Older Ages Increases Risk for Nonremitting Depression

Older adults who are depressed are more likely to stay depressed as they age, especially those who rate themselves as patient, a study presented here at the American Geriatrics Society Annual Scientific Meeting found.

"The take-home message is: depression is not going to treated on its own, especially among sick patients," said Stephen Thielke, MD, a geriatric psychiatrist at the University of Washington, in Seattle, and the study's lead author in an interview with Medscape Internal Medicine.

The study was a retrospective analysis of longitudinal data from the Cardiovascular Health Study and involved nearly 5900 Medicare recipients in 4 American communities who were surveyed between 1990 and 1999. Patients answered a single question to rate their overall health, and depressive symptoms were determined by a score of 10 or more on the Center for Epidemiologic Studies Depression Scale.

More than 70% of subjects with self-rated sickness who were initially depressed still had symptoms of depression when they were evaluated 1 year later, the investigators reported. But even among individuals who reported themselves as healthy, more than 50% who had depressive symptoms were still depressed a year later.

Advancing age was not associated with becoming depressed in older people with self-rated sickness, but it was in those with self-rated health, the authors found.

Although the researchers looked at the relation between depression and specific illnesses, Dr. Thielke told Medscape Internal Medicine that self-rated health in general was a better predictor of depression than specific illness.

They did not study why depression was unlikely to remit in older adults, but Dr. Thielke speculated that one reason, besides poor health, could be an inadequate social network.

"We should not give up on these patients who get stuck in depression," Dr. Thielke said. "There are very effective treatments of depression in older adults."

Treatment of depression in older adults is not as simple as just giving medication, said Rosanne Leipzig, MD, PhD, professor and vice chair of the Department of Geriatrics, Mount Sinai School of Medicine, in New York City. Dr. Leipzig, who was not involved with the study, said that some older adults might not tolerate the effects of antidepressant medication, or they might be unwilling to take medication for other reasons.

"Evidence shows you're more likely to improve a patient's depression with a system of care, including social support, such as talk therapy, combined with medication," she said.

Dr. Leipzig said a drawback of the current study is that it did not report whether patients received any therapy for depression. It also is not clear whether patients actually stayed depressed or improved and then suffered a recurrent episode of depression before re-evaluation, she said.

"Other studies show that older people are more likely than younger people to suffer recurrent depression," Dr. Leipzig said.

(Read More!!)

Evidence-based Suicide Intervention Model for U.S. Army Blocked by NIMH

Depression Cure and Evidence-based Suicide Intervention Model for U.S. Army Blocked by NIMH from Scientific Review
Los Angeles, CA (PRWEB) May 7, 2009 -- Despite an unprecedented crisis in military suicidality, the National Institute of Mental Health (NIMH) has rejected the only evidence-based proposal - the Burris SR process - to cure post traumatic stress disorder (PTSD) and suicide in the U.S. Army.

The rejection shocked proposal scientists, former Marine officer, combat veteran and psychotherapist Dr. Ron Clark, the Principal Investigator (PI), and former USAF officer, psychologist and co-PI Dr. Jeff Litchford.

The Burris SR process proposed by the doctors has a record of success over its 25 year history, and it has established itself as the only evidence-based program process in mental health. The model, referred to by Drs. Clark and Litchford as "Subconscious Restructuring (SR)," is well-suited as the program of choice to overcome PTSD/suicidality problems of combat-returning U.S. Army military personnel and their families. It teaches depressed, traumatized and suicidal service personnel and their families how to restructure their subconscious, and replace dysfunctional components with more appropriate goal-oriented words, pictures, thoughts, emotions and behaviors. When symptoms of depression are present, as in the case of PTSD and suicidality, the Burris SR intervention is especially effective.

No evidence-based program processes were funded in 2007, when $277 million was dispersed via CDMRP to address PTSD and TBI.

The SR intervention begins with a rich data collection and baselining component inherent in three time-proven instruments, and it quickly develops individual skill in subconscious intervention and control over depressive thought processes. Subconscious mapping and the use of empowering questions allow participants to develop a strong, enduring methodology of subconscious restructuring, as traumatic, depressive, and dysfunctional thoughts, fears, guilt, shame and anger are replaced with more appropriate personal goal-oriented constructs.

Through the course of explaining the research plan, the translational epidemiology, and how the problem would ultimately be fixed, NIMH did not recognize the document - a Depression Checklist - proposed for use, as the primary instrument for data collection. The checklist is widely used by those who treat PTSD/suicide to monitor depression, which experts agree is the primary symptom of PTSD and suicidality.

NIMH discounted depression as the most significant issue by stating, "It is not what we would call a strong risk factor."

When the developer of the Burris SR process, Kelly Burris, inquired as to why the proposal was rejected, NIMH stated it did "not believe the model proposal matched the requirements of the RFA." The Project Summary and Research Plan are available at www.KellyBurris.com.

Burris is countering what he affirms as "political and bureaucratic shortsightedness," and, as a patriotic gesture, is making the SR Workbook for Warriors that was going to be made available to all U.S. Army servicemen and women through the NIMH grant available as a free download to all current and former military personal at www.KellyBurris.com.

Source:
emediawire.com

(Read More!!)

More Lawyers Seek Help for Depression, Addictions; Economy a Factor

Lawyer assistance programs are seeing more lawyers seeking help with problems such as depression and substance abuse, and the economic downturn may be at least partly to blame.

Lawyer assistance programs created by bar associations in California and Illinois are seeing twice as many cases as usual; programs in New York and North Carolina are also seeing increases, the National Law Journal reports. Those seeking help range from law students who can’t find jobs, to associates who have been laid off, to older lawyers who can’t retire because of investment losses.

Janet Piper Voss, executive director of the Illinois program, told the National Law Journal that there is no hard evidence the economy is to blame. "But that's the sense we have,” she said. “There is something different going on right now."

Richard Carlton, the manager of education, research and program development for the program in California, told the NLJ that the economy is a factor but it is not necessarily the only reason lawyers are seeking help. Instead it is an added stress that is pushing lawyers to seek help if they already have problems such as addiction or depression.

The Illinois program will add a second weekly therapy session for lawyers who have attempted suicide. The psychologist running the program is Susan Riegler.

"By and large, what I see is depression and a feeling that things won't turn around, or I hear from people who had a lifestyle they can no longer afford," Riegler told the legal newspaper.

Some laid-off lawyers are dealing with problems that aren’t just economic, she added. "People have always asked them, 'What do you do?' and they've said, 'I'm a lawyer,'" she told the NLJ. "When they lose that role in life, it's pretty confusing."

Source:
ABA Journal, Law New Now

(Read More!!)

Parental Depression Effects on Infant Development

Just in time for Mother's Day, a new study underscores the subtle but powerful ways in which a mother's depression can predispose her child to depression. But the real gift to weary moms is a respite from the view that "it's always mom's fault" delivered by a second study -- among the first to look at the influence of a father's emotional and behavioral disorder on his child's future mental health.

It matters.

Mom first: A new study finds that compared with infants born to women without depression, the newborns of mothers who suffered depression during pregnancy or in the immediate postpartum period had greater difficulty establishing and maintaining sleep patterns that ensure that baby (and probably Mom) received sufficient sleep. The study, conducted by researchers at the University of Michigan, is in the May issue of the journal Sleep.

At two weeks and 30 weeks after birth, the babies of women who had sought help for depression during pregnancy took longer -- as long as two hours -- to settle down to nighttime sleep, awoke more often in the night and had more daytime sleep (and thus less nighttime shut-eye) than babies of women without depression.

Dr. Sheila Marcus, a psychiatrist at the University of Michigan Medical School, said it was unclear whether this early pattern of fitful sleep could be evidence of a child's vulnerability to future depression or might be a contributing factor to the development of depression. Either way, future research should focus on whether a program fostering healthy, normal sleep patterns early in the lives of these kids might lower their risk of developing depression later.

On Sunday Postpartum Progress, the most widely read U.S. blog on matters of perinatal mood disorders, has a unique gift: a Mother's Day Rally for Moms' Mental Health. For a 24-hour period, once an hour on the hour, the blog will be posting a letter to new moms on some aspect of protecting, maintaining and restoring mental health in motherhood, written by some of the Web's top parenting- and mommy-bloggers. (This could be more fun than trying to eat your breakfast in bed while the kids bounce on the mattress.)

Now, Dad: In the British medical journal Lancet, Oxford University psychiatrists found that the state of a father's mental health also appears to affect his offspring's prospects of developing mental illness -- especially that of his son. Reviewing existing research on the relationship, the Oxford team, led by Dr. Paul Ramchandani, found that fathers' influence on their children's mental health had been "underemphasized" in favor of studying maternal contributions.

But the increased risk a child faces if his father suffers behavioral or emotional difficulties "is similar in magnitude to that due to maternal psychiatric disorders," the article concludes. The research points to a stronger effect of a father's mental health status on his son and to a greater likelihood that a father's mental illness will boost his son's risk of developing a behavioral disorder -- such as criminality or alcohol abuse -- than an emotional disorder such as depression.

Ramchandani said these findings underscore the need for men to tend to their mental health as they take on larger roles in nurturing their children. Men are less likely than women to seek professional help for mental health issues, and the consequences of that neglect could grow as men's care-giving responsibilities mount.

"In years gone by, if fathers were depressed and distant, it may not have made much of an impact," Ramchandani told the BBC News.

Source:
Los Angeles Times

(Read More!!)

Electroconvulsive therapy (ECT) effective for treatment-resistant depression

The World Health Organization rates major depression as the top cause of disability worldwide, with an estimated 340 million people suffering from an episode of major depression every year. While most patients with major depression find relief through a combination of psychotherapy and medication, about 20 percent of patients fail to respond. Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery, and suffer a heightened risk of suicide and mortality. Sadly, statistics show that the suicide rate in people with major depression is as high as 15 percent.

Electroconvulsive therapy (ECT) is effective in approximately 70 percent of cases in which antidepressant medications do not provide adequate relief of symptoms. However, as many as 20 to 50 percent of patients who initially respond well to ECT treatment, suffer a relapse within six months, therefore, periodic maintenance therapy is often required. For those patients who are resistant to these therapies, more invasive approaches have been used, including vagus nerve stimulation and more recently, deep brain stimulation.

Researchers at three U.S. institutions investigated the use of a new form of stimulation in patients with medically refractive major depression. The results of this study, Long Term Follow-up of Cortical Stimulation to Treat Major Depressive Disorder, was presented by Emad N. Eskandar, MD, Masachusetts General Hospital/Harvard Medical School on Tuesday, May 5, 2009, during the 77th Annual Meeting of the American Association of Neurological Surgeons in San Diego. Co-authors are Douglas Kondziolka, MD (University of Pittsburgh Medical Center), and Brian Kopell, MD (Medical College of Wisconsin).

"Imaging and transcranial magnetic stimulation studies have demonstrated that the left dorsolateral prefrontal cortex (DLPFC) area of the brain plays a critical role in patients with major depressive disorder (MDD). These findings prompted research in which we used an investigational epidural cortical stimulation system to deliver targeted stimulation to the left DLPFC in 12 patients with MDD," said Dr Eskandar.

For the study 12 patients were randomized to single blind active or sham stimulation for 8 weeks, and then all subjects received active stimulation. One patient was excluded from analysis due to a protocol deviation. During the procedure, the electrodes were placed epidurally, outside the dura - the tough membrane that covers the brain, through a small craniotomy. Outcome assessments included the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Depression Rating Scale (HDRS), and the Global Assessment of Functioning (GAF). The following results were noted:

* At 8 weeks, HDRS decreased by 22 percent (active: n=6) versus 3 percent (sham: n=5).
* MADRS decreased 22 percent (active) versus 8 percent (sham).
* GAF increased 23 percent (active) versus 12 percent (sham).
* In all patients, continued improvement was seen at 6 months (average HDRS: 20 percent) and 12 months (average HDRS: 33 percent).
* At 12 months, patients whose electrodes were implanted >20 mm from the precentral sulcus averaged a 59 percent improvement in HDRS compared to a 12 percent improvement in patients (n=6) with electrodes <20mm from the precentral sulcus.
* Four patients with electrodes <20mm from the precentral sulcus elected electrode revision surgery.

"The advantages of cortical stimulation are that it is reversible, nondestructive, less invasive than other forms of stimulation, and can be modified by adjustment of the stimulator settings after implantation. We observed that the position of the electrodes in relationship to the precentral sulcus played an important role in patient outcome. This small study is promising, suggesting that cortical stimulation has potential as a viable treatment option for patients with severe treatment-resistant MDD. The next step is to proceed with a larger multicenter trial," concluded Dr Eskandar.

(Read More!!)

Significant sleep disturbance in infants due to Maternal depression

ANN ARBOR, Mich. - Babies born to depressed moms are likely to suffer from chaotic sleep patterns, which could predispose them to depression later in life, according to a University of Michigan study published in the May issue of the journal SLEEP.
Findings of the study, conducted by U-M sleep expert Roseanne Armitage, Ph.D., are significant because they show that sleep and biological rhythms disturbances persist at least through the first eight months of life in the infants of depressed mothers.

Sheila Marcus, M.D., clinical associate professor of psychiatry at the U-M Medical School, and Heather Flynn, Ph.D., a psychologist and member of the U-M Depression Center Women’s Mood Disorders Program, co-authored the study.

The findings suggest that parents – especially ones with a history of depression – should pay close attention to the conditions they create for their infant’s sleep, says Armitage, leader of the U-M Sleep & Chronophysiology Laboratory team at the U-M Depression Center.

Armitage and her team have shown that insomnia and interrupted sleep are strongly linked to depression.

Their research in depressed adults, teenagers and pre-teens led them to expand their research to babies. Infants need a lot more sleep than grownups, but tend to get it in shorter chunks of time throughout the day and night, at least for the first months of life.

Armitage conducted her research with two groups of new mothers and their babies, funded by the Cohen Sleep Research Fund and the Drs. Jack and Barbara Berman Depression Research Fund at the U-M Depression Center.

One group was made up of mothers who sought help for depression during pregnancy from the U-M Depression Center’s Women’s Mood Disorders Program. The other group had no past or current depression. Each group wore devices that measured sleep time at night, light exposure and daytime activity/rest patterns.

The moms wore the devices during the last trimester of pregnancy, and after their babies were born, the team fitted each child with a tiny actigraph at two weeks of age. Information was collected monthly until babies were 8 months old.

Results indicate that infants born to mothers with depression had significant sleep disturbances compared to low-risk infants. The high-risk group took up to 2 hours more to settle for night time sleep, woke up more often and had more daytime sleep than infants who were born to mothers without depression at two weeks and 30 weeks post-partum.
“We think we may have identified a vulnerability in the initial entrainment of sleep and circadian rhythms that may elevate the risk for these children to develop later depression,” Armitage says. “Our task now is to determine if it is modifiable. Can we reverse the effects and reduce the risk of developing later depression by enriching sleep and circadian rhythms in infancy? ”

Infants and toddlers need to nap during the daytime to get all the sleep they need – 11 to 18 hours for newborns in the first two months, 11 to 15 hours for the next 10 months, and 12 to 14 hours from ages 1 to 3 years. And, newborns wake up in the night when they need food.

“But going to bed at the same time, getting up at the same time, establishing rituals around the bedtime helps infants begin to distinguish between night sleep and day sleep,” says Armitage, a professor of psychiatry at the U-M Medical School. “Put the baby in day clothes for naps, and in night clothes for night sleep – babies pick up these cues.”

Parents can also make sure that babies are regularly around bright light during the day, which helps the body develop circadian rhythms linked to light cycles. The bright light shouldn’t shine directly in babies’ eyes and they should be shielded from direct sunlight and wear sunscreen outside.

By four months of age, a baby’s sleep schedule should have become regular, more focused on nighttime sleep, and their blocks of sleep more “consolidated” or longer – especially at night.

The main thing, she says, is to make sure babies and small children get enough sleep on an increasingly regular schedule – and that their moms do too.

The period immediately after giving birth is a high-risk time for depression, even in women who have never had depression before. Those who have had depression, or have relatives who have suffered depression, are most at risk. This postpartum depression can be worsened by lack of sleep – or triggered by it.

“Chronic sleep deprivation is associated with an elevated risk for depression in everybody, at all stages of life, but in new moms, because of the hormonal changes and the need to recover from the pregnancy and birth, sleep deprivation can really be a problem,” Armitage concludes.

“It can interfere with the social rhythms that are important for keeping the circadian clock in the brain in sync, minimize the amount of energy moms have to care for their infants, and contribute to the development of depression.”

Source:
University of Michigan Health System

(Read More!!)