Easing job stress may ward off depression

NEW YORK (Reuters Health)April 27, 2009 – Reducing on-the-job stress and strain may lower the risk of depression, new research shows.

 Over a 10-year period, workers who initially reported having high-strain jobs but then later reported perceiving their jobs as being less stressful were at the same risk of major depression as their peers who worked at low-strain jobs for the entire time, Dr. JianLi Wang of the University of Calgary in Alberta and colleagues found.

 “These results indicated that interventions targeted to reducing job strain may significantly reduce the risk of depression,” they noted in a report in the American Journal of Epidemiology.

 In a given 30-day period, 4.4 percent of US workers have major depression, the researchers point out, and work stress, also known as job strain, has been linked to depression risk.

 To investigate how changes in job strain over time might influence people’s likelihood of becoming depressed, the researchers looked at 4,866 people participating in the Canadian National Population Health Survey. All had reported on their job strain status in 1994-1995 and again in 2000-2001.

 The researchers divided study participants into four groups: people with low job strain at both time points; people with high job strain at both points; people with low job strain at the first time point and high job strain at the second; and people who initially had high job strain and then reported low job strain.

 Among people with consistently high job strain, 8 percent had an episode of major depression during the study period, compared to 4 percent of those who had low job strain at both time points. For people whose jobs got less stressful, the risk of major depression was 4.4 percent, compared to 6.9 percent for people whose jobs became more stressful.

 Within the group of people with high job strain at both time points, the researchers found, only those who rated their health as good or excellent at the beginning of the study were at greater risk of major depression; those who rated their health as poor to fair weren’t at increased risk. “These participants may have accepted the reality of having poor health and of exposure to various risk factors for health,” Wang and colleagues suggest.

 Because how people see their job’s stressfulness can change frequently, the researchers call for future studies to measure job strain in shorter time increments to better understand how workplace stress relates to depression.

 SOURCE: American Journal of Epidemiology, May 1, 2009.


My 2 Cents:  This article really points to my job situation; a high stress job that landed me on a journey of major depression and short term disability.  It has taken me almost a year to recover, but I’m back and coping – but working at a snail’s pace compared to years before.

Lithium and the Brain


Lithium And The Brain: New Light On Bipolar Treatment Drugs

ScienceDaily (Apr. 27, 2009)Lithium has been established for more than 50 years as one of the most effective treatments for bipolar mood disorder. However, scientists have never been entirely sure exactly how it operates in the human brain.

Now, new research from Cardiff University scientists suggests a mechanism for how Lithium works, opening the door for potentially more effective treatments.

Laboratory tests on cells have shown that Lithium affects a molecule called PIP3 that is important in controlling brain cell signalling. Lithium suppresses the production of inositol, a simple sugar from which PIP3 is made.

Lithium inhibits inositol monophosphatase (IMPase) an enzyme required for making inositol. Importantly, this research shows that increasing the amount of IMPase causes higher levels of PIP3. This can then be reduced by lithium treatment.

High levels of IMPA2, a gene for a variant of IMPase, has previously been linked to bipolar mood disorder. This new result suggests that Lithium could counteract the changes in IMPA2.

Professor Adrian Harwood of Cardiff School of Biosciences, who led the research, said: “We still cannot say definitively how Lithium can help stabilise bipolar disorder. However, our research does suggest a possible pathway for its operation. By better understanding Lithium, we can learn about the genetics of bipolar disorder and develop more potent and selective drugs.

“Further, altered PIP3 signalling is linked to other disorders, including epilepsy and autism, so this well established drug could be used to treat other conditions. Research into Lithium could become very important over the next few years.”

Lithium is currently under clinical trial for the treatment of neurogenerative disorder amyotrophic lateral sclerosis (ALS).

The research, funded by the Wellcome Trust, is published in the journal Disease Models and Mechanisms.

Adapted from materials provided by Cardiff University.

How Cigarettes Calm You Down

ScienceDaily (Apr. 25, 2009) — The calming neurological effects of nicotine have been demonstrated in a group of non-smokers during anger provocation. Researchers writing in BioMed Central’s open access journal Behavioral and Brain Functions suggest that nicotine may alter the activity of brain areas that are involved in the inhibition of negative emotions such as anger.

Jean Gehricke led a team of researchers from the University of California who studied the effect of nicotine patches on the subjects’ tendency to retaliate in response to anger provocation. The subjects played a computer game and could see a video screen of another player who they believed to be their opponent, although, in fact, they were playing alone. After each round, the victor could give his opponent a burst of unpleasant noise – at a duration and volume set by the winner. In some of the subjects, nicotine was associated with a reduced tendency to retaliate, even after provocation by the ‘opponent’.

According to Gehricke, “Participants who showed nicotine-induced changes in anger task performance also showed changes in brain metabolism. Nicotine-induced reductions in length of retaliation were associated with changes in brain metabolism in response to nicotine in brain areas responsible for orienting, planning and processing of emotional stimuli”.

The authors say that their findings support the idea that people of an angry disposition are more susceptible to nicotine’s effects, and are therefore more likely to become addicted to cigarettes. They conclude, “Novel behavioral treatments that affect the cortical and limbic brain areas, like anger management training, may aid smoking cessation efforts in anger provoking situations that increase withdrawal and tobacco cravings”.

Adapted from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.

Herbal Remedy: Teens & Cannabis

Herbal Remedy: Teens Often Use Cannabis For Relief, Not Recreation, Study Finds

ScienceDaily (Apr. 24, 2009) — When legal therapies let them down, some teens turn to cannabis. A new study, published in BioMed Central’s open access journal Substance Abuse, Treatment, Prevention and Policy suggests that around a third of teens who smoke cannabis on a regular basis use it as a medication, rather than as a means of getting high.

Joan Bottorff worked with a team of researchers from the University of British Columbia, funded by the Canadian Institutes of Health Research, to conduct in-depth interviews with 63 cannabis-using adolescents. Of these, 20 claimed that they used cannabis to relieve or manage health problems. Bottorff said, “Marijuana is perceived by some teens to be the only available alternative for those experiencing difficult health problems when legitimate medical treatments have failed or when they lack access to appropriate health care”.

The most common complaints recorded were emotional problems (including depression, anxiety and stress), sleep difficulties, problems with concentration and physical pain. The teens’ experiences with the medical system were uniformly negative. The authors said, “Youth who reported they had been prescribed drugs such as Ritalin, Prozac or sleeping pills, stopped using them because they did not like how these drugs made them feel or found them ineffective. For these kids, the purpose of smoking marijuana was not specifically about getting high or stoned”.

The authors emphasize that the unmet medical needs of these teens are of key importance in these findings. In contrast to the unpleasant side effects of prescribed medications and long, ineffective legal therapies, cannabis provided these adolescents with immediate relief for a variety of health concerns. Of course, cannabis isn’t completely harmless, but as one of the respondents noted, “It’s not good for you, but then again, neither is McDonald’s and a lot of other things”.

Adapted from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.

Pain Relievers Appear Ineffective In Preventing Alzheimer’s In The Very Elderly

ScienceDaily (Apr. 23, 2009) — A new study shows that nonsteroidal anti-inflammatory drugs (NSAIDs), such as the pain relievers ibuprofen and naproxen, do not prevent Alzheimer’s disease or other forms of dementia. Instead, the risk of developing dementia in the study’s very elderly population (most were over age 83 when they developed dementia) was 66 percent higher among heavy NSAID users than among people who used little or no NSAIDs, according to research published online in Neurology®, the medical journal of the American Academy of Neurology.

Researchers identified 2,736 members of Group Health, an integrated healthcare delivery system, who did not have dementia when they enrolled in the study at an average age of 75. The investigators then followed these people for 12 years to see if they developed Alzheimer’s or other forms of dementia. They checked Group Health pharmacy records for NSAIDs (tracking both prescriptions and over-the-counter use) and also asked participants about their use of NSAIDs.

Of the participants, 351 people had a history of using NSAIDs heavily at the study’s start, and another 107 became heavy NSAID users during the follow-up period. Heavy use was defined as having prescriptions for NSAIDs at least 68 percent of the time in two years.

Continue reading “Pain Relievers Appear Ineffective In Preventing Alzheimer’s In The Very Elderly”

Meditation Hopeful for Depression

Meditation Provides Hope For People With Depression

ScienceDaily (Apr. 23, 2009) — People with severe and recurrent depression could benefit from a new form of therapy that combines ancient forms of meditation with modern cognitive behaviour therapy, early-stage research by Oxford University psychologists suggests.

The results of a small-scale randomised trial of the approach, called mindfulness-based cognitive therapy (MBCT), in currently depressed patients are published in the journal Behaviour Research and Therapy.

28 people currently suffering from depression, having also had previous episodes of depression and thoughts of suicide, were randomly assigned into two groups. One received MBCT in addition to treatment as usual, while the other just received treatment as usual. Treatment with MBCT reduced the number of patients with major depression, while it remained the same in the other group.

Professor Mark Williams and colleagues in the Department of Psychiatry at the University of Oxford will follow up the promising preliminary evidence from this small-scale study. They hope to do follow up work with patients to reveal whether MBCT can also help reduce the risk of relapse. The Oxford team are currently carrying out a larger study that will compare MBCT with a group form of cognitive therapy to pinpoint which elements of meditation or talking therapies can help which people.

Professor Williams, who developed the treatment and led this study, said: ‘We are on the brink of discovering really important things about how people can learn to stay well after depression. Our aim is to help people to find long-term freedom from the daily battle with their moods.’

Adapted from materials provided by University of Oxford.


My 2 Cents:  I am so skeptical of therapies, let alone these new ones coming up.  But a friend of mine did experience EMDR, and at first her and I both thought it was hogwash – but it really worked for her.

U.S. spends $9 billion on child mental illness

WASHINGTON (Reuters) – April 22, 2009 – Trchild-mental illnesseating depression and other mental disorders in U.S. children cost $8.9 billion in 2006, making mental illness the most expensive condition to treat in childhood, U.S. government researchers reported on Wednesday.

An estimated 4.6 million children were treated for mental disorders in 2006 at an average cost of $1,931 per child, the Agency for Healthcare Research and Quality reported.

 But more children were treated for asthma than any other disease or injury, the AHRQ found. It said nearly 13 million children were treated for asthma in 2006 at an average cost of $621 for a total of $8 billion.

 Fractures, sprains, burns, and other physical injuries from accidents or violence sent 7 million children to doctors or clinics at a cost of $658 per child or $6.1 billion, the survey found.

 (Reporting by Maggie Fox, editing by Vicki Allen)


My Sweet Emma

Emma with her pink winter coat waiting for her walk
Emma with her pink winter coat waiting for her walk

What do you do when your dog of age 16 passes away?  Do you get another one right away?  Is that taking the memory away from the other dog?  What to do.  My little toy poodle, Casey died in November 2008 of old age – it was a truly distressing time.  I was adamant with my husband “no more dogs”, and then thought, there could be a dog out there waiting to be adopted.  Here’s my story:

Emma and I met for the first time on December 09, 2008.  I was to meet her at her foster mum’s home, for she had been living there for the last 1 ½ months. 

Emma scurried to door to greet my mom and I, then rapidly ran back to her doggie bed.  She was ever so adorable, yet looked ever so frightened also.  But what was I to expect, I knew there could be problems – Emma was rescued from a Puppy Mill.

I shed tears while hearing of Emma’s past, or what they knew of it.  The rescue organization said that when she arrived she like a “block of salt”.  No movement/no expression.  Just sat there.  Also she was termed a “dump dog”.   The dogs unable to breed due to age are gathered up, taken to the “garbage dump” and shot.  Some dogs escape, and my little Emma was one of them. 

These unfortunate dogs from puppy mills didn’t ask to be born.  Into a life of living in undersized cages for all of their lives and bred every time they come into heat from six months of age, twice a year until they are too old and of no use.

It’s a life of freezing in winter and surviving from the heat of summer.  Never a toy,  a tender touch, a friendly voice,  soft bed or treat.  Just behind bars all day; in a prison.

I adopted Emma with no question, but still in the back of my mind thinking “am I taking on too much?”  But no, my mind was made up to adopt a dog and not go through a breeder, plus this was my mission, to give her a permanent home instead of a prison where she survived for her whole 6 years.  I wanted her to experience a soft bed, toys, her own dog dish, someone speaking lovingly to her, and running in an off-leash dog park.

It’s been almost 6 months, and Emma is the sweetest, funniest dog you could meet.  I love this dog to bits.  She loves shoes, doesn’t chew them, for that matter never chews anything, but gathers 4 or 5 of my shoes and carries them to the couch.   When I arrive home from work, Emma’s at the door with the tail wagging and the shoes are on the couch!   She was also very well house-trained, as she infrequently does her business on the floor.  When she was new to my home, she would cower when I came near, but she is now pretty much attached to me, following me and loves to snuggle up against me while watching TV.  Only problem:  Doesn’t care much for my hubby, a little growl here and there.  We heard that men operated the mills and that’s probably why they don’t favor males.  We will have to give it some time.

I love my little doggie.  They said she was a “Schnoodle”  (Schnauzer + Poodle), but I think she is more , a bit Schnauzer + Terrier.  Maybe just a Heinz 57.  She weighs almost 16 lbs.

The foster families that these mill dogs go to before adoption do a fantastic job.

FYI:   99.9% of puppies in pet stores come from PUPPY MILLS and there is always a danger that these puppies have health problems.

Death Certificates Incomplete for Suicide Victims

FRIDAY, April 17 (HealthDay News) — About half of those who commit suicide have been diagnosed with a mental disorder.

But fewer than 10 percent of their death certificates list mental disorder as a contributing factor, a new study shows.

 Incomplete death certificates make it more difficult for health-care policymakers to create prevention strategies, said lead researcher Ian Rockett, a professor of epidemiology and associate chairman of the West Virginia University Department of Community Medicine.

“Death certificates are vital to an understanding of suicide, because they provide frontline data in terms of suicide surveillance,” Rockett said. “We need detailed and accurate information to help get our high suicide rates down. … We can’t track this when reporting is casual, sloppy or nonexistent.”

 The study was published in the online British medical journal BMC Psychiatry.

Suicide is the 11th leading cause of death in the United States, according to the National Institute of Mental Heath. Estimates are that 25 people attempt suicide for every one who carries out the act. Suicide outranks homicide as a cause of death.

Incomplete death certificates were the most common among blacks and Hispanics, the study found.

 Researchers analyzed data from more than 140,000 death certificates listing suicide from 1999 to 2003 that were released by the National Center for Health Statistics.

 They found blacks and Hispanics are much less likely to have depression or other health problems recorded on their death certificates. The gap is largest among males, with white males twice as likely as their minority counterparts to have health problems at the time of their death listed.


Addiction Drug May Help Ease Fibromyalgia

FRIDAY, April 17 (HealthDay News) — Low doses of an inexpensive drug called naltrexone — already used for years to treat drug addiction — helped reduce pain and fatigue in women with the painful disorder fibromyalgia, a new study has found.

“Physicians have been using this off-label for a while,” said study co-author Jarred Younger, an instructor in anesthesia and pain medicine at Stanford University School of Medicine. The findings were published online April 17 in the journal Pain Medicine.

 Fibromyalgia is a chronic ailment, marked by musculoskeletal pain and sensitivity to being touched. Some experts say it may affect up to 4 percent of the population.

 Three prescription drugs are also on the market to treat fibromyalgia, Younger said. But, he added, “the three drugs don’t solve the problem for everyone. Some don’t respond to any of these drugs.”

 Younger said he got the idea to study naltrexone after hearing that some other doctors had success with it and after hearing from some members of fibromyalgia support groups that it had worked for them.

 While the results of the small study look promising, Younger said it’s too early to recommend the drug until more research is in.

 In the study, he gave all 10 women a handheld computer and told them to enter daily reports of pain and other symptoms, describing them all on a scale of not bad to worst. The women were taken off their current fibromyalgia medication, then began to take placebo for two weeks (although they did not know it was placebo). Next they took naltrexone for 8 weeks. They then went through a two-week ”washout” period.

 The researchers then evaluated their symptoms. “The drug reduced symptoms by 30 percent compared to placebo,” Younger said. It was a statistically significant difference, he said.

 That was an overall result, and the drug worked better for some than others. “Six out of the 10 were strong respondents, with at least a 50 percent reduction in symptoms,” Younger said. It didn’t work for all 10 women, he said, and some did not respond at all.

Naltrexone also seemed to ease certain symptoms more than others. “The drug helped daily pain — the higher levels of pain, fatigue and stress,” Younger said.

 One symptom that did not typically improve was “fibro fog,” the foggy thinking associated with the disorder, sleep quality, headaches, gastrointestinal problems and sadness.

Exactly how the drug works is not known for sure, Younger said. One possibility is that naltrexone quiets down a hyperactive immune system, he said.

 Younger is continuing the research, and if the good results seen here bear out, naltrexone may be a good alternative for some patients. “It’s a small dose, and we saw very few side effects,” he said. The most typical was vivid dreaming.

Naltrexone has another point in its favor: cost. Doses of the drug, which must be gotten from special “compounding” pharmacies, total about $40 a month, Younger said.

 Another expert called the study “fascinating.”

 “I was pleased to see that they had such a nice response to the therapy,” said Dr. Patrick Wood, a family medicine physician with a specialty practice in fibromyalgia in Renton, Wash. He serves as medical adviser for the National Fibromyalgia Association.

 The study was small, he said, but scientifically sound. If more research is promising, naltrexone may eventually be a competitor to higher-priced fibromyalgia drugs now on the market, Wood said.

 More information

To learn more about fibromyalgia, visit the National Fibromyalgia Association.



Antidepressants underused in the elderly: study


NEW YORK (Reuters Health) – April 16, 2009 – The results of a postmortem toxicology study indicate that elderly people who commit suicide usually do not have antidepressant medications in their systems at the time of death.

 Antidepressants were found in less than 1 in 4 victims overall, and in even fewer of those in the oldest age group, 85 years and older.

 “Assuming that many of the suicide victims had clinically treatable depression, these findings implicate problems in the delivery of specific antidepressant pharmacologic treatment to the ‘old-old’,” Dr. Robert C. Abrams, from Weill Cornell Medical College, New York, and colleagues conclude in a report in the Journal of Clinical Psychiatry.

 Their findings are based on a study of 255 suicide victims from New York City who were at least 65 years of age at the time of their death between 2001 and 2004.

 Toxicology results available for 162 victims revealed the presence of antidepressant medication in only about 23 percent of cases.

 By age group, rates of antidepressant detection were 22.0 percent in subjects 65 to 74 years of age, 26.8 percent in those 75 to 84 years, and just 16.7 percent in those 85 years and older.

 There was some evidence that many had been using anti-anxiety drugs, hypnotics and painkillers in lieu of antidepressants.

 SOURCE: Journal of Clinical Psychiatry, March 2009.


The ICU and Post-stay Depression

In The ICU, Use Of Benzodiazepines, Other Factors May Predict Severity Of Post-stay Depression

ScienceDaily (Apr. 13, 2009) — Psychiatrists and critical care specialists at Johns Hopkins have begun to tease out what there is about a stay in an intensive care unit (ICU) that leads so many patients to report depression after they go home.

In a study reported online April 10 in Critical Care Medicine, the Hopkins researchers say several factors predicted symptoms of depression six months after hospitalization among very sick ICU patients, including a high level of organ failure and being given relatively high doses of a benzodiazepine sedative.

“The hope is that as we learn more about the effect of variations in ICU care, we’ll be able to predict which patients are most susceptible to depression, prevent some depression by changing ICU practices, and make sure patients receive adequate mental health monitoring after discharge,” says O. Joseph Bienvenu, M.D., Ph.D., an associate professor in the Department of Psychiatry at the Johns Hopkins University School of Medicine.

Bienvenu says doctors have long theorized that a health problem devastating enough to send someone to an ICU might well trigger depression, but because only some patients become depressed, he and his colleagues wondered whether the root causes might be more complex.

“Historically, the only goal for critical care physicians, understandably, was to keep people alive, but now there is interest in longer-term outcomes, such as patients’ mental health and well-being,” says Bienvenu. “So we asked ourselves, could certain aspects of critical illness and ICU care swing patients toward depression?”

To test the idea, Bienvenu and other Johns Hopkins researchers evaluated patients recently admitted to one of 13 ICUs located at four teaching hospitals in Baltimore, Md., including four ICUs at The Johns Hopkins Hospital.

Each of the patients was treated for acute lung injury (ALI), a respiratory distress syndrome that’s considered an archetype of critical illness. Patients with ALI typically require invasive interventions in the ICU, including use of ventilators. Though better care has greatly reduced mortality rates, ALI still kills about 40 percent of those affected.

Bienvenu and his colleagues followed 160 patients who had survived at least six months after their ALI diagnosis. The researchers took note of a variety of features of each patient’s status and care while in the ICU, such as severity of organ failure, their blood sugar levels and other lab work, and the amount and type of sedative they received.

At six months after ALI diagnosis, the researchers administered a questionnaire to patients that measured depressive symptoms ranging from none to possible or probable clinical depression. Of the 160, 26 percent scored above the threshold for possible depression. Compared to other ALI survivors, the depressed patients were more likely to have suffered greater severity of organ failure and to have received 75 mg or more of a benzodiazepine sedative daily.

Bienvenu says that because more severe organ failure may lead to a longer physical recovery period after ICU discharge, patients’ depression may be explained, in part, by a slow recovery. However, he and his colleagues aren’t sure how to explain the association between depression and ICU benzodiazepine dose.

One possibility could be that the amount of this drug received reflects how agitated patients were in the ICU, with very distressed individuals getting higher doses. However, because this relationship hasn’t been seen with other types of sedatives commonly prescribed in the ICU, it’s possible that high doses of benzodiazepine alone may somehow cause depressive symptoms. “This is clearly a question that needs further study,” says Bienvenu.

Adapted from materials provided by Johns Hopkins Medical Institutions, via EurekAlert!, a service of AAAS


Asperger syndrome linked to cortisol response

NEW YORK (Reuters Health) – April 15, 2009 – Upon awakening, there is normally a surge in cortisol, a steroid hormone produced by the adrenal gland and released in response to stress. Now, UK researchers report that this response is absent in adolescent boys with Asperger syndrome, which may explain some of the symptoms of the condition, such as the need for routine and resistance to change.

 Among other functions, the ability to adapt to change is controlled by the hypothalamic-pituitary-adrenal axis, which controls the dramatic increase in cortisol upon awakening, referred to as “the cortisol awakening response,” the study team explains in an article in press in the journal Psychoneuroendocrinology.

 “The cortisol awakening response is a robust and reproducible neuroendocrine phenomenon which has been positively correlated with psychological and physical well-being,” they add.

 Dr. Mark Brosnan from University of Bath and colleagues say their research points to a lack of response in the hypothalamic-pituitary-adrenal axis in individuals with Asperger syndrome, which may help explain why these individuals have difficulties if there are minor changes in their routine or environment.

 In the study, the investigators measured the cortisol in saliva of 20 adolescent males with Asperger syndrome and 18 age-matched controls at the time of awakening and 30 minutes later.

 While a significant cortisol awakening response was clearly evident in the control group, this was not the case in the Asperger group.

 “In our study, the typical marked rise in cortisol, peaking around 30 minutes after waking, was found to be of significant magnitude only in the typically developing control group. Therefore, Asperger syndrome, at least in adolescent males, appears to be characterized by an impaired cortisol awakening response,” Brosnan and colleagues write.

 Brosnan and colleagues say further research is needed to address this “intriguing phenomenon” in Asperger syndrome.

 SOURCE: Psychoneuroendocrinology 2009.


Feeding Tubes and Advanced Dementia?

Do Feeding Tubes Help Or Harm In Advanced Dementia?

ScienceDaily (Apr. 15, 2009) — Family members grappling with the decision to allow a feeding tube for a relative with advanced dementia will find little comfort from a new review of evidence.

Poor food intake is common in individuals with dementia for a variety of reasons. In advanced dementia, health care providers might intervene by feeding patients artificially, usually by inserting a feeding tube through the stomach. This decision is emotional, controversial and influenced by complex ethical issues.

But do feeding tubes actually help people with degenerative dementia? In a new Cochrane review from London, doctors searched for evidence that this intervention was beneficial.

“We found that there is no research evidence that tube feeding prolongs survival or improves the quality of life for people with advanced dementia,” said lead author Elizabeth Sampson, M.D. “In fact, some studies suggest that tube feeding may have an effect opposite to the desired and actually increase mortality, morbidity and reduce quality of life.”

The review appears in the current issue of The Cochrane Library. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Continue reading “Feeding Tubes and Advanced Dementia?”

Cognitive Behavior Therapy Eases Anxiety for Older People

mental health-elderly

The technique lessens worries more than usual care, study finds

TUESDAY, April 7 (HealthDay News) — For older adults, anxiety is an increasingly common problem, and new research suggests that cognitive behavior therapy may help them ease their worries more than standard care does.

Researchers found that people over age 60 who were treated with cognitive behavior therapy (CBT) had less worry, fewer depressive symptoms and improved general mental health at the end of the study compared to people who received biweekly telephone calls from their health-care provider.

“This kind of treatment (CBT) can be useful for people who have anxiety, and it can help them learn how to manage it better,” said the study’s lead author, Melinda Stanley, a professor in the Menninger department of psychiatry and behavioral sciences at Baylor College of Medicine in Houston.

“Many older adults are not always thrilled with the use of medications for anxiety. Many times, they’re already on medications for chronic health conditions, and they may be afraid of side effects. This is a non-medication treatment option,” she noted.

The findings were published in the April 8 issue of the Journal of the American Medical Association.

The prevalence of generalized anxiety disorder is estimated to be more than 7 percent in older people living in the community. People who are more anxious later in life have a higher risk of physical disabilities, memory problems, a lower quality of life, increased use of health-care services and death, according to background information in the study.

Medications are often prescribed to treat anxiety disorders. Benzodiazepines, such as Valium and Xanax, or antidepressants, such as Lexapro and Paxil, are commonly prescribed for people with anxiety, according to the study. But, many people are concerned about the side effects of these medications, particularly benzodiazepines, which may be sedating.

Another study, however, confirmed that Lexapro (escitalopram) was an effective anxiety treatment. This study, published in the Jan. 21 issue of the Journal of the American Medical Association, found that Lexapro was more effective than a placebo in reducing anxiety in older adults, and even helped reduce blood pressure, too.

In the new study, about 42 percent of the volunteers were taking either a benzodiazepine or an antidepressant at the start of the trial. Stanley said the researchers didn’t ask anyone to stop the use of their medications, because they wanted to “make this a more real-world trial.” Stanley said the researchers told the study volunteers that they could change their medication if they needed to, but the study didn’t require it.

The study included a total of 134 people with an average age of 67 years. All were being treated in primary care for their anxiety. About half underwent cognitive behavior therapy with experienced therapists. They had up to 10 sessions of CBT over three months that included relaxation training, problem-solving exercises, behavioral sleep management, cognitive therapy and education and awareness training.

The other half received standard primary care, and they were called biweekly to ensure their safety and provide support if needed. Both groups were told to call the therapists if their symptoms worsened.

Response rates were higher in the CBT group versus the usual care — 40 percent compared to 22 percent, respectively. Worry severity and depressive symptoms were more reduced in the CBT group, and overall mental health was improved more in the CBT group, based on the Penn State Worry Questionnaire.

On another measure, the GAD Severity Scale, the researchers didn’t find a significant statistical difference, but this scale hasn’t really been validated as a measure of change, according to Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City.

“I think this was a very carefully done study that moves us another step along in treating anxiety in older people,” Kennedy said. “Cognitive therapy works for older adults. It significantly reduced people’s anxiety.”

Stanley and Kennedy both said they weren’t aware of any trials that compared the use of medications to CBT. But, Kennedy pointed out that the two treatments aren’t “mutually exclusive.”


Mental Health Problems In Childhood May Predict Later Suicide Attempts In Males

ScienceDaily (Apr. 7, 2009) — Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at age 8, according to a new report. However, later suicide attempts in females are not predicted by mental health issues at this age.

“Suicide among adolescents and young adults is a major public health concern worldwide,” the authors write as background information in the article. “The rates of mortality [death] by suicide have been found to be high among those with medically serious suicide attempts. For effective prevention, knowledge of the key risk factors for suicide is essential.”

Andre Sourander, M.D., of Turku University Hospital, Turku, Finland, and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance and family demographics was gathered from children, parents and teachers. Participants were then tracked through national registers through 2005.

Between ages 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1 percent) either completed suicide or made a suicide attempt serious enough to result in hospitalization.

Of the 27 males who either seriously attempted or completed suicide, 78 percent screened positive for psychiatric conditions at age 8, compared with 11 percent of 27 females who had serious or completed suicide attempts. In addition, males who would go on to make life-threatening or completed suicide attempts were more likely at age 8 to live in a family that did not consist of two biological parents, have psychological problems as reported by a teacher or have conduct, hyperactive or emotional problems. However, none of these factors at age 8 predicted later suicidal behavior in females, and depression at age 8 was not associated with suicide attempts for either sex.

“The main finding of our study is that severe suicidality in adolescence and early adulthood has different childhood trajectories among males and females,” the authors write. “The present study shows that among males severe suicidality (i.e., completed suicide or serious, life-threatening attempts) shows a pathway of persistence throughout the life cycle, starting in early childhood. Four out of five of these males showed a high level of psychiatric symptoms at the age of 8 years.”

Previous research has shown that in females, suicide is associated with depression and other affective disorders, which increase sharply after the beginning of puberty. This may explain why childhood psychiatric conditions do not predict later suicidal behavior in girls, the authors note.

“These findings have considerable public health significance,” they conclude. “The development of measures to effectively screen, detect and treat childhood disorders is a key issue in the effort to prevent suicide among males. This focus is particularly important among males with severe conduct problems because, during adolescence, they usually do not seek mental health services. Further studies are warranted to examine the efficacy of such preventive measures in childhood in the reduction of suicide rates among males.”

Adapted from materials provided by JAMA and Archives Journals.

Psychotherapy Can Ease Post-Surgical Depression

Two techniques worked for patients after heart bypass procedures, study finds

MONDAY, April 6 (HealthDay News) — Two non-drug treatments — cognitive behavior therapy and supportive stress management — seem to be more effective than usual care for treating depression in patients who’ve had coronary artery bypass graft (CABG) surgery, a new study finds.

About 20 percent of bypass patients suffer major depression and another 20 percent experience milder forms of depression, according to background information in the study by Kenneth E. Freedland, of the Washington University School of Medicine in St. Louis, and colleagues.

The study included 123 patients who had major or minor depression one year after bypass. They were randomly selected to receive either usual care (40 patients) as determined by a physician, 12 weeks of cognitive behavior therapy (41 patients), or 12 weeks of supportive stress management (42 patients).

In cognitive behavioral therapy, a psychologist or social worker helped patients identify problems and develop cognitive techniques for overcoming them. In supportive stress management, patients were counseled about how to improve their ability to cope with stressful life events.

All the patients were assessed at the start of the study and again after three, six and nine months. After three months, remission of depression was seen in 71 percent of patients in the cognitive behavior therapy group, 57 percent of patients in the supportive stress management group, and 33 percent of the usual care group.

After nine months, the rates were 73 percent for the cognitive behavior therapy group, 57 percent for the supportive stress management group and 35 percent for the usual care group.

“Cognitive behavior therapy was also superior to usual care on most secondary psychological outcomes, including anxiety, hopelessness, perceived stress and the mental (but not the physical) component of health-related quality of life. On most of these measures, differences between cognitive behavior therapy and usual care were found at all three follow-up assessments. Supportive stress management was superior to usual care only on some of these measures,” Freedland and colleagues wrote.

“In conclusion, this randomized, controlled trial showed that cognitive behavior therapy was an efficacious treatment for depression in patients with a recent history of coronary bypass surgery,” the researchers said. “Supportive stress management was also superior to usual care for depression in these patients, but it had smaller and less durable effects than cognitive behavior therapy.”

The study appears in the April issue of the Archives of General Psychiatry.


Coming Face To Face With Autism

ScienceDaily (Apr. 4, 2009) — In the first study of its kind researchers will use video clips of spontaneously produced facial expressions in a real life social context to explore emotion recognition in autism.

This research, carried out at The University of Nottingham, will go beyond the more artificial emotion recognition tasks that have previously been used. The eye movements of volunteers will also be tracked to find out which areas of the face were looked at while volunteers make spontaneous judgements.

The study is being conducted by PhD student Sarah Cassidy who is a member of the Autism Research Team based in the School of Psychology. Her work has been funded through a PhD studentship from the Economic and Social Research Council.

Her work will investigate if people with autism look at faces, particularly in the eye region, differently.  If so, does this have any relationship with their ability to recognise emotions in others? What is their understanding of emotions in different social contexts? And as a consequence, how difficult is it for them to socialise and communicate with other people?

Sarah said: “Previous research has suggested that people with autism have difficulty inferring emotion from faces due to lack of attention to the eyes and increased attention to the mouth.  However not all studies have shown differences in emotion recognition and eye gaze.  There is also little research asking what role reading emotion from the eyes plays in social communication difficulties in autism, with a few studies suggesting a relationship with social competence and responsiveness.”

Sarah is looking for volunteers aged 18 and over who have a diagnoses of autism, autism spectrum disorder or Aspergers syndrome. She also wants to hear from typically developing people, also over the age of 18, who are interested in helping with her research.

Participants will view 21 video clips of facial expressions and will be asked whether the person in the video received chocolate, monopoly money or a home made gift. Each volunteer will have their eye movements measured and will be asked to provide an emotion label for the facial expression. The test will also include logic and vocabulary tasks and an interview and short questionnaire to provide a measure of how challenging each volunteer finds socialising and communicating with others.

Sarah’s supervisor, Professor Peter Mitchell from the School of Psychology, said: “The procedures developed by Sarah allow us to investigate how people with autism process social information under conditions that are close to real life. Previous research has been somewhat contrived and unlike real life. High functioning people with autism tend to perform well on those artificial tasks and therefore this is not particularly informative about the social difficulties suffered by people with autism. Sarah’s study has features that are much closer to challenges faced by people with autism in real life and therefore has potential to tell us precisely what aspects of social functioning are difficult for them.”

Adapted from materials provided by University of Nottingham