Recurrent Depression

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Psychostimulants for depression: study
1970-01-01 00:59:00
Depression is a common (Singleton 2001), disabling (Spitzer 1995; Cassano 2002), costly (Murray 1997; Thomas 2003) and under-treated condition (Singleton 2001; Bebbington 2000; Demyttenaere 2004; Wang 2005). The health burden of depression is recognised by the World Health Organisation (WHO) and several national programme objectives in individual European states as a priority for health in the 21st century. Depression is characterised by depressed mood or loss of interest or pleasure in nearly all activities in the presence of other symptoms such as loss of appetite, fatigue and lack of energy, sleep disturbance, restlessness or irritability, feelings of worthlessness or inappropriate guilt, difficulty thinking, concentrating or making decisions and thoughts of death or suicide or attempts at suicide (APA 2005). Only about 30% to 40% of people in the community who meet diagnostic criteria for depression receive any form of medical or psychological treatment (Singleton 2001; Lin 1...
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AstraZeneca?s Seroquel XR effective in depression
1970-01-01 00:59:00
AstraZeneca Plc?s extended release version of its blockbuster schizophrenia drug Seroquel has proved effective in treating depression, the company said on Wednesday, opening up a potential new market for the product. Clinical data showed patients with major depressive disorder and generalised anxiety disorder who received Seroquel XR once daily experienced significant reductions in symptom severity compared with those on placebo in each of three trials.
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Mental health facility expands
1970-01-01 00:59:00
According to the National Institute of Mental Heal th , 1 in 4 Americans age 18 or older suffer from a diagnosable mental health disorder each year. 90% will recover or improve greatly with proper care from a mental health professional. Mid-Hudson residents dealing with life?s challenges can find the professional care they want at East Orange Psychiatric Associates, LLP (EOPA). Todd Rochman, MD, Medical Director of EOPA, along with Wendy Affron, LCSW, and their associates: Carol Pucek, NPP, Joan Kaplan, LCSW, Ingrid Anderson, LCSW and George Toth, LCSW, are proud to announce the expansion and relocation of East Orange Psychiatric Associates, LLP in Newburgh, New York.
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Low B12 tied to faster mental decline with age
1970-01-01 00:59:00
Low levels of vitamin B12 could speed mental decline in older people, a new study suggests. Among a group of men and women aged 65 and older, those whose levels of two B12 activity markers indicated higher blood levels of the vitamin had a slower drop-off in cognitive function over 10 years than their peers, researchers found. 
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Psychiatric Advance Directives: Controversies, Benefits
1970-01-01 00:59:00
In theory, psychiatric advance directives provide a way to improve medical decision making during a mental health crisis. Dire ctives indicate, in advance, what treatments a patient prefers or who should make decisions if he or she becomes incapacitated. However, two key controversies surround these directives, reports the December 2007 issue of the Harvard Mental Health Letter. Psychiatric advance directives differ from general advance care directives in two ways. First, general directives dictate decisions about end-of-life treatments that the patient has never actually experienced. In contrast, psychiatric patients are generally dealing with chronic illnesses and have experience with the treatments. Second, the goal of a general advance care directive is to help life end in comfort; the goal of a psychiatric advance directive is to maximize the chances of recovery, while minimizing unwanted interventions.
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Could Fresno mom who killed baby have suffered it?
1970-01-01 00:59:00
Giving birth is not always a joyous occasion. Health experts say childbirth can trigger negative emotions that women are not expecting and are not prepared to handle. While they won?t comment specifically about a Fresno mother accused of drowning her 7-month-old baby in a bathtub on Christmas Eve, they say depression, anxiety, obsessive-compulsive thoughts, and very rarely a condition known as postpartum psychosis?a dangerous break from reality?can follow childbirth.
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Bright Light Therapy Eases Bipolar Depression For Some
1970-01-01 00:59:00
Bright light therapy can ease bipolar depression in some patients, according to a study published in the journal Bipolar Disorders. Researchers from the University of Pittsburgh School of Medicine?s Western Psychiatric Institute and Clinic studied nine women with bipolar disorder to examine the effects of light therapy in the morning or at midday on mood symptoms. ?There are limited effective treatments for the depressive phase of bipolar disorder,? said Dorothy Sit, M.D., assistant professor of psychiatry and the study?s first author. ?While there are treatments that are effective for mania, the major problem is the depression, which can linger so long that it never really goes away.?
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Selective serotonin reuptake inhibitor discontinuation syndrome: a randomiz
1970-01-01 00:59:00
Recent reports describe discontinuation-emergent adverse events upon cessation of selective serotonin reuptake inhibitors including dizziness, insomnia, nervousness, nausea, and agitation. We hypothesized that interruption of fluoxetine treatment would be associated with fewer discontinuation-emergent adverse events than interruption of sertraline or paroxetine treatment, based on fluoxetine?s longer half-life. In this 4-week study, 242 patients with remitted depression receiving maintenance therapy with open-label fluoxetine, sertraline, or paroxetine for 4?24 months had their maintenance therapy interrupted with double-blind placebo substitution for 5?8 days. The Symptom Questionnaire (SQ), the Discontinuation-Emergent Signs and Symptoms checklist, the 28-item Hamilton Depression Rating Scale, and the Montgomery?Asberg Depression Rating Scale were used to assess somatic distress and stability of antidepressant response.
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Online site run by doctors offers relief for those suffering from depressio
1970-01-01 00:59:00
Sam Ozersky?s voice still rings with incredulity when he talks about the American study that changed his thinking about treating patients with mood disorders. The 1996 study compared two groups of 300 people being treated for depression by their family doctors. Doctors with one group were given a short depression treatment program that included counselling to improve medication adherence and behavioural treatment to increase the use of coping strategies.
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Delirium following abrupt discontinuation of fluoxetine
1970-01-01 00:59:00
Sudden discontinuation of serotonin reuptake inhibitors (SRI) can lead to a number of psychological (e.g., nervousness, anxiety, crying spells, psychomotor agitation, irritability, depersonalization, decreased mood, memory disturbances, confusion, decreased concentration, and/or slowed thinking) and somatic (e.g., nausea, dizziness, headache) symptoms. Recent studies have shown that withdrawal symptoms are common with paroxetine, venlafaxine and fluvoxamine, but relatively rare and mild with fluoxetine cessation, likely as a result of its longer half-life. We report an unusual case of a patient who developed delirium after abrupt discontinuation of fluoxetine.
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Synosia completes clinical study of epilepsy drug for mood disorders
1970-01-01 00:59:00
Synosia Therapeutics has announced the successful completion of its first clinical trial, a proof-of-concept study that evaluated new therapeutic options for SYN-111, a sodium channel blocker. The placebo-controlled, double-blind, three-dose study measured drug effect and pattern of response using quantitative electroencephalography (EEG) in healthy volunteers, who all received each dose plus placebo.
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Neuropsychiatric Disease and Treatment
1970-01-01 00:59:00
Background: Atypical antipsychotics are increasingly used in the treatment of a broad spectrum of psychiatric disorders. There is evidence that in addition to treating the positive and negative symptoms of schizophrenia, as well as mania in bipolar disorder, these agents may have a potential role to play in the treatment of depressive disorders. In the following article we review the literature regarding the role of atypical antipsychotics, and specifically, quetiapine, in the treatment of major depressive disorder. Materials and methods: In March 2007 the authors performed a Medline search (English-language) using the keywords quetiapine and depression, revealing a total of 47 articles published. We also looked for cross-references in the published articles, obtained data-on-file from AstraZeneca Pharmaceutical L.P., and included abstracts presented at conferences and recent meetings.
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Haloperidol versus chlorpromazine for schizophrenia: study
1970-01-01 00:59:00
Background Chlorpromazine and haloperidol are benchmark antipsychotic drugs. Both are said to be equally effective when used at equivalent doses, but have different side-effect profiles. Objectives To compare the effects of haloperidol and chlorpromazine for people with schizophrenia and schizophrenia-like psychoses. Search strategy We searched the Cochrane Schizophrenia Group?s register (August 2006). We searched references of all included studies for further trials. We contacted pharmaceutical companies and authors of relevant trials.
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Out-of-the-ordinary tantrums may signal high risk of depression
1970-01-01 00:59:00
Ared-faced toddler pounding her fists on the floor, wailing and screaming, seemingly inconsolable. It?s a perennial occurrence in grocery stores and kitchens across the country. But a temper tantrum may mean more than a child being hungry, tired or not getting their way. According to new research, the nature of a tantrum may help diagnose children with a number of mood and behaviour disorders. Regular, tearful meltdowns are considered to be part of healthy development in toddlers up to the age of about 5. But Andrew Belden, a postdoctoral fellow of psychiatry at Washington University?s school of medicine, has outlined five out-of-the-ordinary temper tantrum red flags that may indicate a child is at high risk of being either depressed or suffering various disruptive disorders. The study was published in this month?s Journal of Pediatrics.
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Toxoplasma Infection Increases Risk of Schizophrenia
1970-01-01 00:59:00
Findings from what is believed to be the largest comparison of blood samples collected from healthy individuals and people with schizophrenia suggest that infection with the common Toxoplasma gondii parasite, carried by cats and farm animals, may increase the risk of schizophrenia. A report on the study, conducted among U.S. military personnel by researchers from Walter Reed Army Institute of Research and Johns Hopkins Children?s Center appears in the January issue of the American Journal of Psychiatry. Researchers found that of the 180 study subjects diagnosed with schizophrenia, 7 percent had been infected with toxoplasma prior to their diagnosis, compared to 5 percent among the 532 healthy recruits. Thus, people exposed to toxoplasma had a 24 percent higher risk of developing schizophrenia. The difference, while seemingly small, is important, researchers say, because the ability to explain even a small portion of the 2 million cases of schizophrenia in the United States may o...
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Depression can hurt college students
1970-01-01 00:59:00
Depression can come into a student?s life without telltale glumness and the blues - it can be relentless fatigue, edgy temper, inability to concentrate and constant friction with roommates. ?Depression is the number one issue students bring to our office,? said Anne Hershbell, clinical director of Counseling Services at Lynchburg College .
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Antidepressant success may vary by race
1970-01-01 00:59:00
Black and Hispanic adults with depression may not do as well on drug therapy as whites do, a study suggests. Researchers found that among nearly 2,700 U.S. adults receiving an antidepressant for major depression, African Americans and Latinos had lower success rates than their white counterparts. 
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Depression linked to bone-thinning in premenopausal women
1970-01-01 00:59:00
Premenopausal women with even mild depression have less bone mass than do their nondepressed peers, a study funded in part by the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), shows. The level of bone loss is at least as high as that associated with recognized risk factors for osteoporosis, including smoking, low calcium intake, and lack of physical activity. Hip bones, the site of frequent fractures among older people, were among those showing the most thinning in depressed premenopausal women. The reduced bone mass puts them at higher risk of these costly, sometimes fatal fractures and others as they age, the researchers note in the November 26 issue of the Archives of Internal Medicine. The report was submitted by Giovanni Cizza, MD, PhD, MHSc, of NIMH and the NIH National Institute of Digestive Disorders and Kidney Diseases (NIDDK); Farideh Eskandari, MD, MHSc, of NIMH; and colleagues.
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Transcranial Magnetic Stimulation Effective in Treating Major Depression
1970-01-01 00:59:00
Researchers at the University of Pennsylvania School of Medicine and other study sites have found that transcranial magnetic stimulation (TMS) ? a non-invasive technique that excites neurons in the brain via magnetic pulses passed through the scalp ? is a safe and effective, non-drug treatment with minimal side effects for patients with major depression who have tried other treatment options without benefit. This study ? the largest to-date studying TMS as a standalone treatment for major depression ? appears in the December 1st issue of Biological PsychiatryVideo is available by contacting the source.
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Psychiatry of intellectual disability
1970-01-01 00:59:00
Psychotropic drugs are often prescribed for unlicensed indications in people with mental health problems and behavioural challenges arising from developmental delay or arrest. Common indications include the management of sleep disturbances, increased arousal and self-injurious behaviour, and problems related to behavioural changes resulting from epilepsy syndromes and dementing disorders. A cross-sectional survey of psychotropic drug prescribing in in-patients with intellectual disability found that 46.4% were receiving at least one psychotropic for an unlicensed indication, most typically in an attempt to manage behavioural problems or to stabilise mood (Haw & Stubbs, 2005b).
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Recurrent unipolar depression requires prolonged treatment
1970-01-01 00:59:00
Psychiatric disorder is now recognised as one of the greatest causes of human suffering. The burden to society of various diseases has been quantified recently using disability-adjusted life years (DALYs), a measure that expresses years of life lost to premature death and years lived with a disability of specified severity and duration. The burden of mental illness is second only to that of cardiovascular conditions in the developed world and when DALYs related to alcohol and drug misuse are included it is the largest single category (Murray & Lopez, 1997). Unipolar major depression currently imposes the second largest burden of any individual disorder in the developed world and, because of the decline in the incidence of ischaemic heart disease, may soon be the leading individual illness category (Murray & Lopez, 1997). Clearly, any improvements in the treatment of unipolar depression would produce great benefits in the health of the public.
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Treatment of Recurrent Unipolar Depression
1970-01-01 00:59:00
The trial by Hochstrasser et al (2001, this issue) provides a timely reminder of the need for such prolonged treatment of recurrent unipolar depression and reinforces the evidence base and conclusions regarding prolonged treatment of recurrent depression in the BAP guidelines (Anderson et al, 2000). In this study the authors examined the prophylactic effect of the selective serotonin reuptake inhibitor citalopram in unipolar recurrent depression. The aim of the study was to compare the prophylactic efficacy of citalopram and placebo and also to determine the long-term tolerability of citalopram. In- and out-patients between the ages of 18 and 65 years, all of whom had to satisfy standardised diagnostic and severity criteria and have had two or more episodes of depression with at least one of these occurring within the past 5 years, were included in the study.
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Genetic aspects of schizophrenia and schizotypy
1970-01-01 00:59:00
It is well established that schizophrenia has a sizeable genetic component and that schizotypy may share common genetic vulnerability with schizophrenia. Meehl (1989) postulated the concept of schizotaxia, anunderlying genetic vulnerability to both schizophrenia and schizotypy. Schizo taxia is apparent in 20?50% of first-degree relatives of people with schizophrenia. It is thus clear that the underlying genetic vulnerability does not necessarily lead to either schizophrenia or schizotypy. Studies have shown that clinical symptoms in first-degree relatives of people with schizophrenia include negative symptoms which are similar in nature to (but less severe than) those seen in schizophrenia (e.g. Kendler et al, 1995). 
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Developmental aspects of schizophrenia and related disorders: possible impl
1970-01-01 00:59:00
Schizophrenia and other schizophrenia-spectrum disorders are neurodevelopmental disorders which may share genetic susceptibility factors and represent differential expressions of an underlying vulnerability. Schizophrenia may have its onset in childhood and can be reliably diagnosed. However, developmental factors modulate disease expression in children. Although the prevalence of schizophrenia in childhood is low, children who develop schizophrenia in adult life may show subtle and non-specific developmental abnormalities, consistent with the neurodevelopmental hypothesis.
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Neurodevelopmental aspects and developmental precursors of schizophrenia
1970-01-01 00:59:00
There is strong evidence that schizophrenia is a neurodevelopmental disorder. Changes in brain structure have been reported in numerous studies of schizophrenia (Keshavan et al, 2005). One focus of epidemiological studies has been the premorbid state and the definition of factors present during childhood or adolescence which might be associated with later onset of disease. This contrasts with the prodrome, which can be seen as comprising the early manifestations of the onset of disease. Follow-back studies It has long been recognised that people who develop schizophrenia may present as ?odd? in childhood (Bleuler, 1911). Follow-back studies, although susceptible to recall bias, do suggest a pattern of early abnormal development. Analysis of school reports of people with schizophrenia showed differences in childhood social behaviour (Watt, 1978) in a reconstructed cohort.
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Post-traumatic stress disorder, resilience and vulnerability
1970-01-01 00:59:00
Post-traumatic stress disorder (PTSD), recognised as a diagnostic entity in 1980, was originally associated with combat or war experiences. It has since been recognised that it is prevalent in any population exposed to traumatic events. Although much has been written about the management of PTSD, the concepts of resilience and vulnerability have not received the same attention. This article reviews the conceptualisation, epidemiology and comorbidities of PTSD and highlights the factors underlying vulnerability and conveying resilience. In the current geopolitical climate, political and social instabilities as well as natural and man-made calamities have been on the increase. Civil wars often result in atrocities, violence, forced migration and mass fatalities. Exposure to such events can lead to psychological strain and pathology. This pathology includes acute stress reaction, adjustment disorder and post-traumatic stress disorder (PTSD). Of these, PTSD is associated with the high...
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Treatment of victims of trauma
1970-01-01 00:59:00
Not all traumatic events cause post-traumatic stress disorder (PTSD), and people develop PTSD symptoms after events that do not seem to be overwhelmingly traumatic. In order to direct services appropriately, there is a need to distinguish time-limited post-traumatic symptoms and acute stress reactions (that may improve spontaneously without treatment or respond to discrete interventions) from PTSD, with its potentially more chronic pathway and possible long-term effects on the personality. In this article, we describe acute and chronic stress disorders and evidence about the most effective treatments. This is an update of a paper originally published 7 years ago (Adshead, 2000). Since then there has been increased interest in post-traumatic stress disorder (PTSD). As the world appears to enter a more uncertain period, attention is being paid to the psychological aftermath of terrorism and natural disasters. However, as the language of PTSD has entered the general lexicon, there is...
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General adult psychiatry - Off-label prescribing in psychiatric practice
1970-01-01 00:59:00
Unlicensed use of licensed drugs is a common feature of prescribing in general psychiatry settings. A cross-sectional survey of prescription cards for 266 psychiatric in-patients in acute wards from 14 NHS trusts found that 7.5% of 1387 prescriptions were outside the terms of the product licence: 75% of these were for indications not covered by the licence, and 25% were at doses above the recommended maximum. In all, 81 patients were prescribed at least one medicine off-label, typically for an unlicensed indication (Douglas-Hall et al, 2001). Other investigations suggest that unlicensed prescribing may be rather more common: for example, an audit of antipsychotic drug prescribing over 5 years in a secondary care NHS trust found that about 40% of prescriptions were for off-label applications (Hodgson & Belgamwar, 2006). Furthermore, a cross-sectional survey of prescriptions for mood-stabilising drugs in 249 in-patients in a tertiary care unit found that 28.5% were receiving presc...
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Psychiatry of old age - Off-label prescribing in psychiatric practice
1970-01-01 00:59:00
Psychiatry of old age Many licensed psychotropic drugs are used for unlicensed indications when treating elderly people with mental health problems. Although at present there are no drugs specifically licensed for the treatment of psychotic and behavioural symptoms in patients with dementia, a postal questionnaire survey of 377 members of the Royal College of Psychiatrists? Faculty of Old Age Psychiatry (recently renamed the Psychiatry of Old Age) found that most doctors had used psychotropic drugs for this indication.
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Child and adolescent psychiatry
1970-01-01 00:59:00
Off-label prescribing to children is common in primary care settings in the UK (Ekins-Daukes et al, 2005). Psychotropic drug prescribing has become a more common aspect of practice in child and adolescent psychiatry (Bramble, 1992, 2003; McNicholas, 2001), but the full extent of unlicensed prescribing in UK child and adolescent mental health services is unknown. A questionnaire survey of community child and adolescent psychiatrists in the West Midlands found that 88% of doctors reported issuing prescriptions for antidepressants and 63% for antipsychotics: it can be assumed most of these prescriptions were for unlicensed indications; two-thirds reported prescribing the unlicensed compound melatonin (Doerry & Kent, 2003).
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