, say this is the first study to examine the benefits of marriage for depressed and non-depressed people.
Williams said "Those 'average' benefits of marriage may be largely limited to people who are depressed before they entered marriage. There may not be strong benefits for everyone."
They collected information from the National Survey of Families and Households. The survey interviewed people in 1987-88 and then again in 1992-94. Frech and Williams used data from 3,066 people who were single in 1987-88. From 12 questions the survey had, it was possible to measure the people's level of depression. For those who got married during the period, they examined measures of marital happiness and marital conflict.
Frech said "We actually found the opposite of what we expected. We thought depressed people would be less likely to benefit from marriage because the depression of one spouse can put a strain on the marriage and undermine marital quality."
Williams had done a previous research which indicated that levels of marital quality and conflict were key in determining depression levels in people after they got married.
Even this study found that those who reported low prevalence of conflict were less likely to be depressed. Hence, the surprise when they found that single depressed people seemed to benefit from marriage more than people who were not depressed when they were single.
They did find that depressed people reported overall lower levels of marital quality after they got married when compared to non-depressed people. Nevertheless, people who had been depressed when single benefited more psychologically from marriage than people who had not been depressed.
They did not investigate why depressed people gain more from marriage.
Williams said "If you start out happy, you don't have as far to go. But also, depressed people may just be especially in need of the intimacy, the emotional closeness, and the social support that marriage can provide. Marriage may give depressed people a greater sense that they matter to someone, while people who weren't depressed prior to marriage may have always thought that way."
The researchers stressed that this study only looked at people who had been married up to five years. Whether or not the benefits are evident for depressed people over a longer period, when children appear in the scene, or the number of divorces are higher, remains to be seen.
Frech said "We can't focus just on average effects of marriage on well-being. As this study shows, there is a great deal of variability in the benefits of marriage."
sociology.ohio-state
Study Reveals Depressed Elderly Risk Early Death
Depression in elderly people is causing early mortality, a University of Liverpool study has found.
In a project involving more than 300 elderly people who had been discharged from hospital, 17% were found to have previously undiagnosed depression and of that figure, 7% died within two years of leaving hospital.
The study also showed that 41% of elderly people who have depression are often later re-admitted to hospital with other illnesses, possibly a result of not receiving appropriate treatment for their depression.
The participants, all aged over 75, were interviewed regularly over a two-year period following discharge from hospital. Factors including physical illness, breathing capacity and social activity were found to impact on the prevalence of depression and consequently the likelihood of re-admission to medical care and early death.
Professor Ken Wilson, from the University's School of Population, Community and Behavioural Sciences, said: "The project has shown that depression is common in older people with physical ill health, recently discharged from medical care. It is often undiagnosed and both patients and doctors confuse it with other illnesses or general signs of ageing. This can have detrimental impact on life expectancy and likelihood of going back into hospital.
"Depression is still a relatively 'new' disease in terms of treatments and services available to sufferers and many older people are still unaware of the symptoms. Often they will visit their doctor presuming they have a physical illness when they are actually showing signs of depression and will not receive appropriate treatment as a result."
The research team hope that their findings will impact on health care policy with the introduction of a pilot project to identify patients at high risk of depression when they are in hospital. Professor Wilson added: "We hope that future research we have planned will inform new approaches to health care for the elderly with serious illnesses so their chance of survival in the community after leaving hospital is maximised."
The research has been published in the International Journal of Geriatric Psychiatry.
About LIVERPOOL UNIVERSITY
As one of the most well-established and renowned universities in the country, Liverpool is a major research institution, associated with eight Nobel Prize winners. It also has an outstanding reputation for the quality of its teaching and its student support services. Many of its departments are world class and this international focus means that graduates from the University of Liverpool are to be found in every corner of the globe.
LIVERPOOL UNIVERSITY
Liverpool
L69 3BX
liv.ac.uk
In a project involving more than 300 elderly people who had been discharged from hospital, 17% were found to have previously undiagnosed depression and of that figure, 7% died within two years of leaving hospital.
The study also showed that 41% of elderly people who have depression are often later re-admitted to hospital with other illnesses, possibly a result of not receiving appropriate treatment for their depression.
The participants, all aged over 75, were interviewed regularly over a two-year period following discharge from hospital. Factors including physical illness, breathing capacity and social activity were found to impact on the prevalence of depression and consequently the likelihood of re-admission to medical care and early death.
Professor Ken Wilson, from the University's School of Population, Community and Behavioural Sciences, said: "The project has shown that depression is common in older people with physical ill health, recently discharged from medical care. It is often undiagnosed and both patients and doctors confuse it with other illnesses or general signs of ageing. This can have detrimental impact on life expectancy and likelihood of going back into hospital.
"Depression is still a relatively 'new' disease in terms of treatments and services available to sufferers and many older people are still unaware of the symptoms. Often they will visit their doctor presuming they have a physical illness when they are actually showing signs of depression and will not receive appropriate treatment as a result."
The research team hope that their findings will impact on health care policy with the introduction of a pilot project to identify patients at high risk of depression when they are in hospital. Professor Wilson added: "We hope that future research we have planned will inform new approaches to health care for the elderly with serious illnesses so their chance of survival in the community after leaving hospital is maximised."
The research has been published in the International Journal of Geriatric Psychiatry.
About LIVERPOOL UNIVERSITY
As one of the most well-established and renowned universities in the country, Liverpool is a major research institution, associated with eight Nobel Prize winners. It also has an outstanding reputation for the quality of its teaching and its student support services. Many of its departments are world class and this international focus means that graduates from the University of Liverpool are to be found in every corner of the globe.
LIVERPOOL UNIVERSITY
Liverpool
L69 3BX
liv.ac.uk
Sex And Depression Study Finds Most Teens' Mental Health Unaffected By Nonmarital Sex
For a decade, the legislative push for "abstinence only" sex education has suggested that nonmarital sex negatively affects a teen's mental health. But a new study shows that the negative mental side effects of a teen's loss of virginity are confined to a small proportion of those who have sex -- specifically, young girls and both boys and girls who have sex earlier than their peers and whose relationships are uncommitted and ultimately fall apart.
Using data from the National Longitudinal Study of Adolescent Health, Ann Meier, University of Minnesota assistant professor of sociology, studied 8,563 seventh- through 12th-graders over an 18-month period, measuring for depression and low self-esteem. Meier compared the mental health of teens who didn't have sex to teens who were virgins at the beginning of the study, but who lost their virginity during the 18-month period.
She found that while the majority of teens did not experience depression as a result of first-time sex, some did -- those being the youngest teens (girls who had sex before age 15 and boys who had sex before 14) and whose relationship was not emotionally close and dissolved after sex. Girls in this group were particularly vulnerable to depression.
Meier believes it's the combination of these factors that make young teens most vulnerable to depression or low self-esteem after first-time sex. "Being female or younger than the average age at first-time sex among your peers increases the chance of depression, as does a lack of commitment or intimacy within the relationship and what happens to the relationship after first-time sex," said Meier. "For girls in uncommitted relationships, ending a relationship with sex has more of an impact on mental health than ending that same relationship if it did not involve sex."
The risk of suffering mental health problems from having sex as a teen is relatively low, but Meier said low risk still represents a large group of teens affected, as half the teen population is having sex. She cautioned that the study does not suggest that positive effects result from first-time sex among teens and said she hopes it will help policy-makers focus help on those most vulnerable rather than promoting a one-size-fits-all approach.
Meier's study, "Adolescent First Sex and Subsequent Mental Health," was published in the May issue of the American Journal of Sociology.
Contact: David Ruth
University of Minnesota
Using data from the National Longitudinal Study of Adolescent Health, Ann Meier, University of Minnesota assistant professor of sociology, studied 8,563 seventh- through 12th-graders over an 18-month period, measuring for depression and low self-esteem. Meier compared the mental health of teens who didn't have sex to teens who were virgins at the beginning of the study, but who lost their virginity during the 18-month period.
She found that while the majority of teens did not experience depression as a result of first-time sex, some did -- those being the youngest teens (girls who had sex before age 15 and boys who had sex before 14) and whose relationship was not emotionally close and dissolved after sex. Girls in this group were particularly vulnerable to depression.
Meier believes it's the combination of these factors that make young teens most vulnerable to depression or low self-esteem after first-time sex. "Being female or younger than the average age at first-time sex among your peers increases the chance of depression, as does a lack of commitment or intimacy within the relationship and what happens to the relationship after first-time sex," said Meier. "For girls in uncommitted relationships, ending a relationship with sex has more of an impact on mental health than ending that same relationship if it did not involve sex."
The risk of suffering mental health problems from having sex as a teen is relatively low, but Meier said low risk still represents a large group of teens affected, as half the teen population is having sex. She cautioned that the study does not suggest that positive effects result from first-time sex among teens and said she hopes it will help policy-makers focus help on those most vulnerable rather than promoting a one-size-fits-all approach.
Meier's study, "Adolescent First Sex and Subsequent Mental Health," was published in the May issue of the American Journal of Sociology.
Contact: David Ruth
University of Minnesota
FDA Warnings About Antidepressants Associated With Lasting, Unintended Changes In Diagnosis And Treatment
Government warnings about suicidality among children taking antidepressants appear to be associated with unintended and persistent changes in the diagnosis and treatment of depression in children and adults, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"In October 2003 the Food and Drug Administration (FDA) issued a Public Health Advisory about the risk of suicidality for pediatric patients taking antidepressants; a boxed warning, package insert and medication guide were implemented in February 2005," the authors write as background information in the article. "The warning was extended to young adults aged 18 to 24 years in May 2007. Immediately following the 2003 advisory, unintended declines in case finding and non-selective serotonin reuptake inhibitor substitute treatment were shown for pediatric patients, and spillover effects were seen in adult patients, who were not targeted by the warnings."
To determine whether these unintentional consequences have persisted, Anne M. Libby, Ph.D., and colleagues at the University of Colorado Denver's School of Medicine analyzed patterns in a national integrated managed care claims database from July 1999 through June 2007. During this time period, 91,748 children (ages 5 to 18), 70,311 young adults (ages 19 to 24) and 630,748 adults (ages 25 to 89) were diagnosed with depression.
Between 1999 and 2004, the rate of diagnosed episodes of depression increased steadily among each group. "After 2004 the observed national rate of pediatric case-finding fell significantly, with the post-advisory decline persisting such that the rate per 1,000 enrollees in 2007 (3.5) approached the 1999 level (3.2)," the authors write. "Based on the historical trend established in the five years prior to the advisory, the 2007 rate per 1,000 enrollees would have been 15.6 for young adults and 20.3 for adults; the actual observed rate was 9.6 for young adults and 12.4 for adults."
In addition, primary care clinicians specifically continued to diagnose fewer cases of depression, with a 44 percent lower rate of diagnosis among pediatric patients, 37 percent lower among young adults and 29 percent lower among adults. This trend is particularly important because the general medical sector sees the largest proportion of patients seeking mental health care in the United States, the authors note.
"Substitution of other forms of treatment might have been an expected outcome of a decrease in first-line treatment for the acute phase of depression," they write. "There was a small but significant increase in the proportion of new depression cases that received at least one visit for psychotherapy within 180 days of diagnosis for adults only. Antidepressant alternatives-atypical antipsychotics and anxiolytics-did not increase statistically or in clinically meaningful ways from their very low base rates in the pre-advisory period."
The findings suggest that initial unintended consequences of the FDA warnings have continued through 2007, the authors conclude. "Diagnosing decreases persist," they write. "Substitute care did not compensate in pediatric and young adult groups, and spillover to adults continued, suggesting that unintended effects are nontransitory, substantial and diffuse in a large national population. Policy actions are required to counter the unintended consequences of reduced depression treatment."
Arch Gen Psychiatry. 2009;66[6]:633-639.
Source
Archives of General Psychiatry
"In October 2003 the Food and Drug Administration (FDA) issued a Public Health Advisory about the risk of suicidality for pediatric patients taking antidepressants; a boxed warning, package insert and medication guide were implemented in February 2005," the authors write as background information in the article. "The warning was extended to young adults aged 18 to 24 years in May 2007. Immediately following the 2003 advisory, unintended declines in case finding and non-selective serotonin reuptake inhibitor substitute treatment were shown for pediatric patients, and spillover effects were seen in adult patients, who were not targeted by the warnings."
To determine whether these unintentional consequences have persisted, Anne M. Libby, Ph.D., and colleagues at the University of Colorado Denver's School of Medicine analyzed patterns in a national integrated managed care claims database from July 1999 through June 2007. During this time period, 91,748 children (ages 5 to 18), 70,311 young adults (ages 19 to 24) and 630,748 adults (ages 25 to 89) were diagnosed with depression.
Between 1999 and 2004, the rate of diagnosed episodes of depression increased steadily among each group. "After 2004 the observed national rate of pediatric case-finding fell significantly, with the post-advisory decline persisting such that the rate per 1,000 enrollees in 2007 (3.5) approached the 1999 level (3.2)," the authors write. "Based on the historical trend established in the five years prior to the advisory, the 2007 rate per 1,000 enrollees would have been 15.6 for young adults and 20.3 for adults; the actual observed rate was 9.6 for young adults and 12.4 for adults."
In addition, primary care clinicians specifically continued to diagnose fewer cases of depression, with a 44 percent lower rate of diagnosis among pediatric patients, 37 percent lower among young adults and 29 percent lower among adults. This trend is particularly important because the general medical sector sees the largest proportion of patients seeking mental health care in the United States, the authors note.
"Substitution of other forms of treatment might have been an expected outcome of a decrease in first-line treatment for the acute phase of depression," they write. "There was a small but significant increase in the proportion of new depression cases that received at least one visit for psychotherapy within 180 days of diagnosis for adults only. Antidepressant alternatives-atypical antipsychotics and anxiolytics-did not increase statistically or in clinically meaningful ways from their very low base rates in the pre-advisory period."
The findings suggest that initial unintended consequences of the FDA warnings have continued through 2007, the authors conclude. "Diagnosing decreases persist," they write. "Substitute care did not compensate in pediatric and young adult groups, and spillover to adults continued, suggesting that unintended effects are nontransitory, substantial and diffuse in a large national population. Policy actions are required to counter the unintended consequences of reduced depression treatment."
Arch Gen Psychiatry. 2009;66[6]:633-639.
Source
Archives of General Psychiatry
The biological clock and what really makes us tick
Genetic Circuitry Key to Array of Human Conditions, UH Circadian Scientists Say
HOUSTON (USA) - From sleep patterns to health conditions, biological clocks get down to what makes us tick.
The University of Houston is home to one of the world's leading centers for biological rhythms research. With five laboratories and a team of more than 30 scholars led by five tenured faculty members, the UH Biological Clocks Program studies an array of issues with far-reaching human implications.
Paul Hardin, a professor of biology and biochemistry at UH, primarily focuses on researching the molecular mechanisms that underlie circadian oscillators, which are biological clocks that control daily rhythms such as sleep-wake cycles and daily cycles of many hormones.
By understanding this molecular circuitry that underlies biological rhythm function in the fruit fly (Drosophila melanogaster), Hardin is determining how daily rhythms in physiology and behavior found in many organisms are controlled by an innate, genetically encoded circadian clock.
This research has allowed Hardin to be able to define certain genetic relationships that, in turn, led to the discovery that circadian oscillators can produce profound effects on the performance of animal sensory systems. His research with fruit flies, then, also is pertinent to biological clock function in mammals.
"Distinct rhythms are present in so many organisms, spanning the evolutionary chain of microbes, plants, animals and humans," Hardin said.
"One of the main reasons for studying circadian rhythms is to uncover the impact they have on human health and well being. A better understanding of the function of these rhythms across species can help us evaluate the consequences of problems that occur when the clock is damaged in humans."
Also known as circadian rhythms, biological clocks offer scientific insight into depression and medication toxicity, as well as helps pinpoint peak attack times related to lung, heart and brain disorders. For instance, it has been found that cancer drug therapies are metabolized much better at certain times of the day.
So, if physicians can pinpoint these ideal times and give those drugs when they do not metabolize and allow the body to clear them naturally, then side effects can be reduced while impact is maximized.
And with such vital signs as blood pressure and heart rate under the control of the circadian clock, respiratory, cardiac and cerebrovascular conditions that are dependent on these vitals also are on the way to being better understood.
Asthma attacks, for example, primarily occur in the middle of the night, while peak time for heart attacks and strokes is typically mid morning.
The mystery behind biological clocks also is key to understanding how sleep-wake cycle disruptions lead to various types of depression and may ultimately uncover ways to better cope with shift work and jet lag.
Hardin's enthusiasm for this burgeoning field is obvious and his contributions significant. He was trained as a molecular geneticist, joining the UH faculty in 1995. He has won a number of awards for his research, among them the Aschoff-Honma Prize that he received this September in Japan.
The award is presented every two years to a scientist working in the field of biological rhythms and currently carries a monetary award of one million yen (approximately $10,000). Hardin and his team also have grants from the National Institutes of Health, Department of Defense and NASA.
About the University of Houston
The University of Houston, Texas' premier metropolitan research and teaching institution, is home to more than 40 research centers and institutes and sponsors more than 300 partnerships with corporate, civic and governmental entities. UH, the most diverse research university in the country, stands at the forefront of education, research and service with more than 35,000 students.
To receive UH science news via e-mail, visit uh/admin/media/sciencelist.html
For more information about UH visit the university's 'Newsroom' at
uh/admin/media/newsroom.
Contact: Lisa Merkl
713/743-8192 (office)
713/605-1757 (pager)
HOUSTON (USA) - From sleep patterns to health conditions, biological clocks get down to what makes us tick.
The University of Houston is home to one of the world's leading centers for biological rhythms research. With five laboratories and a team of more than 30 scholars led by five tenured faculty members, the UH Biological Clocks Program studies an array of issues with far-reaching human implications.
Paul Hardin, a professor of biology and biochemistry at UH, primarily focuses on researching the molecular mechanisms that underlie circadian oscillators, which are biological clocks that control daily rhythms such as sleep-wake cycles and daily cycles of many hormones.
By understanding this molecular circuitry that underlies biological rhythm function in the fruit fly (Drosophila melanogaster), Hardin is determining how daily rhythms in physiology and behavior found in many organisms are controlled by an innate, genetically encoded circadian clock.
This research has allowed Hardin to be able to define certain genetic relationships that, in turn, led to the discovery that circadian oscillators can produce profound effects on the performance of animal sensory systems. His research with fruit flies, then, also is pertinent to biological clock function in mammals.
"Distinct rhythms are present in so many organisms, spanning the evolutionary chain of microbes, plants, animals and humans," Hardin said.
"One of the main reasons for studying circadian rhythms is to uncover the impact they have on human health and well being. A better understanding of the function of these rhythms across species can help us evaluate the consequences of problems that occur when the clock is damaged in humans."
Also known as circadian rhythms, biological clocks offer scientific insight into depression and medication toxicity, as well as helps pinpoint peak attack times related to lung, heart and brain disorders. For instance, it has been found that cancer drug therapies are metabolized much better at certain times of the day.
So, if physicians can pinpoint these ideal times and give those drugs when they do not metabolize and allow the body to clear them naturally, then side effects can be reduced while impact is maximized.
And with such vital signs as blood pressure and heart rate under the control of the circadian clock, respiratory, cardiac and cerebrovascular conditions that are dependent on these vitals also are on the way to being better understood.
Asthma attacks, for example, primarily occur in the middle of the night, while peak time for heart attacks and strokes is typically mid morning.
The mystery behind biological clocks also is key to understanding how sleep-wake cycle disruptions lead to various types of depression and may ultimately uncover ways to better cope with shift work and jet lag.
Hardin's enthusiasm for this burgeoning field is obvious and his contributions significant. He was trained as a molecular geneticist, joining the UH faculty in 1995. He has won a number of awards for his research, among them the Aschoff-Honma Prize that he received this September in Japan.
The award is presented every two years to a scientist working in the field of biological rhythms and currently carries a monetary award of one million yen (approximately $10,000). Hardin and his team also have grants from the National Institutes of Health, Department of Defense and NASA.
About the University of Houston
The University of Houston, Texas' premier metropolitan research and teaching institution, is home to more than 40 research centers and institutes and sponsors more than 300 partnerships with corporate, civic and governmental entities. UH, the most diverse research university in the country, stands at the forefront of education, research and service with more than 35,000 students.
To receive UH science news via e-mail, visit uh/admin/media/sciencelist.html
For more information about UH visit the university's 'Newsroom' at
uh/admin/media/newsroom.
Contact: Lisa Merkl
713/743-8192 (office)
713/605-1757 (pager)
Music On Prescription Could Help Treat Emotional And Physical Pain
New research into how music conveys emotion could benefit the treatment of depression and the management of physical pain.
Using an innovative combination of music psychology and leading-edge audio engineering the project is looking in more detail than ever before at how music conveys emotion.
The project, at Glasgow Caledonian University is supported by the Engineering and Physical Sciences Research Council (EPSRC).
The research could lead to advances in the use of music to help regulate a person's mood, and promote the development of music-based therapies to tackle conditions like depressive illnesses. It could help alleviate symptoms for people who are dealing with physical pain and even lead to doctors putting music on a prescription that is tailored to suit the needs of an individual.
"The impact of a piece of music on a person goes so much further than thinking that a fast tempo can lift a mood and a slow one can bring it down. Music expresses emotion as a result of many factors," says audio engineering specialist Dr Don Knox, project leader. "These include the tone, structure and other technical characteristics of a piece. Lyrics can have a big impact too. But so can purely subjective factors: where or when you first heard it, whether you associate it with happy or sad events and so on. Our project is the first step towards taking all of these considerations - and the way they interact with each other - on board."
Raymond MacDonald, Professor of Music Psychology at Glasgow Caledonian University, is also playing a central role in the initiative.
You can find out more about the research from the team involved on our Youtube channel.
The team has already carried out an unprecedentedly detailed audio analysis of pieces of music, identified as expressing a range of emotions by a panel of volunteers.
Each volunteer listens to pieces of previously unheard contemporary popular music* and assigns each one a position on a graph. One axis measures the type of feeling (positivity or negativity) that the piece communicates; the other measures the intensity or activity level of the music. The research team then assess the audio characteristics that the pieces falling into each part of the graph have in common.
"We look at parameters such as rhythm patterns, melodic range, musical intervals, length of phrases, musical pitch and so on," says Dr Knox. "For example, music falling into a positive category might have a regular rhythm, bright timbre and a fairly steady pitch contour over time. If tempo and loudness increase, for instance, this would place the piece in a more 'exuberant' or 'excited' region of the graph."
The team are now about to start their assessment of the impact of lyrics, and then hope to focus on how individuals use and experience music at a subjective level.
The ultimate aim is to develop a comprehensive mathematical model that explains music's ability to communicate different emotions. This could make it possible, within a few years, to develop computer programs which identify pieces of music that will influence a individual's mood (e.g. to motivate them when exercising or when revising for exams), meet their emotional needs and help them cope better with physical pain.
"By making it possible to search for music and organise collections according to emotional content, such programs could fundamentally change the way we interact with music," says Dr Knox. "Some online music stores already tag music according to whether a piece is 'happy' or 'sad'. Our project is refining this approach and giving it a firm scientific foundation, unlocking all kinds of possibilities and opportunities as a result".
Notes
'Emotion Classification in Contemporary Music' is a 3 year project due for completion at the end of October 2010. It is receiving EPSRC funding of just over ??82,000.
* Music classified by the volunteers consists of contemporary popular music not available on general release, in order to eliminate any personal, subjective connotations any of the pieces may have for the volunteers. "This focus on popular music is an innovative feature of our project as previous studies on music's emotional content have concentrated on classical music," says Dr Knox. "We think concentrating on popular music is important as our work could have important implications for the use of personal music players and on how people interact with their music collections."
In this project, digital music files are analysed using advanced signal processing techniques. Many measures are based on extraction of the signal frequency spectrum over time. From this information, measures of intensity, timbre and rhythm can be calculated, in addition to estimates of musical pitch and tonality.
It is estimated that around 15% of people have a bout of severe depression at some time in their lives.
Using an innovative combination of music psychology and leading-edge audio engineering the project is looking in more detail than ever before at how music conveys emotion.
The project, at Glasgow Caledonian University is supported by the Engineering and Physical Sciences Research Council (EPSRC).
The research could lead to advances in the use of music to help regulate a person's mood, and promote the development of music-based therapies to tackle conditions like depressive illnesses. It could help alleviate symptoms for people who are dealing with physical pain and even lead to doctors putting music on a prescription that is tailored to suit the needs of an individual.
"The impact of a piece of music on a person goes so much further than thinking that a fast tempo can lift a mood and a slow one can bring it down. Music expresses emotion as a result of many factors," says audio engineering specialist Dr Don Knox, project leader. "These include the tone, structure and other technical characteristics of a piece. Lyrics can have a big impact too. But so can purely subjective factors: where or when you first heard it, whether you associate it with happy or sad events and so on. Our project is the first step towards taking all of these considerations - and the way they interact with each other - on board."
Raymond MacDonald, Professor of Music Psychology at Glasgow Caledonian University, is also playing a central role in the initiative.
You can find out more about the research from the team involved on our Youtube channel.
The team has already carried out an unprecedentedly detailed audio analysis of pieces of music, identified as expressing a range of emotions by a panel of volunteers.
Each volunteer listens to pieces of previously unheard contemporary popular music* and assigns each one a position on a graph. One axis measures the type of feeling (positivity or negativity) that the piece communicates; the other measures the intensity or activity level of the music. The research team then assess the audio characteristics that the pieces falling into each part of the graph have in common.
"We look at parameters such as rhythm patterns, melodic range, musical intervals, length of phrases, musical pitch and so on," says Dr Knox. "For example, music falling into a positive category might have a regular rhythm, bright timbre and a fairly steady pitch contour over time. If tempo and loudness increase, for instance, this would place the piece in a more 'exuberant' or 'excited' region of the graph."
The team are now about to start their assessment of the impact of lyrics, and then hope to focus on how individuals use and experience music at a subjective level.
The ultimate aim is to develop a comprehensive mathematical model that explains music's ability to communicate different emotions. This could make it possible, within a few years, to develop computer programs which identify pieces of music that will influence a individual's mood (e.g. to motivate them when exercising or when revising for exams), meet their emotional needs and help them cope better with physical pain.
"By making it possible to search for music and organise collections according to emotional content, such programs could fundamentally change the way we interact with music," says Dr Knox. "Some online music stores already tag music according to whether a piece is 'happy' or 'sad'. Our project is refining this approach and giving it a firm scientific foundation, unlocking all kinds of possibilities and opportunities as a result".
Notes
'Emotion Classification in Contemporary Music' is a 3 year project due for completion at the end of October 2010. It is receiving EPSRC funding of just over ??82,000.
* Music classified by the volunteers consists of contemporary popular music not available on general release, in order to eliminate any personal, subjective connotations any of the pieces may have for the volunteers. "This focus on popular music is an innovative feature of our project as previous studies on music's emotional content have concentrated on classical music," says Dr Knox. "We think concentrating on popular music is important as our work could have important implications for the use of personal music players and on how people interact with their music collections."
In this project, digital music files are analysed using advanced signal processing techniques. Many measures are based on extraction of the signal frequency spectrum over time. From this information, measures of intensity, timbre and rhythm can be calculated, in addition to estimates of musical pitch and tonality.
It is estimated that around 15% of people have a bout of severe depression at some time in their lives.
Risk Of New Suicidal Thoughts During Antidepressant Treatment Has Genetic Component, New AJP Study Shows
DNA samples from patients in the federally funded Sequenced Treatment
Alternatives to Relieve Depression (STAR*D) trial have revealed two genetic markers that
appear to be associated with the emergence of suicidal thoughts during treatment with citalopram,
a selective serotonin reuptake inhibitor (SSRI) antidepressant. The findings strongly suggest a
genetic basis underlying the rare emergence of suicidal thoughts associated with taking an SSRI.
The new findings are reported in the article "Genetic Markers of Suicidal Ideation Emerging
During Citalopram Treatment of Major Depression," by Gonzalo Laje, M.D., and colleagues,
which appears in the October 2007 issue of The American Journal of Psychiatry (AJP), the
official journal of the American Psychiatric Association (APA).
Since the introduction of SSRIs in the 1980s, there has been controversy over whether the
medications can trigger suicidal thoughts or behaviors. The STAR*D trial, funded by the
National Institute of Mental Health, provided a unique opportunity to study the phenomenon of
treatment-emergent suicidal ideation in a large cohort of patients treated with an SSRI.
DNA samples were collected from 1,915 patients in the first phase of the STAR*D trial. Laje
and his colleagues examined 768 genetic markers within 68 different genes. The target genes
were selected to look at five broad signaling pathways of potential importance in antidepressant
effects - serotonin, glutamate, dopamine, norepinephrine, and neurotrophins.
Suicidal ideation was assessed by patient self-report, using item 12 on the Quick Inventory of
Depressive Symptomatology-Self Report (QIDS-SR), which asks the patient about "thoughts of
death or suicide." Patients who scored zero before taking citalopram, but later scored 1, 2, or 3 at
least once during treatment, were categorized as experiencing treatment-emergent suicidal
ideation.
The two genetic markers identified, rs4825476 and rs2518224 (known as single nucleotide
polymorphisms), are located on the GRIA3 and GRIK2 genes, respectively. Both GRIK2 and
GRIA3 encode nerve cell receptors for glutamate, one of the brain's chemical messengers.
In the study, the highest odds of suicidal thoughts were for patients who had both of the identified
markers. None of the patients with suicidal ideation actually attempted suicide. However, two
other participants did attempt suicide, and one of these provided DNA and was found to have
both of the high-risk genetic markers.
???
AJP editor-in-chief Robert Freedman, M.D., stated, "While this is a provocative first step towards
individualization of the treatment of depression based on unique genetic and neurobiological
differences between people, the data are still preliminary and require further investigation."
The identified markers do not appear to be related to a general tendency toward suicide, but rather
to suicidal thoughts specifically emerging during antidepressant treatment. Neither of the
identified genes appears to have been previously associated with suicidal ideation.
"These data suggest that not everyone is at the same risk of suicidal thinking during
antidepressant treatment. For most people the risk is low, but some may be at higher risk, due in
part to their genetic makeup. Can genetic markers help identify those at high risk? It's possible,
but we'd like to see the results replicated in another sample before we reach any firm
conclusions," said Dr. Francis J. McMahon, who is one of the authors and chief of the Genetic
Basis of Mood and Anxiety Disorders Unit at the National Institute of Mental Health.
This study was funded by the National Institutes of Health, the National Institute of Mental
Health, the National Institute on Alcohol Abuse and Alcoholism, the National Human Genome
Research Institute, and the Swedish Research Council. Forest Laboratories provided citalopram
for the STAR*D study. Additional funding disclosures appear at the end of the article.
(Am J Psychiatry 2007; 164:1530-1538)
About the American Journal of Psychiatry
The American Journal of Psychiatry, the official journal of the American Psychiatric Association, publishes a monthly
issue with scientific articles submitted by psychiatrists and other scientists worldwide. The peer review and editing
process is conducted independently of any other American Psychiatric Association components. Therefore, statements
in this press release or the articles in the Journal are not official policy statements of the American Psychiatric
Association. The Journal's editorial policies conform to the Uniform Requirements of the International Committee of
Medical Journal Editors, of which it is a member. For further information about the Journal visit
ajp.psychiatryonline.
About the American Psychiatric Association
The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician
members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use
disorders. Visit the APA at psych and HealthyMinds.
Alternatives to Relieve Depression (STAR*D) trial have revealed two genetic markers that
appear to be associated with the emergence of suicidal thoughts during treatment with citalopram,
a selective serotonin reuptake inhibitor (SSRI) antidepressant. The findings strongly suggest a
genetic basis underlying the rare emergence of suicidal thoughts associated with taking an SSRI.
The new findings are reported in the article "Genetic Markers of Suicidal Ideation Emerging
During Citalopram Treatment of Major Depression," by Gonzalo Laje, M.D., and colleagues,
which appears in the October 2007 issue of The American Journal of Psychiatry (AJP), the
official journal of the American Psychiatric Association (APA).
Since the introduction of SSRIs in the 1980s, there has been controversy over whether the
medications can trigger suicidal thoughts or behaviors. The STAR*D trial, funded by the
National Institute of Mental Health, provided a unique opportunity to study the phenomenon of
treatment-emergent suicidal ideation in a large cohort of patients treated with an SSRI.
DNA samples were collected from 1,915 patients in the first phase of the STAR*D trial. Laje
and his colleagues examined 768 genetic markers within 68 different genes. The target genes
were selected to look at five broad signaling pathways of potential importance in antidepressant
effects - serotonin, glutamate, dopamine, norepinephrine, and neurotrophins.
Suicidal ideation was assessed by patient self-report, using item 12 on the Quick Inventory of
Depressive Symptomatology-Self Report (QIDS-SR), which asks the patient about "thoughts of
death or suicide." Patients who scored zero before taking citalopram, but later scored 1, 2, or 3 at
least once during treatment, were categorized as experiencing treatment-emergent suicidal
ideation.
The two genetic markers identified, rs4825476 and rs2518224 (known as single nucleotide
polymorphisms), are located on the GRIA3 and GRIK2 genes, respectively. Both GRIK2 and
GRIA3 encode nerve cell receptors for glutamate, one of the brain's chemical messengers.
In the study, the highest odds of suicidal thoughts were for patients who had both of the identified
markers. None of the patients with suicidal ideation actually attempted suicide. However, two
other participants did attempt suicide, and one of these provided DNA and was found to have
both of the high-risk genetic markers.
???
AJP editor-in-chief Robert Freedman, M.D., stated, "While this is a provocative first step towards
individualization of the treatment of depression based on unique genetic and neurobiological
differences between people, the data are still preliminary and require further investigation."
The identified markers do not appear to be related to a general tendency toward suicide, but rather
to suicidal thoughts specifically emerging during antidepressant treatment. Neither of the
identified genes appears to have been previously associated with suicidal ideation.
"These data suggest that not everyone is at the same risk of suicidal thinking during
antidepressant treatment. For most people the risk is low, but some may be at higher risk, due in
part to their genetic makeup. Can genetic markers help identify those at high risk? It's possible,
but we'd like to see the results replicated in another sample before we reach any firm
conclusions," said Dr. Francis J. McMahon, who is one of the authors and chief of the Genetic
Basis of Mood and Anxiety Disorders Unit at the National Institute of Mental Health.
This study was funded by the National Institutes of Health, the National Institute of Mental
Health, the National Institute on Alcohol Abuse and Alcoholism, the National Human Genome
Research Institute, and the Swedish Research Council. Forest Laboratories provided citalopram
for the STAR*D study. Additional funding disclosures appear at the end of the article.
(Am J Psychiatry 2007; 164:1530-1538)
About the American Journal of Psychiatry
The American Journal of Psychiatry, the official journal of the American Psychiatric Association, publishes a monthly
issue with scientific articles submitted by psychiatrists and other scientists worldwide. The peer review and editing
process is conducted independently of any other American Psychiatric Association components. Therefore, statements
in this press release or the articles in the Journal are not official policy statements of the American Psychiatric
Association. The Journal's editorial policies conform to the Uniform Requirements of the International Committee of
Medical Journal Editors, of which it is a member. For further information about the Journal visit
ajp.psychiatryonline.
About the American Psychiatric Association
The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician
members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use
disorders. Visit the APA at psych and HealthyMinds.
New Assessment Tool Provides "Psychological Vital Signs" For Psychotherapists
Have you ever
noticed how much information your physician has about
you before she even enters the exam room? All the
information on her clipboard - vital signs, symptoms,
and other important medical data - was collected in
advance in order to maximize the limited time you have
with your doctor. Now mental health professionals can
have access to "psychological vital signs" at the
start of each therapy session through a new 10-minute
psychological test called QPASS: The Quick
Psycho-Affective Symptoms Scan.
QPASS measures anger, anxiety, depression, and scans
for "red flag" behaviors (such as alcohol and drug
abuse) that therapists need to be aware of in order to
help their clients. Test author Dr. Scott Lownsdale
explains how he came up with the idea: "Facing the
challenge of a busy counseling practice, I asked
myself, 'What if we therapists had data on clients'
"psychological vital signs" at the very start of each
session?' Immediately, I saw how a brief self-report
measure of depression, anger, and anxiety - three
important emotional dimensions of psychopathology -
administered before sessions in the waiting area,
could greatly reduce the time required for assessing
clients, and provide more time for actual therapy.
Moreover, it would offer a convenient way to track
progress, screen for psychopathology, and provide
symptom documentation in support of diagnoses and
treatment interventions, which could have relevance to
third party payers and therapist's legal protection."
QPASS has been found to be an accurate measure not
only of depression, anger and anxiety, but other
constructs as well, such as global psychopathology, or
overall psychological distress. QPASS is available
only for use by mental health professionals and
researchers. More information, such as QPASS'
psychometric properties is available at
qpasslive.
There are a number of very good psychological tests
measuring depression, anxiety, and anger already
available - The Beck Depression Inventory, The Beck
Anxiety Inventory and the STAXI, just to name a few.
However, these instruments were developed
independently from one another, requiring the
therapist to assemble a lengthy, cumbersome and
expensive test battery to fully assess these three
emotional constructs for one client. QPASS measures
all of these emotions and also provides data on an
additional 22 psychiatric symptoms as an aid to
therapists.
In addition to being accurate and thorough, QPASS also
saves time and money. Taking the two Beck Inventories
and STAXI requires about half an hour of testing and
costs over $5.00. In comparison, QPASS measures all
three constructs in about 10 minutes for only 69?? per
client. QPASS can be scored in only a few minutes by
the therapist, so that results are immediately
available.
Therapists using QPASS are excited about the new
instrument. "QPASS is practical, easy to administer,
and easy to score. Very useful in busy counseling
practice settings!" says Dr. David Rising, Ed.D.,
Counseling Psychologist, Williamsport, PA. Joan Cook,
Director of Phoenix Christian Counseling Associates,
Phoenix, AZ has this to say about QPASS. "QPASS gives
a quick picture of the impact of issues with new
clients, and also picks up symptoms that are not
always reported in face-to-face interviews. It is now
a standard part of our intake process with every
client."
Dr. Scott Lownsdale is a Licensed Clinical
Professional Counselor in private practice in
Rockford, Illinois since 1993. His articles have been
published in the Journal of Personality Assessment and
the Journal of Psychology & Theology.
qpasslive
noticed how much information your physician has about
you before she even enters the exam room? All the
information on her clipboard - vital signs, symptoms,
and other important medical data - was collected in
advance in order to maximize the limited time you have
with your doctor. Now mental health professionals can
have access to "psychological vital signs" at the
start of each therapy session through a new 10-minute
psychological test called QPASS: The Quick
Psycho-Affective Symptoms Scan.
QPASS measures anger, anxiety, depression, and scans
for "red flag" behaviors (such as alcohol and drug
abuse) that therapists need to be aware of in order to
help their clients. Test author Dr. Scott Lownsdale
explains how he came up with the idea: "Facing the
challenge of a busy counseling practice, I asked
myself, 'What if we therapists had data on clients'
"psychological vital signs" at the very start of each
session?' Immediately, I saw how a brief self-report
measure of depression, anger, and anxiety - three
important emotional dimensions of psychopathology -
administered before sessions in the waiting area,
could greatly reduce the time required for assessing
clients, and provide more time for actual therapy.
Moreover, it would offer a convenient way to track
progress, screen for psychopathology, and provide
symptom documentation in support of diagnoses and
treatment interventions, which could have relevance to
third party payers and therapist's legal protection."
QPASS has been found to be an accurate measure not
only of depression, anger and anxiety, but other
constructs as well, such as global psychopathology, or
overall psychological distress. QPASS is available
only for use by mental health professionals and
researchers. More information, such as QPASS'
psychometric properties is available at
qpasslive.
There are a number of very good psychological tests
measuring depression, anxiety, and anger already
available - The Beck Depression Inventory, The Beck
Anxiety Inventory and the STAXI, just to name a few.
However, these instruments were developed
independently from one another, requiring the
therapist to assemble a lengthy, cumbersome and
expensive test battery to fully assess these three
emotional constructs for one client. QPASS measures
all of these emotions and also provides data on an
additional 22 psychiatric symptoms as an aid to
therapists.
In addition to being accurate and thorough, QPASS also
saves time and money. Taking the two Beck Inventories
and STAXI requires about half an hour of testing and
costs over $5.00. In comparison, QPASS measures all
three constructs in about 10 minutes for only 69?? per
client. QPASS can be scored in only a few minutes by
the therapist, so that results are immediately
available.
Therapists using QPASS are excited about the new
instrument. "QPASS is practical, easy to administer,
and easy to score. Very useful in busy counseling
practice settings!" says Dr. David Rising, Ed.D.,
Counseling Psychologist, Williamsport, PA. Joan Cook,
Director of Phoenix Christian Counseling Associates,
Phoenix, AZ has this to say about QPASS. "QPASS gives
a quick picture of the impact of issues with new
clients, and also picks up symptoms that are not
always reported in face-to-face interviews. It is now
a standard part of our intake process with every
client."
Dr. Scott Lownsdale is a Licensed Clinical
Professional Counselor in private practice in
Rockford, Illinois since 1993. His articles have been
published in the Journal of Personality Assessment and
the Journal of Psychology & Theology.
qpasslive
Assemblymember Mary Hayashi Receives Suicide Prevention Public Policy Award
The American Association of Suicidology will honor Assemblymember Mary Hayashi (D-Hayward) with the Public Policy Award at its 42nd Annual Conference on April 18, 2009. The award honors the efforts of state and national leaders to address the problem of suicide in the United States.
"Assemblymember Hayashi is receiving this year's award because of her role in establishing the California State Office for Suicide Prevention and for her consistent support for suicide prevention efforts in the State of California," said Peter Gutierrez, Ph.D., President of AAS. "We are pleased to recognize the work she has done to support suicide prevention through both her personal and legislative roles."
"I am deeply honored to receive this award from such a respected leader in suicide prevention research," stated Assemblymember Mary Hayashi. "The efforts of the American Association of Suicidology are vital in helping families to cope with loss and grief, and encourages them to become involved in suicide prevention efforts. Through research and information sharing, we know that suicide is more than a personal tragedy, it is a public health crisis and one that can be addressed through public action and policy change."
Assemblymember Hayashi's commitment to addressing mental health issues is driven largely in part by her own personal childhood experience of losing her older sister to suicide. Her story of this journey in becoming a national voice on suicide prevention and other health care issues is detailed in her book, Far From Home: Shattering the Myth of the Model Minority. Among her many achievements, Assemblymember Hayashi worked on the successful campaign to pass Proposition 63, a ground-breaking measure that has raised billions of dollars in new mental health funding. She also serves as a commissioner on the measure's Mental Health Oversight and Accountability Commission.
The American Association of Suicidology Public Policy Award is given only when a local, state, or national elected official is nominated and found to meet the award's criteria, so it is not given every year. Previous award-winners include U.S. Senator Harry Reid of Nevada.
Assemblymember Hayashi serves the 18th Assembly District, which includes San Leandro, Hayward, Dublin, most of Castro Valley and Pleasanton, and a portion of Oakland, as well as the unincorporated areas of Ashland, Cherryland, San Lorenzo and Sunol.
Source
American Association of Suicidology
"Assemblymember Hayashi is receiving this year's award because of her role in establishing the California State Office for Suicide Prevention and for her consistent support for suicide prevention efforts in the State of California," said Peter Gutierrez, Ph.D., President of AAS. "We are pleased to recognize the work she has done to support suicide prevention through both her personal and legislative roles."
"I am deeply honored to receive this award from such a respected leader in suicide prevention research," stated Assemblymember Mary Hayashi. "The efforts of the American Association of Suicidology are vital in helping families to cope with loss and grief, and encourages them to become involved in suicide prevention efforts. Through research and information sharing, we know that suicide is more than a personal tragedy, it is a public health crisis and one that can be addressed through public action and policy change."
Assemblymember Hayashi's commitment to addressing mental health issues is driven largely in part by her own personal childhood experience of losing her older sister to suicide. Her story of this journey in becoming a national voice on suicide prevention and other health care issues is detailed in her book, Far From Home: Shattering the Myth of the Model Minority. Among her many achievements, Assemblymember Hayashi worked on the successful campaign to pass Proposition 63, a ground-breaking measure that has raised billions of dollars in new mental health funding. She also serves as a commissioner on the measure's Mental Health Oversight and Accountability Commission.
The American Association of Suicidology Public Policy Award is given only when a local, state, or national elected official is nominated and found to meet the award's criteria, so it is not given every year. Previous award-winners include U.S. Senator Harry Reid of Nevada.
Assemblymember Hayashi serves the 18th Assembly District, which includes San Leandro, Hayward, Dublin, most of Castro Valley and Pleasanton, and a portion of Oakland, as well as the unincorporated areas of Ashland, Cherryland, San Lorenzo and Sunol.
Source
American Association of Suicidology
Findings Of The Hurricane Katrina Community Advisory Group
Hurricane Katrina Community Advisory Group Survey Findings
INITIAL FINDINGS DISCUSSED WILL CONCERN:
* Recollection of Evacuation preparations
* Post-evacuation stressful experiences
* Current practical problems and proposed solutions
* Rating the helper agencies and organizations
* Residential mobility plans
* Post-traumatic stress reactions
* Post-traumatic personal growth
* The long-term perspective
ALSO TO BE DISCUSSED: LARGER MENTAL HEALTH FINDINGS THAT WILL BE PUBLISHED IN AN ADVANCED ONLINE EDITION OF THE BULLETIN OF THE WORLD HEALTH ORGANIZATION
STUDY ELEMENTS INCLUDE:
* Levels of mental illness
* Suicidal thoughts
Harvard Medical School, through a grant by the National Institute of Mental Health, recruited 1,043 survivors of Hurricane Katrina to create the Hurricane Katrina Community Advisory Group. The Hurricane Katrina Community Advisory Group is providing ongoing information to help monitor the pace of recovery of the more than two million families whose lives were disrupted by Hurricane Katrina.
This teleconference will be used to examine the first set of survey findings. The discussion will center on a baseline survey report issued to the National Institutes of Mental Health this week that covers several areas, including: participants' recollections of evacuation preparations, post-evacuation stressful experiences, current practical problems and proposed solutions, ratings of helper agencies and organizations, residential mobility plans, post-traumatic stress reactions, and post-traumatic personal growth.
The teleconference will also examine Hurricane Katrina Community Advisory Group mental health survey data to be published in an advanced online edition of the Bulletin of the World Health Organization (WHO).
Members of the advisory group as well as study organizers will participate in the call.
SPEAKERS:
Ronald C. Kessler, Ph.D. Head of Survey Team Professor, Department of Health Care Policy Harvard Medical School
Ronald Kessler is a sociologist and psychiatric epidemiologist. He was trained at Temple University, New York University, and the University of Wisconsin. Dr. Kessler is a Professor of Health Care Policy at Harvard Medical School. He is also the Director of the World Health Organization's World Mental Health Survey Initiative. Dr. Kessler's work focuses on psychosocial determinants and consequences of mental health problems. He is the recipient of many awards for his research, such as the Reme Lepuse award from the American Public Health Association and the Paul Hock Award from the American Psychopathological Association. He is a member of the Institute of Medicine of the National Academy of Sciences. He has been designated by the Institute for Scientific Information as the most widely cited researcher in the field.
Richard Powers, M.D. Associate Professor of Neurology and Pathology The University of Alabama at Birmingham
Richard E. Powers is a geriatric psychiatrist and a neuropathologist. He trained at the University of Kentucky College of Medicine and at the Johns Hopkins Hospital. He is currently the Medical Director for the Alabama Department of Mental Health and Mental Retardation as well as an associate professor in the Departments of Pathology and Psychiatry at the University of Alabama at Birmingham School of Medicine. He trained in the office of the medical examiner in the State of Maryland and serves as a forensic neuropathology consultant to medical examiners in Northern Alabama. Dr. Powers has extensive experience in management of public mental health systems and services for persons with dementia and intellectual disabilities. He provided direct clinical care to Hurricane Katrina evacuees in central and southern Alabama during the sheltering phase and mental health services to evacuees located in longer term housing during the recovery phase. Dr. Powers serves on numerous regional and national boards for mental health services organizations. He has published in the fields of clinical psychiatry, experimental neuropathology and the application of forensic pathology to persons with disabilities.
Anthony H. Speier, Ph.D. Director of Disaster Mental Health Operations Louisiana Office of Mental Health
Anthony H. Speier is a clinical psychologist. He was trained at the University of Texas in Austin and Louisiana State University. Dr. Speier is the Director of Disaster Mental Health Operations for the Louisiana Office of Mental Health, in which capacity he is the principal contact for all federally funded crisis counseling programs addressing the emotional impact of hurricanes Katrina on Louisiana residents. Dr. Speier formerly served as the Director of the Division of Program Development and Implementation for the Louisiana Office of Mental Health. Dr. Speier also led the Office of Mental Health SAMHSA COSIG project and has been the principal investigator on a number of CMHS systems change grants focusing on issues specific to adults with severe and persistent mental illness. In his capacity as the State Director for Disaster Mental Health coordination and response activities, Dr. Speier has been the project director for nine federal crisis counseling grants following Presidentially Declared Disasters in Louisiana. He has served as Chair of the Adult Services Division of The National Association of State Mental Health Program Directors. Dr. Speier is a practicing psychologist in Louisiana and holds a clinical appointment at the Louisiana State University Health Sciences Center Department of Psychiatry. Dr. Speier has authored a number of publications and training manuals for the Center for Mental Health Services.
Robert J. Ursano, M.D. Professor of Psychiatry and Neuroscience Chairman, Department of Psychiatry Uniformed Services University of the Health Sciences
Robert Ursano is a psychiatrist. He was trained at the University of Notre Dame, Yale University School of Medicine, Wilford Hall USAF Medical Center, and the Washington Psychoanalytic Institute. Dr. Ursano is a Professor and the Chairman of the Department of Psychiatry at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland and the Director of the USUHS Center for the Study of Traumatic Stress. Dr. Ursano and his group are national leaders in public health policy planning for terrorism. His group has studied trauma and disaster in a wide range of populations and developed educational materials that have been widely disseminated to assist populations exposed to the September 11 attack, Hurricane Katrina, and other large-scale disasters. Dr. Ursano was a member of the National Academies of Science, Institute of Medicine, Committee on Psychological Responses to Terrorism, and the National Institute of Mental Health Task Force on Mental Health Surveillance after Terrorist Attack. He is the recipient of numerous awards for his work, including the Department of Defense Humanitarian Service Award and the Lifetime Achievement Award from the International Traumatic Stress Society. He is a Distinguished Fellow of the American Psychiatric Association, the American College of Psychiatrists, and the American College of Psychoanalysts. He is the Editor of the journal Psychiatry, the journal of interpersonal and biological processes founded by Harry Stack Sullivan. His Individual and Community Responses to Trauma and Disaster (Cambridge University Press) and his two-volume Terrorism and Disaster and Bioterrorism (Cambridge University Press) are among the most widely cited books in the field of trauma studies.
And community respondents who are members of the Hurricane Katrina Community Advisory Group
ORAL HISTORIES OF ADVISORY GROUP MEMBERS ARE ALSO NOW AVAILABLE AT hurricanekatrina.med.harvard/oralhistories.php
FOR MORE INFORMATION, CONTACT: Leah Gourley, public_affairshms.harvard
HARVARD MEDICAL SCHOOL hms.harvard/
Harvard Medical School has more than 5,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.
Contact: John Lacey
hms.harvard/
INITIAL FINDINGS DISCUSSED WILL CONCERN:
* Recollection of Evacuation preparations
* Post-evacuation stressful experiences
* Current practical problems and proposed solutions
* Rating the helper agencies and organizations
* Residential mobility plans
* Post-traumatic stress reactions
* Post-traumatic personal growth
* The long-term perspective
ALSO TO BE DISCUSSED: LARGER MENTAL HEALTH FINDINGS THAT WILL BE PUBLISHED IN AN ADVANCED ONLINE EDITION OF THE BULLETIN OF THE WORLD HEALTH ORGANIZATION
STUDY ELEMENTS INCLUDE:
* Levels of mental illness
* Suicidal thoughts
Harvard Medical School, through a grant by the National Institute of Mental Health, recruited 1,043 survivors of Hurricane Katrina to create the Hurricane Katrina Community Advisory Group. The Hurricane Katrina Community Advisory Group is providing ongoing information to help monitor the pace of recovery of the more than two million families whose lives were disrupted by Hurricane Katrina.
This teleconference will be used to examine the first set of survey findings. The discussion will center on a baseline survey report issued to the National Institutes of Mental Health this week that covers several areas, including: participants' recollections of evacuation preparations, post-evacuation stressful experiences, current practical problems and proposed solutions, ratings of helper agencies and organizations, residential mobility plans, post-traumatic stress reactions, and post-traumatic personal growth.
The teleconference will also examine Hurricane Katrina Community Advisory Group mental health survey data to be published in an advanced online edition of the Bulletin of the World Health Organization (WHO).
Members of the advisory group as well as study organizers will participate in the call.
SPEAKERS:
Ronald C. Kessler, Ph.D. Head of Survey Team Professor, Department of Health Care Policy Harvard Medical School
Ronald Kessler is a sociologist and psychiatric epidemiologist. He was trained at Temple University, New York University, and the University of Wisconsin. Dr. Kessler is a Professor of Health Care Policy at Harvard Medical School. He is also the Director of the World Health Organization's World Mental Health Survey Initiative. Dr. Kessler's work focuses on psychosocial determinants and consequences of mental health problems. He is the recipient of many awards for his research, such as the Reme Lepuse award from the American Public Health Association and the Paul Hock Award from the American Psychopathological Association. He is a member of the Institute of Medicine of the National Academy of Sciences. He has been designated by the Institute for Scientific Information as the most widely cited researcher in the field.
Richard Powers, M.D. Associate Professor of Neurology and Pathology The University of Alabama at Birmingham
Richard E. Powers is a geriatric psychiatrist and a neuropathologist. He trained at the University of Kentucky College of Medicine and at the Johns Hopkins Hospital. He is currently the Medical Director for the Alabama Department of Mental Health and Mental Retardation as well as an associate professor in the Departments of Pathology and Psychiatry at the University of Alabama at Birmingham School of Medicine. He trained in the office of the medical examiner in the State of Maryland and serves as a forensic neuropathology consultant to medical examiners in Northern Alabama. Dr. Powers has extensive experience in management of public mental health systems and services for persons with dementia and intellectual disabilities. He provided direct clinical care to Hurricane Katrina evacuees in central and southern Alabama during the sheltering phase and mental health services to evacuees located in longer term housing during the recovery phase. Dr. Powers serves on numerous regional and national boards for mental health services organizations. He has published in the fields of clinical psychiatry, experimental neuropathology and the application of forensic pathology to persons with disabilities.
Anthony H. Speier, Ph.D. Director of Disaster Mental Health Operations Louisiana Office of Mental Health
Anthony H. Speier is a clinical psychologist. He was trained at the University of Texas in Austin and Louisiana State University. Dr. Speier is the Director of Disaster Mental Health Operations for the Louisiana Office of Mental Health, in which capacity he is the principal contact for all federally funded crisis counseling programs addressing the emotional impact of hurricanes Katrina on Louisiana residents. Dr. Speier formerly served as the Director of the Division of Program Development and Implementation for the Louisiana Office of Mental Health. Dr. Speier also led the Office of Mental Health SAMHSA COSIG project and has been the principal investigator on a number of CMHS systems change grants focusing on issues specific to adults with severe and persistent mental illness. In his capacity as the State Director for Disaster Mental Health coordination and response activities, Dr. Speier has been the project director for nine federal crisis counseling grants following Presidentially Declared Disasters in Louisiana. He has served as Chair of the Adult Services Division of The National Association of State Mental Health Program Directors. Dr. Speier is a practicing psychologist in Louisiana and holds a clinical appointment at the Louisiana State University Health Sciences Center Department of Psychiatry. Dr. Speier has authored a number of publications and training manuals for the Center for Mental Health Services.
Robert J. Ursano, M.D. Professor of Psychiatry and Neuroscience Chairman, Department of Psychiatry Uniformed Services University of the Health Sciences
Robert Ursano is a psychiatrist. He was trained at the University of Notre Dame, Yale University School of Medicine, Wilford Hall USAF Medical Center, and the Washington Psychoanalytic Institute. Dr. Ursano is a Professor and the Chairman of the Department of Psychiatry at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland and the Director of the USUHS Center for the Study of Traumatic Stress. Dr. Ursano and his group are national leaders in public health policy planning for terrorism. His group has studied trauma and disaster in a wide range of populations and developed educational materials that have been widely disseminated to assist populations exposed to the September 11 attack, Hurricane Katrina, and other large-scale disasters. Dr. Ursano was a member of the National Academies of Science, Institute of Medicine, Committee on Psychological Responses to Terrorism, and the National Institute of Mental Health Task Force on Mental Health Surveillance after Terrorist Attack. He is the recipient of numerous awards for his work, including the Department of Defense Humanitarian Service Award and the Lifetime Achievement Award from the International Traumatic Stress Society. He is a Distinguished Fellow of the American Psychiatric Association, the American College of Psychiatrists, and the American College of Psychoanalysts. He is the Editor of the journal Psychiatry, the journal of interpersonal and biological processes founded by Harry Stack Sullivan. His Individual and Community Responses to Trauma and Disaster (Cambridge University Press) and his two-volume Terrorism and Disaster and Bioterrorism (Cambridge University Press) are among the most widely cited books in the field of trauma studies.
And community respondents who are members of the Hurricane Katrina Community Advisory Group
ORAL HISTORIES OF ADVISORY GROUP MEMBERS ARE ALSO NOW AVAILABLE AT hurricanekatrina.med.harvard/oralhistories.php
FOR MORE INFORMATION, CONTACT: Leah Gourley, public_affairshms.harvard
HARVARD MEDICAL SCHOOL hms.harvard/
Harvard Medical School has more than 5,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.
Contact: John Lacey
hms.harvard/
New Paths To Treating Depression Suggested By Animal Studies
New animal research has identified factors, such as the stress response and immune system, that may play important roles in depression. Scientists have also found that the regulation of nerve cell signals influences depression in animals, and that new drug combinations may more effectively treat it. The findings were presented at Neuroscience 2010, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news on brain science and health.
Depression is a common mental disorder that affects more than 121 million people worldwide, according to the World Health Organization. Studies show the most effective treatment for moderate or severe depression is a combination of antidepressant medication and psychotherapy. However, 20 to 40 percent of people with depression are not helped by existing therapies, highlighting the need for new treatment targets and approaches.
The new findings show that:
An inability to cope with stress may play a role in depression. When placed in stressful situations, zebrafish with a mutation in a receptor important in stress management displayed depression-like behavior, which was reversed when the fish were given Prozac (Herwig Baier, PhD, abstract 884.1).
The immune system may be a factor in depression. When an immune hormone that carries "sickness" signals to the brain was blocked in mice, the animals showed fewer depression symptoms (Simon Sydserff, PhD, abstract 666.24).
Mice that lack a molecule involved in regulating nerve cell signals are more active and resilient to stressful situations, behaving the same way as animals given antidepressant drugs. The discovery offers a new target for controlling brain chemicals involved in mood regulation (James Bibb, PhD, abstract 741.9).
Two antidepressants may be better than one. A new animal study shows that when drugs that alter two mood-regulating brain chemicals are combined, they produce a greater antidepressant response (Marina Picciotto, PhD).
Other recent findings discussed show that:
Two brain molecules, p11 and brain-derived neurotrophic factor, are key to making antidepressants work. In time, these results might lead to the development of faster-acting antidepressants with fewer side effects (Jennifer Warner-Schmidt, PhD).
"Finding treatments for disorders of the nervous system is a social imperative," said press conference moderator Robert Greene, MD, PhD, of the University of Texas Southwestern Medical School, an expert in psychiatric disorders. "Basic neuroscience research has formed the basis for significant progress in discovering potentially powerful strategies for new, more effective therapies to combat depression."
This research was supported by national funding agencies, such as the National Institutes of Health, as well as private and philanthropic organizations.
Depression is a common mental disorder that affects more than 121 million people worldwide, according to the World Health Organization. Studies show the most effective treatment for moderate or severe depression is a combination of antidepressant medication and psychotherapy. However, 20 to 40 percent of people with depression are not helped by existing therapies, highlighting the need for new treatment targets and approaches.
The new findings show that:
An inability to cope with stress may play a role in depression. When placed in stressful situations, zebrafish with a mutation in a receptor important in stress management displayed depression-like behavior, which was reversed when the fish were given Prozac (Herwig Baier, PhD, abstract 884.1).
The immune system may be a factor in depression. When an immune hormone that carries "sickness" signals to the brain was blocked in mice, the animals showed fewer depression symptoms (Simon Sydserff, PhD, abstract 666.24).
Mice that lack a molecule involved in regulating nerve cell signals are more active and resilient to stressful situations, behaving the same way as animals given antidepressant drugs. The discovery offers a new target for controlling brain chemicals involved in mood regulation (James Bibb, PhD, abstract 741.9).
Two antidepressants may be better than one. A new animal study shows that when drugs that alter two mood-regulating brain chemicals are combined, they produce a greater antidepressant response (Marina Picciotto, PhD).
Other recent findings discussed show that:
Two brain molecules, p11 and brain-derived neurotrophic factor, are key to making antidepressants work. In time, these results might lead to the development of faster-acting antidepressants with fewer side effects (Jennifer Warner-Schmidt, PhD).
"Finding treatments for disorders of the nervous system is a social imperative," said press conference moderator Robert Greene, MD, PhD, of the University of Texas Southwestern Medical School, an expert in psychiatric disorders. "Basic neuroscience research has formed the basis for significant progress in discovering potentially powerful strategies for new, more effective therapies to combat depression."
This research was supported by national funding agencies, such as the National Institutes of Health, as well as private and philanthropic organizations.
Child Sexual Abuse Victims At Higher Risk Of Fatal Self-Harm, Australia
Victims of child sexual abuse are at increased risk of suicide and accidental fatal drug overdose later in life, according to the authors of a study published in the Medical Journal of Australia.
Dr Margaret Cutajar, a psychologist from the Centre for Forensic Behavioural Science at Monash University, Melbourne, and her co-authors, Professors James Ogloff and Paul Mullen, investigated rates of fatal self-harm in 2759 people who were medically ascertained as being victims of child sexual abuse (CSA) between 1964 and 1995.
They found significantly higher rates of suicide and accidental fatal drug overdose in the CSA cohort compared with age-limited national data for the general population, with relative risks of 18.09 for suicide and 49.22 for accidental fatal drug overdose in CSA victims.
Dr Cutajar said it was surprising that anxiety was the most commonly reported diagnosis among the 20 CSA victims who died from self-harm and for whom psychiatric information was recorded.
"Depression and psychosis have been consistently shown to be strong predictors of suicide; however, most of the CSA victims in our study who died from self-harm had a recorded diagnosis of anxiety disorder," Dr Cutajar said.
"These findings suggest that victims of CSA who die from self-harm have a different psychopathological profile to non-abused individuals who die from self-harm."
The study also found that, on average, almost 20 years had passed from examination for CSA to death, indicating that CSA was not an immediate precipitant to fatal self-harm.
In an accompanying editorial in the MJA, Prof Ross Kalucy, Director of Emergency Mental Health at Flinders Medical Centre, SA, writes that more work needs to be done in examining the intermediary variables in development for victims of CSA who develop psychological problems in adolescence and young adulthood.
"Although child sexual abuse is a marker for later psychosocial problems, it may not be the critical formative experience," Prof Kalucy said.
"The complex psychopathological conditions that are associated with disorders of adolescence and young adulthood need more investigation, and their association with child sexual abuse needs explanation."
The Medical Journal of Australia is a publication of the Australian Medical Association.
Source
Medical Journal of Australia
Dr Margaret Cutajar, a psychologist from the Centre for Forensic Behavioural Science at Monash University, Melbourne, and her co-authors, Professors James Ogloff and Paul Mullen, investigated rates of fatal self-harm in 2759 people who were medically ascertained as being victims of child sexual abuse (CSA) between 1964 and 1995.
They found significantly higher rates of suicide and accidental fatal drug overdose in the CSA cohort compared with age-limited national data for the general population, with relative risks of 18.09 for suicide and 49.22 for accidental fatal drug overdose in CSA victims.
Dr Cutajar said it was surprising that anxiety was the most commonly reported diagnosis among the 20 CSA victims who died from self-harm and for whom psychiatric information was recorded.
"Depression and psychosis have been consistently shown to be strong predictors of suicide; however, most of the CSA victims in our study who died from self-harm had a recorded diagnosis of anxiety disorder," Dr Cutajar said.
"These findings suggest that victims of CSA who die from self-harm have a different psychopathological profile to non-abused individuals who die from self-harm."
The study also found that, on average, almost 20 years had passed from examination for CSA to death, indicating that CSA was not an immediate precipitant to fatal self-harm.
In an accompanying editorial in the MJA, Prof Ross Kalucy, Director of Emergency Mental Health at Flinders Medical Centre, SA, writes that more work needs to be done in examining the intermediary variables in development for victims of CSA who develop psychological problems in adolescence and young adulthood.
"Although child sexual abuse is a marker for later psychosocial problems, it may not be the critical formative experience," Prof Kalucy said.
"The complex psychopathological conditions that are associated with disorders of adolescence and young adulthood need more investigation, and their association with child sexual abuse needs explanation."
The Medical Journal of Australia is a publication of the Australian Medical Association.
Source
Medical Journal of Australia
Evidence Lacking To Support Many Off-Label Uses Of Atypical Antipsychotics
Some newer
antipsychotic medications approved to treat schizophrenia and bipolar
disorder are being prescribed to millions of Americans for depression,
dementia, and other psychiatric disorders without strong evidence that such
off-label uses are effective, according to a new analysis by HHS' Agency
for Healthcare Research and Quality.
The federally funded comparative effectiveness review of these drugs --
called atypical antipsychotics -- identified the medications' potential for
serious side effects while pointing to an "urgent need" for more research
into new treatments for the growing population of dementia patients who
display severe agitation.
"This report emphasizes the importance of understanding the risks and
benefits of different medicines," said AHRQ Director Carolyn M. Clancy,
M.D. "Caution is necessary in the off-label use of atypical antipsychotics,
especially when used in the elderly and when the evidence for effectiveness
is not good."
Atypical antipsychotics are second-generation medicines designed to
cause fewer neurological complications than conventional antipsychotics.
They include aripiprazole (sold as Abilify), olanzapine (Zyprexa),
quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).
Each is approved by the Food and Drug Administration to treat schizophrenia
and bipolar disorder, and risperidone is also approved to treat
irritability in children ages 5 to 16 who have autism.
Some studies suggest that atypical antipsychotics may help patients
with mental health conditions for which there are no FDA-approved
alternatives. Risperidone and quetiapine, for example, help certain
patients with obsessive- compulsive disorder when used in conjunction with
antidepressants. Risperidone and olanzapine improve sleep problems,
depression, and other symptoms in men with combat-related post-traumatic
stress disorder when used to augment therapy with antidepressants or other
psychotropic medications.
Overall, however, researchers found that much of the scientific
evidence for off-label use of antipsychotics was of insufficient quality
because studies were too small or lacked scientific rigor.
Review authors evaluating the potential benefits and risks of the
medications also found strong evidence that atypical antipsychotics can
increase chances of adverse events. Some of the drugs increase risks of
stroke, tremors, significant weight gain, sedation, and gastrointestinal
problems.
The new review was produced by AHRQ's Effective Health Care program. It
was authored by AHRQ's Southern California/RAND Evidence-based Practice
Center. The center examined 84 published studies on atypical antipsychotics
and summarized evidence about several conditions:
Dementia:
One analysis showed a small benefit for risperidone and
aripiprazole in the treatment of agitation and psychosis. Another
suggested olanzapine may help treat psychosis. But a large clinical
trial that explored whether risperidone, olanzapine, and quetiapine
controlled behavioral disturbances in Alzheimer's patients concluded
that the risks of adverse events offset the potential benefits.
Overall, analyses identified potential harms as a small increase in the
risk of death and increased chances of stroke, neurological problems
(such as tremors or muscle contractions), and weight gain.
Depression:
For patients who don't benefit from selective serotonin
reuptake inhibitors (SSRIs), the supplemental use of atypical
antipsychotics was not helpful, according to research. No studies showed
the drugs provided a clear benefit for patients with major depressive
disorder with psychotic features. Evidence is conflicting for bipolar
depression.
Obsessive-Compulsive Disorder:
Atypical antipsychotics significantly
helped patients who don't respond adequately to SSRI therapy, studies
showed. Overall, patients taking the drugs were about 2.7 times as
likely to improve as patients taking placebo. The chances of benefiting
were best for risperidone and quetiapine.
Post-Traumatic Stress Disorder:
Studies of men with combat-related PTSD
showed risperidone and olanzapine, when used with antidepressants or
other psychotropic medications, improved sleep quality, anxiety, and
other symptoms. Studies were inconclusive when measuring benefits for
women.
Personality Disorders:
For patients with borderline personality
disorder, one study suggested olanzapine was more effective than placebo
but showed little benefit when used to augment talk therapy. All studies
of olanzapine were very small, however, and patients experienced
significant weight gain. Two other small trials suggested risperidone
may benefit patients with schizotypal personality disorder, and
aripiprazole may help patients with borderline personality disorder.
Tourette's Syndrome:
Risperidone is more effective than placebo,
according to a small body of research. The benefits of ziprasidone are
uncertain.
Off-label prescribing is a common but relatively understudied practice
in health care. A 2001 AHRQ-funded study concluded that about 21 percent of
prescribed drug use was for conditions not indicated on the label. Cardiac
medications and anticonvulsants were the drugs most commonly used off
label. Most off-label use occurs without scientific support, the study
said.
The report released today, Efficacy and Comparative Effectiveness of
Off- Label Use of Atypical Antipsychotics, is the newest analysis from
AHRQ's Effective Health Care program. That program represents the first
federal effort to compare alternative treatments for significant health
conditions and make the findings public. The program is intended to help
patients, doctors, nurses, and others choose the most effective treatments.
Information on the program, including full reports, can be found at
effectivehealthcare.ahrq.
Agency for Healthcare Research and Quality
effectivehealthcare.ahrq
View drug information on Abilify; Geodon; Risperdal Oral Formulation.
antipsychotic medications approved to treat schizophrenia and bipolar
disorder are being prescribed to millions of Americans for depression,
dementia, and other psychiatric disorders without strong evidence that such
off-label uses are effective, according to a new analysis by HHS' Agency
for Healthcare Research and Quality.
The federally funded comparative effectiveness review of these drugs --
called atypical antipsychotics -- identified the medications' potential for
serious side effects while pointing to an "urgent need" for more research
into new treatments for the growing population of dementia patients who
display severe agitation.
"This report emphasizes the importance of understanding the risks and
benefits of different medicines," said AHRQ Director Carolyn M. Clancy,
M.D. "Caution is necessary in the off-label use of atypical antipsychotics,
especially when used in the elderly and when the evidence for effectiveness
is not good."
Atypical antipsychotics are second-generation medicines designed to
cause fewer neurological complications than conventional antipsychotics.
They include aripiprazole (sold as Abilify), olanzapine (Zyprexa),
quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).
Each is approved by the Food and Drug Administration to treat schizophrenia
and bipolar disorder, and risperidone is also approved to treat
irritability in children ages 5 to 16 who have autism.
Some studies suggest that atypical antipsychotics may help patients
with mental health conditions for which there are no FDA-approved
alternatives. Risperidone and quetiapine, for example, help certain
patients with obsessive- compulsive disorder when used in conjunction with
antidepressants. Risperidone and olanzapine improve sleep problems,
depression, and other symptoms in men with combat-related post-traumatic
stress disorder when used to augment therapy with antidepressants or other
psychotropic medications.
Overall, however, researchers found that much of the scientific
evidence for off-label use of antipsychotics was of insufficient quality
because studies were too small or lacked scientific rigor.
Review authors evaluating the potential benefits and risks of the
medications also found strong evidence that atypical antipsychotics can
increase chances of adverse events. Some of the drugs increase risks of
stroke, tremors, significant weight gain, sedation, and gastrointestinal
problems.
The new review was produced by AHRQ's Effective Health Care program. It
was authored by AHRQ's Southern California/RAND Evidence-based Practice
Center. The center examined 84 published studies on atypical antipsychotics
and summarized evidence about several conditions:
Dementia:
One analysis showed a small benefit for risperidone and
aripiprazole in the treatment of agitation and psychosis. Another
suggested olanzapine may help treat psychosis. But a large clinical
trial that explored whether risperidone, olanzapine, and quetiapine
controlled behavioral disturbances in Alzheimer's patients concluded
that the risks of adverse events offset the potential benefits.
Overall, analyses identified potential harms as a small increase in the
risk of death and increased chances of stroke, neurological problems
(such as tremors or muscle contractions), and weight gain.
Depression:
For patients who don't benefit from selective serotonin
reuptake inhibitors (SSRIs), the supplemental use of atypical
antipsychotics was not helpful, according to research. No studies showed
the drugs provided a clear benefit for patients with major depressive
disorder with psychotic features. Evidence is conflicting for bipolar
depression.
Obsessive-Compulsive Disorder:
Atypical antipsychotics significantly
helped patients who don't respond adequately to SSRI therapy, studies
showed. Overall, patients taking the drugs were about 2.7 times as
likely to improve as patients taking placebo. The chances of benefiting
were best for risperidone and quetiapine.
Post-Traumatic Stress Disorder:
Studies of men with combat-related PTSD
showed risperidone and olanzapine, when used with antidepressants or
other psychotropic medications, improved sleep quality, anxiety, and
other symptoms. Studies were inconclusive when measuring benefits for
women.
Personality Disorders:
For patients with borderline personality
disorder, one study suggested olanzapine was more effective than placebo
but showed little benefit when used to augment talk therapy. All studies
of olanzapine were very small, however, and patients experienced
significant weight gain. Two other small trials suggested risperidone
may benefit patients with schizotypal personality disorder, and
aripiprazole may help patients with borderline personality disorder.
Tourette's Syndrome:
Risperidone is more effective than placebo,
according to a small body of research. The benefits of ziprasidone are
uncertain.
Off-label prescribing is a common but relatively understudied practice
in health care. A 2001 AHRQ-funded study concluded that about 21 percent of
prescribed drug use was for conditions not indicated on the label. Cardiac
medications and anticonvulsants were the drugs most commonly used off
label. Most off-label use occurs without scientific support, the study
said.
The report released today, Efficacy and Comparative Effectiveness of
Off- Label Use of Atypical Antipsychotics, is the newest analysis from
AHRQ's Effective Health Care program. That program represents the first
federal effort to compare alternative treatments for significant health
conditions and make the findings public. The program is intended to help
patients, doctors, nurses, and others choose the most effective treatments.
Information on the program, including full reports, can be found at
effectivehealthcare.ahrq.
Agency for Healthcare Research and Quality
effectivehealthcare.ahrq
View drug information on Abilify; Geodon; Risperdal Oral Formulation.
National Positive Thinking Trial Aims To Prevent Childhood Depression
More than 7,000 school pupils from across the UK will be taking part in the trial of a new positive thinking programme led by the University of Bath designed to prevent children developing problems with depression.
Around one in ten children have symptoms which place them at high risk of becoming seriously depressed. If left unmanaged, these symptoms could have a significant impact upon the child's everyday life and increase the possibility of mental health problems in young adulthood.
The ??1.25 million programme, funded by the NHS Health Technology Assessment Programme (HTA), will involve 13-16 year olds from schools in Bath, Bristol, Nottingham, Swindon and Wiltshire.
The programme uses a technique known as Cognitive Behavioural Therapy (CBT) which has been shown to prevent young people from developing mental health problems by giving them skills which help promote positive thinking, coping and problem solving.
As part of their lessons in Personal Social & Health Education (PSHE), the pupils will be taught how to acknowledge their personal strengths, identify negative thought processes and develop problem solving skills.
This kind of positive health intervention could help make a significant reduction to the risk of developing mental health problems. The whole class approach will benefit all children by helping them develop a robust approach to the challenges of life.
"Depression is a serious problem amongst adolescents that can lead to mental health problems in later life," said Professor Paul Stallard from the Mental Health Research & Development Unit at the University of Bath, who is leading the project.
"Studies have shown that if we give young people the tools that can help them build resilience, they can avoid these issues becoming a problem in later life.
"If this trial is successful, we hope to be able to roll-out this programme to schools throughout the country."
The programme involves academics from the universities of Bath, Bristol and Nottingham and the Peninsular Medical School, and is linked to local clinical services in the areas the trial will be taking place.
Following an initial screening, the CBT programme will be delivered in 10 weekly classroom sessions. The researchers will compare the effects of the programme being delivered by teachers and by specially trained facilitators from outside the school with current PSHE lessons.
Further assessments will be carried out immediately after the CBT programme and at six months and one year after the trial.
These assessments will look at whether the programme is successful in reducing the rates of depressive symptoms amongst children and particularly those who were initially identified with severe symptoms.
A pilot programme will take place in January 2009 with the main study taking place between September 2009 and July 2010.
"We hope that the CBT programme will result in a significant reduction in the number of children at risk of becoming seriously depressed," said Professor Stallard, who is also a chartered clinical psychologist with the Avon & Wiltshire Mental Health Care Partnership Trust.
"Cognitive Behavioural Therapy works by improving the individual's ability to deal with negative situations and to acknowledge and focus on more positive skills and outcomes."
Professor Stallard's book on CBT, Think Good, Feel Good, was highly commended by the British Medical Association and has been translated into 13 languages.
He has won five national awards for a school-based CBT programme (FRIENDS) to prevent children from developing mental health problems.
Professor Stallard presented his latest findings at the School for Health's Research Matters conference on Friday 19 September.
The University of Bath is one of the UK's leading universities, with an international reputation for quality research and teaching.
Around one in ten children have symptoms which place them at high risk of becoming seriously depressed. If left unmanaged, these symptoms could have a significant impact upon the child's everyday life and increase the possibility of mental health problems in young adulthood.
The ??1.25 million programme, funded by the NHS Health Technology Assessment Programme (HTA), will involve 13-16 year olds from schools in Bath, Bristol, Nottingham, Swindon and Wiltshire.
The programme uses a technique known as Cognitive Behavioural Therapy (CBT) which has been shown to prevent young people from developing mental health problems by giving them skills which help promote positive thinking, coping and problem solving.
As part of their lessons in Personal Social & Health Education (PSHE), the pupils will be taught how to acknowledge their personal strengths, identify negative thought processes and develop problem solving skills.
This kind of positive health intervention could help make a significant reduction to the risk of developing mental health problems. The whole class approach will benefit all children by helping them develop a robust approach to the challenges of life.
"Depression is a serious problem amongst adolescents that can lead to mental health problems in later life," said Professor Paul Stallard from the Mental Health Research & Development Unit at the University of Bath, who is leading the project.
"Studies have shown that if we give young people the tools that can help them build resilience, they can avoid these issues becoming a problem in later life.
"If this trial is successful, we hope to be able to roll-out this programme to schools throughout the country."
The programme involves academics from the universities of Bath, Bristol and Nottingham and the Peninsular Medical School, and is linked to local clinical services in the areas the trial will be taking place.
Following an initial screening, the CBT programme will be delivered in 10 weekly classroom sessions. The researchers will compare the effects of the programme being delivered by teachers and by specially trained facilitators from outside the school with current PSHE lessons.
Further assessments will be carried out immediately after the CBT programme and at six months and one year after the trial.
These assessments will look at whether the programme is successful in reducing the rates of depressive symptoms amongst children and particularly those who were initially identified with severe symptoms.
A pilot programme will take place in January 2009 with the main study taking place between September 2009 and July 2010.
"We hope that the CBT programme will result in a significant reduction in the number of children at risk of becoming seriously depressed," said Professor Stallard, who is also a chartered clinical psychologist with the Avon & Wiltshire Mental Health Care Partnership Trust.
"Cognitive Behavioural Therapy works by improving the individual's ability to deal with negative situations and to acknowledge and focus on more positive skills and outcomes."
Professor Stallard's book on CBT, Think Good, Feel Good, was highly commended by the British Medical Association and has been translated into 13 languages.
He has won five national awards for a school-based CBT programme (FRIENDS) to prevent children from developing mental health problems.
Professor Stallard presented his latest findings at the School for Health's Research Matters conference on Friday 19 September.
The University of Bath is one of the UK's leading universities, with an international reputation for quality research and teaching.
'Depression' Is Newest Disability Intensive Course Introduced To College Of Direct Support Curriculum
The College of Direct Support (CDS), an internet-based college for Direct Support Professionals (DSPs) and managed in partnership by Elsevier I MC Strategies and the University of Minnesota's Research and Training Center, has introduced its newest Disability Intensive Course (DIC) into the CDS Curriculum "Depression."
The course on "Depression" is an introduction to a mental health condition and in it, users will learn about the different forms of depression and how it may affect the individuals supported and other people. Depression is a common illness that spans all ages. Direct Support Professionals studying this course will learn to identify the signs and symptoms of depression and the common treatment options, and will help DSPs identify some common prevention and recovery tools. These tools can help those supported and people living with depression.
This is the third DIC course to be added to the CDS curriculum, joining courses on "Autism and Autism Spectrum Disorders" and "Cerebral Palsy." Kelly Nye, Project Coordinator at the Institute on Community Integration (ICI), authored this course, and the internal course editors were Nancy McCulloh and Susan O'Nell, Project Coordinators at the ICI at the University of Minnesota. The ICI team creates and authors all CDS courses.
"CDS strives to be at the cutting edge of issues for Direct Support Professionals, and this disability intensive course on Depression provides a wealth of information for DSPs related to symptoms, causes, treatment and recovery," Nye said of the course she authored. "It also provides DSPs with an improved set of skills to work in their given field to provide the most comprehensive care to individuals with depression. We are pleased to provide DSPs with new and useful information to assist them in their roles as front line leaders in the field of disability services."
A DIC is a specialized course within the CDS that focuses on one disability or condition. Unlike other CDS courses, they have only one lesson. Each course defines and describes the nature of a specific condition. It has information about the causes, characteristics and symptoms, and shares some stories of people who have this condition.
The course on "Depression" is an introduction to a mental health condition and in it, users will learn about the different forms of depression and how it may affect the individuals supported and other people. Depression is a common illness that spans all ages. Direct Support Professionals studying this course will learn to identify the signs and symptoms of depression and the common treatment options, and will help DSPs identify some common prevention and recovery tools. These tools can help those supported and people living with depression.
This is the third DIC course to be added to the CDS curriculum, joining courses on "Autism and Autism Spectrum Disorders" and "Cerebral Palsy." Kelly Nye, Project Coordinator at the Institute on Community Integration (ICI), authored this course, and the internal course editors were Nancy McCulloh and Susan O'Nell, Project Coordinators at the ICI at the University of Minnesota. The ICI team creates and authors all CDS courses.
"CDS strives to be at the cutting edge of issues for Direct Support Professionals, and this disability intensive course on Depression provides a wealth of information for DSPs related to symptoms, causes, treatment and recovery," Nye said of the course she authored. "It also provides DSPs with an improved set of skills to work in their given field to provide the most comprehensive care to individuals with depression. We are pleased to provide DSPs with new and useful information to assist them in their roles as front line leaders in the field of disability services."
A DIC is a specialized course within the CDS that focuses on one disability or condition. Unlike other CDS courses, they have only one lesson. Each course defines and describes the nature of a specific condition. It has information about the causes, characteristics and symptoms, and shares some stories of people who have this condition.
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