Depression, current research

Adolescent depression treatments comparable in efficacy, cost

(Source: Healio Psychiatric Annals 8.12.2016)

To assess efficacy and costs of psychological therapies for maintenance of reduced depression symptoms in adolescents, researchers conducted a multicenter, pragmatic, observer-blind, randomized controlled superiority trial at 15 clinics in England. Adolescents, aged 11 to 17 years, with DSM-IV major depressive disorder (MDD) were randomly assigned to receive cognitive behavioral therapy (n = 155), short-term psychoanalytical therapy (n = 157) or a reference brief psychological intervention (n = 158).  The average duration of treatment did not differ between treatment groups. The depressive symptoms did not significantly differ between adolescents who received CBT or short-term psychoanalytical therapy at weeks 36, 52 or 86. At those weeks CBT and short-term psychoanalytical therapy had no superiority effect compared with the brief psychosocial intervention. Total costs did not significantly differ between treatment groups. The majority of teenagers can benefit from these psychotherapeutic treatments and protect them from future severe depressive episodes.

…..

Depression in Pregnancy May ‘Age’ Children’s Brains, Source: Medscape 21.11. 2016

The investigators studied 52 women for whom Edinburgh Postnatal Depression Scale (EPDS) scores were available during each trimester of pregnancy and at 3 months postpartum. Their children underwent MRI at age 2.6 to 5.1 years.

It has been examined associations between maternal depressive symptoms and MRI measures of cortical thickness and white matter structure in the children.

The study shows that cortical thickness in two areas of the right hemisphere was negatively correlated with second trimester maternal depressive symptoms, after controlling for the child’s age, sex, gestational age, and weight at birth, as well as maternal postsecondary education.

One region was located in the right inferior frontal area and included much of the pars opercularis and pars triangularis and small sections of the precentral and rostral middle frontal areas.The other region was located in the middle and superior temporal regions and included small sections of the inferior temporal and supramarginal areas.

Correlations with second trimester EPDS scores remained strong after controlling for postpartum EPDS scores. Depressive symptoms during the first and third trimesters were not significantly related to cortical thickness.

These types of changes suggest that the children whose mothers were more depressed have a more mature pattern of brain structure. Their gray matter was thinner. It looks like the kids whose mums were more depressed have this premature pattern of brain structure, almost like their brains are developing too soon.

Brain development is obviously a complicated process, and there is very likely a narrow window for an optimal time for stages of development to occur. The findings indicate that with brains developing almost a little bit too soon, these children are losing flexibility and adaptability that other kids might have.

There is a lot of focus on postpartum depression, but prenatal depression exists, and it is actually quite common, and as has been shown it is actually associated with children’s brain structures.

Critical Time

Accumulating evidence suggests that psychopathology may start even earlier than is commonly acknowledged, and some psychiatric illnesses may need to be redefined as neurodevelopmental disorders.

Prenatal stress can lead to pathology via various mechanisms, including oxidative damage and epigenetics. A more thorough understanding of these and other mechanisms may lead to unique therapies that can either reverse the damage of prenatal stressors or prevent the damage altogether.

Depression is undertreated condition. Only about one third of people who are depressed ever receive a diagnosis of depression, and only about a third of people who receive a diagnosis get the treatment that they need..

Major Public Health Concern

In the western societies roughly 1 in 5 people will meet diagnostic criteria for depression in their lifetime. The prevalence of depression in women, overall, is double that of men. Among women who are pregnant Given birth recently increases the rate of depression to roughly four times the rate of depression in men. These statistics suggest that undiagnosed and untreated depression among pregnant women is very common and is a significant public health concern.

Medical attention has focused on depression during pregnancy and the postpartum period with the aim of alleviating the suffering of mothers and helping them care for their new babies and to function more effectively in their families and in their jobs. We have not considered the impact of maternal depression on the development of the baby.

This new study of 52 women and their offspring suggests that the greater severity of depression in the third trimester and the postpartum period is associated with thinning of the cerebral cortex in MRI scans in some of the most highly evolved regions of the brain, including the frontal and temporal cortex. These are brain regions that support higher cognitive and social and emotional functions. Other studies suggest that cortical thinning may in some cases be associated with aspects of cognitive function. The study findings raise the possibility that untreated or ineffectively treated depression affected the development of the brain.

This new study suggests that the risk of developmental impact of maternal antidepressant medications must be weighed against the potential developmental impact of ineffectively treated maternal depression for the offspring.

There are many forms of treatment for mood disorders that carry limited developmental risk for babies, including psychotherapy or antidepressant medications that have very little developmental impact.

…..

Age, Education, Health Status Predict Depression Risk in Women with Diabetes

(Source: HCPLive, 17.11.2016)

Prior studies have shown that adults with diabetes are more prone to depression than the population at large. A 2001 meta-analysis that appeared in Diabetes Care combined results from 20 prior studies that compared depression rates in diabetic and nondiabetic subjects and found that people with diabetes were about twice as likely to be depressed (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). That same meta-analysis found that roughly 28% of diabetic women had suffered comorbid depression, while only 18% of diabetic men did. (Women without diabetes are similarly more prone to depression than men without diabetes.)

“Both clinicians and epidemiologists can expect individuals with diabetes to be twice as likely to be depressed than otherwise similar nondiabetic individuals in similar settings (i.e., individuals selected by similar procedures, of the same sex, and assessed with comparable depression assessment methods),” the authors of the meta-analysis wrote.

“The complex interactions of physical, psychological, and genetic factors that contribute to this association (between diabetes and depression) remain uncertain. Depression may occur secondary to the hardships of advancing diabetes or to diabetes-related abnormalities in neurohormonal or neurotransmitter function. On the other hand, evidence from prospective studies in the U.S. and Japan indicates that depression doubles the risk of incident type 2 diabetes independent of its association with other risk factors.”

….

Depression a Growing, Deadly Threat for Teens, Young Adults

(Source: Medscape, 15.11.2016)

Female adolescents appear most vulnerable for major depression. Coupled with “little change” in mental health treatments, a growing number of young people have untreated depression.

Among those aged 12 to 17 years, the 12-month prevalence of major depressive episodes (MDEs) jumped 37% from 8.7% in 2005 to 11.3% in 2014.

“This aligns with past studies that also found a larger increase in depressive symptoms in girls than boys in more recent years, and recent data on trends in suicide in the United States that identified a greater increase among adolescent girls and young women,” Dr Mojtabai and colleagues say.

The increase in the prevalence of MDE was more modest among young adults aged 18 to 25 years, rising from 8.8% in 2005 to 9.6% in 2014.

Demographic data show that among 12- to 17-year-olds, those with MDE are more apt to be older, not in school, and living in single-parent homes and to have substance use disorders in comparison with their peers without MDE. Among young adults aged 18 to 25 years, those with MDE are more likely to be female, black, and have a substance use disorder. The trends remained significant after adjustment for substance use disorders and sociodemographic factors.

As for treatment, the proportion of adolescents with MDE who received mental health counseling or treatment in the past 12 months for their depression from any type of healthcare provider did not change significantly between 2005 and 2014, the researchers report.

However, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.

Nonetheless, the researchers note that the “growing number of depressed adolescents and young adults who do not receive any mental health treatment for their MDE calls for renewed outreach efforts, especially in school and college health and counseling services and pediatric practices where many of the untreated adolescents and young adults with depression may be detected and managed.”

Deadly Threat

“Depression is a sizeable and growing deadly threat to our US adolescent population. The prioritization of youth depression treatment of our US population health is imperative,” write Anne Glowinski, MD, and Giuseppe D’Amelio, of Washington University in St. Louis, Missouri.

They add that the causes behind the rise in adolescent depression should be investigated scientifically.

They also note that despite the “disturbing” rise in depression among adolescents, the percentage of young people with a history of past-year MDE seen in primary care for depression is only about 10% “and has not appreciably budged in the past decade.”

Since 2007, the American Academy of Pediatrics has recommended that clinicians routinely screen youth aged 11 to 21 for depression. “Sadly, even if this important update influences primary care providers to screen more youth, there will never be enough qualified mental health specialists to take care of the 2.8 million or more adolescents per year, who, if screened and identified, will need treatment and monitoring for depression,” Dr Glowinski and D’Amelio note.

….

Few Adults with Depression Receive Treatment

(Source: HCP Live, 12.10.2016)

Among adults who receive depression care, it is important to align patients with appropriate treatments and health care professionals. With dissemination of integrated care models, opportunities exist to promote depression care that is neither too intensive nor insufficient for each patient’s clinical needs.

Researchers from Columbia University Medical Center analyzed treatment data for approximately 46,000 adults between 2012 and 2013 to characterize the treatment of adult depression. Some of the variables included: depressive symptoms, serious psychological distress, treatment with antidepressants and psychotherapy, health care professionals providing treatment, and age, gender, race, education, marital status, income, and health insurance.

The researchers noted that although antidepressant use has increased in the country, people are still apprehensive that many adults with depression are still not receiving adequate treatment. In some cases, adults receive treatment that does not match the severity of their disease.

Among the 46,000 adults who were screened, about 8.4% had depression; a quarter of those patients received any depression treatment. Of all the patients treated with depression, nearly a third (29.9%) had screened positive for depression, while 21% had serious psychological distress.

Greater clinical focus is needed on depression severity to align depression care with each patient’s needs. These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient.

Adults with depression were more likely to receive care from psychiatrists or other mental health specialists if they had serious compared to less serious psychological distress, the researchers also reported. These adults were also more likely to receive psychotherapy, but not antidepressant medications.

“With the increase in antidepressant use over the last several years, it may come as a surprise to learn that widespread challenges persist in accessing depression care,” Olfson added in the statement. “There are also challenges in connecting depressed patients to the appropriate level of care.”

There were also differences in treatment among the patients, which the investigators categorized into groups by age. In adults with serious psychological distress, the statement continued, four times as many younger adults had psychotherapy and antidepressants than older adults. Additionally, two times as many college-educated adults with depression received both psychotherapy and antidepressants than adults with only a high school education.
….

Nighttime Hot Flashes Linked to Depression in Menopause 

(Source Medpagetoday by Alexandria Bachert 28.09.2016)

Sleep disruption and perceived nighttime hot flashes trigger mild symptoms of depression during menopause. The worsening of mood was predicted by factor such as reductions in perceived sleep efficiency and the number of nighttime hot flashes, but not the number of daytime hot flashes.

“The findings also show that it is not just the sleep problem related to the nighttime flashes that is linked with the mood problem. Rather, both nighttime hot flashes and sleep problems are of concern.”

The study included 29 healthy premenopausal women, ages 18 to 45, who reported no hot flashes, sleep disorders, or psychiatric illnesses. All women received a one-time dose of intramuscular leuprolide at 3.75 mg/day to rapidly induce hypoestrogenism and maintain ovarian suppression for the study period.

Depressive symptoms (using the Montgomery Åsberg Depression Rating Scale and the Beck Depression Inventory), sleep parameters (using two ambulatory polysomnography studies), subjective sleep quality, serum estradiol, and hot flashes were assessed both at baseline and after 4 weeks. Additionally, all women used a diary to record their hot flashes twice a day over the 4-week period — once in the morning to document the nighttime hot flashes and once in the evening to document the daytime flashes.

Some used an experimental model, rather than a naturalistic approach, in order to precisely assess the sequence of symptom onset.

The common menopausal ‘brain’ symptoms of hot flashes, sleep disturbance, and depressive symptoms often present together, and it is hard to know which came first and which problem may be contributing to the other in naturalistic studies. This approach also enables us to subtract out each women’s own baseline sleep and mood patterns in order to isolate the effect of hot flashes on sleep and mood.

Women who reported having frequent nocturnal hot flashes were more likely to have mild symptoms of depression than those who reported fewer or no nocturnal hot flashes. Additionally, it was nighttime hot flashes, not those in the daytime, that were linked to depressive symptoms.

The researchers said, was the importance of screening for mood disturbances during the menopausal transition and early menopause. The study provides specific information to women and clinicians about the importance of treating nighttime hot flashes/night sweats as part of the approach to improving mood disturbance in this population

A further research is warranted, and ideally with a larger study. “One of the next types of studies to be done is what treatments are most effective in reducing hot flashes and improving sleep quality. It could look at the comparative effects of hormonal and nonhormonal therapies on nighttime hot flashes and poor sleep quality, as well as the depressive symptoms.

….

Researchers Confront an Epidemic of Loneliness

(Source The New York Times 05.09.2016)

Loneliness, which Emily Dickinson described as “the Horror not to be surveyed,” is a quiet devastation. But in Britain, it is increasingly being viewed as something more: a serious public health issue deserving of public funds and national attention.

Working with local governments and the National Health Service, programs aimed at mitigating loneliness have sprung up in dozens of cities and towns. Even fire brigades have been trained to inspect homes not just for fire safety but for signs of social isolation.

An explosion of public awareness from local authorities to the Department of Health to the media,” said Paul Cann, chief executive of Age UK Oxfordshire and a founder of The Campaign to End Loneliness, a five-year-old group based in London. “Loneliness has to be everybody’s business.”

Loneliness is an aversive signal much like thirst, hunger or pain. Denying you feel lonely makes no more sense than denying you feel hunger. “Lonely” carries a negative connotation, it is signaling social weakness, or an inability to stand on one’s own.

The unspoken stigma of loneliness is amply evident during calls to The Silver Line. Most people call asking for advice on, say, roasting a turkey. Many call more than once a day. One woman rings every hour to ask the time. Only rarely will someone speak frankly about loneliness.

Silver Line workers leave it up to the caller to mention whether they are feeling lonely. Still, the advisers are trained to listen for signs of unhappy isolation, and gently lead the conversation accordingly, perhaps offering to link the caller to a Silver Line Friend, a volunteer who makes weekly phone calls or writes letters to those who request it.

Sophie Andrews, chief executive of The Silver Line, said she was surprised by the explosion of calls shortly after the service began operating nearly three years ago. The Blackpool call center now receives some 1,500 calls a day. Ms. Andrews said she was most concerned not about those who called The Silver Line, but those who were too depressed by their isolation to pick up the phone. They need to raise awareness with the people who are the hardest to reach.

The problem of loneliness is nuanced and the solutions not as obvious as they might seem. That is, a call-in line can help reduce feelings of loneliness temporarily, but is not likely to reduce levels of chronic loneliness. It also affects several key bodily functions, at least in part through overstimulation of the body’s stress response. Chronic loneliness, his work has shown, is associated with increased levels of cortisol, a major stress hormone, as well as higher vascular resistance, which can raise blood pressure and decrease blood flow to vital organs. Research shows that the danger signals activated in the brain by loneliness affect the production of white blood cells; this can impair the immune system’s ability to fight infections. It is only in the past several years that loneliness has been examined through a medical, rather than psychological or sociological, lens. Dr. Perissinotto, the University of California, San Francisco geriatrician, decided to study loneliness when she began to sense there were factors affecting her patients’ health that she was failing to capture.

Using data from a large national survey of older adults, in 2012 Dr. Perissinotto analyzed the relationship between self-reported loneliness and health outcomes in people older than 60. Of 1,604 participants in the study, 43 percent reported feelings of loneliness, and these individuals had significantly higher rates of declining mobility, difficulty in performing routine daily activities, and death during six years of follow-up. The association of loneliness with mortality remained significant even after adjusting for age, economic status, depression and other common health problems.

….

Many with depression have something else in common 

(Source: CBS NEWS, 29.08.2016)

The onset of depression is so insidious and often times it’s not identified until it’s serious. Treatment usually includes psychotherapy and sometimes medication.

There are many reasons people who are depressed don’t receive treatment. Some adults who experience depressive symptoms don’t believe that they are significant and that they don’t need medical attention, or that they can in any way are helped. For others, the reason they shy away from treatment for depression could be related to stigma or shame.

Discussing treatment for depression can take a back seat. It’s difficult for a primary care doctor to address everything in the short timeframe they usually have to see patients. Many times depression comes along with those very same medical conditions.

The researchers found that among patients who did receive treatment, antidepressants were by far the most common approach, with 87 percent being prescribed such drugs. Psychotherapy came in second, with nearly a quarter of patients getting therapy. Men with depression were less likely to get treatment than women.

Even when patients are open to getting help for their depression, challenges can stand in the way. Some parts of the country, for example, don’t have enough mental health professionals to meet the demand. In different kinds of medical services, the very hardest ones to refer to are mental health services. Patients who are going to primary care doctors are not getting referred for treatment.  Another factor standing in the way of treatment is that it can be hard for someone with depression to motivate and find a mental health provider. Then a lack of motivation and apathy interfere.

….

Prenatal depression may be the most severe form of maternal depression

(Source: The Washington Post News 29.08.2016)

Pregnancy is supposed to be one of the happiest times of a woman’s life, but for many women this is a time of fear, stress, confusion and a constant stream of worries through their mind.

Postpartum depression (PPD), the mental health disorder that affects up to 20 percent of new mothers but there are many women who may not be aware that depression often begins during pregnancy, not just after giving birth. Similar to postpartum depression, prenatal depression is accompanied by feelings of worry, sadness and anxiety. Some unique symptoms as well, which is why researchers at Northwestern University are raising awareness by informing women and their doctors about the signs of pregnancy-related depression. Results from their recent study suggest that such women who develop depression before or during their pregnancies suffer from a more severe version of this mental-health concern and experience more intense feelings of sadness, along with sleep concerns and, in rare instances, paranoia. These women are often juggling a multitude of life stressors, such as pregnancy complications, as well as family and financial stress. In many instances, they struggled with depression or anxiety before they became pregnant.

The U.S. Preventive Services Task Force recommended that all expectant and new mothers receive maternal mental-health screenings, yet many women continue to fall through the cracks of the health-care system. Often, it’s not until after the birth of their babies that these women receive the mental-health treatment that they needed during pregnancy. It’s important to recognize that the symptoms of prenatal and postpartum depression vary for each woman.

Sometimes, individual therapy is not enough to help women suffering from prenatal depression. It’s also important for each pregnant woman to have a postpartum team of care providers and that all expectant mothers join a pregnancy support group so that they can connect with their peers as they prepare for the path to motherhood.

Wendy Davis, director of Postpartum Support International, echoes these sentiments.“It’s important for each and every woman to know that she’s never to blame, and with help, she will feel better.”

….

Prenatal depression may be the most severe form of maternal depression

(Source: The Washington Post News 29.08.2016)

Pregnancy is supposed to be one of the happiest times of a woman’s life, but for many women this is a time of fear, stress, confusion and a constant stream of worries through their mind.

Postpartum depression (PPD), the mental health disorder that affects up to 20 percent of new mothers but there are many women who may not be aware that depression often begins during pregnancy, not just after giving birth. Similar to postpartum depression, prenatal depression is accompanied by feelings of worry, sadness and anxiety. Some unique symptoms as well, which is why researchers at Northwestern University are raising awareness by informing women and their doctors about the signs of pregnancy-related depression. Results from their recent study suggest that such women who develop depression before or during their pregnancies suffer from a more severe version of this mental-health concern and experience more intense feelings of sadness, along with sleep concerns and, in rare instances, paranoia. These women are often juggling a multitude of life stressors, such as pregnancy complications, as well as family and financial stress. In many instances, they struggled with depression or anxiety before they became pregnant.

The U.S. Preventive Services Task Force recommended that all expectant and new mothers receive maternal mental-health screenings, yet many women continue to fall through the cracks of the health-care system. Often, it’s not until after the birth of their babies that these women receive the mental-health treatment that they needed during pregnancy. It’s important to recognize that the symptoms of prenatal and postpartum depression vary for each woman.

Sometimes, individual therapy is not enough to help women suffering from prenatal depression. It’s also important for each pregnant woman to have a postpartum team of care providers and that all expectant mothers join a pregnancy support group so that they can connect with their peers as they prepare for the path to motherhood.

Wendy Davis, director of Postpartum Support International, echoes these sentiments. “It’s important for each and every woman to know that she’s never to blame, and with help, she will feel better.”

….

Depression Can Stalk Families through Generations 

(Source: HealthDay News; 10.08.2016)

People whose parents and grandparents suffered from depression are at much higher risk of developing the illness, a new study suggests. The research found that if a person’s grandparent and parent each had depression, their own odds for the disorder tripled.

“In this study, biological offspring with two previous generations affected with major depression were at highest risk for major depression,” concluded a team led by Myrna Weissman of Columbia University and the New York State Psychiatric Institute, in New York City. Depression is never inevitable, even for members of families with a history of the disease.

Dr. Jeffrey Borenstein, president of the Brain & Behavior Research Foundation in New York City, said that take-home message is that “people should be aware of their family history and immediately seek help if they are experiencing symptoms, since depression is very treatable.”

The study involved 251 young people averaging 18 years of age, plus their parents and grandparents. Compared to young people whose parents did not have depression, those whose parents had major depression were twice as likely to develop the same illness, and were also at higher risk for disruptive disorder, addiction, suicidal thoughts and attempts, and poorer functioning.

Dr. Victor Fornari directs child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y. He said the new research is important because, “no prior study to date has demonstrated the impact of the family history of depression in both the parents and the grandparents with direct interviews of the three generations.”

….

Metabolic Problems in The Brain May Help

(Source: American Journal of Psychiatry, 14.08.2016)

For the second cause of disability worldwide, we know strangely little about how depression works, and what goings-on in the brain actually underlie it. A fascinating new study lends some further insight, however, finding that certain metabolic glitches may explain at least some forms of treatment-resistant depression. Abnormalities in how the brain processes chemicals would affect the synthesis of neurotransmitters, which, if off kilter, could lead to depression that’s resistant to the usual meds. So the new study, published in the American Journal of Psychiatry, points to some interesting new avenues for depression. It also underscores the very physical nature of depression, which should go a long way in reducing the lingering stigma.

The study started out with the story of a young man who had severe depression for many years and had attempted suicide several times. Lisa Pan a study author and psychiatrist had treated the patient for years and other adolescents to young adults at risk for suicide. She was also in the lab, doing neuroimaging to see if she could find markers for suicide risk in the brain and tried every medicine available on the patient. Even ECT treatments only worked for a week.

In accordance to the patient brain chemistry, he had a deficiency in a chemical called biopterin in his cerebrospinal fluid (CSF), which is involved in synthesizing certain neurotransmitters, serotonin and dopamine. So Pan treated the patient with a biopterin analogue until the symptoms disappeared.

In conclusion, people with treatment-resistant depression would have a greater likelihood for this kind of metabolic abnormality than people without depression. In 33 people with treatment-resistant depression and found various metabolic issues in the CSF of 21 vs. none in the control group. When the depressed participants were treated for the specific metabolic deficiency their symptoms improved. Some even experienced total remission from depression.

Right now, the disorder, when treated with medicines, is often treated in a trial-and-error manner. But studies like this one may lead to a more personalized method for treating depression: a detailed individual analysis will be done on a patient, to figure out which type of medication or medicine may be uniquely beneficial.

The competing theories of depression are that the brain doesn’t produce or use serotonin effectively, and the more recent one, that depression is a product of inflammation in the brain. It directly affects the body’s ability to make serotonin–not necessarily reuptake, but reuptake may not be effective if there is an inability to make serotonin and many of the inflammatory models also show direct biochemical effects on serotonin metabolism.

According to Pan, “the study calls out the physiologic nature of the disorder and found clear biologic indicators that this is a medical illness and should go a long way in reducing the stigma. And now, we have some evidence that people really do improve with these treatments.”

….

Determining Onset Timing of Postpartum Depression May Lead to Improvements in Treatment (Source:American Psychiatric Association; 01.08.2016)

The women were screened using the Structured Clinical Interview for DSM-IV (SCID) for Axis I Disorders and the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms (SIGH-ADS), a comprehensive assessment that looks at 21 typical and eight atypical depressive symptoms. Of these 29 symptoms, four (difficulty falling asleep, hypersomnia, paranoia, and obsessive-compulsive traits) were substantially different between the groups. The study participants were given a comprehensive clinical assessment to categorize all their symptoms and identify the depression onset date. The assessment revealed that 25 percent of the women developed depression before pregnancy, 37 percent during pregnancy, and 38 percent after the birth of their child; 75 percent of the women were diagnosed with unipolar depression and 25 percent had bipolar depression.

Women who had depression before pregnancy were likely to have experienced paranoia, insomnia, or hypersomnia during the course of illness. Obsessive-compulsive symptoms were most pronounced in women who developed depression in the postpartum period. Postpartum depression is often tied to concerns over the health and safety of the newborn child. Agitation was significantly higher in women who received a bipolar diagnosis, regardless of onset time.

The study implied that “clinicians cannot just look at total scores when trying to diagnose the onset of depression in a postpartum woman,” Fisher told Psychiatric News.

“The differentiation of chronic, semi-acute, and acute depression reveals the vulnerability and resiliency of the depression identified in the postpartum,” Fisher and colleagues wrote. “A comprehensive assessment of onset timing, typical and atypical symptoms, and unipolar versus bipolar disorder is recommended to improve the effectiveness of postpartum treatment.”

….

Updates in Women’s Health: Psychopharmacologic Approaches in the Perinatal Period: Mood Stabilizers and Antipsychotics (Source: American Psychiatric Association; 01.08.2016)

Psychiatric disorders during pregnancy and the postpartum period are common and as such, psychiatrists are often asked to evaluate and treat pregnant and postpartum women.

Unfortunately, psychiatrists often do not feel well-equipped to manage treatment of perinatal patients, especially with the use of mood stabilizers and antipsychotics due to the concerns about the potential impact of medications on the fetus, pregnancy and delivery itself, and/or lactation. Managing Bipolar disorders is most difficult especially when pregnancy is unplanned. There is a high risk for recurrence of Bipolar disorder during pregnancy when abrupt discontinuation of medication is implemented. Thus, careful study about psychopharmacologic approaches in the perinatal period is of extreme importance.

The mood stabilizers are the first choice in the treatment of Bipolar and Schizoaffective disorders in man and women. However in pregnancy these medications possess several neonatal risks.

In the First-Generation Antipsychotics, there are no patterns of malformation noted, while in the Second-Generation Antipsychotics, there are reports of short-term delays in cognitive, motor, social-emotional and adaptive behavior development.

With the overview of the use of mood stabilizers and antipsychotics, Preconception planning must be taken in consideration because a severe Postpartum Depression, especially those with psychotic features or a manic episode of Bipolar Disorderare a true psychiatric emergencis. During the entire course of treatment, Documentation plays an important role in updating and monitoring the situation of every patient.

…..

Study documents unexpected links in timing, severity of maternal depression symptoms (Source: The Lancet Psychiatry, 03.02.2015)

A study published in the January issue of The Lancet Psychiatry has documented unexpected links in the timing and severity of symptoms of maternal depression, which could help mothers and doctors better anticipate and treat the condition. After following some 8,200 women from 19 centers in seven countries, researchers found that in women with the severest symptoms — suicidal thoughts, panic, frequent crying — depression most often began during pregnancy, not after giving birth, as is often assumed. Women with moderate depression, however, often developed their symptoms postpartum, and were more likely than severely depressed women to have experienced complications during pregnancy like pre-eclampsia, gestational diabetes or hypertension.

….

Depression Should Be Listed as Heart Disease Risk, Says AHA Panel

(Source: Clinical and Research News, Vabren Watts, 10.10.2014)

The American Heart Association’s new recommendation illustrates the continuing progress in integrating mental health care with general medical care. “The AHA recommendation emphasizes that depression is a whole-body illness. This is very important to consider in terms of future reimbursements for treating depression. It’s not just treating a mental health condition; it’s also reducing the risk of heart disease.”

Darrel Regier, M.D., former APA director of research, discusses APA’s involvement with the AHA’s recommendation to consider depression as a major risk factor for heart disease.  Despite publication of numerous studies and meta-analyses showing a link between depression and cardiovascular disease, the American Heart Association (AHA) has yet to formally recognize depression as a risk factor for a poor prognosis in patients with heart disease.

On March 25 in the journal Circulation, a statement was issued by the AHA in response to a systemic literature review, which could lead to depression being considered as a major risk factor in heart disease among adults in the United States.

“Many studies have found that depression predicts increased mortality [for patients with heart disease],” Robert Carney, Ph.D., a panel member and a professor of psychiatry at Washington University School of Medicine, stated during an interview with Washington University BioMed Radio. “But this was the first time that it was formally done, in this way, by the American Heart Association.”

“There is growing recognition among cardiologists that psychosocial factors are associated with [negative cardiac] outcomes,” commented Judith Lichtman, Ph.D., M.P.H., lead author and cochair of the National AHA Writing Committee. Lichtman, who is an associate professor at the Yale School of Public Health, said that the goal of the panel was to review studies to evaluate the evidence linking the risk of depression on outcomes for patients with CHD.

After years of evaluating the selected studies, the panel issued the following scientific statement: “Our review identified heterogeneity in the published findings from these studies in terms of the demographic composition of the samples, the definition and measurement of depression, [and] the length of follow-up. Despite this heterogeneity, the preponderance of evidence supports the recommendation that the AHA should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.”

….

The Perfect Marriage:  Science Begins to Explain Why Antidepressants and Talk

(Source American Journal of Psychiatry, 26.12.2011)

Antidepressants have been used for years to treat mood disorders like depression and anxiety, and we’re relying on them more and more as the go-to treatment. This being the case, researchers know oddly little about how they work – or, more specifically, why they work. Another mystery is why when paired together, antidepressants and talk therapy are so much more effective than either method alone. Now, a new study may explain why the marriage is so successful.

What we do know about how antidepressants function is that they help increase the amount of neurotransmitter between nerve cells. The problem is it that this doesn’t necessarily translate into the behavioral changes that can follow. Some newer evidence has suggested that depression is linked to brain inflammation and/or the destruction of neurons, and that the reason that antidepressants (and exercise, for that matter) work is that they foster the growth of new nerve cells.

According to a new study, antidepressants may indeed set the brain back to a more “plastic” or youthful state, so that the stage is set for talk therapy to work its magic.

The researchers looked at how the antidepressant drug fluoxetine (Prozac®) affected the stress responses of mice. It’s been believed for some time that fluoxetine may make certain parts of the brain more plastic, so the researchers wagered that the drug may also affect areas of the brain important in learning about stressful and non-stressful situations.

To test this idea in mice, first the researchers paired a tone with a painful shock to the feet (a la Pavlov). It doesn’t take many trials for mice to freeze whenever they hear the tone alone, in expectation of a shock; and these mice did just that.

But after this pairing, the researchers set out to “extinguish” the link by playing the tone without the shock. Adult mice are notoriously poor at unlearning the connection once it’s formed: even if they stop reacting to it somewhat, just one more pairing can send them right back into freeze mode. Young mice, on the other hand, are much more adaptable to this extinction training, and have almost no trouble unlearning the association.

As the researchers suspected, mice who were given fluoxetine during extinction behaved much more like young mice, in the ease with which they stopped reacting to the tone. And when they were reintroduced to the shock later on, they weren’t so quick to fall back on their previously stressed behavior. On the other hand, mice who were not given fluoxetine “renewed” their fear response much more quickly upon getting shocked again.

So, if adult mice given fluoxetine behave more like young mice in how quickly they can learn and unlearn new relationships in their environment, what’s going on the brain to explain these behavioral changes?

The brains of the mice who were treated with fluoxetine also looked “younger,” particularly in the cells in their amygdalas, the area of the brain that governs the fear response. One type of cell-adhesion molecule, normally expressed in younger cortical neurons, was more abundant in the mice who had been given fluoxetine. And a protein that normally increases as an animal ages existed in lower levels in the fluoxetine-treated mice. Other changes also indicated that the fluoxetine-treated brain had taken on a “development-like plasticity.”

If the mouse brain is acting like it’s younger, more plastic, more open to new experiences when it’s bathed in antidepressants, what does this mean for human beings battling depression? It could mean that antidepressants help set up the brain to be more receptive to the changes that psychotherapy can bring about. A more youthful-acting brain could be more sensitive to the methods used in therapy: learning new ways to cope, dealing with stressors, and instituting new thought patterns could take root more easily in a more plastic brain.

This study is important since it’s really the first to take a stab at an explanation for why drug-psychotherapy combo is more effective than either method alone. Theoretically, the explanation makes a lot of sense, but more research will need to be done to explore the mechanism more fully – especially in humans.

Concerns have long been raised about why antidepressants don’t work in some people or actually have a negative effect, as well their efficacy compared to placebo and the higher likelihood of relapse that is associated with them. Understanding more about how antidepressants work in the brain is critical, given the number of people on them, and the fact that there are so many unanswered questions about them.