These findings suggest that a dysfunctional biological stress system is at play among depressed individuals. Published in the journal Psychophysiology, the research warns of the importance of testing for cardiovascular disease among people suffering from major depression.

“There have been two competing theories as to why depression is linked to cardiovascular disease,” says first author Jennifer Gordon, who is a PhD candidate at McGill University. “Depressed people may have poorer health behaviors, which may in turn lead to heart problems. The other possibility is physiological: a problem with the stress system known as the fight or flight response. Our study was the first to examine the role of a dysfunctional fight or flight response in depression in a large population.”

Heart rate recovery is a powerful diagnostic tool
A total of 886 participants, who were on average 60 years old, took part in the study conducted by Concordia in association with the Montreal Heart Institute, McGill University, the Hôpital Sacré-Coeur de Montréal, the Université du Québec à Montréal and the University of Calgary.

Approximately 5 per cent of participants were diagnosed with a major depressive disorder. All individuals were asked to undergo a stress test after which their heart rate and blood pressure were recorded. Recovery heart rates and blood pressure levels were compared between depressed and non-depressed individuals.

“We found that it took longer for the heart rate of depressed individuals to return to normal,” says senior author, Simon Bacon, a professor in the Concordia University Department of Exercise Science and a researcher at the Montreal Heart Institute. “Heart rate recovery from exercise is one way to measure the fight or flight stress response. The delayed ability to establish a normal heart rate in the depressed individuals indicates a dysfunctional stress response. We believe that this dysfunction, can contribute to their increased risk for heart disease.”

“The take-home message of this study is that health care professionals should not only address the mental disorder, but also the potential for heart disease in patients who are suffering from major depression,” adds Bacon. “Both of these health issues should be treated to minimize risk of severe consequences.”

Material adapted from Concordia University.

The research team also said the findings may be applicable to patients with other types of disease or injury who spend time in hospital intensive care units hooked up to ventilators that breathe for them.

“When people are discharged from the ICU, we tend, understandably, to focus on their physical health, but our data tell us we need to focus on their mental health, too,” says study leader O. Joseph Bienvenu, M.D., Ph.D., an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Depression can make recovery much more difficult. Identifying depressive symptoms early — and treating them — could make a real difference in how patients fare physically in the long term.”

Bienvenu and his colleagues assessed 186 survivors of acute lung injury from four Baltimore hospitals at three, six, 12 and 24 months after they became ill, and surveyed their levels of depression as well as their ability to independently perform important tasks of daily life, such as using the telephone, shopping and preparing food.

The Hopkins team found that 40 percent of the patients developed depressive symptoms in the first two years after discharge even though they had not previously experienced them, and that 66 percent experienced new physical impairments. The average age of patients in the study was 49 years — people who should be in the prime of their lives but became disabled and unable to return to work, the researchers say. The researchers are continuing to follow these patients to see if the problems persist for an even longer period of time.

“Patients are burdened for a very long time after their hospital stays,” says principal investigator Dale M. Needham, M.D., Ph.D., an associate professor of pulmonary and critical care medicine and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. “We need to figure out what we can do to help these previously productive people get back their lives.”

Needham says it is unclear whether it is the acute lung injury syndrome itself causing the new problems or whether the cause is to be found in how patients are routinely cared for in ICUs. Standard ICU care for patients with acute lung injury often includes deep sedation and bed rest. Long stretches of inactivity are known to cause physical impairment, and the use of high-dose benzodiazepines to sedate ICU patients has been associated with depressive symptoms. Needham suspects that both critical illnesses themselves and typical ICU practices contribute to negative outcomes.

Patients’ lungs typically recover relatively quickly from acute lung injury, a syndrome often caused by pneumonia, but also by other infections or trauma. In acute lung injury, the body’s inflammatory response is revved up and gets out of control, causing fluid to flood into the breathing spaces of the lungs and respiratory failure. An estimated 190,000 Americans suffer from acute lung injury each year and more than 74,000, almost 40 percent, will die while in hospital.

Needham says it is important that intensivists like himself, and psychiatrists like Bienvenu work together to ensure the best outcomes for patients, a collaboration that is frequently missing in the care of ICU patients.

Bienvenu says he was surprised by the finding that depressive symptoms frequently precede new physical impairments, since the conventional wisdom is that the inability after an ICU stay to do things like grocery shopping, driving and walking long distances causes patients to feel demoralized about the loss of these functions. But the reverse appears to be true, he says. Depressed patients, he suggests, are harder to motivate to do the physical activities necessary for recovery and maintenance of function.

Bienvenu says acute lung injury is considered an archetypal critical illness and that its consequences may be present to one degree or another in patients who have suffered other critical illnesses. “All doctors should look out for these symptoms in their patients who have been in the ICU,” he says.

The research was funded by the National Institutes of Health.

Other Hopkins researchers involved in the study include Elizabeth Colantuoni, Ph.D.; Pedro A. Mendez-Tellez, M.D.; Victor D. Dinglas, B.S.; Nadia Husain, M.S.; Cheryl R. Dennison, R.N., Ph.D.; and Peter J. Pronovost, M.D., Ph.D.

Material adapted from Johns Hopkins Medicine.

“Our results were encouraging because depression is so common. It’s one of the costliest disorders internationally,” said lead author Sally Merry, M.D., a pediatric psychiatrist with the department of psychological medicine at the University of Auckland in New Zealand.

Depression can erode young people’s enjoyment of daily life, undercut their social relationships and school performance, and increase their risk of substance use, according to Tamar Mendelson, PhD., an assistant professor at the Johns Hopkins Bloomberg School of Public Health who focuses on strategies to prevent mental illnesses. She notes that a first episode of depression dramatically increases the risk of subsequent episodes, initiating what is often a recurring course of illness.

Preventing depression and other mental illnesses is critical for many reasons, said Mendelson. “For one, there are far too few clinicians to treat all the people suffering from depression and other mental illnesses.” She also points out that even effective, evidence-based treatments for depression do not work for all individuals. Even when care is available, many people with depression or other mental illnesses avoid seeking help because of stigma.

“By intervening before the start of a disorder, prevention strategies have the potential to avert a chronic, episodic course of mental illness. Thus, prevention efforts with children and adolescents are particularly critical,” Mendelson said.

The research team analyzed 53 studies, completed in various countries. The studies included a total of 14,406 participants between the ages of 5 and 19. The youngsters involved were free of depressive disorder at the time they began to participate in the prevention programs.

Young people who participated in prevention programs were significantly less likely to have a depressive disorder in the year following the program than youth who did not participate. The effect was the same whether the interventions were targeted toward a specific subset of children, such as just boys, or universal. The prevention programs were diverse and generally involved groups. “Group-based prevention strategies may offer a means of reaching more individuals than most treatment approaches,” said Mendelson. She added that prevention strategies are often less stigmatizing and therefore more acceptable to people than mental health treatments.

Most of the psychological interventions included some components of cognitive behavioral therapy. Other psychological programs emphasized self-efficacy, stress reduction techniques and methods for handling trauma and maintaining optimism.

Both Merry and Mendelson noted that with widespread depression among young people, these findings have importance for many audiences including young people and their parents, school personnel and healthcare professionals who serve children and families. Policy makers concerned with improving public health and controlling the massive costs associated with depression are also likely to be interested. In many countries, note the authors, “governments are keen to take action” to limit the massive human and financial costs associated with depression.

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

Reference
Merry, S.N., et al. (2011). Psychological and educational interventions for preventing depression in children and adolescents. The Cochrane Library, Issue 12, published online December 7.

“Childbirth has an important influence on the onset and course of bipolar affective disorder, and studies have shown that episodes of post-partum psychosis are often best considered as presentations of bipolar affective disorder occurring at a time of dramatic psychological and physiological change,” the authors write as background information in the article. “It is also clear, however, that a high number of women with the new onset of a psychiatric disorder in the immediate post-partum period do not receive a diagnosis of bipolar disorder.”

Researchers collected data on 120,378 women born in Denmark from 1950 to 1991 who were alive in 2006 and had a history of a first-time psychiatric contact with any type of psychiatric disorder (admission or outpatient contact) with any type of psychiatric disorder excluding bipolar affective disorder. Each woman was followed up with individually from the day of discharge, with data collected on inpatient or outpatient psychiatric contacts during the follow-up period.

A total of 2,870 of these women had their initial psychiatric contact within the first year after delivery of their first child. During follow-up, 3,062 of the 120,378 women received diagnoses of bipolar affective disorder, of which 132 had their initial psychiatric contact 0 to 12 months post-partum. After adjusting for first diagnosis and family history of psychiatric illness, conversion rates to bipolar disorder were significantly predicted by the timing of initial psychiatric contact.

The authors found a significantly higher conversion rate to bipolar affective disorder in women having their initial contact within the first post-partum month. Additionally, the authors found evidence that the severity of the initial post-partum psychiatric episode may be important, as inpatient admissions were associated with a higher conversion rate than were outpatient contacts.

Fifteen years after initial contact, 13.87 percent of women with onset in the immediate post-partum period (0 to 30 days) had converted to bipolar disorder, 4.69 percent of women with later onset (31 to 365 days post-partum) and 4.04 percent of women with onset at other points had converted to bipolar disorder. Additionally, an extended analysis showed that 18.98 percent of women with onset in the immediate post-partum period had converted to bipolar disorder within 22 years after initial psychiatric contact. Conversely, 6.51 percent of women with later post-partum onset and 5.43 percent of women with onset at other points had converted to bipolar disorder after 22 years.

“The present study confirms the well-established link between childbirth and bipolar affective disorder and specifically adds to this field of research by demonstrating that initial psychiatric contact within the first 30 days post-partum significantly predicted conversion to bipolar affective disorder during the follow-up period,” the authors conclude. “Results indicate that the presentation of mental illness in the early post-partum period is a marker of possible underlying bipolarity.”

Material adapted from JAMA.

Reference
Arch Gen Psychiatry. Published online December 5, 2011. doi:10.1001/archgenpsychiatry.2011.157.

“During the 1980s and 1990s, the number of adults diagnosed with and treated for depression increased, and the modality of treatment shifted,” the authors write as background information in the article. “The percentage of adults with depression who received antidepressants increased, and the percentage who received psychotherapy or were hospitalized for depression decreased.”

Researchers examined data from Medicaid claims in Florida to evaluate changes in depression health service utilization, spending, and quality of care from July 1996 through June 2006. Using Medicaid claims data, the authors identified annual cohorts of adults with depression consisting of enrollees age 18 to 64 years having one or more hospitalizations with a principal diagnosis of depression or having at least two outpatient claims of depression on different days.

The number of enrollees identified annually varied from 8,970 to 13,265 with more persons identified toward the end of the study period. Total number of individuals with depression identified over the study period was 56,805. The authors found that during the study period, mental health care spending increased from a mean (average) $2,802 per enrollee to $3,610 per enrollee, reflecting a 29 percent increase. This increase appears to result from a large increase in pharmacotherapy spending (110 percent increase), majority of which was due to spending on antipsychotics (949 percent increase).

During the study period, the percentage of enrollees with depression who received psychotherapy decreased from 56.6 percent to 37.5 percent and the percentage of individuals who were hospitalized decreased from 9.1 percent to 5.1 percent. Conversely, the percentage of individuals who filled prescriptions within any mental health medication classes remained stable or increased, depending on the type of prescription filled.

Antidepressant use increased from 80.6 percent to 86.8 percent, anxiety medication use was unchanged at 62.7 percent and 64.4 percent, and antipsychotic use increased from 25.9 percent to 41.9 percent, during the study period. However, the authors also found that changes in quality of care were mixed, with antidepressant use improving slightly, psychotherapy utilization fluctuating, and follow-up visits decreasing.

“In summary, during the 10-year period between 1996 and 2005, we found a substantial increase in spending for patients with depression, with minimal improvements in quality of care,” the authors conclude. “Our findings underscore the importance of continued efforts to improve quality of care for individuals with depression, as well as the need to understand the efficacy and cost-effectiveness of using antipsychotics for the treatment of individuals with depression in the general community.”

Material adapted from JAMA.

Reference
Arch Gen Psychiatry. 2011;68[12]:1218-1226.

People suffering from depression have a tendency towards unhelpful abstract thinking and over-general negative thoughts, such as viewing a single mistake as evidence that they are useless at everything. Concreteness training (CNT) is a novel and unique treatment approach that attempts to directly target this tendency. Repeated practice of CNT exercises can help people to shift their thinking style.

CNT teaches people how to be more specific when reflecting on problems. This can help them to keep difficulties in perspective, improve problem-solving and reduce worry, brooding, and depressed mood. This study provided the first formal test of this treatment for depression in the NHS.

121 individuals who were currently experiencing an episode of depression were recruited from GP practices. They took part in the clinical trial and were randomly allocated into three groups. A third received their usual treatment from their GP, plus CNT, while some were offered relaxation training in addition to their usual treatment, and the remainder simply continued their usual treatment. All participants were assessed by the research team after two months and then three and six months later to see what progress they had made.

The CNT involved the participants undertaking a daily exercise in which they focused on a recent event that they had found mildly to moderately upsetting. They did this initially with a therapist and then alone using an audio CD that provided guided instructions. They worked through standardized steps and a series of exercises to focus on the specific details of that event and to identify how they might have influenced the outcome.

CNT significantly reduced symptoms of depression and anxiety, on average reducing symptoms from severe depression to mild depression during the first two months and maintaining this effect over the following three and six months. On average, those individuals who simply continued with their usual treatment remained severely depressed.

Although concreteness training and relaxation training both significantly reduced depression and anxiety, only concreteness training reduced the negative thinking typically found in depression. Moreover, for those participants who practiced it enough to ensure it became a habit, CNT reduced symptoms of depression more than relaxation training.

Professor Edward Watkins of the University of Exeter said: “This is the first demonstration that just targeting thinking style can be an effective means of tackling depression. Concreteness training can be delivered with minimal face-to-face contact with a therapist and training could be accessed online, through CDs or through smartphone apps. This has the advantage of making it a relatively cheap form of treatment that could be accessed by large numbers of people. This is a major priority in depression treatment and research, because of the high prevalence and global burden of depression, for which we need widely available cost-effective interventions.”

The researchers are now calling for larger effectiveness clinical trials so that the feasibility of CNT as part of the NHS’s treatment for depression can be assessed.

Published in the journal Psychological Medicine, this study was carried out by a team from the Mood Disorders Centre, which is a partnership between the NHS and the University of Exeter and the Peninsula College of Medicine and Dentistry, a joint entity of the Universities of Exeter and Plymouth and the NHS in the South West.

Material adapted from University of Exeter.

“This is the first study looking at depression as a risk factor for heart disease specifically in young people,” says senior author Viola Vaccarino, MD, PhD, chair of epidemiology at Emory’s Rollins School of Public Health. “We’re finding that depression is a remarkable risk factor for heart disease in young people. Among women, depression appears to be more important than traditional risk factors such as smoking, hypertension, obesity and diabetes which are not common in young women.” First author is Amit Shah, MD, a cardiology fellow at Emory University School of Medicine.

The researchers analyzed data from 7,641 people between the ages of 17 and 39 who participated in the NHANES-III (National Health and Nutrition Examination Survey-III), a nationwide survey conducted by the National Center for Health Statistics between 1988 and 1994. Deaths were tracked through 2006.

Women with depression or a history of attempted suicide had a three times higher risk of dying from cardiovascular disease and a 14 times higher risk of dying from ischemic heart disease (heart attack). The corresponding figures for men were 2.4 times higher risk for cardiovascular disease and 3.5 times higher risk for ischemic heart disease.

Many previous studies of depression and heart disease included older individuals, who generally have a larger burden of heart disease risk factors and associated diseases that may confound the results.

This is the first study to examine a history of suicide attempts along with depression as a marker for future mortality from cardiovascular disease. Also, unlike most previous studies of depression and heart disease, the authors examined major depression, which was assessed with a clinical interview based on accepted diagnostic criteria, instead of using questionnaire scores for depression symptoms. The authors suggest that clinical diagnosis may be “a more robust risk indicator.”

Use of antidepressants was not included as a risk factor because less than six percent of those with depression or a history of attempted suicide reported their use, and no cardiovascular-related deaths occurred in that subgroup.

The researchers considered the possibility that depressed people may have more lifestyle-related risk factors such as smoking and poor diet. They found a significant link to heart disease risk coming from depression and suicide attempts, even after correcting statistically for unhealthy behaviors.

“Direct physiological effects of depression may play a greater role than lifestyle factors in this young population,” the authors write.

Depression may increase risk of heart disease through physiological mechanisms, such as lower heart rate variability and increased cortisol (a stress-related hormone) and inflammation.

“This is a group that normally should be low risk,” Vaccarino says. “Studying these individuals more intensively could be important for understanding how depression affects the heart.”

Material adapted from Emory University.

Reference
A.J. Shah, E. Veledar, Y. Hong, J.D. Bremner and V. Vaccarino. Depression and History of Attempted Suicide as Risk Factors for Heart Disease Mortality in Young Individuals. Arch. Gen. Psych. 68:1135-1142 (2011).

Background
Recent studies have shown that symptoms of clinical depression can arise in children as young as 3, and may in fact be an early manifestation of a childhood mood disorder. However, no studies have investigated the best way to treat the disorder among children so young. In addition, many established psychosocial treatments for depression in adults and older youth, such as cognitive behavioral therapy or interpersonal therapy, might not be a good fit to the developmental needs of very young children.

Yet research has shown that very early behavioral interventions can have a significant impact on the trajectory of conduct problems and neuro-developmental disorders like autism or some developmental delays. These findings suggest that very early intervention for a mood disorder could potentially head off depression later in life.

Toward that end, Joan Luby, M.D., of Washington University and colleagues conducted a preliminary pilot study comparing a novel form of psychotherapy called Parent Child Interaction Therapy -Emotion Development (PCIT-ED) with a psycho-educational program. PCIT includes hands-on components aimed at strengthening the parent-child relationship by teaching positive play techniques and coaching parents through the process, and training parents in methods for handling noncompliance and disruptive behavior. PCIT has already been shown to be effective for treating disruptive disorders among preschoolers. The Emotion Development component was designed to help the parent enhance the child’s ability to recognize emotions in self and others and more effectively regulate intense emotions.

The psycho-education program — the control condition — educated parents in small groups about child development. It emphasized emotional and social development but did not include individual coaching or practice sessions with the parents and their children.

The researchers randomly assigned 54 preschoolers (aged 3-7) and their parents to either PCIT-ED or to the psycho-education program. Each program was conducted over a 12-week period.

Results of the Study
After 12 weeks, depression symptoms among the preschoolers significantly declined in both groups. The group receiving PCIT-ED also showed improvements in levels of anxiety, hyperactivity, conduct problems, hostility and inattention, whereas the group receiving the psycho-education program showed improvements in separation anxiety.

In addition, the PCIT-ED group showed improvements in a child’s executive functioning and his or her ability to recognize and regulate emotions, compared to the control condition. The PCIT-ED group also reported reduced parenting stress and decreases in maternal depression, whereas the psycho-education group did not.

Significance
The results indicate that PCIT-ED is acceptable to families and may be beneficial. The researchers conclude that a full-scale randomized controlled trial is warranted.

What’s Next
While intriguing, the findings are preliminary only and should be interpreted with caution until further research can be conducted.

Material adapted from NIMH.

Reference
Luby J, Lenze S and Tillman R. A novel early intervention for preschool depression: findings from a pilot randomized controlled trial. Journal of Child Psychology and Psychiatry. Online ahead of print Oct. 31, 2011.

The results of the study showed that DBS therapy targeted to an area of the brain known as Brodmann Area 25 provided noticeable improvement in depression symptoms and increased overall quality of life in patients who typically do not respond to treatment. The study enrolled 21 patients who on average had suffered from depression for 20 years, had tried in excess of 16 depression medications, and were considered disabled or unable to work at the time of enrollment.

At one year, 62 percent of all patients in the study had a 40-percent reduction in symptoms and 29 percent experienced a 50-percent reduction in symptoms as measured against their baseline which was established using the Hamilton Rating Scale for Depression.

“The reduction in depression scores is clinically significant as these patients had previously tried multiple medications, psychotherapy, and/or electroconvulsive therapy (ECT) without success,” said Dr. Andres Lozano, neurosurgeon at Toronto Western Hospital, author of the paper and a primary investigator in the study. “To see 62 percent of the patients in this study respond at one year gives us hope that this research may lead to a therapy for this hard-to-treat patient population.”

Patients in the study were also evaluated using a Clinical Global Impression of Severity (CGI-S) rating scale that measures the severity of their illness. Before DBS, 70 percent of the patients were categorized as severely or extremely ill. After 12 months of DBS, over 80 percent of the patients experienced improvement and none of the patients were rated as severely or extremely ill.

Additionally, study results announced earlier at the American Psychiatric Association annual meeting reported that eight of the study patients returned to daily life activities such as work, school and sustaining relationships with family and friends, and two patients were considered to be in remission.

Participants in the St. Jude Medical-sponsored study featured in the Journal of Neurosurgery were implanted with the Libra™ DBS system which delivers mild pulses of current from a device implanted near the collarbone to small electrical leads placed in the subcallosal cingulate (SCC) area of the brain, a structure within Brodmann Area 25.

“These findings are significant as they confirm the basis on which we established the BROADEN pivotal study,” said Rohan Hoare, president of St. Jude Medical Neuromodulation Division. “These results add to the growing evidence suggesting that DBS therapy may help patients who currently don’t have an adequate treatment option in managing severe depression.”

St. Jude Medical is currently conducting a large multi-center pivotal study at up to 20 facilities in the U.S. and internationally under a U.S. Food and Drug Administration (FDA) Investigational Device Exemption. To be eligible for the BROADEN™ study, participants must:

• Have been diagnosed with major depressive disorder
• Be between 21 and 70 years old
• Have had first depressive episode before age 45
• Have tried at least four treatments in their current episode (for example, different medications, different combinations of medications, and/or ECT)

To locate participating centers, please visit www.BROADENstudy.com or call toll-free 866-787-4332.

According to the Journal of Neurosurgery article, the most frequently occurring serious adverse events related to DBS were skin erosion and lead extension malfunction.

Depression affects millions of patients worldwide with more than 21 million adults in the U.S. suffering from some kind of depressive disorder, according to the National Institute of Mental Health. Of these, approximately 4 million live with severe depression that does not respond to traditional treatments such as medications, psychotherapy and ECT.

Three Decades of Leading-Edge Neurostimulation Technology
For more than 30 years, St. Jude Medical Neuromodulation Division has developed new technologies to treat chronic pain and other neurological disorders. Today more than 75,000 patients in 40 countries have been implanted with St. Jude Medical neurostimulation systems. Focused on research, St. Jude Medical is developing new technologies to address a growing list of neurological disorders. Clinical studies are currently underway for Parkinson’s disease, essential tremor, migraine headache, and others.

Material adapted from St. Jude Medical.

Editor Note: BMED Report makes no claim as the the safety or effectiveness of the study for whom the researchers seek participants. You are encouraged to thoroughly investigate the rewards and risks of this study before agreeing to participate in any study, including the one described in this report.

More than 16 percent of U.S. adults are diagnosed with depression at some point during their lives and antidepressants are commonly used to treat them, according to a 2005 study in the Archives of General Psychiatry. However, research in both the American Journal of Psychiatry (2006) and the Annals of Internal Medicine (2008) has shown that only 30 to 50 percent benefit from initial antidepressant treatment. Standard second-step options are adding a new antidepressant while continuing to take the original one, an approach known as augmenting, or switching to a new antidepressant.

Headaches, difficulty sleeping, and sexual dysfunction are among the common side effects of antidepressants. It was previously assumed that either changing or adding a second medication might exacerbate these effects. But new research unexpectedly found only minimal differences in the adverse side effects resulting from either strategy.

“We believed the augment group would have more side effects than the switch group,” said study author Richard Hansen, Ph.D., head of the department of pharmacy care systems at Auburn University.

In the study, nearly 1,300 patients who had not been successfully treated with just the antidepressant citalopram were divided into two groups. One group had their citalopram augmented with bupropion or buspirone. The second group was switched to bupropion, sertraline or venlafaxine. Patients were followed for about five visits over 14 weeks to evaluate what, if any, side effects occurred.

The researchers found that although painful urination and problems with sexual dysfunction were more common in the augment group than the switched group, the differences were not statistically significant.

Hansen said the study should give physicians treating depression a clear take-away message: “For treatment-resistant depression, the decision to augment or switch medications should be based on individual patient’s clinical status, as well as the possible benefits and risks of each treatment.”

Alan Schmetzer, M.D., interim chairman of the department of psychiatry at Indiana University School of Medicine in Indianapolis, agreed and said the likelihood of his patients responding to the first medication at the first dose he prescribes is around 40 to 50 percent.

“This study tries to answer an important question to which there is currently no research available,” said Schmetzer. “It’s worthwhile because if we knew it was harder on patients to do the augmentation strategy, then we would first try switching all of the time.”

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

“Depression during pregnancy is associated with postpartum depression, problems bonding with the baby, and overall, has a large and detrimental impact on both mom and baby,” said lead author Wayne Katon, M.D., of the Department of Psychiatry & Behavioral Sciences at the University of Washington.

Up to 13 percent of women have some form of hypertension during pregnancy. Seventy percent of hypertension during pregnancy is due to physiological changes occurring during pregnancy and blood pressure returns to normal after delivery. Five to seven percent of pregnant women develop a life-threatening condition known as preeclampsia, a severe form of gestational hypertension, which can lead to early delivery and low birth weight. Scientists are unsure of the causes of preeclampsia.

Previous research had suggested there might be a link between depression and pregnancy-induced hypertension and preeclampsia. However, Katon’s research found no link.

Instead, they found that women with hypertension before pregnancy, with or without developing preeclampsia, were 55 to 65 percent more likely to meet the criteria for significant depressive symptoms or to be taking antidepressants.

Many women who have high blood pressure prior to pregnancy also have other risk factors, including health conditions such as diabetes and obesity, noted Katon. “Depression can make adherence to interventions, such as diet, exercise and medication, for these conditions low, further putting the mother’s health at risk.”

The researchers noted that they did not control for obesity, which is linked to both hypertension and depression. “Obesity is an increasing problem in pregnant women and targeting these women for more intensive counseling could be a cost-effective way of reducing the risk of depression during pregnancy,” commented Ernest Graham, M.D., a gynecologist at Johns Hopkins Hospital in Baltimore, Md.

“To my knowledge, very few obstetricians do any formal screening for depression during prenatal check-ups,” said Katon. “They do screen for hypertension. In women with pre-existing hypertension, it is essential to screen for depression at the four month checkup, given the risk of negative birth outcomes and non-adherence to hypertension treatment.”

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

Reference
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Inc. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

On this basis, it has been suggested that telomere length is a measure of biological aging, and telomere length has subsequently been linked to age-related diseases, unhealthy lifestyle, and longevity. The research team shows that shorter telomere length is associated with both recurrent depression and cortisol levels indicative of exposure to chronic stress.

The study included 91 patients with recurrent depression and 451 healthy controls. Telomere length, measured in white blood cells, was shorter among the patients compared with the control group. The scientists also examined the participants’ stress regulation using a so-called dexamethasone suppression test.

“The test revealed that cortisol levels indicative of chronic stress stress are associated with shorter telomeres in both depressed and healthy individuals,” says Mikael Wikgren, a doctoral candidate in the research group. The fact that depressed patients as a group have shorter telomere lengths compared to healthy individuals can be largely explained by the fact that more depressed people than healthy people have disturbed cortisol regulation, which underscores that cortisol regulation and stress play a major role in depressive disorders.

The article is part of Mikael Wikgren’s dissertation work. The research team, led by Professor Rolf Adolfsson, also includes Karl-Fredrik Norrback, Ph.D, (supervisor), doctoral candidate Martin Maripuu, and project coordinator Annelie Nordin. The study was carried out in collaboration with researchers from the Department of Medical Bioscience, Umeå University, as well as scientists at Stockholm University, Linköping University, and Antwerp University.

Material adapted from Umeå universitet.

Abstract / Reference
Wikgren M, Maripuu M, Karlsson T, Nordfjäll K, Bergdahl J, Hultdin J, Del-Favero J, Roos G, Nilsson LG, Adolfsson R, Norrback KF. Short telomeres in depression and the general population are associated with a hypocortisolemic state. Biol Psychiatry. doi:10.1016/j.biopsych.2011.09.015

Previous research has suggested that plaque and tangle deposits in the brain — hallmarks of Alzheimer’s disease and many dementias — are associated not only with memory loss but also with mild symptoms of depression and anxiety in middle-aged and older individuals. The team wanted to see what the brain-scanning technique developed at UCLA would find in older people with MDD.

UCLA researchers have created a chemical marker called FDDNP that binds to both plaque and tangle deposits, which can then be viewed through a positron emission tomography (PET) brain scan, providing a “window into the brain.” Using this method, researchers are able to pinpoint where in the brain these abnormal protein deposits are accumulating.

Researchers compared the FDDNP brain scans of 20 older adults between ages 60 to 82 who had been diagnosed with MDD with the scans of 19 healthy controls of similar age, education and gender. They found that in patients with MDD, FDDNP binding was significantly higher throughout the brain and in critical brain regions, including the posterior cingulate and lateral temporal areas, that are involved in decision-making, complex reasoning, memory and emotions.
 
“This is the first study using FDDNP to assess the abnormal protein levels in brains of older adults with severe depression,” said the study’s senior author, Dr. Gary Small, UCLA’s Parlow-Solomon Professor on Aging and a professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA. “The findings suggest that the higher protein load in critical brain regions may contribute to the development of severe depression in late life.”

Researchers also found that similar protein deposit patterns in the lateral temporal and posterior cingulate areas in patients were associated with different clinical symptoms. Some patients demonstrated indicators of depression only, while others displayed symptoms of mild cognitive impairment as well.

Dr. Small noted that previous research has shown that depression may be a risk factor for or a precursor to memory loss, such as mild cognitive impairment, which can later lead to dementia.

Brain images demonstrate higher FDDNP binding (yellow areas) and thus more abnormal proteins in a patient with major depressive disorder compared with a healthy control.

According to Kumar and Small, more follow-up over time is needed to evaluate the significance of the outcomes of the study’s patient subgroups. Such research will help further assess if depression later in life might be a precursor to mild cognitive impairment and dementia.

In addition, the researchers said, FDDNP used with PET may also be helpful in identifying new treatments and in tracking the effectiveness of current antidepressant therapy and medications designed to help reduce abnormal protein build-up in the brain.

The team is planning larger studies involving investigators at UCLA and the University of Illinois that will address the impact of the genetic marker APOE-4, which is a risk factor for dementia and Alzheimer’s disease.

Additional authors include Prabha Siddarth of the UCLA Department of Psychiatry and Biobehavioral Sciences; Vladimir Kepe of the UCLA Department of Molecular and Medical Pharmacology; and Vicki Manoukian and Virginia Elderkin-Thompson of the Semel Institute for Neuroscience and Human Behavior at UCLA.

Material adapted from University of California, Los Angeles (UCLA), Health Sciences.

Cognitive reframing focuses on thinking differently by “reframing” negative or untrue assumptions and thoughts into ones that promote adaptive behavior and lessen anxiety and depression. Cognitive reframing can be offered by a trained primary health care provider or by a mental health care professional.

Several studies have focused on psychosocial intervention in dementia care, but this is the first review that focused on the effectiveness of cognitive reframing in particular. The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Led by Myrra Vernooij-Dassen Ph.D., of the Radboud University Nijmegen Medical Centre in the Netherlands, the review looked at whether caregivers benefited from various interventions to provide education about dementia and whether their beliefs about caregiving responsibilities and their own needs could be changed.

“We found that changing their thinking and understanding helps a lot to allow more positive feelings to emerge and to reduce distress,” Vernooij-Dassen said.

Caregivers who received a cognitive reframing intervention had fewer symptoms of anxiety and depression and felt less stress or distress related to their caregiving. While reframing helped caregivers manage their stress, it did not change the burden of being a dementia caregiver or their coping skills. However, reframing may also lead to a more positive relationship with the person who has dementia.

“When a caregiver is able to reframe self-defeating cognitions into more constructive reasoning, it is a major change,” said Vernooij-Dassen.

The evidence review comprised eleven randomized controlled trials involving family caregivers of people with dementia. None of the trials focused solely on cognitive reframing, but they all used cognitive reframing as the main component in their intervention. Caregivers ranged in age from 19 to 84. The majority of participants — 40.2 percent — were caring for a spouse.

Dementia symptoms include diminished reasoning, memory, social and language skills that can alter a person’s ability to function in daily life. Alzheimer’s disease is the most common form of advanced dementia.

“Alzheimer’s is a chronic, progressive, fatal disease and caregiving at home for someone with the disease is fraught with many challenges but also rewards,” said, Beth Kallmyer, M.S.W., senior director of constituent services for the Alzheimer’s Association, a non-profit advocacy organization.

Kallmyer said the Alzheimer’s Association encourages caregivers to reach out for assistance and take care of themselves. “Because of the progressive, debilitating nature of the disease and the extended length of the caregiving process, multiple services are needed to provide comprehensive support and education to dementia caregivers.”

Tools to decrease stress for family dementia caregivers will be even more important in years to come as people continue to live longer. Kallmyer said cognitive reframing is one among many appropriate interventions as part of a package of individual support for caregivers. “More research is needed overall for improving our knowledge of how to best support and educate caregivers.”

Vernooij-Dassen emphasized dementia caregivers don’t need to go it alone. “When they need support, reframing their thinking and understanding about dementia can yield positive results.”

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

Reference
Vernooij-Dassen, M. et al. Cognitive reframing for carers of people with dementia. Cochrane Database of Systematic Reviews 2011. Issue 11.

“Cancer-related fatigue is the symptom that most limits quality of life and is most common in patients that survive cancerous processes,” explained Manuel Arroyo, researcher from the University of Granada and lead author of a study that links psychological disorders and physical pain episodes with fatigue after treating a breast tumor.

More than 66% of breast cancer survivors suffer tiredness following recovery, caused directly by the disease, physical deterioration or the treatment received. Therefore, understanding the factors related with fatigue and how they can be alleviated optimizes survivors’ recovery.

Fifty-nine female patients treated for breast cancer were followed-up one year after having clinically overcome the disease. The researchers assessed their psychological and physical condition as well as different aspects linked to the typical medical symptoms following a cancerous process (tiredness, pain, limited movement, depression, etc.).

A statistical procedure (resampling) allowed inferences to be made similar to those that would be obtained from larger samples. “This method means that the data were more reliable and eliminated the problem of having a reduced sample size,” explained Arroyo. “It is difficult to find volunteers because patients are not often very willing to participate in research after having been through such harsh treatment.”

The results show that the patients most affected by tiredness following treatment also suffer episodes of depression and body image deterioration, neck and shoulder pain, and limited arm movement, possibly due to the surgical intervention.

Effects of survival
Following breast cancer treatment, patients present with physical and psychological symptoms that influence their health.

Previous studies have already observed self-esteem- and body image-related disorders following the cancerous process. But for the first time, a team of researchers has associated sensory hypersensitivity, limited movement and certain psychological conditions with fatigue observed following cancer treatment.

“These findings should motivate patient support programs which improve their psychological condition and offer resources that can reduce pain,” pointed out Arroyo, who further stressed that “if fatigue is not treated, patients can suffer it for years, having a serious physical, emotional, social and economic impact.”

Material adapted from Plataforma SINC.

Reference
Cantarero Villanueva, Antarero Villanueva, C- Fernández Lao, C. Fernández de las Peñas, L. Díaz Rodríguez, E. Sánchez Cantalejo, M. Arroyo Morales. “Associations among musculoskeletal impairments, depression, body image and fatigue in breast cancer survivors within the first year after treatment”. European Journal of Cancer Care 20 (2011): 632-636, septiembre de 2011.

The researchers have shown that its activity can be modulated depending on the subject’s genetic makeup, personal history and cognition. These results suggest that the effects of psychotherapies on the cerebral activity of patients could vary according to their genetic traits. This work makes the cover story of the November 2011 issue of Human Brain Mapping.

Several studies published over the past decade point to the possibility that the 5-HTTLPR gene, which codes for the serotonin (a substance involved in emotional regulation) transporter, could play an important role in depression. The promoter of this gene can be in either long or short form, and the short version can accentuate the emotional impact of stressful events. Although this hypothesis remains controversial, it is accepted that the short form of the gene triggers a more intense activation of the amygdala, also known as the cerebellar tonsil, a brain structure involved in emotions and in the recognition of danger signals.

For this new project, the researchers studied the impact of psychological and environmental factors on the “genetic” effect by carrying out functional MRI brain scans on 45 healthy individuals, including carriers of both the short and long form of the gene. During the scans, the subjects were shown photographs of pleasant or unpleasant images and were asked either to indicate whether they found the effect pleasing or displeasing, or to think about the links between the images and themselves.

The results of the scans proved to be different depending on the form of the gene: carriers of the short form showed a higher activation of the amygdala when associating a photo with themselves than when deciding whether an image was pleasing or displeasing. The opposite was observed in the subjects who did not carry the short form. In other words, the activity of the amygdala varied according not only to the form of the gene, but also to the type of mental activity — whether it was an “objective” description of the image or an association with one’s personal history.

Prior to the scans, the subjects were interviewed about any negative events that may have occurred in their lives during the previous year, such as professional difficulties, separation, bereavement, etc. The results showed that the stress experienced during the year also affected the influence of the gene on the activation of the amygdala — such “genetic-environmental” interaction being itself modified by the individual’s mental activity.

The results show that while the subjects’ genetic makeup affects their brain functions, its influence is modulated by both personal history and psychological condition. Extrapolated to the field of depression, these results also suggest that psychotherapy — in particular, cognitive therapy, which consists in helping depressed patients to perceive the world differently — could have diverse cerebral effects depending on certain genes. Researchers are on the case.

Material adapted from CNRS (Délégation Paris Michel-Ange).

Reference
Cognitive Appraisal and Life Stress Moderate the Effects of the 5-HTTLPR Polymorphism on Amygdala Reactivity. Cédric Lemogne, Philip Gorwood, Claudette Boni, Mathias Pessiglione, Stéphane Lehéricy, and Philippe Fossati. Human Brain Mapping, November 2011.

Ann Bettencourt, professor of psychological sciences at MU, studied who is most likely to experience distress following breast cancer diagnosis and when depressive symptoms tend to occur throughout the course of treatment. Bettencourt found evidence that single women and women with children in the home were more likely to be depressed during the year following treatment.

“Many women receive strong support following their initial diagnoses of and treatment for cancer, but then the social support can wane,” Bettencourt said. “Our findings suggest that both single women and mothers with children in the home may need additional support across the entire year following breast cancer diagnosis and treatment.”

The research also links depression levels with income and age. Women with different incomes tend to have similar levels of elevated depression during treatment, but those symptoms decrease among women with higher incomes in the year following treatment. Younger breast cancer survivors experience more depression during treatment than older patients, but report levels similar to those of older women after treatment is complete.

Bettencourt says identifying risk factors for depression among breast cancer patients is an important part of a woman’s prognosis. In a separate study, she links depression with both intentions to adhere to treatment plans and lack of adherence to medication regimens. The research shows that more depressed breast cancer survivors have less favorable attitudes toward and perceptions of treatment regimens and thus are less likely to adhere to them.

“Depression can interfere with patients’ willingness to adhere to medication regimens,” Bettencourt said. “Deviating from the prescribed course of treatment may complicate patient outcomes and threaten prognosis.”

Material adapted from University of Missouri-Columbia.

Reference
The studies, “Predictors of Depressive Symptoms Among Breast Cancer Patients During the First Year Post Diagnosis,” and “Depression and Medication Adherence Among Breast Cancer Survivors: Bridging the Gap with the Theory of Planned Behavior,” were published in Psychology and Health.

“We saw behaviors in the treated rats and neurological problems that indicate their brains are not properly conducting and processing information,” said Rick C.S. Lin, professor of neurobiology and anatomical sciences at UMMC and principal investigator on the study. “However, based on this study alone it, would be premature to conclude that a pregnant mother should stop taking SSRIs. A pregnant mother may do more harm to her baby through untreated depression than by taking prescribed SSRIs. This study is a starting point and a lot more research needs to be done.”

The study appears online Oct. 24, 2011 in the journalProceedings of the National Academy of Sciences atwww.pnas.org.

The researchers treated more than 200 rats with the SSRI citalopram during key stages of brain development. Rats are born at an earlier developmental stage than humans, equivalent to the end of the sixth month of fetal development in humans.

Most rats received treatment for two weeks, beginning eight days post birth, a neurodevelopment period equivalent to the third trimester and early infancy in humans.

In contrast with control-group rats, the investigators found the treated populations were uninterested in play when young and displayed poor social behaviors as adults. The treated rats also showed abnormal responses to changes in their environment. For example, they froze at the sound of a novel tone and showed little interest in exploring new toys.

“These results demonstrate that rat pups, when exposed perinatally to SSRIs, exhibit behavioral traits often seen in ASD,” said Kimberly Simpson, the paper’s first author and UMMC associate professor of neurobiology and anatomical sciences.

Those behaviors occurred more often – and sometimes exclusively – in the treated male rats than in treated females. Similarly, autism spectrum disorder, or ASD, is diagnosed more often in males.

Of numerous SSRIs available, the researchers chose citalopram because it is one of the most specific in targeting the serotonin system with little overlap on other neurotransmitters.

Michael Merzenich, UCSF professor of otolaryngology and physiology, analyzed the rats’ primary auditory cortices using electrophysiologic techniques. In the treated, month-old rats Merzenich found functional abnormalities consistent with ASD.

“What we see in this experiment is a strong impact on the auditory cortex. These animals are not maturing in the normal, progressive way, and those differences are substantial,” said Merzenich, a senior author on the paper. “The cortex is sluggish and represents sounds with low accuracy. The listening cortex is delayed in development and is impaired into adulthood.”

Delayed development of the representation of aural speech is a hallmark of ASD in children, Merzenich said. It contributes to these children’s struggles with language and reading.

Another brain abnormality common in ASD is a thinner corpus callosum, particularly in the forward third of the structure. Like a massive nerve-fiber bridge, the corpus callosum connects the brain’s two halves and transmits electrical signals between them. It also plays a key part in higher intellectual function, said Ian Paul, UMMC professor of psychiatry and human behavior.

“This nerve fiber tract [corpus callosum] was disrupted in the same way in these rats’ brains,” he said.

Many callosal axons in the treated rats had abnormal or missing myelin sheathing, a coating necessary for proper neuroconductivity.

“Without that myelin wrapping the signal slows or doesn’t get through at all. The abnormalities in these rats would suggest the left and right sides of their brains are not communicating properly,” said Paul, a senior co-author on the paper.

Lin said the researchers analyzed multiple aspects – behavior, pathology, brain morphology, neurochemistry and neurophysiology – to conduct a broad survey and get a sense of structural and functional abnormalities.

A $1.3 million EUREKA grant to Lin from the National Institute of Mental Health funded the study.

The study in rats follows an epidemiologic study in humans, published in July in the Archives of General Psychiatry. That investigation found that children of mothers who took SSRIs during the year prior to giving birth ran twice the normal risk of developing autism.

“While one must always be cautious extrapolating from medication effects in rats to medication effects in people, these new results suggest an opportunity to study the mechanisms by which antidepressants influence brain and behavioral development,” said Dr. Thomas R. Insel, director of the NIMH. “These studies will help to balance the mental health needs of pregnant mothers with possible increased risk to their offspring.”

The incidence of pregnant women taking SSRIs has grown from about .5 percent in 1985 when the first one came on the market to nearly 10 percent today, Paul said.

Autism was initially described in 1943 and through the next decades the parameters expanded. In 1996, the rate of incidence was less than 1 in 1,000 births and by 2007 it reached about 1 in 200. The rates of incidence of ASD have roughly doubled every three-to-five years to 1 in 91 currently, he said.

“The diagnosis has widened with the awareness that it’s a spectrum disorder that encompasses a whole range of communication problems, but that doesn’t account for all the increase by any means,” Paul said.

Merzenich said a genetic component for autism risk is found in certain families, more strongly expressed in some members than in others.

“Genetic weakness can put a child at risk for autism origin,” he said. The neurological distortions attributable to SSRIs plausibly add to the child’s neurological burdens. We think that SSRIs may thereby increase the risks of ASD. In any event, further study in child populations should determine if this is or is not the case.”

Lin cautioned that pregnant women shouldn’t quit taking prescribed antidepressants based solely on the study’s results.

“In this study we eliminated as many external factors as possible. But real-life situations are much more complex,” he said.

Stress hormones – which affect the same neurological systems as SSRIs – can also be detrimental to a developing baby, Simpson said, indicating another significant difference between the laboratory study and real-life situations.

“We intentionally looked for treatment effects in groups of rats that were considered normal at the beginning of the study and were birthed from normal mothers. The effects of SSRIs on babies carried by depressed mothers are not known,” she said.

Lin also emphasized the findings call for more study of SSRIs, particularly in humans.

“We need to know which one causes minimal damage but also at what dose, for how long and at what points in pregnancy. So basically, we still have a lot to learn,” he said.

He credited a multidisciplinary team of investigators for the work.

“This kind of work could never have been done in one lab,” Lin said. “It’s absolutely the result of a team approach that took people in pediatrics, pharmacology, neurobiology and anatomical sciences, psychiatry, physiology and otolaryngology.”

Material adapted from University of California, San Francisco (UCSF).

Many young people in the Netherlands use cannabis. Nearly 30% of 16-year-olds indicate that they have used cannabis on at least one occasion, and 12% that they have used it during the past month. Besides poorer performances at school, the use of cannabis also increases the risk of developing schizophrenia and psychosis. Smoking hashish and weed were thought to increase the risk of depression, but no conclusive evidence for this was available to date. Otten suspects that this is partly because his predecessors failed to consider the individual genetic vulnerability to depression.

Long-term study
Over a five-year period, data were collected from 428 families and their two adolescent children. Each year the children answered questions on topics such as their behaviour and depressive symptoms. The variant of the serontonin gene (5-HTT) responsible for increased vulnerability to developing depression was also determined. In young people with a special variant of the gene, cannabis use led to an increase of depressive symptoms.

Robust effect
‘The effect is robust. It still remains, even if you take into account a series of other variables that could cause the effect, such as smoking behaviour, alcohol use, upbringing, personality and socio- economic status. Some people might think that young people with a disposition for depression would start smoking cannabis as a form of self-medication, and that the presence of depressive symptoms is therefore the cause of cannabis use. However, in the longer term that is definitely not the case. Although the immediate effect of cannabis may be pleasant and cause a feeling of euphoria, in the longer term we observe that cannabis use leads to an increase in depressive symptoms in young people with this specific genotype.’

Knowing what the negative effects of cannabis use could be is important because although cannabis may cause an immediate euphoric feeling, for a large group in the population its use can lead to an increase of depressive symptoms in the longer term.

Material adapted from Radboud University Nijmegen.

Results of Goral’s study, which surveyed 9,509 Israeli adults, suggest that even mild depressive symptoms — with no accompanying diagnosis of clinical depression — may be associated with such health-related risk factors as smoking, physical inactivity and insufficient sleep. The findings are consistent with other studies that found that negative health-related risk factors lead to poor asthma control and may contribute to the link between asthma and depression.

Adequate sleep is vital to good health. Yet, Goral’s study found that 56 percent of asthmatic people with depressive symptoms slept for 6 hours or less compared with 38 percent of people with asthma and no depressive symptoms. Asthma symptoms and certain asthma medications can be associated with poor sleep, which depressive symptoms may make even worse. Similarly, depressive symptoms were associated with a 70 percent increased likelihood of smoking. Smoking is associated with poor asthma control and worsening symptoms.

Carole Madeley, M.D., director of respiratory health programs at the Ontario Lung Association, confirms that depression can lead to sub-optimal asthma self-management.

“Depression is more common in people with asthma than in the general public,” she said, “and goes undiagnosed more often. It is associated with worse asthma-related quality of life and self-management. Asthma patients—especially those with severe asthma—should be assessed for depression, which should be treated as part of the overall asthma management.”

Nonetheless, Madeley points out that research findings related to asthma and depression are not generally conclusive, and further studies are needed.

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

Professor Jianfeng Feng

The researchers used MRI scanners to scan the brain activity in 39 depressed people (23 female 16 male) and 37 control subjects who were not depressed (14 female 23 male). The researchers found the fMRI scans revealed significant differences in the brain circuitry of the two groups. The greatest difference observed in the depressed patients was the uncoupling of the so-called “hate circuit” involving the superior frontal gyrus, insula and putamen. Other major changes occurred in circuits related to risk and action responses, reward and emotion, attention and memory processing.

The hate circuit was first clearly identified in 2008 by UCL Professor Semir Zeki who found that a circuit which seemed to connect three regions in the brain (the superior frontal gyrus, insula and putamen) when test subjects were shown pictures of people they hated.

The new University of Warwick led research found that in significant numbers of the depressed test subjects they examined by fMRI that this hate circuit had become decoupled. Those depressed people also seemed to have experienced other significant disruptions to brain circuits associated with: risk and action, reward and emotion, and attention and memory processing. The researchers found that in the depressed subjects:

• The Hate circuits were 92% per cent likely to be decoupled
• The Risk/Action circuit was 92% likely to be decoupled
• The Emotion/Reward circuit was 82% likely to be decoupled

Professor Jianfeng Feng, from the University of Warwick’s Department of Computer studies said that:

“The results are clear but at first sight are puzzling as we know that depression is often characterized by intense self loathing and there is no obvious indication that depressives are less prone to hate others. One possibility is that the uncoupling of this hate circuit could be associated with impaired ability to control and learn from social or other situations which provoke feelings of hate towards self or others. This in turn could lead to an inability to deal appropriately with feelings of hate and an increased likelihood of both uncontrolled self-loathing and withdrawal from social interactions. It may be that this is a neurological indication that is more normal to have occasion to hate others rather than hate ourselves.”

Material adapted from University of Warwick.

Epigenetics is the science of changes in genetic expression that are not caused by actual changes in DNA sequencing. It is these mechanisms that have been the recent focus of intergenerational investigations into the transmission of stress vulnerability.

Inheritance is complex. We have all known that mothers and fathers have tremendous influence on their children, but “this study highlights how complicated the relationship between genetic, epigenetic, and environmental contributions can be with regards to the inheritance of important behavioral traits,” commented Dr. John Krystal, editor of Biological Psychiatry.

Most work to date has focused on maternal effects. In this fascinating new study, researchers investigated paternal effects instead, and found that male mice exposed to chronic stress pass those stress behaviors along to their offspring. Both their male and female offspring showed increased depression and anxiety-like behaviors, although the effects were stronger in males. Importantly, these behavioral changes were only present in offspring produced through natural reproduction, and not in those offspring that were produced via in vitro fertilization. That interesting twist suggests that most stress-related vulnerabilities are transmitted to subsequent generations behaviorally, rather than epigenetically.

“This type of translational animal work is important to help scientists focus their work in humans”, explained lead author Dr. Eric Nestler, from Mount Sinai School of Medicine in New York. “These findings in mice raise the possibility that part of an individual’s risk for clinical depression or other stress-related disorders may be determined by his or her father’s life exposure to stress, a provocative suggestion that now requires direct study in humans.”

Elsevier

Reference 
The article is “Paternal Transmission of Stress-Induced Pathologies” by David M. Dietz, Quincey LaPlant, Emily L. Watts, Georgia E. Hodes, Scott J. Russo, Jian Feng, Ronald S. Oosting, Vincent Vialou, and Eric J. Nestler. Oosting is affiliated with Utrecht University, Utrecht, the Netherlands. The remaining authors are affiliated with Mount Sinai School of Medicine, New York. The article appears in Biological Psychiatry, Volume 70, Number 5 (September, 2011),doi: 10.1016/j.biopsych.2011.05.005, published by Elsevier.

Caffeine is the most frequently used central nervous system stimulant in the world, and approximately 80 percent of consumption is in the form of coffee, according to background information in the article. Previous research, including one prospective study among men, has suggested an association between coffee consumption and depression risk. Because depression is a chronic and recurrent condition that affects twice as many women as men, including approximately one of every five U.S. women during their lifetime, “identification of risk factors for depression among women and the development of new preventive strategies are, therefore, a public health priority,” write the authors. They sought to examine whether, in women, consumption of caffeine or certain caffeinated beverages is associated with the risk of depression.

Researcheres studied 50,739 U.S. women who participated in the Nurses’ Health Study. Participants, who had a mean (average) age of 63, had no depression at the start of the study in 1996 and were prospectively followed up with through June 2006. Researchers measured caffeine consumption through questionnaires completed from May 1980 through April 2004, including the frequency that caffeinated and noncaffeinated coffee, nonherbal tea, caffeinated soft drinks (sugared or low-calorie colas), caffeine-free soft drinks (sugared or low-calorie caffeine-free colas or other carbonated beverages) and chocolate were usually consumed in the previous 12 months. The authors defined depression as reporting a new diagnosis of clinical depression and beginning regular use of antidepressants in the previous two years.

Analysis of the cumulative mean consumption included a two-year latency period; for example, data on caffeine consumption from 1980 through 1994 were used to predict episodes of clinical depression from 1996 through 1998; consumption from 1980 through 1998 were used for the 1998 through 2000 follow-up period; and so on. During the 10-year follow-up period from 1996 to 2006, researchers identified 2,607 incident (new-onset) cases of depression. When compared with women who consumed one cup of caffeinated coffee or less per week, those who consumed two to three cups per day had a 15 percent decrease in relative risk for depression, and those consuming four cups or more per day had a 20 percent decrease in relative risk. Compared with women in the lowest (less than 100 milligrams [mg] per day) categories of caffeine consumption, those in the highest category (550 mg per day or more) had a 20 percent decrease in relative risk of depression. No association was found between intake of decaffeinated coffee and depression risk.

“In this large prospective cohort of older women free of clinical depression or severe depressive symptoms at baseline, risk of depression decreased in a dose-dependent manner with increasing consumption of caffeinated coffee,” write the authors. They note that this observational study “cannot prove that caffeine or caffeinated coffee reduces the risk of depression but only suggests the possibility of such a protective effect.” The authors call for further investigations to confirm their results and to determine whether usual caffeinated coffee consumption could contribute to prevention or treatment of depression.

Material adapted from JAMA.

Reference
Arch Intern Med. 2011;171[17]:1571-1578.

“Stroke is a leading cause of death and permanent disability, with significant economic losses due to functional impairments. Depression is highly prevalent in the general population, and it is estimated that 5.8 percent of men and 9.5 percent of women will experience a depressive episode in a 12-month period. The lifetime incidence of depression has been estimated at more than 16 percent in the general population,” according to background information in the article. Whether depression increases the risk of stroke has been unclear.

The researchers conducted a systematic review and a meta-analysis of prospective cohort studies to describe the association between depression and risk of total and subtypes of stroke. The researchers conducted a search of the medical literature and identified 28 prospective cohort studies that met criteria for inclusion in the analysis. The studies, which included 317,540 participants, reported 8,478 stroke cases during a follow-up period ranging from 2 to 29 years.

The researchers found that when the data from the studies were pooled, analysis indicated that depression was associated with a 45 percent increased risk for total stroke; a 55 percent increased risk for fatal stroke; and a 25 percent increased risk for ischemic stroke. Depression was not associated with an increased of hemorrhagic stroke.

The corresponding absolute risk difference associated with depression based on the most recent stroke statistics for the United States was estimated to be, per 100,000 individuals per year, 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke.

The researchers speculate that depression may contribute to stroke through a variety of mechanisms, including having known neuroendocrine (relating to the nervous and endocrine systems) and immunological/inflammation effects; poor health behaviors (i.e., smoking, physical inactivity, poor diet, lack of medication compliance) and obesity; having other major comorbidities, such as diabetes and hypertension, both of which are major risk factors for stroke; and antidepressant medication use, which may contribute to the observed association.

“In conclusion, this meta-analysis provides strong evidence that depression is a significant risk factor for stroke. Given the high prevalence and incidence of depression and stroke in the general population, the observed association between depression and stroke has clinical and public health importance. More studies are needed to explore the underlying mechanisms and elucidate the causal pathways that link depression and stroke.”

Material adapted from JAMA.

Reference
JAMA. 2011;306[11]:1241-1249.

This ruminative thinking can be either passive and maladaptive (i.e., worrying) or active and solution-focused (i.e., coping). New research by Stanford University researchers, published in Elsevier’s Biological Psychiatry, provides insights into how these types of rumination are represented in the brains of depressed persons.

The interactions of two distinct and competing neural networks, the default mode network (DMN) and the task positive network (TPN), are particularly relevant to this question. Whereas the DMN supports passive, self-related thought, the TPN underlies active thinking required for solving problems, explained study author J. Paul Hamilton.

Using brain imaging technology, Hamilton and his colleagues found that, in depressed patients, increasing levels of activity in the DMN relative to the TPN are associated with higher levels of maladaptive, depressive rumination and lower levels of adaptive, reflective rumination. These findings indicate that the DMN and TPN interact in depression to promote depression-related thinking, with stronger DMN influence associated with more worrying, less effective coping, and more severe depression.

“It makes sense that non-productive ruminations would engage default-mode networks in the brain as these systems enable the brain to ‘idle’ when humans are not focused on specific tasks,” commented Dr. John Krystal, editor of Biological Psychiatry. “Better understanding the factors that control the switch between these modes of function may provide insights into depression and its treatment.”

Material adapted from Elsevier.

Reference
The article is “Default-Mode and Task-Positive Network Activity in Major Depressive Disorder: Implications for Adaptive and Maladaptive Rumination” by J. Paul Hamilton, Daniella J. Furman, Catie Chang, Moriah E. Thomason, Emily Dennis, and Ian H. Gotlib. The authors are affiliated with Stanford University, Stanford, California. The article appears in Biological Psychiatry, Volume 70, Number 4 (August 15, 2011), DOI 10.1016/j.biopsych.2011.02.003, published by Elsevier.

Optimal follow-up visits and adequacy of antidepressant dosing was associated with better adherence during both the acute and continuation phases of treatment.

Though the study was conducted in Ohio, the findings are likely to have broad relevance to Medicaid-eligible children and adolescents across the United States who share similar problems affecting their access to quality mental health care, researchers say.

“There have been a lot of great advances in terms of medication and therapy interventions for depression. The best treatment is a combination of cognitive behavioral therapy and antidepressants,” said Cynthia Fontanella, an assistant professor of social work and psychiatry at Ohio State University and lead author of the study.

“But there is a huge gap between the science and what is happening in the real world. And the gap is even greater for kids who live in poverty.”

The findings underscore the need for clinicians treating this population to deliver care according to guidelines established by the American Academy of Child and Adolescent Psychiatry, and to develop interventions that improve adherence in the most vulnerable groups, the study authors conclude.

Untreated or poorly treated depression can lead to recurrence, which can increase suicidal behavior and drive up health care costs by increasing the likelihood of hospitalization.

The study is published in the current issue of The Annals of Pharmacotherapy.

Studies suggest that depression affects as many as 20 percent of youths by age 18, and that antidepressant use in people under age 20 has increased three- to five-fold in the past decade. Those experiencing depression are at risk for a number of problems, ranging from school failure and teen pregnancy to substance abuse and suicide.

Compared to youths covered by private insurance, children on Medicaid use more mental health services and are more likely to be prescribed psychotropic medications. They are considered at higher risk for psychiatric disturbances because of the multiple stresses associated with living in poverty.

“This population is very vulnerable,” Fontanella said. “Not only do they have to deal with poverty and other psychosocial issues, but also issues commonly associated with poverty, such as transportation limitations, single-parent households and unemployment. All this makes them even more vulnerable to receiving not just a poor quality of care, but poor access to mental health care.”

The researchers examined data from Medicaid eligibility and claims files for children and adolescents between the ages of 5 and 17 years who were diagnosed with a new episode of depression between Jan. 1, 2005, and Dec. 30, 2007. They examined cases in which the children were prescribed at least one antidepressant – most of which came from the SSRI (selective serotonin reuptake inhibitor) class of antidepressants – within 30 days of the diagnosis and were continuously enrolled in Medicaid for six months after the prescription date.

Antidepressant adherence measures were derived from the Health Plan Employer Data and Information Set (HEDIS) quality indicators on antidepressant management. Using what is called a medication possession ratio, the researchers predicted that when prescriptions for the youths were filled at a pharmacy for at least 80 percent of the days for which they were prescribed medications, the children were adhering to the treatment.

The cases of 1,650 pediatric depression patients were included in the analysis. Of those, 817, or 49.5 percent, adhered to the treatment during the acute phase – the first three months. About half stopped taking the medicine within one month of starting treatment. And 41.6 percent of the patients who maintained treatment for the first three months also adhered to treatment during the continuation phase of three additional months.

Overall, only 340, or 20.6 percent, of the youths completed a full six months of antidepressant treatment as recommended by the standards set by HEDIS.

“Nonadherence is common,” Fontanella said. “With only half of the kids adherent during the first three months and only a fifth adherent for the full six months of treatment, most of these kids are not even meeting the minimum standards of care.”

Additional analyses showed that children aged 5 to 12 were more adherent than were adolescents, and non-Hispanic whites were more adherent than minority youths.

Higher rates of adherence during the first three months were associated with better follow-up care and proper dosing of the antidepressants: More than 58 percent of kids who had at least three contacts with a mental health practitioner kept taking their drugs, compared to about one-third of children who had fewer contacts. Similarly, 53.7 percent of children taking what was considered an adequate dose of their antidepressant adhered to treatment, compared to 37.1 percent of youths who received an inadequate dose.

Follow-up and dosing had even greater effects during the later treatment period.

“From a social work and physician perspective, follow-up is critical to monitor not just adherence but also adverse side effects, the potential for increased suicidal behavior and the other negative consequences associated with depression, like poor school performance, relationship issues and a variety of high-risk behaviors,” Fontanella said.

Material adapted from Ohio State University.

While research has enhanced the understanding of the nature and course of adult grief, the authors write, “Relatively little is known about the course of grief in children and adolescents.” (The authors define “grief” as “the subjective experience of loss,” and “bereavement” as referring to “status with respect to loss, regardless of subjective experience.”) The investigators examined the grief reactions of children and adolescents after a parent’s sudden death to determine how those reactions affected bereaved participants’ mental well-being and ability to function.

Nadine M. Melhem, Ph.D., from the Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, and colleagues studied children, adolescents and families experiencing a parental death from July 2002 to January 2007. The researchers used coroners’ reports and a newspaper advertisement to recruit participants ages 7 through 18 years whose parent died by suicide, unintentional injury or sudden natural causes. A modified version of the adult Inventory of Complicated Grief was used to assess the state of grief in child and adolescent participants; the original version of this instrument was completed by surviving parents. Other assessment tools were used to determine whether children and adolescents experienced other psychiatric disorders and functional impairment and to evaluate the severity of their grief symptoms. Assessments occurred at baseline, a mean (average) of 8.5 months after the parent died; approximately one year later; and approximately two years after the parental death. Of the 182 initial child and adolescent participants, 165 and 141 completed the one- and two-year follow-ups, respectively.

For most participants (58.8 percent), grief scores decreased significantly between nine and 21 months after the parent’s death and then stayed low. In a second group (30.8 percent), grief reactions increased at about nine months but then steadily declined through the 33 rd month after the parent died. Grief scores were high at the ninth month and remained high through the 33 rd month for 10.4 percent of participants.

Parental death due to unintentional injury and higher self-reported depression at nine months were associated with higher grief scores. The 10.4 percent of participants with high grief scores that did not decline much were more likely to have functional impairment at nine months post–parental death, a previous history of depression and new-onset posttraumatic stress disorder. Children and adolescents were more likely to experience depression during follow-up if their surviving parent had complicated or prolonged grief, if they felt others were accountable for the death or if they experienced other life events since the death.

The authors summarize that prolonged grief appears to contribute to functional impairment and psychiatric problems in children and adolescents after the sudden death of a parent. They suggest that interventions which focus on prolonged grief be developed for these young people, as well as for those with increased grief reactions at nine months after the parent’s death. Lastly, the authors point out that the surviving parent’s grief reaction was associated with the risk that children and teens with complicated grief would develop depression. “These findings have important clinical implications regarding intervention and prevention efforts,” they write. “It is imperative to assess the surviving parent and to intervene, when appropriate, to improve the outcomes for parentally bereaved children and adolescents.”

Material adapted from Archives of General Psychiatry.

Reference
Arch Gen Psychiatry. 2011;68[9]:911-919.

Patients who ruminate and activate the brain’s frontal lobes are more likely to relapse into depression than those who respond with acceptance and activate visual areas in the back of the brain. Part of what makes depression such a devastating disorder is the high rate of relapse: each time a person becomes clinically depressed, increases their chances of becoming depressed by 16%. However, the fact that some patients are able to fully maintain their recovery points to the possibility that differences in the way they respond to everyday emotional challenges may reduce their chances of relapse.

Using functional magnetic resonance imaging to examine that possibility, researchers presented sixteen formerly-depressed patients with sad movie clips while taking pictures of their brain activity. Over the next year and a half, nine of the sixteen patients relapsed into depression. The researchers compared the brain activity of relapsing patients against those who remained healthy and against another group of people who had never been depressed.

When faced with sadness, relapsing patients showed more activity in a frontal region of the brain known as the medial prefrontal gyrus. Responses in this frontal region were also linked to higher rumination scores, the tendency to think obsessively about negative events. Patients who did not relapse showed more activity in the rear part of the brain responsible for processing visual information. Responses in this visual area were also linked to greater feelings of acceptance and non-judgment of experience. Both the frontal and visual responses to sadness were atypical in that they were not found in people who had never been depressed.

“Despite achieving an apparent recovery from the symptoms of depression, this study suggests that there are important differences in how formerly depressed people respond to emotional challenges that predict future well-being,” explained author Dr. Norman Farb. “For a person with a history of depression, using the frontal brain’s ability to analyze and interpret sadness may actually be an unhealthy reaction that can perpetuate the chronic cycle of depression.”

Dr. John Krystal, editor of Biological Psychiatry added, “Relapse is one of the most vexing problems in depression treatment. Having a biomarker for relapse could guide a new generation of treatment research.”

Further evaluation is needed to determine whether the brain’s reaction to sadness can predict a person’s risk for future depression on an individual, case-by-case basis. It will also be important to examine whether people identified as being at risk for relapse can be trained to change their way of responding to negative emotion or whether treatment strategies can be developed that would target the hyperactivity of this cortical region when processing sad or other negative stimuli.

Material adapted from Elsevier.

Reference
The article is “Mood-Linked Responses in Medial Prefrontal Cortex Predict Relapse in Patients with Recurrent Unipolar Depression” by Norman A.S. Farb, Adam K. Anderson, Richard T. Bloch, and Zindel V. Segal. The authors are affiliated with University of Toronto, Toronto, Ontario, Canada. Farb and Anderson are also with Rotman Research Institute, Baycrest, Toronto, Ontario, Canada. The article appears in Biological Psychiatry, Volume 70, Number 4 (August 15, 2011), DOI 10.1016/j.biopysch.2011.03.009, published by Elsevier.

These findings are the result of a four-year study conducted by UT Southwestern’s psychiatry department in conjunction with the Cooper Institute in Dallas. The National Institute of Mental Health-funded study, begun in 2003, is one of the first controlled investigations in the U.S. to suggest that adding a regular exercise routine, combined with targeted medications, actually can relieve fully the symptoms of major depressive disorder.

“Many people who start on an antidepressant medication feel better after they begin treatment, but they still don’t feel completely well or as good as they did before they became depressed,” said Dr. Madhukar Trivedi, professor of psychiatry and the study’s lead author. “This study shows that exercise can be as effective as adding another medication. Many people would rather use exercise than add another drug, particularly as exercise has a proven positive effect on a person’s overall health and well-being.”

Study participants diagnosed with depression, who ranged in age from 18 to 70 and who had not remitted with treatment using a selective serotonin reuptake inhibitor antidepressant medication, were divided into two groups. Each group received a different level of exercise intensity for 12 weeks. Sessions were supervised by trained staff at the Cooper Institute and augmented by home-based sessions.

Participants – whose average depression length was seven years – exercised on treadmills, cycle ergometers or both, kept an online diary of frequency and length of sessions, and wore a heart-rate monitor while exercising at home. They also met with a psychiatrist during the study.

By the end of the investigation, almost 30 percent of patients in both groups achieved full remission from their depression, and another 20 percent significant displayed improvement, based on standardized psychiatric measurements. Moderate exercise was more effective for women with a family history of mental illness, whereas intense exercise was more effective with women whose families did not have a history of the disease. For men, the higher rate of exercise was more effective regardless of other characteristics.

“This is an important result in that we found that the type of exercise that is needed depends on specific characteristics of the patient, illustrating that treatments may need to be tailored to the individual,” said Dr. Trivedi, director of the Mood Disorders Research Program and Clinic at UT Southwestern. “It also points to a new direction in trying to determine factors that tell us which treatment may be the most effective.”

Other researchers from UT Southwestern involved in the study were Dr. Tracy Greer, assistant professor of psychiatry; Dr. Thomas Carmody, assistant professor of clinical sciences and psychiatry; Dr. Prabha Sunderajan, clinical assistant professor of psychiatry; and Bruce Grannemann, faculty associate in psychiatry. Scientists from Louisiana State University, South Carolina State University, the American Psychological Association, Martindale Research Corp. and Klein Buendel Inc. also contributed.

In addition to NIMH funding, the study was supported by grants and awards from the National Alliance for Research on Schizophrenia and Depression, and the National Cancer Institute.

Material adapted from UT Southwestern Medical Center.

“We were surprised to find just how low the levels of omega-3 fatty acids were in the entire sample,” said Army Col. (Dr.) Michael D. Lewis, lead author on the study and assistant professor in the Department of Preventive Medicine and Biometrics at the USU. “There still was a significant suicide risk when we stratified the population. When we compared the 1,400 samples with the lowest levels of DHA to the remaining 200, there was a 62 percent increased risk that the samples were from a documented suicide. We need to continue to evaluate these results with a well-designed interventional study, but this represents a potential simple nutritional intervention that warrants further investigation.”

“Our findings add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risks,” said U.S. Public Health Service Capt. (Dr.) Joseph Hibbeln, acting chief of the Section of Nutritional Neurosciences in NIAAA’s Laboratory of Membrane Biochemistry and Biophysics and corresponding author. “For example a previous placebo-controlled trial demonstrated that 2 grams of omega-3 fatty acids per day reduced suicidal thinking by 45 percent, along with depression and anxiety scores among individuals with recurrent self-harm.” He adds that in a prior study they found low blood levels of DHA correlated with hyperactivity of brain regions in a pattern that closely resembles the pathology of major depression and suicide risk.

Omega-3 fatty acids are essential nutrients that the body cannot make so they must come from food sources. DHA, the major omega-3 fatty acid concentrated in the brain, is important throughout life for optimal brain development and function. Seafood is a major dietary source of omega-3 fatty acids. Previous studies have associated low levels of omega-3 fats or low dietary intake of seafood, with suicide, thoughts of suicide, and depression. Many, but not all, treatment studies also have reported mental health benefits of supplemental DHA, including reduced anxiety, depression, and risk of psychosis.

Material adapted from Uniformed Services University of the Health Sciences (USU).

Researcher Katrina Leupp

“Women are sold a story that they can do it all, but most workplaces are still designed for employees without child-care responsibilities,” said Katrina Leupp, a University of Washington sociology graduate student who led the study. In reality, juggling home and work lives requires some sacrifice, she said, such as cutting back on work hours and getting husbands to help more.

“You can happily combine child rearing and a career, if you’re willing to let some things slide,” Leupp said. She will present her study Aug. 21 at the American Sociological Association’s annual meeting in Las Vegas, Nev.

Leupp analyzed survey responses from 1,600 women, all 40 years old and married, across the United States. The respondents, a mix of stay-at-home moms and working mothers, were participating in the National Longitudinal Survey of Youth, administered by the U.S. Department of Labor.

As young adults, the women answered questions about work-life balance by ranking how much they agreed with statements, such as “A woman who fulfills her family responsibilities doesn’t have time for a job outside the home,” “Working wives lead to more juvenile delinquency” and “A woman is happiest if she can stay at home with her children.”

Then, when the women were 40, Leupp measured their levels of depression.

She found that the stay-at-home moms had more depression symptoms than the working moms in the study, which agrees with findings from other studies.

“Employment is ultimately beneficial for women’s health, even when differences in marital satisfaction and working full or part time are ruled out,” said Leupp. She added that there is some truth to the adage, “Stay-at-home moms have the hardest job in the world.”

But among the working moms in the study, Leupp found that those with the supermom attitude – who as young adults consistently agreed with statements that women can combine employment and family care – were at a higher risk for depression compared with working moms who had a more realistic view.

“Employed women who expected that work-life balance was going to be hard are probably more likely to accept that they can’t do it all,” Leupp said. These moms may be more comfortable making tradeoffs, such as leaving work early to pick up kids, and, Leupp shows they have fewer depression symptoms.

But women who expect that work and family life can be satisfactorily combined without many tradeoffs may be more likely to feel like they are failing when they struggle to achieve this ideal. Guilt over not being able to manage the work-family balance and frustration over division of household labor could also play roles in the increase of depression symptoms in the supermom group.

“Supermoms have higher expectations for fairness, so it makes sense that they would be more frustrated with the division of household chores,” Leupp said.

So, should superdads help? Perhaps. Leupp did not include fathers in her study, but says that most men don’t cut back on employment hours to accommodate child rearing.

“Employment is still ultimately good for women’s health,” Leupp said. “But for better mental health, working moms should accept that they can’t do it all.”

Material adapted from University of Washington.

The study was the first randomized clinical trial to demonstrate an intervention that raises hope in patients with acute coronary syndrome, a condition that includes chest pain and heart attack. Previous research has shown that hope and its opposite, hopelessness, have an impact on how patients face uncertain futures.

“The study shows that a spiritual retreat like the Medicine for the Earth program can jumpstart and help to maintain a return to psycho-spiritual well-being,” says study lead author Sara Warber, M.D., associate professor of family medicine at the U-M Medical School and director of U-M’s Integrative Medicine program. “These types of interventions may be of particular interest to patients who do not want to take antidepressants for the depression symptoms that often accompany coronary heart disease and heart attack.”

The findings were published in the July issue of Explore: the Journal of Science and Healing.

The retreat group was compared to two other groups: one received standard cardiac care and the other participated in a lifestyle change retreat run by the U-M Cardiovascular Center that focused on nutrition, physical exercise and stress management.

The spiritual retreat portion of the study was conducted at the Windrise Retreat Center in Metamora, Michigan, about 50 miles north of Detroit. In the Medicine for the Earth program, participants are encouraged to see themselves as part of an interconnected web of life. The approach is founded on the work of co-author Sandra Ingerman, M.A., who wrote the book Medicine for the Earth: How to Transform Personal and Environmental Toxins, which emphasizes principles of love, harmony, beauty, unity and peace.

The study used a number of standard mental and physical benchmarks to assess the success of the program.

The spiritual retreat group went from a baseline score of 12 on the Beck Depression Inventory, indicating mild to moderate depression, to an improved score of 6 immediately afterward, a 50-percent reduction. Their scores remained that low half a year later. The lifestyle group saw their scores drop from 11 to 7 and remain there. The control group’s score started at 8 and went down to 6.

Participants also showed marked improvement in their scores on a test measuring hope. Scores on the State Hope Scale can range from 6 to 48, with higher scores indicating greater hope. All three study groups started with average scores between 34 and 36. After the spiritual retreat, participants’ average scores rose and stayed at 40 or above, while the other two groups’ averages remained significantly lower, ranging from 35 to 38, three and six months later.

“Our work adds an important spiritual voice to the current discussion of the importance of psychological well-being for patients facing serious medical issues, such as acute coronary artery disease,” Warber says.

Additional Authors: Jenna Wunder, M.P.H., Alyssa Northrop, M.P.H., Brenda Gillespie Ph.D., Katherine Smith M.P.H., Katherine S. Rhodes, Ph.D., Melvyn Rubenfire, M.D., all of U-M. Vera L. Moura, M.D., of University of North Carolina at Chapel Hill. Kate Durda, M.A., independent teacher of Medicine for the Earth.

Disclosures: Ingerman and Durda make some income teaching Medicine for the Earth trainings. Sandra Ingerman makes some royalties on her book, Medicine for the Earth. Both donated their time for this study.

Material adapted from University of Michigan Health System.

Reference
“Healing the Heart: A Randomized Pilot Study of a Spiritual Retreat for Depression in Acute Coronary Syndrome Patients,” Explore: The Journal of Science and Healing, July 2011.

The authors say the risks and benefits of different antidepressants should be carefully considered when prescribing these drugs to elderly patients and have called for further research to investigate the findings.

Dr. Carol Coupland, Associate Professor in Medical Statistics in The University of Nottingham’s Division of Primary Care said: “We’ve found some evidence from our study that the older tricyclic antidepressants may be associated with lower risks of several adverse outcomes compared with newer antidepressants in older people diagnosed as having depression.

“This was an unexpected finding, and so further research using other data sources is needed to confirm these findings as well as provide more evidence on the benefits of different antidepressants in this group of people.”

Depression is a common condition in older people and antidepressants — particularly SSRIs — are widely used. However, very little is known about the safety of these drugs in older people.

The team of researchers from the Universities of Nottingham and East Anglia set out to investigate the potential link between antidepressant treatment and the risk of a number of potentially life-threatening outcomes in older people.

They identified 60,746 UK patients aged 65 and over with a newly diagnosed episode of depression between 1996 and 2007 using the QResearch primary care database. Many patients had other conditions, such as heart disease and diabetes, and were taking several medications.

Patients were tracked until the end of 2008. During this time, 89 per cent (54,038) received at least one prescription for an antidepressant, and a total of 1,398,359 prescriptions for antidepressants were received. Of these 57 per cent were for SSRIs, 31 per cent for TCAs, 0.2 per cent for monoamine oxidase inhibitors (MAOIs) and 13.5 per cent for other antidepressants.

Antidepressant use was then analysed against several adverse outcomes including all-cause mortality, attempted suicide or self harm, heart attack, stroke, falls, fractures, epilepsy or seizures and high salt levels in the blood (hyponatraemia).

After adjusting for factors that could affect the results, including age, sex, severity of depression, other illnesses and use of other medications, the team found that SSRIs and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with TCAs.

Those taking SSRIs were more likely to die, suffer a stroke, fall or fracture, have epilepsy or a seizure and have hyponatraemia compared with TCAs. The group of other antidepressants were associated with an increased risk of mortality, attempted suicide or self-harm, stroke, fracture and epilepsy or seizures.

Patients in the study had a seven per cent risk of dying over one year while they were not taking antidepressants, while the comparable risks were 8.1 per cent when taking TCAs, 10.6 per cent for SSRIs and 11.4 per cent for the group of other antidepressants. For stroke, one-year risks were 2.3 per cent, 2.6 per cent and three per cent (compared with 2.2 per cent when not on antidepressants) and for fracture they were 2.2 per cent, 2.7 per cent and 2.8 per cent compared with 1.8 per cent.

Among individual drugs trazodone, mirtazapine and venlafaxine carried the highest risk for some adverse outcomes.

Rates of most adverse outcomes were highest in the 28 days after starting the antidepressant and also in the 28 days after stopping.

The authors also point out that TCAs were prescribed at lower doses than SSRIs and other antidepressant drugs, which they say “could in part explain our findings.” They also caution that differences between patients prescribed different antidepressant drugs may account for some of the associations seen in the study, underlining the need for further research to confirm the findings.

Material adapted from University of Nottingham.

Reference
Carol Coupland, Paula Dhiman, Richard Morriss, Antony Arthur, Garry Barton, Julia Hippisley-Cox, “Antidepressant Use and Risk of Adverse Outcomes in Older People: Population Based Cohort Study,” British Medical Journal, August 2011, DOI 10.1136.

“Our study controlled for obesity, smoking, sedentary lifestyle and HbA1c levels, and still found that depression was associated with an increased risk of retinopathy,” said co-author Wayne Katon, M.D. HbA1c is a blood test that measures a person’s average blood sugar levels over several months.

Katon is the director of health services and psychiatric epidemiology at the University of Washington Medical School, in Seattle. He and his colleagues studied 2,359 patients with diabetes enrolled in the Pathways Epidemiologic Study and assessed their level of depression using the Patient Health Questionnaire-9 (PHQ-9), a self-reported survey of depression symptoms.

Over the five-year follow-up period, 22.9 percent of the patients who had PHQ-9 scores that ranked as “major depression” developed diabetic retinopathy compared with 19.7 percent of the patients without depression. With a five-point increase on the PHQ-9 score, patients’ risk of having diabetic retinopathy increased by up to 15 percent.

“Our findings suggested that psychobiologic changes associated with depression such as increased cortisol levels and activity of blood-clotting factors may be linked to the development of retinopathy,” Katon said.

“There is no question that the burden of depression among patients with diabetes is very high and that depression is a risk factor for worse outcomes in patients with diabetes, as was seen in this study,” said Todd Brown, M.D., an assistant professor of medicine at the division of endocrinology and metabolism at Johns Hopkins University.

He added that multiple explanations might account for these findings — some related to biological changes and some due to behavioral social issues, such as decreased physical activity and poorer utilization of health care.

“The big question with all of this is whether identifying and treating depression in patients with diabetes will change clinical outcomes,” Brown said. “And currently, there are no universal recommendations for depression screening among patients with diabetes.”

Material adapted from Health Behavior News Service, part of the Center for Advancing Health.

Reference
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Inc. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

Researcher Sonja Lyubomirsky

PAIs are intentional activities such as performing acts of kindness, practicing optimism, and counting one’s blessing gleaned from decades of research into how happy and unhappy people are different. This new approach has the potential to benefit depressed individuals who do not respond to pharmacotherapy or are not able or willing to obtain treatment, is less expensive to administer, is relatively less time-consuming and promises to yield rapid improvement of mood symptoms, holds little to no stigma, and carries no side effects.

More than 16 million U.S. adults – about 8 percent of the population – suffer from either major or chronic depression. About 70 percent of reported cases either do not receive the recommended level of treatment or do not get treated at all, according to the National Institute of Mental Health. Globally, the World Health Organization estimates that depression affects more than 100 million people.

Although antidepressants can be lifesaving for some individuals, initial drug therapy produces full benefits in only 30 percent to 40 percent of patients. Even after trying two to four different drugs, one-third of people will remain depressed.

The research team – Kristin Layous and Joseph Chancellor, graduate students at UC Riverside; Sonja Lyubomirsky, professor of psychology and director of the Positive Psychology Laboratory at UC Riverside; and Lihong Wang, M.D., and P. Murali Doraiswamy, M.B.B.S., FRCP, of Duke University – conducted a rigorous review of previous studies of PAIs, including randomized, controlled interventions with thousands of normal men and women as well as functional MRI scans in people with depressive symptoms.

“Over the last several decades, social psychology studies of flourishing individuals who are happy, optimistic and grateful have produced a lot of new information about the benefits of positive activity interventions on mood and well-being,” Lyubomirsky said. However, such findings have not yet entered mainstream psychiatric practice.

“Very few psychiatrists collaborate with social scientists and no one in my field ever reads the journals where most happiness studies have been published. It was eye-opening for me as a psychopharmacologist to read this literature,” Doraiswamy said.

Lyubomirsky said that after she and Doraiswamy exchanged notes, “the obvious question that popped up was whether we can tap into the PAI research base to design interventions to galvanize clinically depressed people to move past the point of simply not feeling depressed to the point of flourishing.”

Although the paper found that positive activity interventions are effective in teaching individuals ways to increase their positive thinking, positive affect, and positive behaviors, only two studies specifically tested these activities in individuals with mild depression.

In one of these studies, lasting improvements were found for six months. Effective PAIs used in the study included writing letters of gratitude, counting one’s blessings, practicing optimism, performing acts of kindness, meditating on positive feelings toward others, and using one’s signature strengths, all of which can be easily implemented into a daily routine at low cost.

People often underestimate the long-term impact of practicing brief, positive activities, Lyubomirsky said. For example, if a person gets 15 minutes of positive emotions from counting her blessings, she may muster the energy to attend the art class she had long considered attending, and, while in class, might meet a friend who becomes a companion and confidant for years to come. In this way, even momentary positive feelings can build long-term social, psychological, intellectual, and physical skills and reserves.

The researchers’ review of brain imaging studies also led them to theorize that PAIs may act to boost the dampened reward/pleasure circuit mechanisms and reverse apathy – a key benefit that does not usually arise from treatment with medication alone.

“The positive activities themselves aren’t really new,” said Layous, the paper’s lead author. “After all, humans have been counting their blessings, dreaming optimistically, writing thank you notes, and doing acts of kindness for thousands of years. What’s new is the scientific rigor that researchers have applied to measuring benefits and understanding why they work.”

A major benefit of positive activities is that they are simple to practice and inexpensive to deliver.

“If we’re serious about tackling a problem as large as depression, we should be as concerned about the scalability of our solutions as much as their potency,” Chancellor said,

While PAIs appear to be a potentially promising therapy for mild forms of depression,” Doraiswamy cautioned, “they have not yet been fully studied in people with moderate to severe forms of depression. We need further studies before they can be applied to help such patients.”

Kim Jobst, a physician and editor-in-chief of the Journal of Alternative and Complimentary Medicine, said the review provides one location in which to reference all relevant PAI findings to date, and includes recommendations that should prove useful to researchers, clinicians and the public. The journal is devoted to publishing research about novel and unconventional treatment approaches.

Material adapted from University of California – Riverside.

Download / Reference
Kristin Layous, Joseph Chancellor, Sonja Lyubomirsky, Lihong Wang, & P. Murali Doraiswamy. Delivering Happiness: Translating Positive Psychology Intervention Research for Treating Major and Minor Depressive Disorders. THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, Volume 17, Number 8, 2011, pp. 1–9.

In conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative, researchers from 20 centers collaborated to investigate the prevalence of depression around the globe. To be classified as having had a Major Depressive Episode (MDE) a person was additionally required to fulfill five out of nine criteria including sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration.

Based on detailed interviews with over 89,000 people, the results showed that 15% of the population from high-income countries (compared to 11% for low/middle-income countries) were likely to get depression over their lifetime with 5.5% having had depression in the last year. MDE were elevated in high-income countries (28% compared to 20%) and were especially high (over 30%) in France, the Netherlands, and America. The country with the lowest incidence was China at 12% but, in contrast, MDE were very common in India (at almost 36%).

Some aspects were cross cultural – women were twice as likely to suffer depression as men and the loss of a partner, whether from death, divorce or separation, was a main contributing factor. However the contribution of age varied from country to country. Age of onset of depression was almost two years earlier in low income countries and, while the amount of difficulty a person had with aspects of their life increased with depression and how recent their last attack was, it was more apparent in people from high income countries.

Prof. Evelyn Bromet from State University of New York at Stony Brook said, “This is the first study which uses a standardized method to compare depression and MDE across countries and cultures. We have shown that depression is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Understanding the patterns and causes of depression can help global initiatives in reducing the impact of depression on individual lives and in reducing the burden to society.”

Material adapted from BioMed Central.

Download / Reference
Evelyn Bromet, Laura Helena Andrade, Irving Hwang, Nancy A Sampson, Jordi Alonso, Giovanni de Girolamo, Ron de Graaf, Koen Demyttenaere, Chiyi Hu, Noboro Iwata, Aimee N Karam, Jagdish Kaur, Stanislav Kostyuchenko, Jean-Pierre Lepine, Daphna Levinson, Herbert Matschinger, Maria Elena Medina Mora, Mark Oakley Browne, Jose Posada-Villa, Maria Carmen Viana, David R Williams and Ronald C Kessler BMC Medicine (in press). Cross-National Epidemiology of DSM-IV Major Depressive Episode. BMC Medicine.

Background

St. John’s Wort is a plant whose yellow flowers have been the source of extracts used medicinally for centuries. It is widely used to treat depression, as a nutritional supplement in the United States, and as a prescription medication in Europe. Evidence from clinical trials of St. John’s Wort has failed to show effectiveness for treatment of major depression, but researchers have raised the question as to whether the herb might offer benefit for people with less severe depression.

This Study

This study, focusing specifically on minor depression, was conducted by Mark Hyman Rapaport and colleagues at the Cedars-Sinai Medical Center and David Geffen School of Medicine in Los Angeles; the Massachusetts General Hospital, in Boston; and the University of Pittsburgh. Participants in the study had minor depression, defined as the presence of two to four symptoms used to diagnose major depression with at least one symptom being depressed mood or anhedonia (a lack of pleasure in activities usually found enjoyable). Symptoms had to have been present for six months to two years. Subjects were randomly assigned to receive St. John’s Wort, the antidepressant medication citalopram, or a placebo. Neither participants, nor the staff treating them, knew what treatment they took. Seventy-three subjects completed the trial.

Results from the trial showed that no treatment relieved depression more than any other; patients in all three of the treatment groups showed improvements in symptoms over the course of the study, and in measures of quality of life and psychological well-being.

Patients in all three treatment groups, including placebo, also frequently reported side effects. In addition, before treatment began in this study, more than half of participants responded positively when they were asked if they had any of a broad list of physical or psychological complaints. This finding suggests that it is important to assess both physical and psychological symptoms even before treatment begins; otherwise, many of these symptoms might be interpreted as medication-related.

Significance

While minor depression is by definition a milder condition than major depression, research suggests it has consequences for health and well-being that go beyond the symptoms themselves, including lost work days, social difficulties, and possibly a higher risk of developing future major depression.

The authors are careful to point out that the reason that there was no difference in benefit between St. John’s Wort, citalopram, and placebo was not because the study was too small to detect a difference, but because participants taking placebo experienced substantial improvement in measures of depression and well-being—participation in the study had positive effects. In addition, participants taking all three treatments — even those on placebo — experienced side-effects. Fewer of the subjects taking St. John’s Wort reported that side effects were distressing (40 vs. 60 percent), but St. John’s Wort recipients reported more gastrointestinal and sleep problems than those receiving placebo.

Identifying effective and safe ways to treat minor depression remains an important goal; further research on non-pharmacologic treatment is needed to identify the optimal psychotherapies for minor depression.

This study was funded by the National Institute of Mental Health and the National Center for Complementary and Alternative Medicine, National Institutes of Health.

Material adapted from NIMH.

Reference

Rapaport, M.H., Nierenberg, A.A., Howland, R., Dording, C., Schettler, P.J., and Mischoulon, D. The treatment of minor depression with St. John’s Wort or citalopram: Failure to show benefit over placebo. Journal of Psychiatric Research 45:931-941, 2011.

Researcher Alison Stuebe

“We found that women who said they disliked breastfeeding were 42 percent more likely to experience postpartum depression at two months compared to women who liked breastfeeding. We also found that women with severe breast pain at day one and also at two weeks postpartum were twice as likely to be depressed compared to women that did not experience pain with nursing,” said Stephanie Watkins, MSPH, MSPT, lead author of the study and a doctoral student in the UNC Gillings School of Global Public Health.

The idea for the study, published online ahead of print by the journal Obstetrics & Gynecology, grew from the clinical experience of senior author, Alison Stuebe, MD, an assistant professor in the Department of Obstetrics and Gynecology in the UNC School of Medicine.

“We found that very commonly the same moms who were struggling with breastfeeding were also depressed,” she said. “There was a tremendous clinical overlap.”

In the study, Stuebe, Watkins and UNC co-authors Samantha Meltzer-Brody, MD, MPH and Denniz Zolnoun, MD, MPH, set out to determine if this anecdotal association would be backed up by statistical analysis of relevant data. For this purpose, they used data collected as part of the Infant Feeding and Practices Study II, and assessed the postpartum depression status of the 2,586 women in that study with the Edinburgh Postnatal Depression Scale.

Of those women, 8.6 percent met the criteria for major depression two months after giving birth. Women who reported disliking breastfeeding during the first week were 1.42 times as likely to be depressed at two months. Women who reported severe breastfeeding pain on their first day were 1.96 times as likely to be depressed at two months.

For health care providers, this study shows that mothers with breastfeeding difficulties should be screened for depression and referred to counseling when depression is confirmed. But the study also provides a message for mothers, Stuebe said.

“If they’re struggling with breastfeeding, they should seek help and tell their provider. If they don’t have joy in their life, if they wake up in the morning and think, ‘I just can’t do this another day’ – that’s a medical emergency. They shouldn’t just say, ‘I’m going to power through this and snap out of it.’ They should call their provider and say, ‘I just don’t feel right, I’m wondering if I could be depressed, can I come in and talk to you about it?’”

Material adapted from University of North Carolina School of Medicine.

A new study published in Biological Psychiatry has approached that problem by following a large population of elderly individuals over a 10 year period. Researchers performed an initial imaging scan on subjects to obtain a baseline measurement of their hippocampal volume and then performed follow-up scans 5 and 10 years later. During this time, they also repeatedly assessed the individuals for both depressive symptoms and depressive disorders.

Corresponding author Dr. Tom den Heijer explains their findings: “We found that persons with a smaller hippocampus were not at higher risk to develop depression. In contrast, those with depression declined in volume over time. Our study therefore suggests that a small hippocampal volume in depressed patients is more likely an effect of the depression rather than a cause.”

“The principal importance of this type of research is that it may provide insight into age-related impairments in the function of the hippocampus,” reflected Dr. John Krystal, Editor of Biological Psychiatry. “For example, in Alzheimer’s disease, memory problems and disorientation are prominent symptoms, reflecting among other things the impaired function of the hippocampus.”

Future studies will be needed to better understand whether current treatments protect the hippocampus and hippocampal function.

Material adapted from Elsevier.

Reference
“A Study of the Bidirectional Association Between Hippocampal Volume on Magnetic Resonance Imaging and Depression in the Elderly” by Tom den Heijer, Henning Tiemeier, Hendrika J. Luijendijk, Fedde van der Lijn, Peter J. Koudstaal, Albert Hofman, and Monique M.B. Breteler. The authors are affiliated with Erasmus Medical Center, Rotterdam, the Netherlands. den Heijer is also from Sint Franciscus Gasthuis, Rotterdam, the Netherlands. Luijendijk is also from Bavo, Europoort, the Netherlands. The article appears in Biological Psychiatry, Volume 70, Number 2 (July 15, 2011), published by Elsevier.

Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour, is the lead author of a new paper in the journal Frontiers of Psychology.

The meta-analysis suggests that people who have not been taking any medication are at a 25 per cent risk of relapse compared to 42 per cent or higher for those who have taken and gone off an anti-depressant.

Andrews and his colleagues studied dozens of previously published studies to compare outcomes for patients who used anti-depressants compared to those who used placebos. They analyzed research on subjects who started on medications and were switched to placebos, subjects who were administered placebos throughout their treatment, and subjects who continued to take medication throughout their course of treatment.

Andrews says anti-depressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new depression.

Though there are several forms of anti-depressants, all of them disturb the brain’s natural regulatory mechanisms, which he compares to putting a weight on a spring. The brain, like the spring, pushes back against the weight. Going off antidepressant drugs is like removing the weight from the spring, leaving the person at increased risk of depression when the brain, like the compressed spring, shoots out before retracting to its resting state.

“We found that the more these drugs affect serotonin and other neurotransmitters in your brain – and that’s what they’re supposed to do – the greater your risk of relapse once you stop taking them,” Andrews says. “All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking anti-depressants to prevent a return of symptoms.”

Andrews believes depression may actually be a natural and beneficial – though painful – state in which the brain is working to cope with stress.

“There’s a lot of debate about whether or not depression is truly a disorder as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful,” he says.

Longitudinal studies cited in the paper show that more than 40 per cent of the population may experience major depression at some point in their lives.

Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship, or the loss of a job. Andrews says the brain may blunt other functions such as appetite, sex drive, sleep, and social connectivity, to focus its effort on coping with the traumatic event.

Just as the body uses fever to fight infection, he believes the brain may also be using depression to fight unusual stress. But not every case is the same, and severe cases can reach the point where they are clearly not beneficial, he emphasizes.

Material adapted from McMaster University .

Researcher Jennifer Johnson, PhD

“We found that current major depression increased the risk of crack use, but depression in the past year that had gotten better did not,” said Jennifer Johnson, assistant professor (research) of psychiatry and human behavior in the Warren Alpert Medical School of Brown University and lead author of the study. “This suggests that if the depression remits, the risk of crack use goes down. Screening for depression and effective depression treatment may be important components of drug court services.”

Addiction and depression are closely associated, said Johnson, who is also affiliated with Brown’s Center for Alcohol and Addiction Studies. It isn’t always clear how the two affect each other, especially at an urgent moment such as entry into the court system. Johnson set out to untangle the two by analyzing data gathered by researchers at Washington University in St. Louis as part of an HIV prevention study.

Among the 261 women in the study, 16 percent had a current major depressive episode and 40 percent had experienced a major depressive episode in their lifetime. Among the women currently depressed, 46 percent used crack during the next four months. Among women who weren’t currently depressed, only 25 percent used crack in the next four months.

At the beginning of the study, the analysis statistically adjusted for whether women were using crack, which is highly addictive, and took the timing of the women’s depression into account, said Johnson, who is also affiliated with the Center for Prisoner Health and Human Rights, a collaboration of Brown University and The Miriam Hospital.

Women who had been depressed at some time in the past, even in the last year, did not have an increased risk of crack use compared to women who had never been depressed, Johnson found. Women who were currently depressed, however, were significantly more likely to use crack than women who were never depressed. Furthermore, currently depressed women had nearly four times the odds of using crack during follow-up compared to women who had been depressed at some point in their past. The odds were nearly six times greater compared to women who were depressed within the last year, but not currently.

“It doesn’t matter if they’ve been depressed in the past,” she said, “only how they’re doing right now.”

The data hint that depression may have contributed to crack use in this population, Johnson said.

“It is well known that crack use can cause depression and depression can contribute to crack use,” Johnson said. “However, in this study baseline depression [at the beginning of the study] was not associated with baseline crack use, but was associated with future crack use, suggesting that depression may have led to crack use and not vice versa.”

If women in drug court can be successfully screened and treated for depression, Johnson said, the resulting reduction in crack use predicted by the analysis might benefit not only the women but also the community.

“The public ends up paying the cost of drug court and incarceration,” she said. “Depression treatment isn’t that expensive.”

In addition to Johnson, the paper’s other authors are Linda B. Cottler, Catina O’Leary, Catherine W. Striley, Arbi Ben Abdallah, and Susan Bradford, all of Washington University. Cottler’s grant from the National Institute of Nursing Research funded the original HIV-prevention study for which the data was acquired. Johnson’s analysis of addiction and depression was supported by a grant from the National Institute on Drug Abuse.

Material adapted from Brown University.

Future randomized controlled studies should examine whether this intensive CBASP program is more effective than standard psychiatric interventions or CBASP outpatient treatment.

Cognitive behavioral analysis system of psychotherapy (CBASP) was initially developed as an outpatient treatment for chronic depression. It integrates cognitive-emotional, behavioral, interpersonal, and psychodynamic theories and strategies by addressing directly the specific psychopathology of chronic depression. Given the high degree of suicidality, comorbidity, and therapy resistance in chronic depression, however, many of these patients require inpatient treatment.

In this study, the investigators report on a first specialized program for chronic depression that adapted CBASP to an inpatient setting and evaluated the feasibility and short- and long-term outcome. The new CBASP group therapy focuses on a modified approach for conducting situation analysis and on Kiesler’s circle training with the extensive use of role playing and shaping. The entire treatment team was trained in CBASP; regular workshops and weekly supervisions for both the team and the individual therapists were conducted. Specific CBASP elements were implemented in other accompanying treatments, such as nurse encounters, physiotherapy, music therapy, and occupational group therapy. A patient support group was established to avoid relapse after discharge. Patients received optimized pharmacotherapy in addition to the CBASP program in compliance with current national and international guidelines for depression treatment.

Ten inpatients with severe chronic depression according to DSM-IV were included in this pilot study. The SCID I and II were used for diagnosis. Early trauma and life events were assessed by using the Childhood Trauma Questionnaire (CTQ). Follow-up data were collected 6 months after discharge. Concerning feasibility, all patients completed the treatment. The CBASP concept proved to be feasible and there were no major difficulties integrating the concept into the daily clinical routine.

The 24-item version of the Hamilton Depression Rating Scale (HAMD) served as the primary outcome measure and the Beck Depression Inventory (BDI) as the secondary measure. T-tests for paired samples revealed significant improvements and large effect sizes in the primary outcome HAMD-24 (p = 0.000) and in the BDI (p = 0.002). Treatment response was defined a priori as a reduction in symptom severity of at least 50% on the HAMD, and remission was defined as a score of 10 or less on the HAMD scale.

Six out of the 10 patients were classified as responders and 4 of these fulfilled the remission criterion. Exploratory analyses revealed that the nonresponders had a significantly higher number of personality disorders (p = 0.038). Finally, the 6-month naturalistic follow-up assessments were completed by 9 out of the 10 patients. Outpatient psychotherapy was continued by 6 patients (CBASP: 3, cognitive-behavioral therapy:2, schema therapy: 1), 9 patients were still on pharmacotherapy, and 6 patients regularly attended the CBASP support group. The findings on short- and long-term outcomes as well as on feasibility of the inpatient CBASP program are promising.

However, response rates were lower in this in-patient study than those in outpatient CBASP studies. This might be a consequence of the inclusion of a more severely ill patient sample with high comorbidity, long duration of the depressive episode, and high levels of therapy resistance. Concerning follow-up data, it is remarkable that the patients who remitted remained in remission over 6 months, that all patients had improved satisfaction with psychosocial domains, and that only 1 patient relapsed.

Material adapted from Journal of Psychotherapy and Psychosomatics.

Reference
Brakemeier, E.-L., Engel, V., Schramm, E., Zobel, I., Schmidt, T., Hautzinger, M., Berger, M., Normann, C.: “Feasibility and Outcome of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) for Chronically Depressed Inpatients: A Pilot Study,” Psychother Psychosom 2011;80:191-194.

Clinicians and scientists at the Mount Sinai School of Medicine in New York City used state of the art brain imaging technology to understand how the brains of women with postpartum depression differed from non-depressed postpartum woman. The results of the study were unexpected.

“Depression comes in two flavors, unipolar and bipolar.” says Dr. Michael E. Silverman lead author of the study. “Unipolar depression is characterized by severe depression, whereas bipolar type depressions include times of unusually elevated mood or energy – referred to as mania or hypomania.” According to the DSM-IV, the diagnostic manual used by psychiatrist and psychologists, postpartum depression is classified as a unipolar type depression. The results of the study suggest this classification might be inaccurate.

According to Dr. Silverman, “Certain areas of the brain, particularly a cortical region known as the amygdala, are known to become very active in unipolar depression. The brains of the depressed postpartum woman however looked much different. In fact, the more severe the postpartum depression the less the women’s brains responded how one would expect in a unipolar depression.”

Despite the current classification of postpartum depression, doctors and clinicians with experience treating depressed mothers often note specific differences between unipolar depression and the depression that occurs immediately after childbirth. The study published this week provides new brain evidence suggesting that postpartum depression might be neurologically different as well.

Postpartum depression, the most common complication associated with childbirth, affects approximately 20% of all new mothers or nearly 800,000 US women annually. If left untreated the depression can last for months or even years. While depression after childbirth has been reported by doctors since the time of Hippocrates (400 BC), the causes of postpartum depression remain poorly understood.

“Compounding the problem is the fact that new mothers are often expected to be superwomen, managing personal, home and often work lives in addition to caring for a new child, all on about 75% less sleep”, says Silverman. “And while symptoms of hypomania should be considered diagnostically significant, especially in the postpartum period, at the current time they aren’t.” Silverman further warns, “The improper treatment of a bipolar type postpartum depression can have catastrophic consequences for both the mother and child.” Indeed, research has suggested that postpartum depression is the single greatest cause of maternal death.

Silverman notes an additional importance of this finding, “The period immediately following birth is a critical time for the newborn’s development and postpartum depression can constitute a serious threat to the infant’s well-being. While these results are surprising, they help to explain why mothers who suffer from postpartum depression are prone to making decisions that put their infant(s) at increased risk for harm.”

Material adapted from Mount Sinai School of Medicine.

“Approximately 70 percent of mothers who said they experienced high levels of anxiety or depression while they were pregnant reported their child had wheezed before age 5,” said Marilyn Reyes, lead author of the study. “Understanding how maternal depression affects a child’s respiratory health is important in developing effective interventions.”

The study of 279 inner-city African-American and Hispanic women was conducted before, during pregnancy, and after birth. The study results support growing research that the prenatal period is a time when children are particularly susceptible to asthma-related risks. While somewhat similar findings have been reported in non-minority populations, this study at the Columbia Center for Children’s Environmental Health is the first to report an association between stress and wheeze in minority populations.

“The symptoms of pediatric asthma can range from a nagging cough that lingers for days or weeks to sudden and scary breathing emergencies,” said allergist Rachel Miller, MD, study senior author. “With the right treatment, your child can sleep through the night, avoid missing time from day care or preschool, and breathe easy.”

Common asthma symptoms include:

• Coughing, especially at night
• Wheezing or whistling sound, especially when breathing out
• Trouble breathing or fast breathing that causes the skin around the ribs or neck to pull in tightly
• Frequent colds that settle in the chest

If your child’s symptoms keep coming back, it might be asthma. If you think your child may have asthma, see an allergist. To learn more about asthma and allergies, and find an allergist near you visit www.AllergyAndAsthmaRelief.org.

Material adapted from American College of Allergy, Asthma and Immunology (ACAAI).

“The results suggest prolonged exposure to polluted air can have visible, negative effects on the brain, which can lead to a variety of health problems,” Fonken said. “This could have important and troubling implications for people who live and work in polluted urban areas around the world.”

The study appears online this week in the journal Molecular Psychiatry.

For this study, Fonken and colleagues in Ohio State’s Department of Neuroscience collaborated with researchers in the university’s Davis Heart and Lung Research Institute.

In previous studies in mice, the Davis research group – including Qinghua Sun, associate professor of environmental health sciences, and Sanjay Rajagopalan, professor of cardiovascular medicine – found that fine air particulate matter causes widespread inflammation in the body, and can be linked to high blood pressure, diabetes and obesity. This new study aimed to extend their research on air pollution to the brain.

“The more we learn about the health effects of prolonged exposure to air pollution, the more reasons there are to be concerned,” said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State. “This study adds more evidence of pollution’s negative effects on health.”

In the new study, mice were exposed to either filtered air or polluted air for six hours a day, five days a week for 10 months – nearly half the lifespan of the mice. The polluted air contained fine particulate matter, the kind of pollution created by cars, factories and natural dust. The fine particulates are tiny – about 2.5 micrometers in diameter, or about 1/30th of the average width of a human hair. These particles can reach deep areas of the lungs and other organs of the body. The concentration of particulate matter that the mice were exposed to was equivalent to what people may be exposed to in some polluted urban areas, according to the researchers.

After 10 months of exposure to the polluted or filtered air, the researchers performed a variety of behavioral tests on the animals. In a learning and memory test, mice were placed in the middle of a brightly lit arena and given two minutes to find an escape hole leading to a dark box where they feel more comfortable. They were given five days of training to locate the escape hole, but the mice who breathed the polluted air took longer to learn where the escape hole was located. The mice exposed to polluted air also were less likely to remember where the escape hole was when tested later.

In another experiment, mice exposed to the polluted air showed more depressive-like behaviors than did the mice that breathed the filtered air. The polluted-air mice showed signs of higher levels of anxiety-like behaviors in one test, but not in another.

But how does air pollution lead to these changes in learning, memory and mood? The researchers did tests on the hippocampal area of the mice brains to find the answers.

“We wanted to look carefully at the hippocampus because it is associated with learning, memory and depression,” said Fonken, who, along with Nelson, are also members of Ohio State’s Institute for Behavioral Medicine Research.

Results showed clear physical differences in the hippocampi of the mice who were exposed to polluted air compared to those who were not.

The researchers looked specifically at branches that grow off of nerve cells (or neurons) called dendrites. The dendrites have small projections growing off them called spines, which transmit signals from one neuron to another. Mice exposed to polluted air had fewer spines in parts of the hippocampus, shorter dendrites and overall reduced cell complexity.

“Previous research has shown that these types of changes are linked to decreased learning and memory abilities,” said Nelson.

In other studies, several of the co-authors of this study from the Davis research center found that chronic exposure to polluted air leads to widespread inflammation in the body, which is linked to a variety of health problems in humans, including depression. This new study found evidence that this low-grade inflammation is evident in the hippocampus.

In mice that breathed the polluted air, chemical messengers that cause inflammation – called pro-inflammatory cytokines – were more active in the hippocampus than they were in mice who breathed the filtered air.

“The hippocampus is particularly sensitive to damage caused by inflammation,” Fonken said. “We suspect that the systemic inflammation caused by breathing polluted air is being communicated to the central nervous system.”

The research was supported by grants from the National Institutes of Health.

Other co-authors, all from Ohio State, included Qinghua Sun, associate professor of environmental health sciences; Sanjay Rajagopalan, professor of cardiovascular medicine; Xiaohua Xu, in environmental health sciences; Zachary Weil, in neuroscience and psychology; and Guohua Chen, in the Davis Heart and Lung Research Institute.

Material adapted from Ohio State University.

Researcher Christie Palladino

“There are a lot of barriers to translating information into everyday practice situations,” said Dr. Christie Palladino, an obstetrician/gynecologist with Georgia Health Sciences University’s Education Discovery Institute and principal investigator on the study. “We wanted to understand what it’s like for prenatal care providers to deal with depression care.”

Providers felt burdened having to make instant decisions about complex issues, the multidisciplinary research team found. And those decisions varied dramatically, even within the same clinic.

“There was no system-level support for providers,” Palladino said. “They felt as if they were making decisions out on an island.”

That sense of isolation, coupled with a lack of direction about how to treat pregnant women with depression, may explain why fewer than half of women who need treatment receive it. Adding to the disconnect was providers’ discomfort in talking about the disease with both patients and mental health care providers.

“In training, we tend to talk about how frequent a disease is, what the known causes are and the treatments that are available, but we don’t address developing referral relationships,” Palladino said. “We need to focus on not only knowledge of the disease, but also on the intrinsic motivations.”

To address the problem, GHSU’s Education Discovery Institute is conducting a pilot project to teach such skills. Residents and faculty in OB-GYN, psychiatry, and pediatrics are collaborating to develop and test tailored educational interventions in perinatal depression care, in hopes of quickly implementing the content into clinical practice. Palladino is applying for a Health Resources and Services Administration grant to test the curriculum and intervention at other locations as well.

An earlier study led by Palladino discovered that depressed women had significantly longer-than-average hospital stays: more than 24 hours prior to delivery.

“That’s a long time for an otherwise healthy woman to be in the hospital before going into labor,” Palladino said. “It has serious consequences for the mother, for the family, and for the hospital system in terms of time and cost.”

The study, published in the Journal of Women’s Health and funded by the Robert Wood Johnson Foundation, also confirmed previous research linking depression to an increased risk of complications such as pre-term delivery, pre-eclampsia, premature membrane rupture, and gestational diabetes.

“I was in a fantastic residency program, but treating depression during pregnancy wasn’t even on the map at the time,” Palladino said, noting that many OB-GYN residency programs still lack mental health training. “This has become my passion.”

Material adapted from Georgia Health Sciences University.

Researcher Wendy Sword, PhD

Postpartum depression negatively affects the mother, child, partner, and other children in the family. According to the Canadian Mental Health Association, up to 20 per cent of new mothers experience postpartum depression and an estimated 10 to 35 per cent of women will experience a recurrence of postpartum depression.

In their research, Sword and her colleagues set out to examine the relationship between mode of delivery and postpartum depression at six weeks following hospital discharge. They evaluated almost 1,900 new mothers. One-third had C-section deliveries.

Almost eight per cent had postpartum depression at six weeks after discharge. The research team found no association between postpartum depression and mode of delivery, and this finding is consistent with previous studies.

But their investigation did show the 5 strongest predictors of postpartum depression are:

1. the mother being less than 25-years-old;
2. the mother having to be readmitted to hospital;
3. non-initiation of breastfeeding;
4. good, fair, or poor self-reported postpartum health;
5. and urinary incontinence or involuntary urination.

“We were surprised to find that urinary incontinence is a risk factor for postpartum depression,” said Sword. “Urinary incontinence following childbirth has not received much attention as a factor contributing to postpartum depression, and we do not yet fully understand the reasons incontinence is linked to depression.”

Sword notes that urinary incontinence is not an uncommon problem after giving birth, and although women may be embarrassed by this issue, it is important that they talk to their health care providers about their concerns. She adds that health professionals should also be proactive and ask women about any bladder problems as part of their postpartum assessments, as it is important to identify problems early so that appropriate action can be taken to improve symptoms and women’s well-being.

Material adapted from McMaster University.

Whether depressed or not, patients with morbid obesity lost about 60 percent of their excess weight within one year and reported an average 30 percent improvement in quality of life. Patients with clinically diagnosed depression, however, had a higher rate of minor complications (4.0% vs. 3.3%) than non-depressed patients. There were no significant differences in major complications. Among patients with depression, use of antidepressant medication dropped by about 20 percent (72% to 60%) one year after surgery and remained at that level after three years of follow-up.

“Depression and anxiety are relatively common among those with chronic diseases like obesity and Type 2 diabetes, and these conditions can sometimes interfere with treatment,” said finks. “This study suggests bariatric patients suffering from depression can experience health outcomes and quality of life improvements comparable to non-depressed patients. However, doctors and patients still need to consider psychological issues, state of mind and commitment to lifestyle changes after surgery in assessing whether bariatric surgery is appropriate and indicated for any particular patient.”

University of Michigan researchers examined data from 25,469 patients across 29 hospitals in the Michigan Bariatric Surgery Collaborative (MBSC), a consortium of the state’s hospitals and surgeons that maintains a prospective registry of bariatric surgery patients. Between 2006 and 2010, researchers found 11,687 bariatric patients (46%) were being treated for at least one psychiatric disorder with depression (41%) and anxiety (15%) among the most common. Follow-up surveys of these patients were conducted each year for three years after surgery.

Excess weight loss at one year was similar between patients suffering from a psychiatric disorder and those with no known disorder (57.2% vs. 58.7%). All patients reported 28 to 32 percent improvement in quality of life measures including increased mobility, family life, social interactions, and independent living.

“The relationship between obesity and psychiatric disorders has been established,” said James E. Mitchell, MD, Professor and Chair, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences and author of the book, “Bariatric Surgery: A Guide for Mental Health Professionals.” “But often obesity isn’t the only reason for psychological issues. Further study is needed to determine what else health professionals and patients can do before and after an obesity intervention to further enhance mental health and health status, particularly as people go from high BMIs to low ones and vice versa over time.”

Bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions [1]. People with morbid obesity have BMI of 40 or more, or BMI of 35 or more with an obesity-related disease such as Type 2 diabetes, heart disease or sleep apnea. Recently the FDA approved the use of an adjustable gastric band for BMI 30 and above, recognizing that there is an increase in mortality and medical complications of obesity at even this level of obesity.

According to the ASMBS, more than 15 million Americans have morbid obesity. Studies have shown patients may lose 30 to 50 percent of their excess weight 6 months after surgery and 77 percent of their excess weight as early as one year after surgery [2].

The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB). Bariatric surgery limits the amount of food the stomach can hold and/or limits the amount of calories absorbed by surgically reducing the stomach’s capacity to a few ounces.

The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion [3], double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018 [4]. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of bariatric surgery due in large part to improved laparoscopic techniques and the advent of bariatric surgical centers of excellence. The risk of death from bariatric surgery is about 0.1 percent [5] and the overall likelihood of major complications is about 4 percent [6].

American Society for Metabolic & Bariatric Surgery (ASMBS).

Citations
1. RA Weiner. “ Indications and Principles of Metabolic Surgery.” U.S. National Library of Medicine. 2010; 81(4):379-94

2. AC Wittgrove et al. “Laparoscopic Gastric Bypass, Roux-en-Y: Technique and Results in 75 Patients With 3-30 Months Follow-up.“ Obesity Surgery. 1996. 6:500-504.

3. EA Finkelstein. “Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates.” Health Affairs. 2009. 28(5):822-831.

4. K Thorpe. America’s Health Rankings. “The Future Costs of Obesity.” 2009.

5. Agency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Jan. 2007.

6. Flum et al. “Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery.” New England Journal of Medicine. 2009. 361:445-454. http://content.nejm.org/cgi/content/full/361/5/445

“Other agents that work through this pathway and block the enzyme may also similarly induce anti-depressant-like effects and hold promise for development of new treatments,” said Lisa Monteggia, Ph.D., of the University of Texas Southwestern Medical Center, Dallas.

Researcher Lisa Monteggia

Unlike currently available antidepressants that take weeks to work, ketamine can lift mood within hours. Yet adverse side effects preclude it from becoming a practical treatment. So, researchers have been studying its mechanism of action in hopes of developing safer alternatives that work the same way.

Earlier studies had shown that the growth factor, called brain-derived neurotrophic factor (BDNF), produces antidepressant-like effects. To find out if BDNF is involved in ketamine’s action, the researchers gave the drug to mice genetically engineered to lack BDNF. Unlike in control mice, ketamine failed to produce a fast-acting antidepressant-like response in such BDNF knockout mice exposed to experimental situations that trigger depression-like behaviors. This and other tests confirmed that ketamine’s rapid antidepressant effects depend on rapid synthesis of BDNF in the brain’s memory center, or hippocampus.

The researchers determined that this happens so quickly — within 30 minutes — because it only requires the translation of BDNFmRNA into protein, rather than transcription, which involves new gene expression and takes much longer.

Ketamine achieves this boost in BDNF levels by first blocking a protein on neurons (brain cells) called the NMDA receptor. The Texas team discovered that this blockade, in turn, deactivates an enzyme called eukaryotic elongation factor 2 (eEF2) kinase, that restrains BDNF synthesis. So, ketamine (and presumably other agents that similarly turn off the enzyme) effectively takes the brakes off of this antidepressant mechanism.

When in their default state, neurons that mediate ketamine's action engage in the brain's equivalent of background chatter. They spontaneously spray out (orange) the chemical messenger glutamate (green circles), which binds to NMDA receptors (black ovals) on adjoining neurons. This activates the enzyme eEF2 kinase, which suppresses synthesis of BDNF, a growth factor that has antidepressant effects. Treatment with ketamine blocks the binding of the neurotransmitter to the receptors (blue dots on black ovals), which inactivates the enzyme, taking the brakes off translation of BDNF into protein. This jumpstarts a fast-acting antidepressant effect. Source: Lisa Monteggia, Ph.D., University of Texas Southwestern Medical Center (click to enlarge)

“Selectively inhibiting the eEF2 kinase was sufficient to trigger a rapidly acting antidepressant response in control mice but not in mice lacking BDNF,” explained Monteggia.

The researchers discovered that the boost in BDNF occurs while neurons are in their default mode — not doing anything in particular. But the cells continue communicating via a low level of background chatter, spontaneously releasing chemical messengers that bind to receptors. So, when ketamine blocks NMDA receptors, it prevents their naturally-occurring messenger chemical, glutamate, from binding to them.

“Interference with such spontaneous neurotransmission to trigger production of a protein represents a novel mode of drug action,” Monteggia noted. “It may also hold clues to what goes awry in the brain in disorders like depression.”

Although BDNF levels fall off sharply following the transient increase triggered by ketamine, she says evidence may also support a role for BDNF in the drug’s longer-term antidepressant effects. The exact role of another enzyme implicated in ketamine’s antidepressant action remains to be determined, in light of the new findings. Yale researchers reported last Fall that the drug triggered increased connections between neurons via effects on the enzyme, called mTOR.

“This discovery of a novel pathway involved in mediating fast-acting antidepressant action holds hope for development of new rapid-acting medications,” said Monteggia.

Material adapted from NIMH.

Reference
NMDA receptor blockade at rest triggers rapid behavioural antidepressant responses. Autry AE, Adachi M, Nosyreva E, Na ES, Los MF, Cheng PF, Kavalali ET, Monteggia LM. Nature. 2011 Jun 15. doi: 10.1038/nature10130. [Epub ahead of print] PMID:21677641

In the article titled “Maternal Postnatal Depression and the Development of Depression in Offspring Up to 16 Years of Age,” Dr. Murray and her British colleagues report on 100 mothers (ranging from 18 to 42 years of age), 58 with postpartum depression, and the likelihood of their children to development depression over a 16 year period [1]. The authors identified first time mothers with depression at 2 months postpartum, along with a group of non-depressed women, and evaluated the mothers and their children at 18 months, and 5, 8, 13, and 16 years of age.

Maternal depression was assessed using the SPI at recruitment, the Schedule for Affective Disorder and Schizophrenia, and the Structured Clinical Interview for DSM-IV. At each assessment, marital conflict was assessed using a combination of interview and questionnaire tools. At 18 months, infant attachment was assessed, using a standardized observational measure of infant responses to maternal separation and reunion in an unfamiliar environment, known as Ainsworth’s Strange Situation Procedure. At 5 and 8 years, trained researchers rated the children on emotional and behavioural responses to assess their ego resilience. At 16 years, diagnostic interviews were conducted by a clinical researcher blind to maternal state using the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version (KSADs).

Murray and colleagues discovered that children of postnatally depressed mothers were at substantially increased risk for depression. In fact, offspring’s rate of depression by age 16 was more than 40% with the average age of first onset of depression at age 14. Interestingly, the researchers found that some years before the onset of depression, an associated impairment of the children’s attachment to their mother during infancy. In addition, lower child ego resilience, measured at years 5 and 8, were associated with the increased risk of depression. Marital conflict and further maternal depression that extended beyond the postnatal period were significantly associated with offspring lifetime depression.

In a related editorial in the same issue of the Journal, Dr. David Reiss observes, “The striking findings from Murray et al. emphasize the impact of maternal depression on the marital process and how important this process in the evolution of the child’s depression [2].

The researchers conclude, “The substantially raised risk for depression among offspring of postnatally depressed mothers underlines the importance of screening for PND and of delivering early interventions.”

Material adapted from Elsevier.

References / Abstract
1. Murray L, Arteche A, Fearon P, Halligan S, Goodyer I, Cooper P. Maternal Postnatal Depression and the Development of Depression in Offspring Up to 16 Years of Age. Journal of the American Academy of Child and Adolescent Psychiatry. 2011;50(5):460– 470.

2. Reiss D. Parents and Children: Linked by Psychopathology but Not by Clinical Care. Journal of the American Academy of Child and Adolescent Psychiatry. 2011; 50(5):431-434.