Depression in women: Understanding the gender gap

 

About twice as many women as men experience depression. Several factors may increase a woman's risk of depression.  By Mayo Clinic Staff About 1 in 5 women develop depression at some point in life. Women are nearly twice as likely as men to have depression. Depression can occur at any age, but it's most common in women between the ages of 40 and 59. Some mood changes and depressed feelings occur with normal hormone changes. But hormone changes alone don't cause depression. Other biological factors, inherited traits and life experiences are also involved. Here's what contributes to depression in women — and what you can do about it. Puberty After puberty, depression rates are higher in females than in males. Because girls typically reach puberty before boys do, they're more likely to develop depression at an earlier age than boys. This depression gender gap lasts until after menopause. Hormone changes during puberty may increase some girls' risk of developing depression. However, temporary mood swings related to changing hormones during puberty are normal — these changes alone don't cause depression. Puberty is often associated with other factors that can play a role in depression, such as: Emerging sexuality and identity issues Conflicts with parents Increasing pressure to achieve in school, sports or other areas of life Premenstrual problems For most females with premenstrual syndrome (PMS), symptoms such as abdominal bloating, breast tenderness, headache, anxiety, irritability and a blue mood are minor and short-lived. But a small number of females have severe and disabling symptoms that disrupt their studies, jobs, relationships or other areas of their lives. At that point, PMS may cross the line into premenstrual dysphoric disorder (PMDD) — a type of depression that generally requires treatment. The exact interaction between depression and PMS remains unclear. It's possible that cyclical changes in estrogen, progesterone and other hormones can disrupt the function of brain chemicals such as serotonin that control mood. Inherited traits, life experiences and other factors appear to play a role. Pregnancy Dramatic hormonal changes occur during pregnancy, and these can affect mood. Other issues may also increase the risk of developing depression during pregnancy or during attempts to become pregnant, such as: Lifestyle or work changes Relationship problems Previous episodes of depression, postpartum depression or PMDD Lack of social support Mixed feelings about being pregnant Unwanted pregnancy Miscarriage Infertility Stopping use of antidepressant medications Postpartum depression Many new mothers find themselves sad, angry, irritable and prone to tears soon after giving birth. These feelings — sometimes called the baby blues — are normal and generally subside within a week or two. But more-serious or long-lasting depressed feelings may indicate postpartum depression, particularly if signs and symptoms include: Low self-esteem Anxiety Agitation Inability to care for your baby Thoughts of harming your baby Postpartum depression is a serious medical condition requiring prompt treatment. It occurs in about 10 to 25 percent of women. It's thought to be associated with major hormonal fluctuations that influence mood, predisposition to mood and anxiety disorders, birth complications, and poor social support. Next   http://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20047725

Monoamine oxidase inhibitors (MAOIs)

 

MAOIs — Learn about the benefits, side effects and risks of these older antidepressants.  By Mayo Clinic Staff Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant developed. They're effective, but they've generally been replaced by antidepressants that are safer and cause fewer side effects. Use of MAOIs typically requires diet restrictions because they can cause dangerously high blood pressure when taken with certain foods or medications. In spite of side effects, these medications are still a good option for some people. In certain cases, they relieve depression when other treatments have failed. How MAOIs work Antidepressants such as MAOIs ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants, MAOIs work by changing the levels of one or more of these naturally occurring brain chemicals. An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available. This is thought to boost mood by improving brain cell communication. MAOIs also affect other neurotransmitters in the brain and digestive system, causing side effects. MAOIs are sometimes used to treat conditions other than depression, such as Parkinson's disease. MAOIs approved to treat depression The Food and Drug Administration (FDA) has approved these MOAIs to treat depression: Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Emsam) Tranylcypromine (Parnate) Selegiline is available as a skin (transdermal) patch. Using a patch may cause fewer side effects than MAOIs taken by mouth. If you're using the lowest dose patch, you may not need diet restrictions, but ask your doctor. Side effects of MAOIs Because of side effects and safety concerns, MAOIs are most often tried when other antidepressants don't work. The most common side effects of MAOIs include: Dry mouth Nausea, diarrhea or constipation Headache Drowsiness Insomnia Skin reaction at the patch site Dizziness or lightheadedness Other possible side effects include: Involuntary muscle jerks Low blood pressure Reduced sexual desire or difficulty reaching orgasm Sleep disturbances Weight gain Difficulty starting a urine flow Muscle aches Prickling or tingling sensation in the skin (paresthesia) Next References June 21, 2013 See more In-depth   http://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

College depression: What parents need to know

 

College depression is a common problem. Understand why the transition to college makes young adults vulnerable to depression — and what you can do about it . By Mayo Clinic Staff Helping your child make the emotional transition to college can be a major undertaking. Know how to identify whether your child is having trouble dealing with this new stage of life — and what you can do to help. What is college depression and why are college students vulnerable to it? Depression is an illness that causes a persistent feeling of sadness and loss of interest. College depression isn't a clinical diagnosis. Instead, college depression is depression that begins during college. College students face many challenges, pressures and anxieties that can cause them to feel overwhelmed. They might be living on their own for the first time and feeling homesick. They're also likely adapting to a new schedule and workload, adjusting to life with roommates, and figuring out how to belong. Money and intimate relationships can also serve as major sources of stress. Dealing with these changes during the transition from adolescence to adulthood can trigger or unmask depression during college in some young adults. What are the impacts of college depression? Depression during college has been linked to: Impaired academic performance Smoking Risky behaviors related to alcohol abuse, such as having unsafe sex What are the signs that a student is dealing with college depression? Many college students occasionally feel sad or anxious, but these emotions pass within a few days. Untreated depression persists and interferes with normal activities. Signs and symptoms that a student might be experiencing depression during college include: Feelings of sadness or unhappiness Irritability or frustration, even over small matters Loss of interest or pleasure in normal activities Insomnia or excessive sleeping Changes in appetite or weight Agitation or restlessness Angry outbursts Slowed thinking, speaking or body movements Indecisiveness, distractibility and decreased concentration Fatigue, tiredness and loss of energy Feelings of worthlessness or guilt, fixation on past failures, or self-blame when things aren't going right Trouble thinking, concentrating, making decisions and remembering things Frequent thoughts of death, dying or suicide Crying spells for no apparent reason Unexplained physical problems, such as back pain or headaches Next

8 Things People With Depression Want You To Know

 

Health Lifestyle by Matt Duczeminski People who suffer from clinical depression carry with them a social stigma that unfortunately exacerbates the serious problems they deal with on a daily basis. Since the disease is completely misunderstood by the general public, those who suffer from depression are generally shunned or, at the very least, treated differently in some way by friends, family, and colleagues. By becoming informed about the true essence of clinical depression, people can better equip themselves to help those they care about that suffer from the disease.   1. They may or may not take meds People diagnosed with clinical depression don’t necessarily take medication for their symptoms. And if they do, that doesn’t mean they’ll magically “get happy” after popping a couple pills. And it certainly doesn’t mean they’re just faking to get access to drugs. In fact, because of the stigma attached to taking drugs to offset depression, many people who suffer from the disease choose not to take medication. Unfortunately, this can be detrimental to their health, as some people truly do need medication to help them, but will refuse them based on how society views “pill popping.”   2. They don’t mean to ditch you People who suffer from depression often isolate themselves from their friends and family. Unfortunately, those on the outside looking in may get the wrong idea, thinking the person suffering is actively trying to shut everyone else out of their lives. In fact, the reason people suffering from depression distance themselves from friends and family is because they don’t want to burden others with their problems. They know it’s draining to be around them (because it’s draining to be themselves), so they don’t want to throw a pity party while everyone else is trying to have fun. This is a major reason friends and family need to make an even greater effort to be there for friends who suffer from this debilitating disease.   3. They’re not “faking” it Because depression is misunderstood by the general public, people find it hard to believe those who suffer from it actually can show signs of happiness and emotions other than sadness. When a depressed person musters up the courage to go out with friends, they’ll sometimes be able to “snap out of it,” telling jokes and laughing with the group for a few hours, and it may seem like nothing is wrong. However, depression transcends fleeting moments, and acts as a forcefield around the person that prohibits good moods from lasting very long. While those who suffer from depression can in fact enjoy themselves at times, anxiety and despair rear their ugly heads later on when they settle in from a relatively fun night.   4. They know they’re too much to deal with Like I said, people who suffer from depression don’t want to burden others with their issues. They understand that at times they can be “Debbie Downers,” and don’t want to bring everyone else down with them. And they know their moods can fluctuate at times, so they would rather stay home alone than risk having a meltdown in front of their friends. However, this is when friends need to step it up and be more understanding and compassionate than they’ve ever been before.   5. Being “depressed” isn’t the same as suffering from clinical depression People throw around the term “depressed” as a synonym for sad so much that it tends to lose meaning. If your pet dies, you’ll definitely be saddened by it, and you’ll probably be sad for a while. But it won’t be a debilitating feeling that keeps you from living your daily life. And it’s a reaction to a terrible event that happened to you. Clinical depression doesn’t come from any external stimuli. The reason clinical depression is so hard to defeat is there is seemingly no reason for a person to be so down in the first place. Since they can’t point out the reason they’re feeling low, it’s incredibly hard to tackle the issue.   6. Don’t be soft with us I know I just spoke about how important it is to be there for your friend who’s currently suffering from depression, but it’s also important to not be so soft with them that you come off as being patronizing. Although you should definitely be careful not to offend them, you shouldn’t feel as if you need to walk on eggshells around them, either. Remember: clinical depression isn’t so much a response to external factors as it is a manifestation of the mind and chemical imbalance. The best thing you can do for a friend suffering from depression is to simply be the friend you’ve always been to them.   7. People with depression aren’t weak Since the term “being depressed” is so overused in society, many people operate under the misconception that actually being depressed is a sign of weakness. People think “I was sad last week, too. But I got over it pretty quickly,” so they assume that other people who suffer from depression are “milking it” in some way. There’s a saying about those who suffer from depression that says they have simply “been strong for far too long.” In other words, they’ve lived with this crippling disease for an incredibly long time, and only recently hit the breaking point at which they needed to find help. People who suffer from depression aren’t weak. In fact, they’re some of the strongest members of our society.   8. It’s not about “getting over it,” but getting through it I alluded to this in the last section, but some people are under the misconception that depressed people simply need to “get over it.” Also mentioned before was the notion that there is no catalyst that pushes a person into a downward spiral of depression, so it’s incredibly hard to pinpoint the source of the problem. When you say you “got over” something, you simply mean you let it go and moved on with your life. To beat clinical depression, you can’t “let it go” or ignore it. You have to face it head on and work through it. Again, for someone to face clinical depression with every bit of willpower they have shows just how strong that person is. source : http://www.lifehack.org/297991/8-things-people-with-depression-want-you-know?mid=20150727&ref=mail&uid=580391&feq=daily   Love this article? Share it with your friends on Facebook

Smartphone usage could be analyzed to warn of depression

 

Although you might not realized you're depressed, your smartphone may know better (Credit: Shutterstock) One of the problems with depression is that because it often forms so gradually, many people don't even realize that they're suffering from it – they just assume that normal life is pretty dreary. With that in mind, researchers from Chicago's Northwestern University have devised a method of analyzing at-risk individuals' smartphone use, to see if they're developing signs of the disorder. In a study conducted at the university, the phone-usage of 28 test subjects (20 women and eight men, average age of 29) was monitored over a two-week period. They also all completed a PHQ-9 questionnaire, which is commonly used to assess depression by asking questions about symptoms such as sadness, hopelessness and sleep disturbances. When the smartphone-activity and PHQ-9 data was tabulated and cross-referenced, it was found that the 14 subjects who scored highest for depression on the questionnaire also had some phone-related traits in common. These included more overall use of their smartphones (an average of 68 minutes a day, as opposed to 17 for the other test subjects), spending more time at home or in fewer locations (as measured by their phone's GPS tracking feature), and a less regular day-to-day travel schedule. While increased phone usage might suggest more contact with other people, the researchers believe that it instead indicates non-social activity such as web-surfing and game-playing. These could be examples of "avoidance behavior," that people engage in to avoid dealing with mental anguish. The fact that the subjects left home less often is in keeping with the known fact that depressed people tend to lack the motivation to get out and do things, instead opting to remain sedentary. Likewise, not maintaining a consistent daily schedule has also been linked to depression. All told, the study matched smartphone use to subjects' level of depression with 87 percent accuracy. While approaches such as questionnaires are certainly helpful, the researchers believe that patients often lack accuracy when performing such self-assessment techniques. "The significance of this is we can detect if a person has depressive symptoms and the severity of those symptoms without asking them any questions," says Northwestern's Dr. David Mohr, senior author of a paper on the study. "We now have an objective measure of behavior related to depression. And we’re detecting it passively. Phones can provide data unobtrusively and with no effort on the part of the user." The paper was recently published in the Journal of Medical Internet Research. Source: Northwestern University

Elementary teachers' depression symptoms related to students' learning

February 11, 2015 Society for Research in Child Development A new study has found that teachers who report having more symptoms of depression had classrooms that were of lesser quality, and that students in these classrooms had fewer performance gains. Researchers looked at 27 teachers and their 523 third-grade students in a Florida school district. Teachers reported the frequency of their symptoms of clinical depression, and students' basic reading and math skills were assessed throughout the year. Teachers experience some of the highest levels of job-related stress, and such stress may leave them more vulnerable to depression. How do elementary school teachers' symptoms of depression affect the quality of the classroom environment and students' learning? A new study has found that teachers who reported more symptoms of depression than their fellow teachers had classrooms that were of lesser quality across many areas, and students in these classrooms had lower performance gains, particularly in math. "Teaching is one of the most stressful occupations," notes Leigh McLean, doctoral student in the Department of Psychology, and Carol Connor, professor of psychology, at Arizona State University, who conducted the study, beginning when they were at Florida State University. "One of the troubling consequences of occupational stress is that it can contribute to elevated rates of symptoms of depression. Our study reveals some of the negative implications of higher rates of teachers' symptoms of depression for students." The study appears in the journal Child Development. The researchers looked at 27 teachers and their 523 third-grade students (primarily White and from a range of socioeconomic backgrounds) in a Florida school district. Teachers reported the frequency of their symptoms of clinical depression, and students' basic reading and math skills were assessed throughout the year. Using classroom video recordings, trained observers assessed the quality of the classroom environment. The students who were the most vulnerable to the negative effects of their teachers' depression were those who were already struggling in math, suggesting that the children who needed to improve the most were less likely to be able to do so when they were in classrooms with more depressed teachers. Students with weaker math achievement made greater gains when they were in higher-quality classrooms with less depressed teachers. Teaching is consistently identified as one of the most stressful occupations in the United States, but almost no mental health support systems exist in schools to help teachers cope with this chronic stress. Research on depression and teaching is sparse, but one study of early education teachers found that almost 25 percent had diagnosed depression, compared with about 18 percent of nonteachers. Although some pioneering studies have looked at the effectiveness of mental health interventions on teachers' classroom performance--and suggest that such programs have strong potential for positive change--most current models of professional development don't address mental health. "Our study is one of the first to reveal that the constellation of symptoms that point to risks for depression hurt not only the teachers who experience these symptoms, but also the development of the teachers' students--especially students who are struggling academically," McLean and Connor note. "The study highlights the need for nationwide mental health support systems for educators, not only for teachers' benefit, but for the benefit of students." Specifically, the study's authors suggest that schools engage mental health professionals to help teachers deal with depression. Professional development programs that help teachers learn how to handle adverse and stressful situations in the classroom as they're teaching would be beneficial, as would providing comprehensive health insurance that covers mental health support, they say. Story Source: The above story is based on materials provided by Society for Research in Child Development. Note: Materials may be edited for content and length. Journal Reference: Leigh McLean and Carol McDonald Connor. Depressive Symptoms in Third-Grade Teachers: Relations to Classroom Quality and Student Achievement. Child Development, 11 FEB 2015 DOI: 10.1111/cdev.12344

Serotonin-deficient brains more vulnerable to social stress

Mice genetically deficient in serotonin -- a crucial brain chemical implicated in clinical depression -- are more vulnerable than their normal littermates to social stressors, according to a Duke study appearing this week in the Proceedings of the National Academy of Sciences. Following exposure to stress, the serotonin-deficient mice also did not respond to a standard antidepressant, fluoxetine (Prozac), which works by boosting serotonin transmission between neighboring neurons. The new results may help explain why some people with depression seem unresponsive to treatment with selective serotonin reuptake inhibitors (SSRIs), the most common antidepressant drugs on the market today. The findings also point to several possible therapeutic strategies to explore for treatment-resistant depression. "Our results are very exciting because they establish in a genetically defined animal model of serotonin deficiency, that low serotonin could be a contributing factor to the development of depression in response to psychosocial stress -- and can lead to the failure of SSRIs to alleviate symptoms of depression," said senior author Marc Caron, the James B. Duke professor of cell biology in the Duke University School of Medicine, and a member of the Duke Institute for Brain Sciences. The exact causes of depression are unclear. Although scientists have traditionally thought that low brain serotonin could cause depression, the idea is difficult to test directly and increasingly controversial. At the same time, researchers have gained a greater appreciation for the many environmental factors -- especially stress -- that can bring on or worsen depression. In the new study, researchers used a transgenic mouse strain called Tph2KI that has only 20-40% of normal levels of serotonin in its brain. These mice harbor an extremely rare mutation that was first identified in a small group of people with major depression. Caron's group has been studying how the Tph2KI mice respond to different kinds of stress, showing previously that serotonin deficiency can affect susceptibility to some types of stress but not others, findings that may have implications for understanding how low levels of serotonin could contribute to mental illness. In the new study, lead author Benjamin Sachs, a postdoctoral researcher in Caron's group, tested the responses of these mice to a type of psychosocial stress: social defeat stress. The team stressed out mice by housing them each with an aggressive stranger mouse briefly every day for 7-10 days. Later, the scientists examined whether the test mice would avoid interacting with an unfamiliar mouse -- a depression-like behavior. A week of social stress was not sufficient for normal mice to show signs of depression, but the serotonin-deficient mice did. Longer periods of stress exposure led to depression-like behavior in both groups. The researchers then found that a 3-week treatment with Prozac following the stress exposure alleviated depression-like symptoms in normal mice, but not mutant mice. Prozac and other SSRIs work by blocking the ability of cells to recapture serotonin, so it makes sense that the drugs would be less effective in animals with abnormally low levels of serotonin to begin with, Caron said. A few case studies have suggested that targeting a brain area called the lateral habenula could help alleviate treatment-resistant depression. This area is known as a 'punishment' region of the brain because its neurons are active in the absence of reward. And scientists think that an overactive lateral habenula might trigger depression. In the new study, the Caron group targeted the lateral habenula with a designer drug and receptor (called DREADDs for 'designer receptors exclusively activated by designer drugs') that allows them to control the activity of particular neurons in a living animal. Inhibiting lateral habenula neurons reversed the social avoidance behavior in the serotonin-deficient mice, they found. Although DREADDs aren't appropriate for use in humans, showing that the lateral habenula-targeted drugs can be used to alleviate depression-like behavior in animals is "an important first step," Sachs said. "The next step is to figure out how we can turn off this brain region in a relatively non-invasive way that would have better therapeutic potential," Sachs added. Another clue for potential new therapies came from biochemical comparisons of the brains of the mutant and normal mice. The researchers found that social stressors seemed to change where in the brain the signaling molecule β-catenin is being produced in normal mice, but not in the Tph2KI mice. Taken with other evidence, these new findings suggest that serotonin deficiency may block a critical molecular pathway that includes β-catenin and that may be involved in resilience. "If we can identify what's both upstream and downstream of β-catenin we might be able to come up with attractive drug targets to activate this pathway and promote resilience," Sachs said. The research was funded by the National Institutes of Health (MH79201, MH60451, F32-MH093092, MH79201-03S1), the Lennon Family Foundation, Duke University's Trinity College of Arts and Sciences, and the Duke Institute for Brain Sciences.

New Tool for Depression

 

The loss of actor and comedian Robin Williams has opened up a national conversation on depression. There are many tools available for people to try and cope with this mental illness. Recent studies show that curcumin—an active component of the spice turmeric—is gaining attention for its antidepressant qualities. Curcumin was shown in a recent study to be as effective as the antidepressant medication fluoxetine (Prozac) in patients with major depressive disorder. Patients who took 1,000 millgrams (mg) of curcumin per day fared as well as those who took 20 mg of fluoxetine. Curcumin was also well tolerated, and the study authors concluded that it was effective and safe. Lead author Ajay Goel, PhD, said curcumin may also help alleviate short-term mood issues. He added that the spice’s anti-inflammatory properties make it a good choice for everyone. A recent eight-week randomized, double-blind, placebo-controlled study showed that individuals diagnosed with major depressive disorder who took BCM-95 Curcumin (500 mg twice daily) had significantly more relief from symptoms than those taking placebo. Interestingly, the positive results were even greater in those with atypical depression, which is generally more difficult to treat. Researchers theorize that the anti-inflammatory power of curcumen may account for this finding. Sources: "Curcumin for the Treatment of Major Depression: A Randomized, Double-Blind, Placebo-Controlled Study" by A. Lopresti et al., Journal of Affective Disorders, 6/1/14 “Efficacy and Safety of Curcumin in Major Depressive Disorder” by J. Sanmukhani et al., Phytother Res, 7/13 “Nature’s Prozac,” Prevention, 1/14

Mindfulness treatment as effective as CBT for depression, anxiety

 

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Group mindfulness treatment is as effective as individual cognitive behavioral therapy (CBT) in patients with depression and anxiety, according to a new study from Lund University in Sweden and Region Skåne. This is the first randomized study to compare group mindfulness treatment and individual cognitive behavioral therapy in patients with depression and anxiety in primary health care.

The researchers, led by Professor Jan Sundquist, ran the study at 16 primary health care centres in Skåne, a county in southern Sweden. They trained two mindfulness instructors, from different occupational groups, at each primary health care centre during a 6-day training course.

In spring 2012, patients with depression, anxiety or reactions to severe stress were randomized to either structured group mindfulness treatment with approximately 10 patients per group, or regular treatment (mainly individual CBT). Patients also received a private training programme and were asked to record their exercises in a diary. The treatment lasted 8 weeks. General practitioner and mindfulness instructor Ola Schenström designed the mindfulness training programme and model for training instructors.

A total of 215 patients were included in the study. Before and after treatment, the patients in the mindfulness and regular treatment groups answered questionnaires that estimated the severity of their depression and anxiety. Self-reported symptoms of depression and anxiety decreased in both groups during the 8-week treatment period. There was no statistical difference between the two treatments.

"The study's results indicate that group mindfulness treatment, conducted by certified instructors in primary health care, is as effective a treatment method as individual CBT for treating depression and anxiety," says Jan Sundquist. "This means that group mindfulness treatment should be considered as an alternative to individual psychotherapy, especially at primary health care centres that can't offer everyone individual therapy."

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Story Source:

The above story is based on materials provided by Lund University. Note: Materials may be edited for content and length.

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Journal Reference:

1. Jan Sundquist, Åsa Lilja, Karolina Palmér, Ashfaque A. Memon, Xiao Wang, Leena Maria Johansson And Kristina Sundquist. Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial. The British Journal of Psychiatry, November 2014 DOI: 10.1192/bjp.bp.114.150243

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Could Depression Actually Be a Form of Infectious Disease?

 

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Major depressive disorder (MDD) should be re-conceptualized as an infectious disease, according to Turhan Canli, PhD, Associate Professor of Psychology and Radiology at Stony Brook University. In a paper published in Biology of Mood & Anxiety Disorders, Dr.Canli suggests that major depression may result from parasitic, bacterial, or viral infection. He presents examples that illustrate possible pathways by which these microorganisms could contribute to the etiology of MDD.

MDD remains highly prevalent disease with some 15 to 20 percent of the population experiencing MDD at some point. Recurrence is common, and pharmacological treatments have not changed. Because the causal aspects of the disease are not clearly defined, research to find causes remains paramount to help improve treatments.

"Given this track record of MDD, I propose reconceptualizing the condition as some form of infectious disease," said Dr. Canli, who is also Director of Stony Brook's SCAN Center, a member of the Program in Neuroscience, and a Senior Fellow in the Center for Medical Humanities, Compassionate Care, and Bioethics. "Future research should conduct a concerted effort search of parasites, bacteria, or viruses that may play a causal role in the etiology of MDD."

In the paper, Dr. Canli presents three arguments why reconceptualizing MDD as an infectious disease may be a fruitful endeavor.

First, he points out that patients with MDD exhibit illness behavior such as loss of energy, and that inflammatory biomarkers in MDD also suggest an illness-related origin. Second, he describes evidence that parasites, bacteria and viruses that infect humans in a way that alters their emotional behavior. Thirdly, Dr. Canli brings the notion of the human body as an ecosystem for microorganisms and the role of genetics.

Based on these points, Dr. Canli suggests a major research step would be to conduct large-scale studies with depressed patients, controls, and infectious-disease related protocols to determine the association or causal nature of infectious disease and depression.

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Story Source:

The above story is based on materials provided by Stony Brook University. Note: Materials may be edited for content and length.

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Journal Reference:

1. Turhan Canli. Reconceptualizing major depressive disorder as an infectious disease. Biology of Mood & Anxiety Disorders, 2014; 4 (1): 10 DOI: 10.1186/2045-5380-4-10

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The Rise of All-Purpose Antidepressants

 

Doctors are increasingly prescribing SSRIs to treat more than just depression

Oct 16, 2014 By Julia Calderone

Antidepressant use among Americans is skyrocketing. Adults in the U.S. consumed four times more antidepressants in the late 2000s than they did in the early 1990s. As the third most frequently taken medication in the U.S., researchers estimate that 8 to 10 percent of the population is taking an antidepressant. But this spike does not necessarily signify a depression epidemic. Through the early 2000s pharmaceutical companies were aggressively testing selective serotonin reuptake inhibitors (SSRIs), the dominant class of depression drug, for a variety of disorders—the timeline below shows the rapid expansion of FDA-approved uses.

As the drugs' patents expired, companies stopped funding studies for official approval. Yet doctors have continued to prescribe them for more ailments. One motivating factor is that SSRIs are a fairly safe option for altering brain chemistry. Because we know so little about mental illness, many clinicians reason, we might as well try the pills already on the shelf.

Common Off-Label Uses
Doctors commonly use antidepressants to treat many maladies they are not approved for. In fact, studies show that between 25 and 60 percent of prescribed antidepressants are actually used to treat nonpsychological conditions. The most common and well-supported off-label uses of SSRIs include:

• Abuse and dependence
• ADHD (in children and adolescents)
• Anxiety disorders
• Autism (in children)
• Bipolar disorder
• Eating disorders
• Fibromyalgia
• Neuropathic pain
• Obsessive-compulsive disorder
• Premenstrual dysphoric disorder

Investigational Uses
SSRIs have shown promise in clinical trials for many more disorders, and some doctors report using them successfully to treat these ailments:

• Arthritis
• Deficits caused by stroke
• Diabetic neuropathy
• Hot flashes
• Irritable bowel syndrome
• Migraine
• Neurocardiogenic syncope (fainting)
• Panic disorder
• Post-traumatic stress disorder
• Premature ejaculation

An Expanding Repertoire: Above are the SSRIs approved in the U.S. and the dates the FDA approved each to treat various disorders.

This article was originally published with the title "All-Purpose Antidepressants."

 

Depression increasing in many countries including in the USA.

 

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Analyzing data from 6.9 million adolescents and adults from all over the country, Twenge found that the US people now report more psychosomatic symptoms of depression, such as trouble sleeping and trouble concentrating, than their counterparts in the 1980s.

"Previous studies found that more people have been treated for depression in recent years, but that could be due to more awareness and less stigma," said Twenge, the author of "Generation Me: Why Today's Young people from the USA are More Confident, Assertive, Entitled -- and More Miserable than Ever Before." "This study shows an increase in symptoms most people don't even know are connected to depression, which suggests adolescents and adults really are suffering more."

Compared to their 1980s counterparts, teens in the 2010s are 38 percent more likely to have trouble remembering, 74 percent more likely to have trouble sleeping and twice as likely to have seen a professional for mental health issues. College students surveyed were 50 percent more likely to say they feel overwhelmed, and adults were more likely to say their sleep was restless, they had poor appetite and everything was an effort -- all classic psychosomatic symptoms of depression.

"Despite all of these symptoms, people are not any more likely to say they are depressed when asked directly, again suggesting that the rise is not based on people being more willing to admit depression," said Twenge.

The study also found that the suicide rate for teens decreased, though the decline was small compared to the increase in symptoms of depression. With the use of anti-depressant medications doubling over this time period, Twenge speculates that medication may have helped those with the most severe problems but has not reduced increases in other symptoms that, she says, can still cause significant issues.

Twenge's findings were published in the journal Social Indicators Research, and an updated and revised edition of "Generation Me" is being released today.

 

Nota do blog – Depressão e outras doenças relacionadas são observadas em quase todos os paises, emergentes e desenvolvidos, e podem estar ligadas à fatores climáticos, econômicos, sociais, comportamentais, e outros. Nos Estados Unidos que é o país-alvo do artigo acima, hábitos prejudiciais, como privação de sono, uso de estimulantes ou medicamentos controlados, excesso ou falta de alguns tipos de alimentos, como por exemplo, excesso de açúcares e falta de verduras de folhas verde-escuras, podem estar contribuindo para essa onda de estados depressivos, e tantos outros fatores mais. Os adolescentes e os adultos jovens, na maior parte, ficam muito tempo ligados em jogos, celulares, computadores, televisão, e esquecem-se dos exercícios, e não se preocupam em obterem informações ligadas à um estilo de vida saudável. O resultado será então um progressivo cansaço físico e mental, que será traduzido por um estado depressivo.

Mas vários outros paises desenvolvidos também sofrem com esses mesmos problemas, não sendo portanto uma “epidemia de depressão” somente dos Estadunidenses. Mas um país tão importante para o mundo em geral deve incrementar seus esforços no sentido de determinar as causas desse aumento nas condições depressivas.

Quando os Estados Unidos esfria, o resto da humanidade bate os dentes.

 

 

 

 

 

 

Brief depression questionnaires could lead to unnecessary antidepressant prescriptions

 

September 29, 2014

University of California - Davis Health System

Short questionnaires used to identify patients at risk for depression are linked with antidepressant medications being prescribed when they may not be needed, according to new research. Known as "brief depression symptom measures," the self-administered questionnaires are used in primary care settings to determine the frequency and severity of depression symptoms among patients.

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Short questionnaires used to identify patients at risk for depression are linked with antidepressant medications being prescribed when they may not be needed, according to new research from UC Davis Health System published in the September-October issue of the Journal of the American Board of Family Medicine.

Known as "brief depression symptom measures," the self-administered questionnaires are used in primary care settings to determine the frequency and severity of depression symptoms among patients. Several questionnaires have been developed to help reduce untreated depression, a serious mental illness that can jeopardize relationships, employment and quality of life and increase the risks of heart disease, drug abuse and suicide.

The UC Davis team was concerned that the questionnaires might lead to prescriptions for antidepressant medication being given to those who aren't depressed. Antidepressants are effective in treating moderate-to-severe depression but can have significant side effects, including sexual dysfunction, sedation and anxiety. They also have to be taken over several months to be effective.

"It is important to treat depression, but equally important to make sure those who get treatment actually need it," said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study.

The exploratory study included 595 patients of primary care offices affiliated with Kaiser Permanente in Sacramento, San Francisco VA Medical Center, Sutter Medical Group in Sacramento, UC Davis, UC San Francisco and VA Northern California Healthcare System.

Patients selected for the study were considered at low risk for depression and therefore poor candidates for antidepressants, based on results of a widely-employed brief screening tool known as the Patient Health Questionnaire -- 9 (PHQ-9), which was administered by the research team. The screener, which includes questions about changes in sleep, concentration, energy and appetite, was completed the same day the patients had appointments to see their primary care physicians, who were unaware their patients had completed the PHQ-9.

Based on a review of medical records, the patients were divided into two groups: those who were asked during their doctors' office visits to complete brief depression symptom questionnaires, besides the one administered by the researchers, and those who were not. The groups were compared in terms of rates of depression diagnoses and prescriptions for antidepressants received from their physicians.

Of the 545 patients who did not complete brief depression questionnaires during their doctors' office visits, 10.5 percent were diagnosed with depression and 3.8 percent were prescribed antidepressants.

Of the 50 patients who completed brief depression questionnaires during their doctors' office visits, 20 percent were diagnosed with depression and 12 percent were prescribed antidepressants.

Jerant said the study highlights the need for research to determine the best ways to apply brief depression questionnaires in daily practice, as use of the screeners tripled the likelihood that patients in the study who were not apt to be depressed would receive depression treatment.

Part of the problem could be in how questionnaire results are interpreted, Jerant said. Depression symptoms such as insomnia, fatigue and poor concentration are associated with many health conditions.

"The questionnaires aren't diagnostic in the sense that there's a certain score that means the patient definitely does or does not have depression," Jerant said. "Formal interviews are required to help doctors decide whether a patient's fatigue, for instance, is caused by depression. That fatigue could also be due to chronic lung or heart disease. It could also be due to an adjustment disorder that is usually transient and isn't likely to respond to antidepressants. We need to give providers good guidance on how to use brief symptom measures in evaluating patients and making treatment decisions."

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Story Source:

The above story is based on materials provided by University of California - Davis Health System. Note: Materials may be edited for content and length.

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Journal Reference:

1. A. Jerant, R. L. Kravitz, E. Fernandez y Garcia, M. D. Feldman, C. Cipri, D. Nishio, A. Knoepfler, M. K. Wooddell, V. Baquero, P. Franks. Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures. The Journal of the American Board of Family Medicine, 2014; 27 (5): 611 DOI: 10.3122/jabfm.2014.05.140038

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How physical exercise protects the brain from stress-induced depression

 

September 25, 2014

Karolinska Institutet

Physical exercise has many beneficial effects on human health, including the protection from stress-induced depression. However, until now the mechanisms that mediate this protective effect have been unknown. In a new study in mice, researchers show that exercise training induces changes in skeletal muscle that can purge the blood of a substance that accumulates during stress, and is harmful to the brain.

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In a study in the journal Cell, Jorge Ruas and Maria Lindskog show how physical exercise protects the brain from stress-induced depression in mice.

Physical exercise has many beneficial effects on human health, including the protection from stress-induced depression. However, until now the mechanisms that mediate this protective effect have been unknown. In a new study in mice, researchers at Karolinska Institutet in Sweden show that exercise training induces changes in skeletal muscle that can purge the blood of a substance that accumulates during stress, and is harmful to the brain. The study is being published in the journal Cell.

"In neurobiological terms, we actually still don't know what depression is. Our study represents another piece in the puzzle, since we provide an explanation for the protective biochemical changes induced by physical exercise that prevent the brain from being damaged during stress," says Mia Lindskog, researcher at the Department of Neuroscience at Karolinska Institutet.

It was known that the protein PGC-1a1 (pronounced PGC-1alpha1) increases in skeletal muscle with exercise, and mediates the beneficial muscle conditioning in connection with physical activity. In this study researchers used a genetically modified mouse with high levels of PGC-1a1 in skeletal muscle that shows many characteristics of well-trained muscles (even without exercising).

These mice, and normal control mice, were exposed to a stressful environment, such as loud noises, flashing lights and reversed circadian rhythm at irregular intervals. After five weeks of mild stress, normal mice had developed depressive behaviour, whereas the genetically modified mice (with well-trained muscle characteristics) had no depressive symptoms.

"Our initial research hypothesis was that trained muscle would produce a substance with beneficial effects on the brain. We actually found the opposite: well-trained muscle produces an enzyme that purges the body of harmful substances. So in this context the muscle's function is reminiscent of that of the kidney or the liver," says Jorge Ruas, principal investigator at the Department of Physiology and Pharmacology, Karolinska Institutet.

The researchers discovered that mice with higher levels of PGC-1a1 in muscle also had higher levels of enzymes called KAT. KATs convert a substance formed during stress (kynurenine) into kynurenic acid, a substance that is not able to pass from the blood to the brain. The exact function of kynurenine is not known, but high levels of kynurenine can be measured in patients with mental illness. In this study, the researchers demonstrated that when normal mice were given kynurenine, they displayed depressive behaviour, while mice with increased levels of PGC-1a1 in muscle were not affected. In fact, these animals never show elevated kynurenine levels in their blood since the KAT enzymes in their well-trained muscles quickly convert it to kynurenic acid, resulting in a protective mechanism.

"It's possible that this work opens up a new pharmacological principle in the treatment of depression, where attempts could be made to influence skeletal muscle function instead of targeting the brain directly. Skeletal muscle appears to have a detoxification effect that, when activated, can protect the brain from insults and related mental illness," says Jorge Ruas.

Depression is a common psychiatric disorder worldwide. The World Health Organization (WHO) estimates that more than 350 million people are affected.

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Story Source:

The above story is based on materials provided by Karolinska Institutet. Note: Materials may be edited for content and length.

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Journal Reference:

1. Leandro Z. Agudelo, Teresa Femenía, Funda Orhan, Margareta Porsmyr-Palmertz, Michel Goiny, Vicente Martinez-Redondo, Jorge C. Correia, Manizheh Izadi, Maria Bhat, Ina Schuppe-Koistinen, Amanda Pettersson, Duarte M. S. Ferreira, Anna Krook, Romain Barres, Juleen R. Zierath, Sophie Erhardt, Maria Lindskog, and Jorge L. Ruas. Skeletal Muscle PGC-1a1 Modulates Kynurenine Metabolism and Mediates Resilience to Stress-Induced Depression. Cell, September 2014

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Three-quarters of depressed cancer patients do not receive treatment for depression; new approach could transform care.

 

Major depression in cancer patients

Three papers reveal that around three-quarters of cancer patients who have major depression are not currently receiving treatment for depression, and that a new integrated treatment program is strikingly more effective at reducing depression and improving quality of life than current care.

 

Can Antidepressants Make You Feel Worse?

 

By Nancy Schimelpfening

Updated June 19, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

While antidepressants are quite effective at relieving depression, it is possible that some patients -- in particular young people -- may temporarily feel worse when they first begin taking an antidepressant or when they make changes in their dosage.

In October 2004, the U.S. Federal Drug Administration (FDA) issued what is known as a "black-box" warning stating that certain antidepressants, when used in young people 24 years old and under, could increase their risk for suicidal thoughts and behaviors.  However, the FDA noted that there was no association found between antidepressant use and suicidal thoughts and behaviors in adults over the age of 24.  In addition, antidepressants actually appeared to reduce the risk in adults aged 65 and older.

This black box warning -- which is the most serious type of warning that can be issued regarding a prescription medication -- was ordered following a thorough review of all available clinical trials, including unpublished ones, regarding the use of antidepressants in children and adolescents.

The study included a total of 24 short-term trials of nine different antidepressants used in over 4,400 child and adolescent patients.  In addition, there were 295 short-term trials of 11 different antidepressants involving 77,000 adult patients.

While the risk of suicidality varied between drugs, the pattern of seeing increased suicidality in young people remained true for almost all drugs studied.

It should be noted that no suicides actually occurred among the young people studied.  Although there were some suicides among the adults studied, the numbers were too few for any conclusions to be drawn about whether the antidepressants used were a causal factor.  It must borne in mind that depression is also a known risk factor for suicide and cannot be ruled out in these cases.

The black box warning further suggests that patients of all ages should be monitored closely when they begin treatment with an antidepressant.  They should be watching for any signs of worsening depression, increased suicidality or changes in behavior.  In addition, families and other caregivers should be instructed to contact the patient's physician or other appropriate medical professional in the event that any problems occur.

In particular, the FDA recommends that a healthcare provider be contacted if you -- or a person who you are caring for -- experience any of the following:

• Thoughts of suicide or death
• Suicide attempts
• New or worsening depression
• New or worsening anxiety
• New or worsening irritability
• Feelings of agitation or restlessness
• Panic attacks
• Problems with sleeping
• Aggression, anger or violence
• Impulsiveness
• Extreme increases in activity or talking (signs of mania)
• Any other unusual changes in mood or behavior

While a black box warning might cause some to feel concerned, they should be aware that the benefits to be obtained from treating depression with an antidepressant greatly outweigh the risks in the majority of cases.  Untreated depression is quite serious and is much more likely to lead to suicide than an antidepressant is.  The warning is simply provided so that people can be aware of this potential effect and take appropriate measures to get help if they do begin to feel worse.

New research shows blood tests could be effective in diagnosing depression

 

Research suggests a blood test to detect depression is possible (Photo: Shutterstock)

At present, reaching a diagnosis for depression typically involves interviews with the patient, resulting in a drawn out and costly process. Some recent research efforts have sought to address this, such as a diagnostic technique that measures electrical activity in the brain to more quickly detect mental illness. Now a team of Austrian researchers has demonstrated a link between levels of serotonin in the blood and the depression network in the brain, meaning that diagnosing depression could soon become a much more efficient undertaking.

Working at the Department of Biological Psychiatry at the Medical University of Vienna, a team led by Associate Professor Lukas Pezawas examined the relationship between the speed of serotonin uptake in blood platelets and the neural depression network in the brain.

The study focused on the serotonin transporter (SERT), a protein in the membrane that enables serotonin to be transported into the cell. In the brain, this regulates the depression network and is key in fending off depressive conditions.

Recent studies have demonstrated that not only is this serotonin transporter also present in the blood, it works in the same way that it does in the brain, ensuring that the concentration of serotonin in the blood plasma is kept at healthy levels. In observing this process alongside functional magnetic resonance imaging of the brain, the team concluded that there is in fact a close relationship between the rate of serotonin uptake in the blood and the function of the neural depression network.

"This is the first study that has been able to predict the activity of a major depression network in the brain using a blood test," says Pezawas. "While blood tests for mental illnesses have until recently been regarded as impossible, this study clearly shows that a blood test is possible in principle for diagnosing depression and could become reality in the not too distant future."

The team's research was published in the journal PLOS ONE.

Source: Medical University of Vienna