среда, 15 декабря 2010 г.

Spirituality protects against depression

Those who worship a higher power often do so in different ways. Whether they are active in their religious community, or prefer to simply pray or meditate, new research out of Temple University suggests that a person's religiousness - also called religiosity - can offer insight into their risk for depression.
Lead researcher Joanna Maselko, Sc.D., characterized the religiosity of 918 study participants in terms of three domains of religiosity: religious service attendance, which refers to being involved with a church; religious well-being, which refers to the quality of a person's relationship with a higher power; and existential well-being, which refers to a person's sense of meaning and their purpose in life.
In a study published on-line this month in Psychological Medicine, Maselko and fellow researchers compared each domain of religiosity to their risk of depression, and were surprised to find that the group with higher levels of religious well-being were 1.5 times more likely to have had depression than those with lower levels of religious well-being.
Maselko theorizes this is because people with depression tend to use religion as a coping mechanism. As a result, they're more closely relating to God and praying more.
Researchers also found that those who attended religious services were 30 percent less likely to have had depression in their lifetime, and those who had high levels of existential well-being were 70 percent less likely to have had depression than those who had low levels of existential well-being.
Maselko says involvement in the church provides the opportunity for community interaction, which could help forge attachments to others, an important factor in preventing depression. She added that those with higher levels of existential-well being have a strong sense of their place in the world.
"People with high levels of existential well-being tend to have a good base, which makes them very centered emotionally," said Maselko. "People who don't have those things are at greater risk for depression, and those same people might also turn to religion to cope."
Maselko admits that researchers have yet to determine which comes first: depression or being religious, but is currently investigating the time sequence of this over people's lives to figure out the answer.
"For doctors, psychiatrists and counselors, it's hard to disentangle these elements when treating mental illness," she said. "You can't just ask a patient if they go to church to gauge their spirituality or coping behaviors. There are other components to consider when treating patients, and its important information for doctors to have."

пятница, 10 декабря 2010 г.

Wyeth’s Pristiq: New Treatment For Major Depression

Wyeth Pharmaceuticals’ PRISTIQ (desvenlafaxine), a new serotonin-norepinephrine reuptake inhibitor (SNRI) approved to treat adult patients with major depressive disorder (MDD), is now available in U.S. retail pharmacies nationwide. The recommended dose of PRISTIQ is 50 milligrams (mg) once daily. The Company begins full-scale selling and educational efforts regarding PRISTIQ for physicians this week.
%26quot;We are proud to make PRISTIQ available as a new treatment option for the millions of American adults who struggle with depression,%26quot; comments Philip Ninan, M.D., Vice President, Wyeth Medical Affairs, Neuroscience. %26quot;The recommended therapeutic dose of PRISTIQ is 50 mg once daily. Titration is not required to reach the recommended therapeutic dose.%26quot; Dosage adjustment (50 mg every other day) is necessary, however, in patients with severe renal impairment or end-stage renal disease.
PRISTIQ, an SNRI approved by the U.S. Food and Drug Administration on February 29, 2008, is an important new treatment option for the millions of adults in the United States who have MDD. Discovered and developed by Wyeth, PRISTIQ demonstrates the Company’s significant and continued commitment to developing new therapies in the field of neuroscience.
At the recommended dose of 50 mg, the discontinuation rate due to an adverse experience for PRISTIQ (4.1 percent) was similar to the rate for placebo (3.8 percent) in clinical studies. The most commonly observed adverse reactions in patients taking PRISTIQ for MDD in short-term, fixed-dose studies (incidence greater than or equal to 5 percent and at least twice the rate of placebo in the 50 mg dose groups) were nausea, dizziness, hyperhidrosis, constipation and decreased appetite.
About Major Depressive Disorder
Major depressive disorder (MDD) is a common mental disorder, affecting about 121 million people worldwide. In the United States, MDD affects approximately 15 million adults, or 6.7 percent of the U.S. population age 18 and older in a given year. In fact, depression is among the leading causes of disability and the fourth leading contributor to the global burden of disease. Further, a research study estimated that the total economic burden of depression was $83.1 billion in 2000, including direct treatment costs and suicide- and work-related costs.
Important Treatment Considerations
* Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders.
* Anyone considering the use of PRISTIQ or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.
* Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.
* Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
* Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

воскресенье, 5 декабря 2010 г.

Homeowners In Foreclosure Suffer Major Depression

The nation’s home foreclosure epidemic may be taking its toll on Americans’ health as well as their wallets. Nearly half of people studied while undergoing foreclosure reported depressive symptoms, and 37 percent met screening criteria for major depression, according to new University of Pennsylvania School of Medicine research published online this week in the American Journal of Public Health. Many also reported an inability to afford prescription drugs, and skipping meals. The authors say their findings should serve as a call for policy makers to tie health interventions into their response to the nation’s ongoing housing crisis.
“The foreclosure crisis is also a health crisis,” says lead author Craig E. Pollack, MD, MHS, who conducted the research while working as an internist and Robert Wood Johnson Foundation Clinical Scholar at Penn. “We need to do more to ensure that if people lose their homes, they don’t also lose their health.”
In addition to the high number of participants reporting depression symptoms, the study of 250 Philadelphia homeowners undergoing foreclosure also shed light on other health care problems that may be spurred by difficulties keeping up with housing costs. The study participants were recruited with the Consumer Credit Counseling Service of Delaware Valley, a non-profit, U.S. Housing and Urban Development-approved mortgage counselor.
The authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent), though similar health problems were seen among both the insured and uninsured. Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent). The study also revealed that for 9 percent of respondents, a medical condition in their family was the primary reason for the home foreclosure, and more than a quarter of those surveyed said they had significant unpaid medical bills.
Because the financial hardships of foreclosure may lead homeowners to cut back on health care spending that they consider “discretionary” – preventive care visits, healthy foods or drugs for chronic conditions like hypertension – Pollack theorizes that the prolonged period of time that most homeowners spend in foreclosure could have a serious effect on health outcomes. In addition, the stress of undergoing foreclosure may exacerbate health-undermining behaviors. Among the participants who smoke, for instance, 65 percent said they had been smoking more since they received notice of foreclosure. The “exceptionally high” rate of depressive symptoms found in the study is especially concerning, Pollack says, compared to previous research showing that only about 12.8 percent of people living in poverty meet criteria for major depressive disorder.
“When people purchase homes, they are buying a piece of the American Dream,” says co-author Julia Lynch, PhD, the Janice and Julian Bers Assistant Professor in the Social Sciences in Penn’s department of political science. “Losing a home can be especially devastating because it means the loss of this dream. When this happens, there is reason to worry not only about the health of the home owner but also that of family members and the broader community they live in.”
The authors say that the data collected in Philadelphia may be only the tip of the iceberg when compared to other cities that have experienced a sharp spike in housing foreclosures. Although foreclosure filings nearly doubled between 2007 and 2008 in Philadelphia, other large cities have higher unemployment and foreclosure rates.
To combat the health problems revealed in the study, Pollack and Lynch suggest that health care workers and mortgage counseling agencies coordinate their efforts to help people at risk of foreclosure access both medical and housing help. Doctors, they suggest, should ask their patients about their housing situation and steer them towards mortgage relief resources. Mortgage counselors, meanwhile, can provide information about how to access safety net health care, enroll in public insurance programs like SCHIP or Medicaid, or apply for nutritional assistance programs for pregnant and nursing mothers and their children. The implications for policy, too, are vast.
“This study raises the stakes of the housing crisis,” Pollack says. “The policy push to get people into mortgage counseling should be combined with health outreach in order to fully help people during this tremendously difficult period in their lives.”

среда, 1 декабря 2010 г.

Should young people be given antidepressants for depression treatment?

Youth and depression treatment
Depression is disabling a growing proportion of children, but evidence on treatment is disputed. In this week’s BMJ, two experts debate whether young people should be given antidepressants.
To deny these vulnerable groups the possibility of receiving antidepressants would be to withhold one of the few evidence based treatments available to them, argues Andrew Cotgrove, Clinical Director and Consultant in Adolescent Psychiatry at Pine Lodge Young People’s Centre in Chester.
It is the use of selective serotonin reuptake inhibitors (SSRIs) in children that has been most controversial. However, objective analysis of the studies shows a significant benefit over placebo for some SSRIs and guidelines recommend that they can be used for the treatment of depression and obsessive-compulsive disorder in young people.
Research shows that there is an increase in suicide related events, but the risk is small and can be reduced further by careful monitoring, he says. There is also some evidence that psychological treatments (cognitive behavioural therapy, interpersonal therapy, and family therapy) are effective for depression in young people, but the effects are small.
Worrying methodological errors, publication bias, and omissions of evidence in the conduct and reporting of some SSRI trials have rightly alarmed the medical profession and the public, he writes. However, careful and objective review of the evidence shows that antidepressants have a place in treating young people with depression or obsessive-compulsive disorder.
Parents and young people need to be told the risks and benefits, given advice, and be supported in choosing an evidence based treatment.
Removing antidepressants from this choice would take away one of the few potentially effective interventions for these disabling conditions, he concludes.
Continuing to use SSRIs in young people is not good value for money, dangerous, and ethically unsound, argues Sami Timimi, Consultant Child and Adolescent Psychiatrist in Lincolnshire.
None of the studies on SSRIs for childhood depression have showed significant advantage over placebo. Despite this, national guidelines have concluded that fluoxetine has a favourable balance of benefit over risk.
But the profile for fluoxetine is similar to that of all other SSRIs, says Timimi – it has little efficacy and is potentially dangerous. However, he acknowledges that the high placebo response can make it difficult for doctors faced with a distressed young person to accept that SSRIs may be ineffective.
Distorted reporting hasn’t helped this situation, he adds, and marketing spin has taken precedence over scientific accuracy. One reason for doing the studies in the first place was to justify well established prescribing patterns. It created a trend which has been difficult to reverse despite the evidence. But reverse it we must, as it is neither value for money nor clinically useful, may have resulted in a small but tragic number of avoidable suicides, and contributed to a trend of inappropriately medicalising common emotional states and experiences.
Most states of childhood distress are self limiting and do not require extensive intervention but, when intervention is necessary, psychotherapy has a well established record of effectiveness, he concludes.