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Depression
Topic Started: Jan 24 2006, 08:39 PM (713 Views)
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Rock Star From Mars

Anyone here can tell me in a nut shell or layman's terms what are the differences between "major depression" and "atypical depression" -?

I've done a bit of Googling on it (see links below), but I wish I could find a page that sums it all up. I'm still not sure I see what the differences are...

Atypical Depression- from Healthy Place

Major Depression - Healthy Place

Depression and Varied Types of Depression
  • - seems to say that in the case of atypical depression (as opposed to major depression), the difference is that outside events control the mood of the person afflicated, whereas inteneral considerations affect those with major depression.
Atypical Depression - Recognizing a common form of depression

Excerpt:
  • According to the DSM-IV, as opposed to major depression, the patient with atypical features experiences mood reactivity, with improved mood when something good happens. In addition, the DSM-IV mandates at least two of the following: increase in appetite or weight gain (as opposed to the reduced appetite or weight loss of "typical" depression); excessive sleeping (as opposed to insomnia); leaden paralysis; and sensitivity to rejection.
Major Depression: Coexisting Conditions and Diagnosis

Although this page tries to sum it up, I'm still kind of left scratching my head, wondering what the differences are -
  • 11. What is major depression?

    Major depression is a well-characterized medical illness that consists of a number of discrete symptoms. These include a persistently depressed mood for several weeks or longer and an inability to experience pleasure or enjoy normal activities.

    Changes in basic functions include sleep and appetite disturbances, diminished interest in sex, and difficulty in making day-to-day decisions. Sufferers may also feel physically or cognitively anxious, agitated or very slow. Most conspicuously, they may sometimes have suicidal thoughts or even attempt suicide.

    12. What is atypical depression?

    Atypical depression distinguishes people who seem to have many of the symptoms of major depression, but have difficulty staying asleep or seem to sleep too much. Additionally, instead of having a diminished appetite, they have a marked increase in appetite, a sensitivity to interpersonal rejection and leaden paralysis-a feeling of being so depressed that it is major effort to do even basic tasks. Atypical depression resembles hibernation in that metabolism is slowed and sufferers sleep great lengths and eat excessively.
If anyone here can tell me the difference in simpler terms off the top of their heads or paste in URLs/ info from web pages that explain it better, I'd appreciate it. Thanks.
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madame duran


I'm not a psychologist by any stretch of the imagination but judging by the info from those links you gave, I'd say that the mood of a person with atypical depression is linked to a given situation (e.g. feeling good while hanging out with friends, doing stimulating activities...then immediately 'crashing' in despair when they are no longer around. I'm not talking about the achey feeling you get from being a little wistful or lonesome--it's more debilitating than that). With major depression, the feelings of the person are more persistantly sad. It doesn't matter whether friends are around or not, the person just can't enjoy anything anymore. As far as symptoms go, the major difference stated is that atypical depressed people tend to eat/sleep excessively while "typical"/major depressed people are opposite. Also, atypicals are highly sensitive to personal rejection.

That explanation any better?



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anshirk
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madonna go away
[ *  *  *  *  *  * ]
i lost my mom because of the doctors who gave the prescription for the treatment of this disease she was only in her 40's.

she commited /attempted suicide three times , she never looked after us from the years 1981-1994. we looked after ourselves . my dad was my mom and still is .my aunt and grandmother took care of us . my aunt took care of us she still does .
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The 1 Not Fooled
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I used to think "atypical" was the term they gave to somebody who didn't quite present as a classic manic-depressive? I love to read the DSM-IV, but sometimes it doesn't make sense. There is sooo much room for interpretation. Case in point - myself. I've had pretty much the same symptoms for about ten years and different doctors have diagnosed me "Bipolar Type Two (atypical)", "Major Depression-Recurrent", "Dysthymic", and "Mood Disorder Not Otherwise Specified". And one doesn't have to manic-depressive to be prescribed lithium or other mood stabilizers; just as one doesn't have to be psychotic to be prescribed an anti-psychotic. These days, they'll give you just about anything.
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Anshirk, I'm so sorry to hear about your loss.

I'm glad you have a loving Dad, grandmother, and aunt, though. I wish I knew what more to say - I care about people and feel bad for them and like to help them, but I've never known what words to say to someone when it comes to things like this.

1NF and Madame Duran - thanks for your insights.

I had never even heard of "atypical depression" before I got a thing in the mail the other day and began looking it up on the web.

Madame Duran - yeah, I think you're right and the "atypical" variety seems to be determined largely by situational considerations.

I see myself in both sets of criteria - for clinical depression (also known as "major depression") and atypical depression.

I have some attributes cited in the "atypical" group, but not all, but I also have some characteristics from the clinical / major depression group.

Also, my sleep habits have flip- flopped so much over the years (I used to have bouts with insomnia, then I'd get into months or years of sleeping too much, back to insomnia, back to over sleeping...)

I don't know where I fall in that (sleeping habits), and that seems to be one criteria doctors use to figure out if you're "atypical" or have some other kind of depression.

Also, my eating habits have varied over the years. Either eat too much or not enough.

Madame Duran summarized,
Quote:
 
With major depression, the feelings of the person are more persistantly sad. It doesn't matter whether friends are around or not, the person just can't enjoy anything anymore.
That sounds more like me, but like I said, I do seem to have a few of the "atypical" symptoms, too.

Depression sucks rocks. I'm not saying I never, ever experience any joy or happiness at all ever, but by and large, life ain't a picnic or a bunch of giggles, that's for sure.

I've noticed that people who do not have any kind of mental health issues do not understand people who do.

People with depression and other problems get faced with really insenstive, stupid comments (and attitudes) by people who have never experiencd it and who do not have a clue - which makes me feel like these emoticons > :grr: :(

Thanks again for your input. Feel free to use this thread to post any more information or thoughts you have on depression. If I have any more info or questions, I'll post, too.
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FDA approves first patch to treat depression

Excerpts:
  • Feb 28, 2006

    WASHINGTON (Reuters) - The first skin patch to treat major depression in adults has won final approval to be sold in the United States, the U.S. Food and Drug Administration said on Tuesday.

    Patients taking higher doses of the Emsam patch will have to follow strict dietary guidelines but those taking the lowest dose will be free to eat cheese, smoked meats and other foods usually restricted with certain antidepressants.

    The patch is made by Somerset Pharmaceuticals Inc., a joint venture of Mylan Laboratories Inc. and Watson Pharmaceuticals Inc.. Bristol-Myers Squibb has U.S. marketing rights for the patch.

    Like other monoamine oxidase inhibitors (MAOI), Emsam can carry the risk of high blood pressure if patients eat those and other foods containing the compound tyramine.

    "The advantage of the patch, nominally, is that it allows you to take an MAOI, and you can still eat your pizza, too," said Dr. Alan Gelenberg, head of the University of Arizona's psychiatry department.
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Patients taking higher doses of the Emsam patch will have to follow strict dietary guidelines but those taking the lowest dose will be free to eat cheese, smoked meats and other foods usually restricted with certain antidepressants.

That's dumb; it defeats the whole purpose of this thing being available in patch form in the first place. I remember researching this very type of medication myself years ago when I was having too many problems (that is, high blood pressure episodes) with my MAOI pill. Monoamine Oxidase Inhibitors are nasty stuff; they should be taken off the market, in my opinion. In fact, it is my understanding that Fen-Phen was particularly a double whammy because both composite drugs had MAO-inhibiting properties and should NEVER have been combined.
Please, no matter how depressed a person is, don't ever let a doctor talk you into "needing" one of these medications. It's hell.
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Drugs Cure Depression In Half of Patients

Excerpts:
  • Doctors Have Mixed Reactions To Study Findings

    By Shankar Vedantam
    Washington Post Staff Writer
    Thursday, March 23

    Antidepressants fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study released yesterday.

    Significant numbers of patients continue to experience symptoms such as sadness, low energy and hopelessness after intensive treatment, even as about an equal number report an end to such problems -- a result that quickly lent itself to interpretations that the glass was either half empty or half full.

    .... According to government statistics, depression afflicts 15 million Americans a year. About 189 million prescriptions for antidepressants were written last year, and the disease costs the nation $83 billion annually because of treatment costs, lost productivity, absenteeism and suicide.

    .... It is troubling that large numbers of patients continued to have problems, he [David Rubinow, a professor and the chairman of the psychiatry department at the University of North Carolina at Chapel Hill] said.

    Additionally, he [Rubinow] noted that the drugs used in the study -- Celexa, Wellbutrin, Zoloft and Effexor -- work in very different ways yet had roughly equal effectiveness when it came to treating depression. This suggests that the underlying brain mechanisms of depression are far more complicated than simple notions of a single chemical imbalance.
Same story, different sources:

'Patience needed' in treating depression

Excerpt:
  • A $US35 million study, the largest conducted under real world conditions, found when one antidepressant fails to work, switching to a different drug or adding a second one raises the chance of beating depression.

    No single drug was more effective than another, said the study to be published in today's edition of The New England Journal of Medicine.
Study: Patients shouldn't give up on banishing depression

Excerpt:
  • Untreated depression contributes to more than 30,000 suicides in the USA each year and is the fourth-leading cause of disability, Rubinow says.
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Paxil Suicide Risk in Young Adults
  • May 12, 2006 -- The antidepressant Paxil and its controlled-release version, Paxil CR, are getting a new warning about suicide risk in young adults.

    The FDA and Paxil’s maker, drug company GlaxoSmithKline, are notifying doctors about the warning, which is being added to the drug’s package inserts.

    Antidepressants already carry a warning about a possible increase in suicidal thinking and behavior in children and adolescents with depressiondepression and other psychiatric disorders who take antidepressants.

    The new Paxil warning focuses on young adults aged 18-30. Paxil (paroxetine) is not approved for patients younger than 18.
Please click link to read the rest of the article
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Maybe Tom Cruise is on to something about antidepressants
  • WASHINGTON — The manufacturers of Prozac and other antidepressants should include prescribing information about an uncommon but life-threatening lung problem that affects babies born to mothers who take the drugs during pregnancy, health officials said Wednesday.

    The U.S. Food and Drug Administration said it had asked the companies to add information about the possible risk of the lung disorder, called persistent pulmonary hypertension. Meanwhile, the agency said it is seeking more information about the risk.

    Babies with the disorder have high pressure in the blood vessels of their lungs and are not able to get enough oxygen into their bloodstream, the FDA said.

    One or two babies per 1,000 in the U.S. develop the disorder shortly after birth. However, infants whose mothers took antidepressants in the second half of pregnancy had six times the expected risk of developing the lung disorder, researchers reported in a study published Feb. 9 in the New England Journal of Medicine.

    That report came out days after the Journal of the American Medical Association published a study that illustrated the potential risk of relapsed depression in women who stopped taking prescribed antidepressants during pregnancy.

    The two studies worried many women, since they implied there are risks in pregnancy to both continuing on the medications and not.

    Women who are pregnant or who are thinking about getting pregnant and take selective serotonin reuptake inhibitors should not stop taking the antidepressants without first talking to a doctor, the FDA said in a public health advisory intended for doctors and patients. The drugs, also called SSRIs, include Prozac, Zoloft, Paxil and Lexapro.

    The FDA said it would further update the labels of the drugs as additional information becomes available.
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Quote:
 
the lung disorder, called persistent pulmonary hypertension

I wonder how related this disorder is to primary pulmonary hypertension, which is what some of the victims of Fen-phen suffered. Fen-phen, like Prozac, was quite effective in suppressing appetite. And if I recall correctly, SSRI's are still not supposed to be prescribed concurrently with MAO Inhibitors (Fen-phen was found to have tremendous MAO-Inhibiting ability).
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Depression is mentioned about a third of the way into the article:

Cool Under Fire? It's All In Your Head
  • hu Oct 18, 2:19 PM ET

    CHICAGO (Reuters) - A mechanism in the brain may explain why some people keep their cool and others crumble under stress, U.S. researchers said on Thursday.

    "We have identified the ways in which the brain naturally copes with chronic stressful experiences," said Dr. Vaishnav Krishnan of the University of Texas Southwestern Medical Center, whose study appears in the journal, Cell.

    Psychologists have long understood that some people are more vulnerable than others to stress, which can lead to depression and even post-traumatic stress disorder.

    But little is known about mechanisms in the brain that explain this vulnerability.

    Krishnan and colleagues set out to study this problem in mice that were exposed to stress.

    What they found was mice that were most vulnerable to stress had too much of a chemical in a region of the brain that processes reward signals.

    And they found a significant increase in this same chemical in humans with depression.

    It turns out that resilient mice produce a kind of protective response that allows them to recover from stress. Vulnerable mice lack this defense.

    "ACTIVE PROCESS"

    "One of the major insights provided by this work is that resilience to stress is an active process," Dr. Eric Nestler of UT Southwestern said in a statement.

    Nestler, Krishnan and colleagues placed genetically similar mice into a cage with a large, aggressive mouse -- basically a bully.

    Then they recorded their ability to interact socially, especially when exposed to other, more aggressive mice.

    While some behaved timidly even 30 days after the bully encounter, others had shaken it off and were able to interact normally.

    The researchers then looked at two of the brain's reward centers -- the ventral tegmental area and the nucleus accumbens -- to see if there were differences there. These areas are part of the reward circuit of the brain and also known to be involved in fear conditioning.

    What they found is that neurons were firing rapidly in the stressed-out mice, releasing a nerve growth factor called brain-derived neurotrophic factor or BDNF that has been linked with poor coping skills.

    Vulnerable mice showed an increase of BDNF in the nucleus accumbens; resilient ones did not.

    Resilient mice put the brakes on this excess neuron firing -- and increased release of BDNF -- by increasing the production of potassium channels, which govern the speed at which neurons fire.

    Krishnan said the finding is important because the researchers also found high concentrations of BDNF in tissue taken from this same brain region in depressed people.

    "It seems to be a signature of vulnerability to depression," Krishnan said.

    The researchers think the finding might help lead to new therapies that build up resiliency in people.
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Healing Codes.com

The guy at that site claims to have a cure for depression, and he claims to be a Christian. I don't know.

If you have a cure for depression, and you're a Christian, you would give that info away for free, you would not charge $300+ for it, as he does.

I saw the guy interviewed on a Christian show, and he said once he figured out how to heal depression, he applied his knowledge to his wife, and in 15 minutes, she was toally cured (after having suffered clinical depression for 12 years).

And yet... if you go to his site and buy his package (containing books, DVDs, etc), I can tell you that it would take longer than 15 minutes to read and view all that stuff.

How can you do all the following stuff in only 15 minutes?
  • Your Package will Contain:
    • The Healing Codes Manual
    • The Healing Codes McGrane Interview CD™
    • The Healing Codes Quick & Easy Turbo Start DVD
    • The Healing Codes Testimonial DVD
    • The Healing Codes Journal
    • The Healing Codes Pocket Guide
    • Set of 6 Audio CD’s - A Step by step Guide through The Healing Codes process

    Package Includes:

    • A Training Tele-seminar – to teach you how to use the package
    • You can access this Tele-seminar 24 hours a day, 7 days a week
    • An introductory Call from a Certified Coach
    • Includes up to eight sessions of custom coaching with a Certified Coach
    • FREE Live Conference calls every Thursday night – answering questions
    • 800# help desk
Something is just not right.

On another page, they mention 12 days:
  • The Healing Codes (THC) consist of pointing the fingertips at 4 healing centers discovered by Dr. Loyd. You would do it in certain sequences for certain periods of time. You would do sessions 1 or more times per day for however long you are instructed to do them.

    There are different ways to begin this very comprehensive program. One way is to start what we call '12 Days to a Changed Life' and another is to focus on the primary issue you are dealing with.
And then there's this odd bit on their site:
  • The Healing Codes Used On Animals

    Two choices:

    1. do it on the animal using the same placement of hands as you would for a human;

    2. do it on yourself as a surrogate for the animal and at the end, "release the healing to your animal."

    Your intention as defined in the Prayer/Request and by the Truth Focus Statement will help you.

    To identify which Codes to do, refer to the Problem Reference Chart and select the most applicable item and do the Codes that are associated with that item.
They have to be kidding.

The whole thing sounds like a big fraud and scam to me.

Cod liver oil and depression articles:

Cod liver oil 'treats depression'
  • It may make the stomach turn, but scientists in Norway suggest that taking a spoonful of cod liver oil each day could stave off depression.

    In a study of almost 22,000 people aged over 40, those who regularly took the oil were less likely to suffer depression than those who did not.

    The study in the Journal of Affective Disorders also suggested the longer one took it, the less depressed one became.

    The oil is rich in Omega-3 fatty acids which are linked to various benefits.

    Children's brains are said to be boosted by Omega-3s, which have also been claimed to reduce the risk of stroke, heart attack and cancer, although some studies have cast doubt on this.

    Other factors

    In this latest claim, scientists said a spoonful of cod liver oil could reduce the risk of depression by as much as 30%.

    Depressive symptoms among cod liver oil users was 2.5%, compared to 3.8% in the rest of the population.

    The researchers looked at 21,835 people aged between 40-49 and 70-74 across Norway between 1997 and 1999.

    When compiling their report, they said they also took into account other factors which could impact upon depression, including age, gender, whether one smoked, drank coffee or alcohol, as well as levels of education and physical activity.

    Professor David Kendall said given that fish oil seems to improve cardiovascular health, it may not be that surprising to learn that healthier people are less depressed.

    He did not rule out the idea that fish oil could directly impact upon depression, but he did warn that socio-economic factors did not appear to have been taken into account in the study. Richer people, he said, tend to be healthier and have less depression.

    In the UK, there is growing momentum behind finding alternative treatments for depression, amid mounting concern that too many people are being given prescription drugs such as Prozac after being diagnosed.

    Over 31 million such prescriptions were issued in 2006 - a 6% rise on the previous year.
Cod liver oil, fish oil and Omega 3 and Depression
  • Research has found that people who suffer from depression who received a daily dose of 1 gram of an omega-3 fatty acid such as cod liver oil for 12 weeks experienced a decrease in their symptoms, such as anxiety, sadness and sleeping problems (10).
    cod liver oil and fish oil for depression

    All the patients had already tried prescription drugs before enrolling in the study, including selective serotonin reuptake inhibitors (SSRIs) such as Zoloft, Paxil and Prozac, or drugs from an older family of drugs called tricyclic antidepressants, all of which are considered standard treatments for depression.

    Previous studies have suggested that the balance of omega-3 fatty acids in the brain may be skewed in people with depression, and earlier studies have shown that cod liver oil and fish oil supplements can help alleviate the symptoms of depression and schizophrenia.

    If you suffer from depression, I would also recommend you look into SAM-E which has been used for 20 years in Europe to treat depression and is very effective.

    If the relationship between depression and omega 3 fatty acid interests you, I would highly recommend Dr. Stoll's book "The Omega-3 Connection". Dr. Stoll is a Harvard psychiatrist who has done a good job of compiling the evidence supporting the use of cod liver oil and fish oil to treat depression.

    If you take your omega 3 in liquid form, as opposed to capsules, the dose for both the cod liver oil or fish oil liquid should be about 1-2 teaspoons per day. This is a good initial dose for most people but if you notice any belching, it is likely that your gallbladder is not digesting the oil properly and you may need to take a high potency enzyme with plenty of the fat digesting enzyme lipase.

    Ideally, you would want to measure your vitamin D levels. Unfortunately very few doctors do this. But if you overdose on vitamin D you can actually cause hardening of your arteries and osteoporosis as it causes a reverse effect. In short, I would recommend you take cod liver oil during the winter months when our exposure to the sun is minimal, and fish oil during the summer months.

    If you use beneficial products like cod liver oil without doing blood tests to check your vitamin D levels, you should keep the dose at 1 to 2 teaspoons per day to prevent overdosing or switch to plain fish oil (which contains no vitamin D).

    Use 1 teaspoon per day for a child. When you give your child cod liver oil, you will also be supplying them with essential omega-3 fatty acids which will maximize their brain development.

    Find out how to preserve your cod liver oil, what kind of supplement to look for, on page 2.
Fish Oil to Treat Depression?
  • Diet and Depression

    Joseph Hibbeln, M.D., a psychiatrist at the National Institute of Health, thinks omega-3's might explain why the rate of depression is rising in the United States.

    In a health-conscious push to rid our diets of saturated fats and cholesterol, Americans have been eating less red meat and eggs -- two good sources of omega-3's. Furthermore, we have been switching to the polyunsaturated fats, such as corn, soybean, and sunflower oils, which are relatively low in omega-3's.
    Supplement or Go Fish

    But just how to mend that situation remains controversial. Omega-3's might worsen some chronic illnesses. (Check with a doctor if you have such a condition before starting to take supplements.) The Food and Drug Administration is now considering what quantity of omega-3's to recommend; currently it has no recommendation but classifies three grams per day as "safe."

    Though Stoll gave patients 10 grams of fish oil a day for his study, he advises starting with lower doses. He believes that packaged fish oil supplements are the easiest -- and possibly safest -- way to increase omega-3 levels.

    "Unfortunately in our country eating too much fresh fish is potentially dangerous because of possible mercury and pesticide levels," he explains. "Farm-raised fish is perhaps safer, but depending on what they are fed, the fish may not have the needed quantity of omega-3's."

    But concerns have also been raised about the levels of contamination in fish oil supplements. Regulators do not currently test the purity of supplements.

    Hibbeln cautions that people should not take cod liver oil in the quantity necessary to get three grams per day of omega-3's because that much cod liver oil would contain dangerous levels of vitamin A.

    On the other hand, flaxseed oil is a good source of omega-3's. It can be taken as a supplement or used in salad dressings. Unlike fish oils, which contain a different combination of omega-3's, flaxseed oil should not be cooked because heat can destroy the omega-3's.

    More answers are expected soon. The National Institute of Mental Health's Center for Complementary and Alternate Medicine is sponsoring Stoll in a large new study, one of three now under way. All three are expected to be complete by the end of next year.
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Antidepressants Under Scrutiny
  • Sweeping Overview Suggests Suppression of Negative Data Has Distorted View of Drugs

    By DAVID ARMSTRONG and KEITH J. WINSTEIN
    January 17, 2008; Page D1 Over Efficacy

    The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results, according to a review of unpublished data submitted to the Food and Drug Administration.

    As a result, doctors and patients are getting a distorted view of how well blockbuster antidepressants like Wyeth's Effexor and Pfizer Inc.'s Zoloft really work, researchers asserted in this week's New England Journal of Medicine.

    Since the overwhelming amount of published data on the drugs show they are effective, doctors unaware of the unpublished data are making inappropriate prescribing decisions that aren't in the best interest of their patients, according to researchers led by Erick Turner, a psychiatrist at Oregon Health & Science University. Sales of antidepressants total about $21 billion a year, according to IMS Health.

    ....Pharmaceutical companies are under no obligation to publish the studies they sponsor and submit to the FDA, nor are the researchers they hire to do the work. The researchers publishing in the New England Journal were able to identify unpublished studies by obtaining and comparing documents filed by the companies with the FDA against databases of medical publications.

    .... For example, Pfizer submitted five trials on its drug Zoloft to the FDA, the study says. The drug seemed to work better than the placebo in two of them. In three other trials, the placebo did just as well at reducing indications of depression. Only the two favorable trials were published, researchers found, and Pfizer discusses only the positive results in Zoloft's literature for doctors.

    One way of turning the study results upside down is to ignore a negative finding for the "primary outcome" -- the main question the study was designed to answer -- and highlight a positive secondary outcome. In nine of the negative studies that were published, the authors simply omitted any mention of the primary outcome, the researchers said.

    The resulting publication bias threatens to skew the medical professional's understanding of how effective a drug is for a particular condition, the researchers say. This is particularly significant as the growing movement toward "evidence-based medicine" depends on analysis of published studies to make treatment decisions.

    Dr. Turner, who once worked at the FDA reviewing data on psychotropic drugs, said the idea for the study was triggered in part by colleagues who questioned the need for further clinical drug trials looking at the effectiveness of antidepressants.

    "There is a view that these drugs are effective all the time," he said. "I would say they only work 40% to 50% of the time," based on his reviews of the research at the FDA, "and they would say, 'What are you talking about? I have never seen a negative study.'" Dr. Turner, said he knew from his time with the agency that there were negative studies that hadn't been published.

    The suppression of negative studies isn't a new concern. The tobacco industry was accused of sitting on research that showed nicotine was addictive, for instance. The issue has come up before notably with antidepressants: In 2004, the New York state attorney general sued GlaxoSmithKline for alleged fraud, saying it suppressed studies showing that the antidepressant Paxil was no better than a placebo in treating depression in children.

    Glaxo denied the charge and eventually settled with the attorney general. The company later posted on its Web site the full reports of all of the studies of Paxil in children.

    ....Some studies that don't eventually get published are registered with online trial registries, including the federal government's www.clinicaltrials.gov. Nonetheless, many studies still aren't being registered or reported, says Kay Dickersin, the director of the Center for Clinical Trials at the Johns Hopkins Bloomberg School of Public Health. "We need something more meaningful," she said. "The average person has no idea that www.clinicaltrials.gov is not comprehensive."

    The New England Journal study also points to the need for the FDA to disclose more information about the studies it receives, says Robert Hedaya, a professor of clinical psychiatry at Georgetown University Hospital. He said it was "disturbing" that the information on the negative studies wasn't made widely available by the FDA.

    The 'Effect Size'

    In this week's study, the researchers found that failing to publish negative findings inflated the reported effectiveness of all 12 of the antidepressants studied, which were approved between 1987 and 2004. The researchers used a measurement called effect size. The larger the effect size, the greater the impact of a treatment.

    The average effect size of the antidepressant Zoloft rose 64% by the failure to publish negative or questionable data on the drug, the researchers found.
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Postnatal depression ‘can be worse with a male baby’

St. Jude Starting Trial On Brain Stimulation For Depression
  • Feb 7, 2008

    St. Jude Medical Inc. (STJ) has garnered Food and Drug Administration approval to launch a trial the company plans to use to pursue U.S. approval for a pacemaker-like device that uses electricity to treat severe depression.

    The invasive treatment involves implanting wires in a part of the brain that can be overactive in patients with severe depression, and using electric stimulation from a connected device to calm that activity. There are limited data backing this approach, but St. Jude aims to collect enough evidence in the new randomized study to pave the way to regulatory support.

    "Our intent is to receive a PMA as a result of this trial," said Rohan Hoare, vice president of research and development at St. Jude's ANS Division, referencing a type of FDA device approval.

    The patients who could potentially benefit from this technology have long-term depression and have failed numerous treatment attempts with drugs or electroconvulsive therapy. About four million Americans are estimated to fit into this category, creating a broad potential market for medical device companies with effective systems.

    A handful of device makers are exploring or have actively pursued the market, including device heavyweight Medtronic Inc. (MDT), which like St. Jude has deep brain stimulation technology. Northstar Neuroscience Inc. (NSTR) and Cyberonics Inc. (CYBX) are smaller device companies with an interest in depression treatment - the latter company has an FDA-approved nerve stimulation tool, but has been stymied by lack of insurance reimbursement coverage.

    St. Jude, a St. Paul, Minn., company known for heart-rhythm devices such as pacemakers and defibrillators, has a growing business for devices used to treat certain neurological issues. The neuromodulation business produced $210 million in revenue in 2007, a 17% climb from the prior year, but still represented a small portion of St. Jude's overall $3.78 billion sales tally on the year.

    The company got into the neuromodulation business by purchasing Advanced Neuromodulation Systems, or ANS, in 2005.

    The FDA has granted what is known as an investigational device exemption that clears St. Jude to begin enrollment for the "Broaden" trial, which will start at three centers and then add centers later on, Hoare said.

    Due to competition in the chase for a depression-treatment device, Hoare declined in an interview to say how many patients will be included in the St. Jude-funded trial, and didn't forecast timing for potential device approval. The need to enroll patients, track them for a year and then pursue regulatory approval suggests it could take a couple of years or so to bring a depression- treatment device to the market.

    All patients in the randomized study will receive a device, but it won't be turned on for one-third of patients until after six months. According to researcher Andres Lozano, a neurosurgeon from the University of Toronto, patients won't be able to tell whether it's on or not. The trial will run for a year, with an option for longer-term study.

    The specific approach St. Jude is taking is based on work by Lozano and neurologist Helen Mayberg, now with Emory University School of Medicine, Atlanta, that led them to try deep brain stimulation in a part of the brain called "Brodmann Area 25" that is thought to be linked to severe depression.

    They tested the technology on six patients in a study earlier this decade - they used Medtronic deep brain stimulation technology in that study - and saw positive results.

    "The idea is that this area of the brain is abnormal in patients with depression," Lozano said in an interview. "What we're essentially doing is applying a dimmer switch."

    St. Jude said it holds intellectual property rights and has patents pending for the use of stimulation in this part of the brain, and has another depression study under way overseas that studies use of stimulation there for depression. Results from that trial, which has about 20 patients, will be unveiled at medical conferences this spring.

    In comparison with other potential device treatments for depression, Lozano said stimulating the Brodmann Area 25 may differ because "it is a very direct approach." Further research will determine the effectiveness of this or other methods, he said.

    St. Jude's nearby rival Medtronic, Minneapolis, has also talked about its interest in using deep brain stimulation to treat severely depressed people. The company issued a press release in April 2006 saying it planned to pursue a " major clinical trial" on the matter, and that it holds several patents related to treatment of psychiatric disorders including depression.

    In that release, a Medtronic official said the company would be working with the FDA "in the coming months to complete a study design." A study has not launched yet, but Medtronic continues to support research on the matter and plans to initiate a clinical study this year, spokeswoman Cindy Resman said.

    Cyberonics has approval to treat severe depression with its pacemaker-like device that hooks up to a major nerve. However, the company's efforts to open up a real market for the expensive technology were more or less blocked last year when the government denied Medicare reimbursement. That decision pushed Cyberonics into cost-cutting mode and redirected the company's focus to its main market for epilepsy treatment.

    Northstar Neuroscience has yet another style of neuromodulation technology that stimulates the outer surface of the brain, or cortex. The company had been pursuing the market for stroke rehabilitation, but announced last month that its key stroke trial failed, sending shares into a tailspin and raising questions about what the small company will do next.

    Northstar is now considering using its cash and technology to explore treatment of severe depression or tinnitus - the perception of ringing in the ears - and has said it plans to say more later this month about what market it will pursue.

    -By Jon Kamp
Pacemaker for the brain? St. Jude to study depression therapy

St. Jude to test antidepressant

St. Jude Medical Announces Clinical Study of Deep Brain Stimulation for Depression

St. Jude to launch depression study

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Do you need an anti-depresssant?
  • 1 What am I feeling?

    Sadness, apathy, hopelessness: These are signs of depression.

    But consider what’s going on in your life, too:
    “Some people feel sad because something bad has happened,” Zuckerman says. “That’s normal and it shouldn’t necessarily be medicated away.”

    If you’re blue when things are fine or you can’t rebound from a setback, that’s a danger sign.

    2 Has my mood interfered with my life?

    If it impairs how you function in relationships or at work, there’s cause for concern, says Dr. Mathew.

    Many truly depressed women lose interest in things they once loved but consider it a personal failure, says Rona Hu, M.D., assistant professor of psychiatry at Stanford University School of Medicine.

    “Women often blame themselves and don’t realize they need to be treated,” Dr. Hu says.

    3 Have I been down for more than two weeks?

    That could mean you need treatment.

    4 Am I sure it’s not a physical problem?

    Some conditions that are common in women, such as thyroid disorders, have symptoms similar to depression. Have a checkup to rule those out before you start an antidepressant.

    5 Have I tried drug-free options?

    Therapy and exercise are proven remedies for mild to moderate depression (see “What to Try Before You Take an Antidepressant,” page 149), but too few people opt for them. Again, do so before you take an antidepressant.

    If you answered yes to questions two through five, you may need help.

    Your doctor can weigh your options, but if you decide to take medication, remember that it works best when teamed with lifestyle changes.

    “Taking an antidepressant without dealing with things like stress is not the most effective way to treat depression,” says Robin Dea, M.D., regional director of mental health services for Kaiser Permanente in Northern California.
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Do you take herbal supplements?
  • Do you think of the herbal supplement section at Whole Foods as the candy aisle for your health? While there's certainly plenty of evidence that natural is best, some health experts fear that we might be a little too gaga over the latest herbal tonics and potions--to the detriment of our health...
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Natural levels of lithium in drinking water help reduce suicides

Excerpt
  • Very low levels of lithium in drinking water may help prevent suicide in the general population, according to a new study.

    By Richard Alleyne

    The study has prompted calls for further research into the possibility of adding lithium to drinking supplies – like water fluoridation to improve dental health.

    Researchers at Oita University in Japan measured natural lithium levels in tap water in 18 communities in the surrounding region of southern Japan.

    The lithium levels ranged between 0.7 micrograms per litre and 59 micrograms per litre.

    The researchers then calculated the suicide rate in each of the 18 areas. They found that the suicide rate was significantly lower in those areas with the highest levels of lithium in the water.

    Writing in the British Journal of Psychiatry, the researchers said: "Our study suggests that very low levels of lithium in drinking water can lower the risk of suicide. Very low levels may possess an anti-suicidal effect."

    Lithium is a naturally occurring metal found in variable amounts in food and water. In medicine, very high doses are used to treat bipolar disorder and mood disorders.

    But so far the potential benefit of using low levels of lithium to reduce the risk of suicide has not been studied closely.

    Professor Allan Young, a Vancouver-based psychiatrist, has described the study as "intriguing".





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Why Antidepressants Don't Live Up to the Hype
  • by John Cloud
    May 6, 2009

    In the '90s, Americans grew fond of the idea that you can fix depression simply by taking a pill — most famously fluoxetine (better known as Prozac), though fluoxetine is just one of at least seven selective serotonin reuptake inhibitors (SSRIs) that have been prescribed to treat hundreds of millions of people around the world.

    But in the past few years, researchers have challenged the effectiveness of Prozac and other SSRIs in several studies. For instance, a review published in the Journal of Affective Disorders in February attributed 68% of the benefit from antidepressants to the placebo effect.

    Likewise, a paper published in PLoS Medicine a year earlier suggested that widely used SSRIs, including Prozac, Effexor and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression.

    Meanwhile, pharmaceutical companies maintain that their research shows that SSRIs are powerful weapons against depression. (Here's a helpful blog post that summarizes the debate.)

    Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients — those with a limited range of psychological problems.

    People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs — which is unfortunate for the 45% to 60% of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse. (Multiple diagnoses are known in medical parlance as comorbidities.)

    The new study, published online in April by the American Journal of Psychiatry, was conducted using data from a large, government-funded trial called Sequenced Treatment Alternatives to Relieve Depression, which usually goes by the moniker STAR*D.

    The STAR*D project, which collected data from 2001 to 2004 at 41 U.S. psychiatric facilities, was one of the most ambitious efforts ever to understand how best to treat people with major depression. STAR*D participants comprise a powerful research sample because they are highly representative of all depressed Americans.

    Very few depressed people were excluded from STAR*D; only women who were pregnant, those with seizure disorders and a few others with acute conditions were kept out. All other psychiatric and medical comorbidities were allowed.

    The authors of the new paper, a team of 11 researchers led by University of Pittsburgh professor of epidemiology Stephen Wisniewski, were curious how the STAR*D group would compare with a typical group of patients selected for a run-of-the-mill drug-company trial for a new antidepressant — the very trials on which the Food and Drug Administration bases its decisions regarding new drug approval.

    Drawing on their own experiences in helping to conduct such trials, which have far more stringent inclusion criteria than the STAR*D group, Wisniewski and his team divided the STAR*D patients into two groups — an "efficacy" sample of patients who would normally be included in a typical Phase III clinical trial for a new antidepressant and a "nonefficacy" sample of patients who would normally be rejected.

    Depressed STAR*D patients who were classified for inclusion had no more than one general medical condition (like, say, heart disease) and no more than one additional primary psychiatric disorder besides depression.

    All patients with multiple comorbidities — along with anyone whose depression had lasted more than two years — were excluded. Once the authors crunched all the numbers, they found that only 22% of STAR*D patients met entry criteria for a conventional antidepressant trial.

    All the STAR*D patients were taking citalopram, an SSRI marketed in North America as Celexa. Not surprisingly, those who met standard inclusion criteria for a clinical trial had significantly better outcomes on the drug. In the efficacy group, 52% responded to Celexa vs. 40% of the nonefficacy group.

    Patients in the latter group also took longer to respond and had to be readmitted to psychiatric settings more often. "Thus," the authors conclude, "current efficacy trials suggest a more optimistic outcome than is likely in practice, and the duration of adequate treatment suggested by data from efficacy trials may be too short."

    To bolster their findings, the authors cite a smaller 2002 study that arrived at similar results: in that paper, published in the American Journal of Psychiatry, Dr. Mark Zimmerman of Brown University and his colleagues found that of 315 patients with major depressive disorder who sought care, only 29, or 9.2%, met typical criteria for an efficacy trial.

    Similarly, psychologist Ronald Kessler of Harvard co-authored a 2003 paper in the Journal of the American Medical Association that concluded that most "real world" patients with major depression would be excluded from clinical trials because of comorbidities.

    Such findings help explain why antidepressants haven't quite lived up to their promise. But the University of Pittsburgh's Wisniewski, the lead author of the new study, cautions against interpreting the results as an indictment against greedy drug companies eager to exclude difficult patients in order to show better results. "If the population in a [clinical] trial were more representative, that would come at a cost," he says. Researchers expect a certain number of bad reactions during clinical trials; some of these reactions can cause serious medical problems.

    If patients enter a trial with multiple complications — if they are, say, not only depressed, but also cocaine-addicted, hypertensive and diabetic — you dramatically increase the chances of adverse side effects. "That's why trials to determine efficacy are done on a relatively homogeneous population," Wisniewski says.

    That's understandable, but the new study does shed light on the limitations of antidepressants. Conducting clinical trials with representative samples would undoubtedly be more complex — and expensive — since patients with multiple risk factors would have to be monitored more carefully. But for a future generation of antidepressants to be truly effective for most patients, more-inclusive trials may be the best answer.
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Study: Early Therapy Can Save Teens from Depression

Coping Skills May Reduce Teen Depression

Prevent Depression in Teens With Cognitive Behavioral Therapy
  • June 04, 2009 04:47 PM

    Cognitive behavioral therapy can prevent teenagers from becoming clinically depressed, even if their parents are depressed, too. That’s great news, because serious depression afflicts 2 million teenagers each year and puts them at greater risk of suicide and depression throughout life.

    Anyone who’s been depressed knows how miserable it is; one friend described it as “having the flu all the time.” I wouldn’t wish that on anyone, and especially not a kid.

    This latest news, in a depression study just out in the Journal of the American Medical Association, is yet another bit of evidence that cognitive behavioral therapy is a valid treatment for depression.

    Half of the 316 teenagers in the study, led by Vanderbilt University psychology professor Judy Garber, took part in eight weekly, 90-minute group sessions, in which they were taught problem-solving skills and practiced them.

    Cognitive behavioral therapy isn’t traditional, long-term “talk therapy”; it’s a short-term treatment, usually lasting no more than 20 sessions, based on the idea that people’s thoughts cause their feelings and behaviors. Thus if people change how they think about a situation and how they respond to it, they can feel better, even if the situation hasn’t changed.

    The teenagers had all been clinically depressed before or had mild symptoms of depression. The children were chosen because their parents also had had an episode of depression at least once in the child’s life. Having a parent with depression increases the odds that the child will have problems, too.

    After six months, the teens who had been in the therapy groups were less likely to have become depressed (21.4 percent vs. 32.7 percent).

    The therapy was most effective in preventing depression in children whose parent wasn’t depressed at the time (11.7 percent vs. 40.5 percent); its benefit disappeared if a parent of the child was depressed.

    Proof, if any is needed, that parents’ behavior has a huge influence on their children’s health and behavior, even when they’re teenagers.

    “Most therapists do traditional therapy,” says Mary Alvord, a psychologist in Rockville, Md., who uses CBT to help children change behaviors that are causing difficulties at school and home.

    “All good therapies have similarities—forging a relationship, trust. But with CBT, you work with what the person wants to change in a very direct manner. You’re collaborating in a more direct way than with traditional therapy.” That includes homework assignments that involve parents, with the goal of parents taking over.

    Finding cognitive behavioral therapy can be tricky, because it’s advertised more than it’s actually delivered. Here’s a description of what CBT actually is, from the Association for Behavioral and Cognitive Therapies. (The association also has a decent online therapist finder.) In cognitive therapy, a person learns to:

    * Distinguish between thoughts and feelings.
    * Become aware of how thoughts can influence feelings in ways that sometimes are not helpful.
    * Learn about thoughts that seem to occur automatically and how they can affect emotions.
    * Evaluate critically whether these "automatic" thoughts and assumptions are accurate or perhaps biased.
    * Develop the skills to notice, interrupt, and correct these biased thoughts.

    We humans tend to let our thoughts run our emotions more than we realize, which can be a real problem if those thoughts are off base. It’s easy to imagine how a teenager already prone to depression could let thoughts like “I’m a terrible person” or “my life is hopeless” take over. CBT can help rewrite that script.
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Ten percent of Americans being treated with an antidepressant

US Antidepressant Use Increases, Study Finds

Number of Americans taking antidepressants doubles
  • The number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall, a study shows.

    About 10% of Americans — or 27 million people — were taking antidepressants in 2005, the last year for which data were available at the time the study was written. That's about twice the number in 1996, according to the study of nearly 50,000 children and adults in today's Archives of General Psychiatry.

    Yet the majority weren't being treated for depression. Half of those taking antidepressants used them for back pain, nerve pain, fatigue, sleep difficulties or other problems, the study says.

    Among users of antidepressants, the percentage receiving psychotherapy fell from 31.5% to less than 20%, the study says. About 80% of patients were treated by doctors other than psychiatrists.

    Patients today may be more likely to ask about antidepressant advertising, says study author Mark Olfson of Columbia University and the New York State Psychiatric Institute. During the study, spending on direct-to-consumer antidepressant ads increased from $32 million to $122 million.

    Doctors today also are more comfortable prescribing antidepressants, partly because the newer drugs are safer and cause fewer serious side effects, says James Potash of Johns Hopkins Hospital in Baltimore, who wasn't involved in the study.

    David Spiegel of Stanford University School of Medicine says he's glad to see more people getting treatment for depression, which causes more disability than any other medical condition.

    But Olfson says his study shows that doctors need more training in mental health. And he says he's concerned about the decline in patients receiving psychotherapy. Patients who receive only medication may not get the help they need, he says.

    Many patients are unable to see psychiatrists, however, because of insurance barriers. Many doctors no longer accept insurance because of low reimbursement rates for therapy, Spiegel says.

    The study ended before the passage of a 2008 law that requires employers with more than 50 workers to provide comparable benefits for mental and medical care.

    Studies suggest doctors should be cautious about prescribing antidepressants to children.

    In 2004, the Food and Drug Administration issued a "black box" warning that the medications could increase the risk of suicidal thoughts in children. Use of antidepressants by children fell nearly 10% the next year, according to Olfson's 2008 study of the subject.

    Antidepressant use had been rising so quickly in the years before the warning, however, that the rate of use in 2005 was still higher than in 1996.
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