depression

Worldwide, 13% of women who give birth suffer from postnatal depression, which causes a significant deterioration in a mothers quality of life and her ability to care for her baby. Now, Spanish researchers have developed a model to diagnose this illness with a predictive power of 80% the best result to date for this kind of depression.

“Early diagnosis of postnatal depression would make it possible to intervene to prevent it from developing among women at risk”, Salvador Tortajada, lead author of the study and a researcher at the Polytechnic University of Valencia (UPV), tells SINC.

The experts studied data on 1,397 Spanish women who gave birth between December 2003 and October 2004 in seven hospitals in Spain, and devised various models that can predict with an 80% success rate which mothers run the risk of developing depression during the first weeks after giving birth.

This study, which is the first of its kind in Spain and has been published recently in the journal Methods of Information in Medicine, gives the best results to date in terms of predicting this illness. “Now it needs clinical evaluation, and for psychiatrists to start to test it directly on patients in order to study the true potential of these tools”, says Tortajada.

The researchers used artificial neuronal networks and extracted a series of risk factors highlighted in previous studies the extent of social support for the mother, prior psychiatric problems in the family, emotional changes during the birth, neuroticism and polymorphisms in the serotonin transport gene (genes with high levels of expression lead to an increased risk of developing the illness).

They also discovered two protection factors that reduce the risk of depression age (the older the woman the lower her chance of depression), and whether or not a woman has worked during pregnancy (which reduces the risk). The researcher points out that “it can be seen that these factors are relevant in the neuronal networks, but not by using other statistical methods”. The path is now clear for future studies to corroborate these findings.

However, many studies have shown that between 10 and 15% of women who give birth suffer from depression, normally between the second and third month after having given birth. This illness affects the patients emotional and cognitive functions (in extreme cases leading to suicidal tendencies), and may have serious knockon effects on the childs future development.

Source
SINC

The prevalence of anxiety, depression and substance dependency may be twice as high as the mental health community has been led to believe.

It depends on how one goes about measuring.

Duke University psychologists Terrie Moffitt and Avshalom Caspi and colleagues from the United Kingdom and New Zealand used a longterm tracking study of more than 1,000 New Zealanders from birth to age 32 to reach the conclusion that people vastly underreport the amount of mental illness theyve suffered when asked to recall their history years after the fact.

But such selfreporting from memory is the basis of much of what we know about the prevalence of anxiety, depression, alcohol dependence and marijuana dependence. Longitudinal studies like the Dunedin Study in New Zealand that track people over time are rare and expensive, Moffitt said.

“If you start with a group of children and follow them their whole lives, sooner or later almost everybody will experience one of these disorders,” said Moffitt, the Knut SchmittNielsen professor of psychology and neuroscience at Duke.

The Great Smoky Mountains Study, a similar effort based at Duke, has tracked 1,400 American children from age 913 into their late 20s and found similar patterns, said Jane Costello, a professor medical psychology at Duke who runs the study.

“I think weve got to get used to the idea that mental illness is actually very common,” Costello said. “People are growing up impaired, untreated and not functioning to their full capacity because weve ignored it.”

The prevalence of mental illness has been hotly debated by policy makers and mental health providers for many years. The pharmaceutical and health insurance industries also have a stake in the debate, Moffitt said.

The best retrospective studies, the US National Comorbidity Surveys (NCS) and the New Zealand Mental Health Survey, have found the incidence of depression from ages 18 to 32 at a rate of about 18 percent. But they have been roundly criticized by some for their rates being too high. The latest analysis from the Dunedin Study found 41 percent of that age range had experienced clinically significant depression.

Similarly, the survey studies have reported a 6 to 17 percent lifetime rate of alcohol dependence between ages 1832, versus nearly 32 percent in the Dunedin Study.

Guidelines published by the American Psychiatric Association that set the bar for defining what is and isnt a treatable illness are currently being revised by a rewriting of the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM). But given the findings of these longitudinal studies, the stringency of the diagnostic criteria might need to be reconsidered, said Moffitt, who is on the committee writing the new DSMVstandards.

“Researchers might begin to ask why so many people experience a disorder at least once during their lifetimes and what this means for the way we define mental health, deliver services and count the economic burdens of mental illness,” Moffitt said.

On the one hand, it could be argued that the diagnostic standards have been set too low if so many people can be considered mentally ill. On the other hand, perhaps these findings argue for more and better mental health care because the disorders are more common than anyone had realized.

“There are two opposing camps, and Im agnostic about that,” Moffitt said.

At the very least, maybe these findings can help reduce the stigma against mental illness and mental health care, Moffitt added. New Zealand, for example, has begun a new campaign of public service announcements featuring sports heroes saying theyve experienced mental health issues.

“If were serious about this problem, we need to get serious about preventing it,” Costello added. “We do know a lot more about prevention now.”

Moffitt and Caspis findings from the Dunedin Study appear online in the journal Psychological Medicine. Their work was supported by the New Zealand Health Research Council, the US National Institutes of Health and the UK Medical Research Council.

Source
Karl Leif Bates

As part of its ongoing effort to support bipolar depression awareness and education, AstraZeneca (NYSE AZN) is bringing The Bipolar Journey Living With Bipolar Depression interactive exhibit to patients and caregivers across America. Those who have been touched by bipolar depression the depressive phase of bipolar disorder are encouraged to visit a nearby exhibit site and learn more about living with this disease and how to help manage it.

“The more you understand about bipolar depression, the better equipped you are to cope with your disease or help a loved one do the same,” said Janet Taylor, M.D., a New Yorkbased Psychiatrist in private practice. “In my experience working with patients and families, Ive learned that an engaging, interactive approach can be very effective. The Bipolar Journey exhibits consumerfocused activities provide insight and clarity into the life of a patient living with and managing bipolar depression.”

The Bipolar Journey features imagery, multimedia activities, and interactive tools to help patients connect with experts as well as other patients and caregivers who have dealt with the impact of bipolar depression in their own lives. For example, a unique tool lets visitors select questions that interest them and hear tailored video responses from Dr. Taylor. Through a powerful feature called “My Story,” visitors can step into a photo booth to give a short message of inspiration about their experience with bipolar depression. Select messages are then posted on an “inspiration wall” to travel around the country with the exhibit, inspiring hope in others. Additional features include a podcast listening station and a short video.

One of the main goals of The Bipolar Journey is to give patients the resources they need to help find appropriate support to manage their disease. In addition to encouraging patients to work with a physician to develop a treatment plan, the exhibit offers opportunities to register for Thinking Forward(TM), a support program that provides free information, resources, and practical advice for people with bipolar depression.

Be sure to click on the links to your right to download a tour schedule, examples of featured activities, a fact sheet about bipolar disorder, photos, and additional resources.

About Bipolar Disorder

Approximately 8 million American adults may be affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness.(1,2) Bipolar disorder consists of recurring episodes of mania and depression.(3) Bipolar I disorder is characterized by one or more manic or mixed episodes, often with one or more episodes of major depression, whereas bipolar II disorder is distinguished by one or more major depressive episodes accompanied by at least one hypomanic episode.(3)

Throughout their lives, patients with bipolar I disorder experience depressive symptoms approximately three times longer than manic symptoms.(4) Similarly, patients with bipolar II disorder spend almost forty times longer in the depressed state than in hypomania.(5) Up to 50 percent of patients with bipolar disorder attempt suicide, and approximately 15 to 20 percent complete suicide.(6)

Bipolar disorder is often misdiagnosed as major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease. In fact, many patients face ten years or more before a correct diagnosis is made.(7) Therefore, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.(8)

Bipolar disorder is typically managed through a treatment strategy with several phases including acute and maintenance phases. In the acute phase, the goal is to treat the patient until symptoms remit; the maintenance treatment phase aims to reduce the risk of recurrence of future episodes.(8)

About AstraZeneca

AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of the healthcare services. AstraZeneca is one of the worlds leading pharmaceutical companies with global healthcare sales of $31.6 billion and is a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infectious disease medicines. In the United States, AstraZeneca is a $ 13.5 billion dollar healthcare business.

References

1. Hirschfeld RMA, Calabrese JR, Weissman MM, et al. Screening for Bipolar in the Community. J Clin Psychiatry. 2003; 645359.

2. US Bureau of the Census.

3. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC APA; 2000; 382397.

4. Judd LL, Akiskal HS, Schettler PJ, et al. The Longterm Natural History of the Weekly Symptomatic Status of Bipolar I Disorder. Arch Gen Psychiatry. 2002; 59530537.

5. Judd LL, Akiskal HS, Schettler PJ, et al. A Prospective Investigation of the Natural History of the Longterm Weekly Symptomatic Status of Bipolar II Disorder. Arch Gen Psychiatry. 2003; 60261269.

6. MA, Chaudhury SR, Mann JJ. Pharmacotherapy of Suicidal Behavior in Bipolar Disorder. Archives of Suicide Research. 2005; 9(3)237250.

7. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and Impact of Bipolar Disorder How Far Have We Really Come? Results of the National Depressive and ManicDepressive Association 2000 Survey of Individuals With Bipolar Disorder. J Clin Psychiatry. 2003; 64161174.

8. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Bipolar Disorder, Second Edition. April 2002.

Venlafaxine and duloxetine alleviate symptoms better than sham drug
The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (GBA) to investigate whether patients with depression benefit from taking drugs belonging to the selective serotonin and norepinephrine reuptake inhibitor (SNRI) drug class. Up till now, 2 of these drugs have been approved as antidepressants in Germany venlafaxine and duloxetine. The Institute published its final report on 18 August. According to this report, the benefit of both drugs has been proven compared to a sham drug (placebo) patients respond better to the therapy and suffer less from the symptoms of depression. Moreover, there are indications that both drugs protect against relapse in addition to alleviating symptoms.

Interplay of biological and psychosocial factors
There are various assumptions about when and how depression occurs. The possible causes and influencing factors are manifold. What is not disputed is that the complete clinical picture of depression is the result of a complex interplay of biological and psychosocial factors. There are indications that a modification or reduction in the transfer of certain messenger substances in the central nervous system plays a part. This is where most drug therapies start their effect. The comparatively new SNRI drug class is intended to influence two of these messenger substances (neurotransmitters) by inhibiting the reuptake of serotonin and norepinephrine.

Manufacturers provide unpublished data
IQWiG and its external experts found a total of 80 clinical trials that could be included in the assessment. Sixteen compared duloxetine (manufacturer Lilly) with a sham drug or another antidepressant, 62 tested venlafaxine (manufacturer Wyeth) in the same way, 2 trials compared the 2 drugs directly with each other. The manufacturers of both the drugs investigated (Lilly and Wyeth) provided a great deal of unpublished data.

In these trials, the effect of the drugs is mostly measured on scales that patients and/or health practitioners can use to document changes in symptoms. IQWiGs benefit assessment included outcomes such as the change in depressive symptoms and accompanying symptoms such as anxiety, pain or sleep disorders, as well as mortality, suicidal tendency, quality of life, daily routine (social functioning level) and adverse drug effects.

Patients respond better to both drugs than to placebo
IQWiG and its external experts came to the conclusion that in acute therapy patients respond better to both drugs than to a sham drug. There is greater alleviation of symptoms, and in some cases they recede to such an extent that some patients no longer fulfil the criteria for a depression diagnosis. As far as relapse prevention is concerned, there is at least an indication that patients benefit more from duloxetine and venlafaxine than from a sham drug. In contrast to duloxetine, there is also proof in the case of venlafaxine that the drug provides more effective protection than placebo against a renewed occurrence of depressive symptoms (recurrence prevention). In the direct comparison of venlafaxine and duloxetine, neither drug displays superiority over the other with regard to alleviating depressive symptoms.

With reference to the healthrelated quality of life, an advantage was proven for duloxetine in the comparison with placebo, but not for venlafaxine. However, if the drugs are compared directly, there is no relevant difference. In the comparison with a sham drug, both drugs also improve the patients ability to manage their daily routine (social functioning level).

Venlafaxine has limited additional benefit compared to other antidepressants
In the comparison with another antidepressant drug class, selective serotonin reuptake inhibitors (SSRI), venlafaxine displays an advantage it alleviates depressive symptoms better than the comparator drugs. However, the same does not apply to duloxetine.

Differences are visible in side effects
The investigation into adverse drug effects revealed that venlafaxine is superior to duloxetine in the direct comparison, as fewer patients discontinued therapy due to side effects. In this context, however, both drugs are inferior to SSRI.

Little influence on accompanying symptoms of depression
With regard to accompanying symptoms of depression, such as anxiety, pain or sleep disorders, there is only one relevant difference revealed in the included trials In the venlafaxine group, patients suffered less from anxiety conditions than in the placebo group. However, no relevant effect could be established for either of the two drugs with regard to the other accompanying symptoms investigated. This applies both to the comparison with a sham drug and the comparison with other antidepressants.

Report preparation procedure
IQWiG published the preliminary results in the form of the preliminary report at the beginning of December 2008 and interested parties were invited to submit comments. When the comments stage ended, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee, at the end of June 2009. Documentation of the written comments and minutes of the oral debate are published in a separate document simultaneously with the final report. The report was produced in collaboration with external experts.

Source
Dr. AnnaSabine Ernst

Depression is a major public health problem, and one of the most important challenges for psychiatrists is to determine whether an individual with depression should receive cognitivebehavioral therapy or treatment with antidepressant medication. A study by researchers from Emory University, presented at the Annual Meeting of the Organization for Human Brain Mapping in San Francisco, used brain imaging along with sophisticated statistical techniques to examine the differences in brain function that result from these two different kinds of treatment. Forty individuals with depression were scanned with magnetic resonance imaging after undergoing cognitive behavioral therapy or antidepressant therapy. The researchers found that they could distinguish the brain activity of individuals undergoing the two different treatments, and in particular that the two treatments differently affected the communication of the brain areas that are thought to play a role in depression, including the communication between the prefrontal cortex and the nucleus accumbens, and between the subgenual cingulate and the thalamus. The results provide a basis for future research that will try to predict which individuals will benefit from different treatments for depression.

Authors S. Chen, G. Derado, Y. Guo, F.D. Bowman, Emory University, Atlanta, GA, United States

Researchers trying to uncover why premature birth is a growing problem in the United States and one that disproportionately affects black women have found that prepregnancy depressive mood appears to be a risk factor in preterm birth among both blacks and whites.

Black women, however, have nearly two times the odds of having a preterm birth compared to white women, according to Amelia Gavin, a University of Washington assistant professor of social work and lead author of a new study that appears online in the June issue of the Journal of Womens Health.

“Preterm births are one of the most significant health disparities in the United States and the overall number of these births increased from 10.6 percent in 2000 to 12.8 percent in 2005,” she said.

While there appears to be some sort of link between giving birth prematurely and depressed mood, the study found no cause and effect, said Gavin, who studies health disparities. She believes the higher preterm birth rate among blacks may be the result of declining health over time among black women.

For this study, premature birth referred to any child born after less than 37 weeks of gestation. Normal gestation ranges from 38 to 42 weeks. Data for the study was drawn from a larger longitudinal investigation looking at the risks for cardiovascular disease among more than 5,000 young adults in four metropolitan areas. The Coronary Artery Risk Development in Young Adults Study also collected information about mental health and pregnancy outcomes. Between 1990 and 1996, 555 women in the larger study gave birth. These women were the subjects in the depressionpremature birth study.

“At this point we cant say that prepregnancy depressive mood is a cause of preterm birth or how race effects this association,” said Gavin. “But it seems to be a risk factor in giving birth prematurely and higher prepregnancy depressive mood among black women compared to white women may indirectly contribute to the greater odds of preterm birth found among black women.”

In the study 18.1 percent of the black women had a preterm birth compared to 8.5 percent of the white women.

This difference may be the result of what she calls “weathering,” or accelerated declines in health due to repeated socioeconomic and political factors.

“What some people experience by being black takes a toll on the physiological system, and over time wear and tear that occurs across neural, neuroendocrine and immune systems as a result of chronic exposure to stressors lead to health disparities for blacks. Some of this may manifest itself in premature birth and lowbirth weight,” Gavin said.

The study did not look at depressive mood or depression during pregnancy because the larger research project did not collect that data. She hopes to replicate and expand her findings by analyzing data from another study to look at depressive mood prior to pregnancy and childhood poverty to see if those two factors in part explain the black and white difference in preterm delivery. That study also will look at the role antidepressive medication plays in preterm birth.

“My ultimate goal is to incorporate a life course health development framework to examine disparities in birth outcomes,” she said. “You have to look at the context of health across the life course of a woman, not just during pregnancy.”

The consequences of higher preterm delivery are a growing burden on the health care system and parents. Studies have shown that preterm babies have higher morbidity rates and U.S. preterm birth rates are creeping up with no good explanation. In the U.S. the population at greatest risk for major depression is women of childbearing age and the onset and course of depression are often intertwined with reproductive events. A recent national study reported that 8.4 percent of pregnant women in the past year experienced major depression and only slightly more than 14 percent of those women sought treatment for any mood disorder.

Coauthors of the study are David Chae of Emory University, Sarah Mustillo of Purdue University, and Dr. Catarina Kiefe of the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center. The National Center for Research Resources and the Roadmap for Medical Research, both components of the National Institutes of Health, funded the research.

Source
Joel Schwarz

A new multicenter study, conducted at The Feinstein Institute for Medical Research in collaboration with five other centers throughout the country, tested the commonly prescribed antidepressant citalopram and found that it was no more effective than placebo in altering obsessive features of the condition the spinning, rocking and repetitive behavior.

Like everything in medicine, the use of antidepressants in children with autism spectrum disorder took off before there was strong scientific proof about its effectiveness. In the last decade, its use has grown so that today more than 40 percent of autistic children swallow a daily dose of an antidepressant.

This study, published in the June 2009 issue of Archives of General Psychiatry, should serve to reduce the number of antidepressant prescriptions written for children with autism and similar conditions on the autism spectrum.

“Parents of children with autism spectrum disorders face an enormous number of treatment options, not all of which are research based,” said Thomas R. Insel, MD, Director of the National Institute of Mental Health (NIMH). “Studies like this help us to better understand which treatments are likely to be beneficial and safe.” The study was funded by the NIMH and other NIH institutes.

The Feinstein Institutes Joel D. Bregman, MD, an expert on autism and one of the study investigators, said that the initial use of antidepressants grew out of a belief that some of the repetitive behaviors are similar to those seen among people with obsessive compulsive disorder. “We cant rely on apparent similarities to other conditions and clinical experiences to guide our treatment strategies.” Dr. Bregman said. “This was a large doubleblind clinical trial that showed that this class of medicine is not effective in reducing these behaviors. These types of studies are essential.”

The study followed 149 children between the ages of five and 17. About half were given a placebo dose and the others received the antidepressant. They were tested repeatedly over the 12week study period. A positive response was defined by improvement on a number of behavioral measurements. “There was no significant difference in the rate of positive response” on these tests, the scientists concluded. “Results of the trial do not support the use of citalopram for the treatment of repetitive behavior in children and adolescents with autism spectrum disorder.”

Citalopram is in a class of antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs).

Initial smaller studies reported that SSRIs did make a difference. There is some biologic evidence to suggest that it would. Scientists have reported abnormalities in the brain regions that make the chemical serotonin. And people with obsessive compulsive disorder (OCD) also have serotonin abnormalities and often respond to the medication that helps the serotonin cells to function more normally. SSRIs are the most frequently prescribed medications for children with autism, Asperger disorder, or pervasive developmental disordernot otherwise specified (PDDNOS) spectrum disorder.

Part of the explanation for the mixed study results is that the placebo response is very high. In the latest study, one in three children in both groups 32.9 percent of those treated with citalopram and 34.2 percent of those treated with placebo were reported to have fewer or less severe symptoms.

The authors on the paper included Bryan H. King, MD, Seattle Childrens Hospital; Eric Hollander, MD, Mount Sinai School of Medicine; Linmarie Sikich, MD, University of North Carolina, Chapel Hill; James T. McCracken, MD, University of California Los Angeles; Lawrence Scahill, MSN., PhD, Yale University; Dr. Bregman, MD, of the Feinstein Institute and North Shore Long Island Jewish Health System; Craig L. Donnelly, MD, Dartmouth Medical School; Evdokia Anagnostou, MD, Mount Sinai School of Medicine (currently at the University of Toronto); Kimberly Dukes, PhD, DMSTAT; Lisa Sullivan, PhD, Boston University; Deborah Hirtz, MD, National Institute of Neurological Disorders and Stroke (NINDS); Ann Wagner, PhD, NIMH; Louise Ritz, MBA, NIMH (currently at NINDS); and the STAART Psychopharmacology Network, a novel federal initiative.

Source
Jamie Talan

For patients who experience pain and depression, common coexisting conditions, an intervention that included individually tailored antidepressant therapy and a pain selfmanagement program resulted in greater improvement in the symptoms of these conditions than patients who received usual care, according to a study in the May 27 issue of JAMA.

Pain complaints account for more than 40 percent of all symptomrelated outpatient visits, and depression is present in 10 percent to 15 percent of all patients who receive primary care. Pain and depression frequently coexist (30 percent50 percent cooccurrence), effect the treatment responsiveness of each, and have adverse effects on quality of life, disability, and health care costs, according to background information in the article.

Kurt Kroenke, M.D., of Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, and colleagues conducted a study to determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and coexisting depression. The trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) included 250 patients who had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity. Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). Depression was assessed with the 20item Hopkins Symptom Checklist, and pain primarily with the Brief Pain Inventory.

The intervention consisted of 12 weeks of optimized antidepressant therapy (actively managed by a nurse care manager); followed by 6 sessions of a pain selfmanagement program over 12 weeks (during each session, the nurse care manager introduces new strategies for patient selfmanagement, assists the patient in choosing strategies, and supervises the patient as he/she practices the chosen strategy); and a 6month continuation phase, in which symptoms were monitored and treatments reinforced, with a focus on preventing relapse.

The researchers found that the intervention group had significantly better outcomes for depression. The intervention group was more than twice as likely to experience depression response (46 of 123 intervention patients [37.4 percent] vs. 21 of 127 usual care patients [16.5 percent]) and nearly 4 times as likely to experience complete remission (17.9 percent vs. 4.7 percent) at 12 months, corresponding to a much lower number of patients with major depression (40.7 percent vs. 68.5 percent).

Intervention patients were also much more likely than usual care patients to report overall improvement in their pain at 12 months (47.2 percent vs. 12.6 percent).

In terms of the trials primary outcome, the intervention group was significantly more likely to experience a composite response, defined as a reduction of 50 percent or greater in depression and a reduction of 30 percent or greater in pain. This difference in composite response rates was significant at both 6 months (23.6 percent for intervention patients vs. 7.9 percent for usual care patients) and 12 months (26.0 percent vs. 7.9 percent).

“It is possible that pain improvement in our trial reflected a main effect of improved mood (i.e., an antidepressant effect on mood rather than an analgesic effect), and that as depression lifts, patients may experience pain as being less intense and less disabling. Conversely, it is also possible that the improvement in depression was mediated by an improvement in pain (i.e., as pain improves, patients feel less depressed) or that both depression and pain lessened as a result of treatment effects on a common pathway,” the authors write.

“Because pain and depression are among the leading causes of decreased work productivity, an intervention that is effective for both conditions may further strengthen a business model. Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and costeffectiveness. Given the prevalence, morbidity, disability, and costs of the paindepression dyad, the SCAMP trial results have important implications.”

JAMA. 2009;301[20]20992110.

Whites experiencing depression are far more likely to be diagnosed by a physician than other ethnic groups, according to a new Consumer Health Sciences (CHS) study presented today at the 14th Annual ISPOR (International Society for Pharmacoeconomic and Outcomes Research) Conference in Orlando, Florida. The study reveals that 76% of whites with selfreported depression symptoms are officially diagnosed, compared to just 58.7% of blacks, 62.7% of Hispanics and 47.4% of Asians.

Findings also show strong differences among ethnic groups in the prevalence of depression among the four ethnic groups studied. Of the 53.8 million Americans reporting they suffer from depression a quarter of the US population 25.8% are white, 19.8% are black, 27.6% are Hispanic and 16.1% are Asian. (Respondents who were not among the four ethnic groups being examined were excluded from the study.)

“Although the differences in prevalence are significant, the wide variations in diagnosis rates are particularly critical and alarming, since patients must be diagnosed to be treated,” says Michael Fronstin, Chief Operating Officer of CHS. “While we are unsure of the cultural or socioeconomic drivers behind those variations, it is clear that steps must be taken to provide both patient and physician education programs that support increased diagnoses and more timely therapy for minority patients.

“One of the issues the research uncovered is that patients dont associate depression symptoms with the actual condition. We must provide the tools and training for medical providers and patients to be able to discuss depression, as well as its specific symptoms, in culturally relevant terms that ensure those who are suffering get the help they need.”

Reporting Symptoms Does Not Mean Recognizing Depression

The CHS study assessed depression by asking respondents if, over the last month, they have often experienced being down, depressed or hopeless and/or having little interest or pleasure in doing things. The results show a clear disconnect between patients reporting depression symptoms and recognizing the underlying condition.

Of those who do not self report having depression, 11.5% of whites, 12.5% of blacks, 13% of Hispanics and 12.7% of Asians indicate they are suffering from one of the depression symptoms. In addition, 10.1% of whites, 11.5% of blacks, 12.9% of Hispanics and 11.2% of Asians not selfreporting depression are, in fact, experiencing both symptoms.

“While recommendations have been made at the policy level to increase access to care and treatment for minority patients, thats just part of the solution,” says Fronstin. “We also must raise both physician and patient awareness of the importance of talking openly about symptoms.”

About the National Health and Wellness Survey (NHWS)

The studys results were drawn from the 2008 US National Health and Wellness Survey (NHWS), a nationally representative, selfadministered survey conducted annually via the Internet. Topics covered include the health status, attitudes and outcomes among adults 18 or older.

CHS, a Kantar Health company, conducts NHWS annually in the US, Europe and Asia. The survey is the largest selfreported patient database in the healthcare industry.

New research on a brain chemical involved in development sheds light on why some individuals may be predisposed to anxiety. It also strengthens understanding of cellular processes that may be common to anxiety and depression, and suggests how lifestyle changes may help overcome both.

The animal study, in the May 13 issue of The Journal of Neuroscience, shows an important role for fibroblast growth factor 2 (FGF2), a chemical important in brain development, in anxiety. The findings advance understanding of cellular mechanisms involved in anxiety and illuminate the role of neurogenesis, or cell birth and integration in the adult brain, in this process. Together, these findings may offer new drug targets for the treatment of anxiety and potentially for depression as well.

According to the National Institute of Mental Health, approximately 40 million Americans adults have anxiety disorders, and 14.8 million suffer from major depression. These disorders often cooccur people with anxiety frequently also have depression, and research suggests that the two disorders may share common causes. Previous human studies led by the senior author, Huda Akil, PhD, at the University of Michigan and her collaborators in the Pritzker Consortium, showed that people with severe depression had low levels of FGF2 and other related chemicals. However, it was unclear whether reductions in FGF2 were the cause or effect of the disease.

This new study, led by Javier Perez, PhD, also at the University of Michigan, examined FGF2 levels in rats selectively bred for high or low anxiety for over 19 generations. Consistent with the human depression studies, the researchers found lower FGF2 levels in rats bred for high anxiety compared to those bred for low anxiety.

The study also suggests that environmental enrichment reduces anxiety by altering FGF2. Other researchers have shown that anxiety behaviors in rats can be modified by making changes to their environment, perhaps akin to lifestyle changes for people. Perez and colleagues found that giving the highanxiety rats a series of new toys reduced anxiety behaviors and increased their levels of FGF2. Furthermore, they found that FGF2 treatment alone reduced anxiety behaviors in the highanxiety rats.

“We have discovered that FGF2 has two important new roles its a genetic vulnerability factor for anxiety and a mediator for how the environment affects different individuals. This is surprising, as FGF2 and related molecules are known primarily for organizing the brain during development and repairing it after injury,” Perez said.

Finally, the findings suggest that part of FGF2s role in reducing anxiety may be due to its ability to increase the survival of new cells in a brain region called the hippocampus. Previous research has suggested that depression decreases the production and incorporation of new brain cells, a process called neurogenesis. Although the researchers found that highanxiety rats produced the same number of new brain cells as lowanxiety rats, they found decreased survival of new brain cells in highanxiety rats compared to lowanxiety rats. However, FGF2 treatment and environmental enrichment each restored brain cell survival.

“This discovery may pave the way for new, more specific treatments for anxiety that will not be based on sedation like currently prescribed drugs but will instead fight the real cause of the disease,” said Pier Vincenzo Piazza, MD, PhD, Director of the Neurocentre Magendie an INSERM/University of Bordeaux institution in France, an expert on the role of neurogenesis in addiction and anxiety who was not involved in the current study.

The research was supported by the National Institute of Mental Health, National Institute on Drug Abuse, Office of Naval Research, and The Pritzker Neuropsychiatric Disorders Research Fund.

Source
Debra Speert