Advances in the treatment of depression

recent article in The News-Sentinel offers new hope to the “15-25 percent of the 19 million Americans with depression” who do not respond to treatment using medication, psychotherapy, or electroshock therapy (ECT). While that estimate seems a little high to me (I would estimate that at least 90% of depressed patients eventually respond to medication and/or psychotherapy, although it does sometimes take a bit of trial and error, with a small percentage requiring ECT), there is no doubt that some patients are resistant to these treatment options.

Vagus Nerve Stimulation therapy device for treating psychiatric disorder is undergoing FDA approval

Vagus Nerve Stimulation therapy, used since 1997 to reduce seizures in epilepsy patients who did not respond to medication, might give hope to people whose depression keeps them from working, caring for families and enjoying life… The first implant for treating a psychiatric disorder is on target for final approval by the Food and Drug Administration within 60 days. In mid-June, the electrical nerve stimulator was recommended by an FDA committee…

The concept for using the VNS for depression came serendipitously after epileptic patients noted improvements in their moods. The implant works like this: A small generator, similar to a cardiac pacemaker, is surgically implanted into the left side of the chest. Wires from the generator are wrapped around the left vagus nerve, which runs alongside the carotid artery. The vagus nerve sends messages to deep regions of the brain, stimulating and changing brain activity, particularly in areas regulating mood, Lisanby said. The generator delivers electrical pulses for 30 seconds, about once every five minutes, for people with depression.

The generator can be turned on and off using a hand-held magnetic wand. While epileptic patients with the VNS implant are taught how to control the stimulator according to seizure activity, for people with depression, the generator is on continuously…

As with research into treatments for many physical illnesses and medical conditions, to me what is significant about reports like this is not how many people can be helped or even whether or not this particular treatment proves to be effective – what is important is that it is a reminder that research into improved methods for treating these illnesses is ongoing. If you are among those who are currently struggling with depression, anxiety disorders, or major mental illness, and feeling frustrated by the treatments you have tried so far, do not give up hope. With a bit of patience and some trial-and-error, there is a very good possibility that you will either find an existing treatment that is beneficial to you, or you may be one of those who is helped by something currently under development.

As with research into treatments for many physical illnesses and medical conditions, to me what is significant about reports like this is not how many people can be helped or even whether or not this particular treatment proves to be effective – what is important is that it is a reminder that research into improved methods for treating these illnesses is ongoing. If you are among those who are currently struggling with depression, anxiety disorders, or major mental illness, and feeling frustrated by the treatments you have tried so far, do not give up hope. With a bit of patience and some trial-and-error, there is a very good possibility that you will either find an existing treatment that is beneficial to you, or you may be one of those who is helped by something currently under development.

depression, depression treatment, electrical stimulation

Medication in children: Controlling symptoms or controlling behavior?

This isn’t a new issue but it is one that emerges repeatedly, amid reports of increases in the rate of diagnosis of disorders like ADHD and corrsponding increases in the use of medications for treating those disorders. Are there really more children meeting the criteria for ADHD, childhood bipolar disorder, or obsessive-compulsive disorder than 10 or 20 years ago? Or are we relying too much on complaints from school teachers and stressed-out parents about difficult behavior?

Use of drugs to control kids worries specialists
by Carol Marbin Miller, Miami Herald

Troubled youngsters across the nation are being prescribed mood-altering drugs with increasing frequency, raising questions among psychiatrists and researchers specializing in the mental health needs of children. Supporters of the current trends in child psychiatry see the burgeoning use of often expensive new drugs as a sign that needy children are gaining access to a mental healthcare system that once often excluded them.Critics disparage the statistics as evidence that healthy but unruly children are being given drugs for the convenience of their caretakers, not because they need them.My suspicion is that physicians and psychologists really have become better at recognizing certain disorders and in understanding that children can and do exhibit symptoms of disorders such as bipolar disorder or obessive compulsive disorder, though such diagnoses in children were rare in the past. I also suspect that we will in time determine that some of the increase is due to environmental toxicity and fallout from substantial increases in stress levels in the lives of our children and their families, impacting directly and indirectly on the neurobiology of emotional and behavioral controls.

But I also believe that part of the problem is that schools, parents, and physicians without appropriate training in the diagnosis of such disorders are increasingly “diagnosing” these children based on superficially simple-to-complete behavior checklists, and physicians are then using these “diagnoses” to prescribe and administer medications that may well be not only unhelpful but potentially damaging to developing bodies and nervous systems.

Perhaps one solution is to require that a diagnosis be obtained from a professional with appropriate training in child psychology and psychopathology before any psychotropic medications can be prescribed.

pediatric psychology, child psychology, child psychiatry, ADHD, depression, OCD, bipolar disorder, psychiatric medication

Pets as Serotonin Boosters

Puppy Love: Pets and serotonin

There have been indications for some time from anectdotal reports and research that people, especially seniors, who live with a pet (usually a dog or a cat) are healthier, happier, and recover more rapidly from illness. A common assumption has been that this is the result of a combination of the required increased activity in caring for the pet, and the companionship provided by another living thing. This article points to another reason…

Puppy Love
July 21, 2004
by Karen Lurie, ScienCentral

Any dog owner can tell you about the benefits of spending time with a furry friend. But now there’s some science to back it up.  ‘We have known for a long time that people like to interact with dogs and that it makes them feel happy and they enjoy it,’ says Rebecca Johnson, a gerontologist at University of Missouri-Columbia’s Sinclair School of Nursing. ‘But it’s important to know how this affects the changes in their bloodstream, so we can see which patients might be the best to benefit from this kind of interaction.’

In her on-going study, Johnson asks 50 dog owners and 50 non-pet owners, with ages ranging from 19 to 73, to play with a live dog and a robot dog. Before and after the interactions, she draws blood samples from human and dog, to compare hormone levels. ‘One of the hormones that we are interested in, which is called serotonin, is the hormone that controls depression in people,’ Johnson explains.

Johnson’s preliminary results show that serotonin increases when people pet their own dogs. ‘We think this is very important because of the large numbers of people in this country and abroad that are depressed, particularly the elderly, that we think may benefit from this kind of interaction,’ says Johnson. However, interaction with an unfamiliar dog didn’t affect serotonin levels. When it came to the robotic dog, serotonin levels actually dropped.

The dogs in the study all benefited from human interaction, whether they previously knew the person or not. Veterinarian Richard Meadows measured the dogs’ blood pressure and blood hormone levels during the test period. “It’s both good for the dog and it’s good for the person, and this appears at this state to be almost universally true,” he says.

pets, pet therapy, depression, mental health

Depressed Teens: Antidepressants and psychotherapy

If you pay attention to the news at all, you will have heard the published fears about the use of antidepressant medications in teens and children purportedly increasing the risk of suicide. Since the original warnings in an unpublished and as yet non-replicated British study, a number of reports have emerged with, at first glance, a somewhat confusing array of findings. One of those studies was reported in several newspapers internationally, with the same study under headlines proclaiming that the study proved the orgininal fears to be true, proved them to be false, or proved them to be true in the first few days or weeks of beginning medication.The following study is I think of interest because it lays out a more reasoned and less hysterical view of the dilemma.

A depressing dilemma

Experts warn that depression in children needs treatment, yet questions remain about link between antidepressants, suicide The new generation of antidepressants launched by the arrival of Prozac in 1987 ushered in an era of help for depression without many of the serious side effects of the older drugs. But concerns have mounted in the last two years over whether the popular drugs are safe for children and adolescents.U.S. and British health regulators warned last year that questions remain about whether the drugs increase suicidal thoughts in some younger patients. Mental health experts also agree that because of a lack of study, inadequate proof exists showing the new antidepressants, except Prozac, work in children and adolescents. The situation has put parents in a quandary because many American psychiatrists believe the 4 percent of severely depressed adolescents won’t get better without medication.

Severe depression is a known cause of suicide, while the risk from the drugs is theoretical, they have said. “What a difficult spot to be in,” said Dr. Tom Vaughan, a child and adolescent psychiatrist at Children’s Hospital. “It’s really unfair not to treat the depression because you know that’s associated with suicide.”

Prozac, the first to raise alarm bells over a possible link between teenage suicide and antidepressant use, has been largely cleared. After several studies in patients younger than 18 showed its safety and effectiveness, the U.S. Food and Drug Administration last year granted Prozac approval for use in children.

The other antidepressant drugs known as SSRIs – or selective serotonin reuptake inhibitors – do not have FDA approval for use in patients younger than 18, although many doctors prescribe them anyway. Other SSRIs include Paxil, Zoloft, Celexa, Lexapro and Fluvoxamine….

The most recent concern was sparked last year over a study of Paxil showing a possible increase in suicidal thoughts among some children and adolescents, although no suicides were reported. British drug regulators in December urged doctors not to prescribe new patients SSRIs, except for Prozac. Data did not show that benefits of the drugs outweighed the risks, they said. The FDA continues to review the situation and has recommended caution in prescribing the antidepressants to patients younger than 18. The National Institute of Mental Health is spearheading several studies of the issue, and drug makers recently warned doctors to watch patients closely for increased suicidal behavior, especially when they first start medication.

Dr. Jim Cullinan, a child and adolescent psychiatrist, said the British approach was extreme, especially since there is no evidence showing a link between the antidepressants and suicide. On the other hand, Cullinan and Vaughan point to data showing both an increased use of SSRIs in patients younger than 18 and a corresponding decrease in teenage suicide. The data do not prove a cause-and-effect relationship between the two trends, although the doctors both say many of their patients get better with medication.

Vaughan said research has shown that the best treatment for severe depression is a combination of therapy and medicine. “Combined interventions are most effective,” he said. Cullinan, medical director for inpatient child and adolescent psychiatry at Children’s Hospital and UAB Hospital, said he doesn’t want concern over a slight risk with antidepressants to keep parents from getting help for their children.

“Depression is a real disease that teenagers and children can get,” Cullinan said. “Depression is a brain disorder. Children suspected of having depression need to be seen by a professional. … We don’t want people scared and trying to ride it out on their own.”

I think that with time we will see increasing evidence that on balance these medications are beneficial to the vast majority of depressed patients who use them. Does that mean that everyone who is depressed should be taking antidepressant medications? Of course not. Does it mean that the medications are without side-effects? Again of course not. But to me it does say that depressed patients are best served when given information about the benefits and side-effects and should be encourages to give careful consideration to the use of such medications in combination with counselling or psychotherapy. And in my opinion scaring depressed individuals away from something that may well be beneficial and may in some cases save lives is fundamentally unethical.

depression, medication, SSRI, antidepressant, teens, teenagers, adolescents, children, suicide

Omega-3 essential fatty acids

There is now increasing evidence that omega-3 essential fatty acids (EFAs) are helpful in the prevention and treatment of anxiety, depression, seasonal affective disorder, bipolar disorder, eating disorders, and attention deficit disorder. This article gives us one more reason to pay attention to this element in our diets.

Eating Fish Can Cut Risk of Heart Rhythm Disorder

WASHINGTON (Reuters) July 19, 2004 — Chalk up another benefit of eating fish — it can reduce the risk of deadly irregular heartbeats, researchers reported on Monday. Baked or broiled but not fried, fish helped reduce the risk of atrial fibrillation, Dr. Dariush Mozaffarian of Brigham and Women’s Hospital and Harvard Medical School in Boston and colleagues found.

“The results suggest that regular intake of tuna or other broiled or baked fish may be a simple and important deterrent to atrial fibrillation among older men and women,” Mozaffarian said in a statement issued by the American Heart Association.

More than 2 million Americans are affected by atrial fibrillation, a chronic condition that causes fatigue, shortness of breath and an inability to exercise.

The heart’s two upper chambers, called the atria, quiver instead of beating effectively. Blood is not pumped out properly and may pool and clot.

These clots cause about 15 to 20 percent of strokes.

Writing in the journal Circulation, Mozaffarian and colleagues said they studied 4,815 people over the age of 65.

They asked them to describe what they ate, beginning in 1989, and then watched them for 12 years.

Doctors discovered 980 cases of atrial fibrillation in the volunteers. Those who reported eating more baked or broiled fish were the least likely to have atrial fibrillation.

Those who said they ate fish one to four times per week had a 28 percent lower risk, compared to those who ate fish less than once a month.

The researchers credit the omega-3 fatty acids found in many types of fish as well as in walnuts, flaxseed and many green leafy vegetables. Omega-3’s are also believed to reduce the risk of a range of heart disorders, and are important to brain development and function.

omega 3, EFA, essential fatty acid, depression, mood disorders, SAD, anxiety, heart health, nutrition

Opinion and evidence

New Power Lines Stir Health Debate

SAN FRANCISCO (Reuters) – Lara Lighthouse is fighting the planned route of a 230,000-volt power line near San Francisco because she’s afraid it will make her family sick. “We would have to move if this line is built too close to our property. We don’t want to take the risks,” she said.

California’s push to build more transmission lines to satisfy growing demand for electricity is stirring concern over possible health effects from electric and magnetic fields — EMFs — created by electricity lines. Angry homeowners in the paths of big transmission projects near San Francisco and in Southern California have bombarded state utility regulators with pleas to detour the lines away from homes, schools and offices.

A review of scientific studies by the state’s Department of Health Services said there was no conclusive evidence that EMFs are harmful but studies have suggested links to childhood leukemia, adult brain cancer, Lou Gehrig’s disease and miscarriage. The Edison Electric Institute, a utility industry trade group, said “although several studies conducted in the past suggest a link between proximity to power lines and some forms of childhood cancer, only a few show a statistically significant link and many show no link at all.”

“Nationwide, EMF concerns have receded significantly over the years, and much of the opposition to new transmission projects has been of the garden-variety NIMBY type,” said Jim Owen, an EEI spokesman. “However, EMF as an issue is unlikely ever to disappear entirely.” ….

California utilities, under pressure from the CPUC, are launching new transmission lines in fast-growing suburban areas to make the power grid more reliable. More transmission capacity and new power plants aim to avert a rerun of California’s electricity crisis in 2000-2001, when a supply shortfall triggered blackouts and the bankruptcy of PG&E Corp.’s Pacific Gas & Electric utility, the state’s biggest.

Lighthouse, a mother of two young children, and several hundred of her neighbors in the San Francisco suburb of Burlingame fear that EMFs are harmful and want the PG&E line moved about a mile away from their homes and buried at least 11 feet deep. “We are very concerned about EMFs and health risks. They have to be taken into account when routing power lines, so people are not exposed to high levels,” Lighthouse said.

Underground lines usually are buried about 5 feet to 6 feet, but Paul Moreno, a PG&E spokesman, said the utility could go to 11 feet but does not want to shift the alignment as far as the neighbors do. “EMFs are used in efforts to stop or realign transmission projects,” he said. “The reality is these lines give off very low levels of EMFs at the right of way, far lower than you would find in homes, offices and schools.”

This is an issue that periodically resurfaces despite little or no evidence of any short-term or long-term adverse effects of living close to EMFs. Interestingly, most of the same people who worry about EMFs don’t seem to fear mcirowave ovens, television sets, or even cell phones (I’m not suggesting they should, by the way… I just find the inconsistency interesting from a psychological point of view).
What does it take to convince people that something isn’t a danger, and can that ever be accomplished once a fear about it has been aroused? Perhaps the skepticism and cynicism about our political leaders and big industry is to blame. Maybe many of us feel we’ve been misled or lied to so many times that we don’t trust the evidence that scientists, industrialists, and politicians place before us.

health, electromagnetic radiation, medicine