Depression

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Depression

NIH - Medical Encyclopedia Depression

"Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time. … The main types of depression include: Major depression -- five or more symptoms listed above must be present for at least 2 weeks, but major depression tends to continue for at least 6 months. (Depression is classified as minor depression if less than five depressive symptoms are present for at least 2 weeks.) and Dysthymia -- a chronic, generally milder form of depression but lasts longer -- usually as long as two years. Depression also includes atypical depression, postpartum depression, Premenstrual dysphoric disorder (PMDD), and Seasonal affective disorder (SAD). … If you are depressed for 2 weeks or longer, you should contact your doctor, who can offer treatment options. … Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others."

Highlighted Article

Regular exercise, anxiety, depression and personality: A population-based study. (Prev Med. 2006)

"This study corroborates and extends previous findings: regular exercise is cross-sectionally associated with lower neuroticism, anxiety and depression and higher extraversion and sensation seeking in the population."

CONTINUE YOUR INFOMEDSEARCH RESEARCH with our previous InfoMedLinks. Start with InfoMedLinks 2006.

Depression

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial (BMJ 2007) "Conclusions For adolescents with moderate to severe major depression there is no evidence that the combination of CBT plus an SSRI in the presence of routine clinical care contributes to an improved outcome by 28 weeks compared with the provision of routine clinical care plus an SSRI alone."

Advances in cognitive-behavioural therapy for unipolar depression. (an J Psychiatry. 2007)

The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk. (Depress Anxiety. 2007)

Cognitive-behavioral therapy for depression in Parkinson's disease: A pilot study. (Mov Disord. 2007)

Phone-Based Therapy Eases Long-Term Depression"The study, published in the April issue of the Journal of Consulting and Clinical Psychology, found that when patients received brief telephone-based psychotherapy soon after they started taking antidepressants, strong positive effects -- such as improvements in their depression symptoms and satisfaction with their care -- continued for up to 18 months after the first telephone consult."

Device Therapy

Drug Side-Effects and Interactions

Drug Tests: Wellbutrin vs. Generic Bupropion

Acute worsening of chronic depression during a double-blind, randomized clinical trial of antidepressant efficacy: differences by sex and menopausal status. (J Clin Psychiatry. 2007)

Serotonin-Selective Reuptake Inhibitor-Induced Enuresis in Three Pediatric Cases. (J Child Adolesc Psychopharmacol. 2007)

Lower Bone Mineral Density Found in Older Men Using SSRIs "In a large observational study of older men — the Osteoporotic Fractures in Men Study (MrOS) — bone mineral density (BMD) was lower among the men who used selective serotonin reuptake inhibitors (SSRIs) but not among those who used other antidepressants."

Antidepressants Linked to Bone Loss "Older men and women who take the class of antidepressants known as selective serotonin reuptake inhibitors may have an increased rate of bone loss. But the studies documenting this finding are preliminary and shouldn't be seen as a reason to change medications, the authors stressed. "

Serotonin Syndrome

Association of Low Bone Mineral Density With Selective Serotonin Reuptake Inhibitor Use by Older Men (Arch Intern Med. 2007) "Conclusions In this population of men, BMD was lower among those reporting current SSRI use, but not among users of other antidepressants. Further research is needed to confirm this finding in light of widespread SSRI use and potentially important clinical implications."

Use of Antidepressants and Rates of Hip Bone Loss in Older Women (Arch Intern Med. 2007) "Conclusion Use of SSRIs but not TCAs is associated with an increased rate of bone loss at the hip in this cohort of older women."

[Inappropriate ADH secretion-induced hyponatremia and associated with paroxetine use.] (Rev Med Interne. 2007) "DISCUSSION: Hyponatremia induced by SIADH is a serious but underestimated complication of SSRI treatment. This complication occurs in the elderly people within the first month of treatment. Monitoring of the serum sodium concentration during the first month of treatment is recommended for older patients."

FDA issues new warnings on antidepressants "Young adults beginning treatment with antidepressants should be warned about an increased risk of suicidal thoughts and behavior, federal health officials said Wednesday. The Food and Drug Administration proposed labeling changes that would expand a warning now on all antidepressants. The current language applies only to children and adolescents. The expanded warning would apply to adults 18-24 during the first month or two of treatment with the drugs, the FDA said. "

Depression Drugs May Up Diabetes Risk "Taking antidepressants seems to dramatically increase the risk of developing type 2 diabetes among people who are already at risk for the disease. That is the finding from a major government-funded study designed to determine the role of lifestyle and drug therapy in preventing diabetes. Researchers from the Diabetes Prevention Program, sponsored by the National Institutes of Health, reported that depression alone did not predict progression to diabetes in people at risk for the disease. But taking antidepressants was associated with a two- to threefold increase in risk. "

Depression drugs may lead to apathy in the elderly "Among depressed older adults, use of an SSRI antidepressant like Prozac may lead to apathy, even though it relieves symptoms of depression, clinicians in Canada report."

Selective Serotonin Reuptake Inhibitors Increase Fracture Risk in Older Adults "The use of selective serotonin reuptake inhibitors (SSRIs) increases the risk for fracture, falling, and lower bone mineral density (BMD) in older adults … The fractures that occurred tended to be at clinically relevant sites among daily users of SSRIs (40% forearm, 21% ankle and foot, 13% hip, 13% rib, 9% femoral, and 4% back)."

Treatment-associated suicidal ideation and adverse effects in an open, multicenter trial of fluoxetine for major depressive episodes. (Psychother Psychosom. 2007) "Background: Some reports suggest that a subset of depressed patients may experience suicidality - that is increase or emergence of suicidal ideation (SI) or behavior - after initiation of an antidepressant. … Conclusions: New SI was relatively common in this trial of fluoxetine and associated with the emergence of activation and overall symptomatic worsening. Whether prophylaxis against or aggressive treatment of adverse events can decrease emergence of SI merits further study."

Drugs

Which antidepressants have demonstrated superior efficacy? A review of the evidence. (Int Clin Psychopharmacol. 2007) "Three antidepressants met these criteria: clomipramine, venlafaxine, and escitalopram. Three antidepressants were found to have probable superiority: milnacipran, duloxetine, and mirtazapine. Only escitalopram was found to have definite superiority in the treatment of severe depression; probable superiority was identified for venlafaxine and possible superiority for milnacipran and clomipramine. This review of published data found evidence that only a very few antidepressants are shown to be more effective than others."

Paxil Study 329: Paroxetine vs Imipramine vs Placebo in Adolecents. "GlaxoSmithKline’s Study 329 of medication for adolescent depression failed to demonstrate any benefit for paroxetine over placebo in adolescents and demonstrated a worrying profile of adverse events for paroxetine. The study was ultimately published in 2001 by the Journal of the American Academy of Child and Adolescent Psychiatry with Keller as the primary author. This misleading paper has been a focus of interest for Healthy Skepticism since 2002. In 2003 we wrote to the Editor of JAACAP raising concerns about the misleading reporting by the authors that exaggerated benefit and downplayed adverse effects. "

Exercise

Exercise on par with drugs for aiding depression "Regular exercise may work as well as medication in improving symptoms of major depression, researchers have found. In a study of 202 depressed adults, investigators found that those who went through group-based exercise therapy did as well as those treated with an antidepressant drug. A third group that performed home-based exercise also improved, though to a lesser degree. Importantly, the researchers found, all three groups did better than a fourth group given a placebo -- an inactive pill identical to the antidepressant. "

Exercise may help with hard-to-treat depression"Regular exercise may improve depression symptoms in people who've failed to get better with antidepressant medication, the results of a small study suggest. The study found that depressed women who started a supervised exercise regimen had significant improvements in their symptoms over the next 8 months. Those who didn't exercise showed only marginal improvements. Before the study, all of the women had tried taking antidepressant medication for at least two months but had failed to improve. "

Efficacy of physical activity in the adjunctive treatment of major depressive disorders: preliminary results. (Clin Pract Epidemol Ment Health. 2007) "CONCLUSIONS: Physical activity seems a good adjunctive treatment in the long term management of patients with Depressive Episodes. Randomized placebo controlled trials are needed to confirm the results."

Does physical activity moderate the association between depressive symptoms and disability in older adults? (Int J Geriatr Psychiatry. 2007) "CONCLUSION: The association between depressive symptoms and disability is moderated by physical activity in older persons. The findings suggest that healthcare professionals need to promote moderate amount of physical activity as a potential intervention tool in attenuating the depression-disability connection in later life, especially among those with high levels of physical and mental impairments."

General Information

Does early response predict outcome in psychotherapy and combined therapy for major depression? (J Affect Disord. 2007) "CONCLUSION: Although a number of early nonresponsive patients will achieve remission, this study points out that these patients are at risk factor for ultimate treatment failure. This could be an indication for clinicians to adapt their treatment strategy."

Alcohol consumption and the use of antidepressants. (CMAJ. 2007)

To Treat Depression, Take Action

Guidelines

AHRQ - Antidepressant Medicines - A Guide for Adults With Depression

The Effect of Adherence to Practice Guidelines on Depression Outcomes (Annals 2007) "Conclusions: Adherence to guidelines was high for one third of the recommendations that were measured but was very low for nearly half of the measures, pointing to specific needs for quality improvement. Guideline-concordant depression care appears to be linked to improved outcomes in primary care patients with depression."

NGC - Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. (2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - Antidepressant Use in Children, Adolescents, and Adults

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Can Omega-3 Fatty Acids Help Depression?

Other

Other Treatments

Electroconvulsive Therapy Effective Option for Severe Depression

Radiotherapy

Supplements-Vitamins-CAM

Why fish oils may not always be adequate treatments for depression or other inflammatory illnesses: Docosahexaenoic acid, an omega-3 polyunsaturated fatty acid, induces a Th-1-like immune response. (Neuro Endocrinol Lett. 2007)

Efficacy of St. John's wort extract WS((R)) 5570 in acute treatment of mild depression : A reanalysis of data from controlled clinical trials. (Eur Arch Psychiatry Clin Neurosci. 2007)

Review backs antidepressant effects of omega-3s "The results of a major review of published research that examined the relationship between depression and level of omega-3 fatty acids in the diet suggest that omega-3 fatty acids have antidepressant effects. However, the researchers point out that the quality of the studies means it's still too soon to say definitively that omega-3s can treat depression or bipolar disorder. … Fish and fish oil, as well as flax seed oil, are rich sources of omega-3 polyunsaturated fatty acids (PUFAs). Because areas in which there is high omega-3 PUFA consumption have a lower prevalence of depression, much interest has been generated in their use as antidepressants, the researchers note in the Journal of Clinical Psychiatry."

Effects of dietary supplements on depressive symptoms in older patients: A randomised double-blind placebo-controlled trial. (Clin Nutr. 2007) "CONCLUSION: Oral nutritional supplementation of hospitalised acutely ill older patients led to a statistically significant benefit on depressive symptoms."

Omega 3 fatty acids and the brain: review of studies in depression. (Asia Pac J Clin Nutr. 2007)

Heavy metals found in some St. John's wort products " Some St. John's wort herbal supplements on the market are contaminated with cadmium, one product is also contaminated with lead, while others have less of the herb's active ingredients than their labels claim, according to an analysis of 10 brands released this month. Just four of the products White Plains, New York-based ConsumerLab.com tested met the company's quality standards. "We have found problems with St. John's wort in the past and it was disconcerting to see that we found the same problems again in a completely different group of products," Dr. Tod Cooperman, the president of ConsumerLab.com, told Reuters Health."

Little Evidence Omega-3 Fights Depression: Study "There's no evidence that omega-3 fatty acids on their own fight depression and only limited evidence that they're effective against depression when used in combination with antidepressant drugs, according to new research. Previous studies had suggested an association between omega-3 levels and behavior and mood disorders, including depression, according to background information in the review article, published in the journal Drug and Therapeutics Bulletin. "

Surgery

Transplantation

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