Pages

.

Seasonal Affective Disorder (SAD) - Take Action

SAD patients who take antidepressants in autumn can prevent winter depression

For patients with seasonal affective disorder (SAD), starting treatment with an antidepressant medication during the fall can reduce the risk of developing depression throughout the fall and winter months, reports a study in the Oct. 15 issue of Biological Psychiatry, official journal of the Society of Biological Psychiatry, published by Elsevier, a world-leading scientific and medical publisher.

"These are the first systematic studies that indicate that SAD can actually be prevented in some patients by starting antidepressants early in the season, before the development of symptoms," comments Norman E. Rosenthal, M.D., Clinical Professor of Psychiatry, Georgetown Medical School, and one of the authors of the paper and leader of the research team that first described SAD over 20 years ago.

Dr. Rosenthal and colleagues performed a study with more than 1,000 patients with SAD from the northern United States and Canada. The patients, 70% of whom were women, reported an average of 13 previous episodes of fall-winter depression. Notwithstanding this long history, almost 60% of patients had received no previous treatment for their episodes of depression.

The researchers attempted to prevent the development of fall-winter depression though pre-emptive treatment with the antidepressant bupropion extended release tablets. One group of patients was randomly assigned to start treatment with bupropion-XL during the fall, while they were still well. Patients in the other group received an inactive placebo. The two groups were then followed over the winter season.

The relapse rate was 16% for patients taking bupropion extended release compared with 28% for those taking placebo. Early antidepressant treatment reduced the overall risk of fall-winter depression by about 44%. The antidepressant medication was generally well tolerated. When the patients stopped taking bupropion extended release in the spring, there was no increase in the depression relapse rate compared with the placebo group.

Patients with SAD have episodes of depression occurring in the fall and winter months. Although the cause is unknown, SAD appears related to reduced exposure to sunlight during the fall and winter in northern latitudes-genetic factors likely play a role as well. As in the current study, many patients with SAD are not treated with antidepressant medications, despite having many previous episodes of seasonal depression.

Starting antidepressant treatment in the fall offers a new option for reducing the rate of fall-winter depression in patients with SAD, the results suggest. "It is a highly novel approach to start treatment before the development of a major depressive disorder," says Dr. Rosenthal, author of the newly revised Winter Blues: Seasonal Affective Disorder: What It Is and How to Overcome It (Guilford Publications, 2005).

"The strategy makes sense when dealing with a condition where the pattern of relapse is somewhat predictable and the symptoms being prevented can be highly distressing and debilitating," comments Dr. Rosenthal. "In my opinion, the treatment used in the present study offers a valuable new option for those afflicted year after year by winter depression."

About the Society of Biological Psychiatry

The Society of Biological Psychiatry was founded in 1945 to emphasize the medical and scientific study and treatment of mental disorders. Its continuing purpose is to foster scientific research and education and to raise the level of knowledge and comprehension in the field of psychiatry. To achieve its purpose, the Society sponsors an annual meeting, grants awards to distinguished clinical and basic research workers, and publishes the journal Biological Psychiatry. Visit the Society's website at sobp.org

About Elsevier

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (sciencedirect.com), MD Consult (mdconsult.com), Scopus (mdconsult.com), bibliographic databases, and online reference works.

Joshua R. Spieler, Publisher
j.spieler@elsevier.com
Elsevier
http://www.elsevier.com
reade more... Résuméabuiyad

Stress, Deprivation Leads To Overeating - And Adds To Your Depression!

Mix stress, deprivation and tempting foods and you get overeating

DAVE'S COMMENTS: Articles like these are important. Often depression treatment involves issues of compulsive eating. Remember, professional help is always available here.

Two studies in the October issue of Behavioral Neuroscience show that when animals are stressed, deprived and exposed to tempting food, they overeat, with different degrees of interaction. The powerful interplay between internal and external factors helps explain why dieters rebound and even one cookie can trigger a binge if someone's predisposed to binge.

The findings also implicate the brain's opioid, or reward, system in regulating overeating, especially when the food is extra-tempting - and not only in under-fed animals. This knowledge may help even non-stressed people to avoid overeating, keep their weight down and improve their health. Behavioral Neuroscience is published by the American Psychological Association (APA).

A study by M. Flavia Barbano, PhD, and Martine Cador, PhD, at the University of Bordeaux 2 in France, separated the distinct roles in consumption played by food deprivation and the "yum" factor, establishing that the interplay between internal and external factors regulates food intake, at least in mammals. Although much has been learned about human overeating, it is easier to untangle and verify the different variables involved in controlled animal studies.

Working with laboratory rats, the researchers tested three aspects of eating behavior: motivation (how bad did they want it), anticipation (how excited were they in advance), and intake (how much did they eat), all relative to homeostasis (satiety or deprivation) and food type (ordinary lab chow or "highly palatable" chocolate breakfast cereal, as verified by a pre-test of different foods).

For motivation, the researchers measured how fast 16 rats - who either had eaten freely or been put on a diet -- ran down an alley to a bowl of either chow or Choc and Crisp, a German-brand cereal. The animals ran faster when they were either food-deprived or presented with the chocolate cereal. However, when the food-sated animals were presented with Choc and Crisp, they ran just as fast as the hungrier rats.

The authors also measured anticipation in 32 rats by comparing activity levels when placed in individual cages where they would get either chow or cereal. First, the authors got the rats used to unpredictable feeding times; then for 10 days fed them a half hour after they went into the cage. Whether they expected chow or cereal, the food-restricted rats were more active, rearing up a lot more. Regardless of food type, only the deprived rats were more active, so the researchers concluded that anticipatory activity depends not on food type but on whether the animal has had enough to eat (homeostatic state).

As for actual intake, when presented with the Choc and Crisp, the food-sated group ate almost as much as the food-deprived group. But when presented with lab chow, they ate very little. Barbano and Cador concluded that highly palatable food motivates an animal to eat more than it really needs. When food type and satiety interact, attractiveness overrides satiety -- a phenomenon known to anyone who has ever stood in a buffet line.

In another key study, neuroscience psychologist Mary Boggiano, PhD, and her colleagues at the University of Alabama at Birmingham focused on the regulatory role of the brain's opioid system. Opioids or endorphins (the brain's "feel good chemicals") play a key role in our liking of food. Yet external substances such as heroin and morphine mimic endorphins by binding to the same receptors in the brain, produce a sense of reward (among other functions). The researchers compared how binge-eating rats versus non-binge eating rats responded to drugs that either turn on opioid receptors (butorphanol, which treats pain) or block them (naloxone, which treats heroin addiction).

From the rats' responses to these drugs, Boggiano and her colleagues inferred how stress and dieting change the brain's opioid control of eating. The binge eating occurred after rats experienced both foot shock (stress) and cyclic caloric restriction (dieting). Either caloric restriction or stress alone were not enough to produce changes in food intake, but stressed and underfed rats ate twice the normal amount of Oreo® cookies, which rats find rewarding. In other words, animals subjected to both stressors became binge eaters, confirming how strongly these outside factors interact to change eating behavior.

The findings also implicated opioids in the neurochemistry of binge eating. The highly rewarding butorphanol enhanced the binge eating; the reward-blocker naloxone suppressed how much the stress/deprived rats ate, to the level of the control rats. The authors say this pattern of findings in rats who were sated at the time of testing strengthens the evidence that reward, more than metabolic need, drives binge eating. Boggiano and her colleagues speculate that sensitized opioid-receptor signaling may be necessary to initiate binge eating. In the rats, stress and reduced calories seemed to sensitize those receptors to the presence of highly palatable food, in this case cookies. This, they write, "may underlie the common clinical observation that just a bite of highly palatable (often forbidden) food triggers binges and makes it difficult to abstain from binge eating."

The researchers speculate that the deprived and stressed rats may have been in a "hedonic deprivation state," essentially craving something good and rewarding. The research underscores how what is viewed as an unhealthy behavior (indulging in palatable foods, which are cheap, convenient and often high in fat and sugar) may have its roots in the need to survive. It suggests that binge eating is an adaptive response to abnormal environmental conditions. Boggiano cites other scientists' findings that among healthy people without eating disorders, dieting is the biggest predictor of stress-induced overeating.

In light of their findings, she says, "Highly palatable food can mimic opioid drugs by releasing opioids or activating sensitized receptors, so imagine so imagine what it can do in a human with a history of dieting. If only rat chow is available, even rats with a history of dieting when stressed rats don't binge -- but when they get a little bite of cookie first, they do." As a result, she says when treating bulimics and binge eaters, it may not be a good idea to introduce palatable (junk) food too early in therapy.

However, she thinks that binge eaters' sensitized opioid receptors should return to normal as long as they stay away from very-low-calorie diets and from trigger foods for a long time, perhaps relative to the amount of time they've had the disorder. In the meantime, scientists could perhaps develop a safe opioid blocker that could help binge eaters fight off food cravings. However, Boggiano believes that the main key is not drugs but behavioral change around food, recognizing stressors and avoiding restrictive diets.

"Binge eating is normal," she says. "It's your brain's best way to respond to expected starvation. It's restrictive dieting and stressing so much about your body weight and shape that is abnormal."

Articles both appear in Behavioral Neuroscience 2005, Vol. 119, No. 5:

1. "Various Aspects of Feeding Behavior Can Be Partially Dissociated in the Rat by the Incentive Properties of Food and the Physiological State;" M. Flavia Barbano, PhD, and Martine Cador, PhD, Laboratoire de Neuropsychobiologie des Désadaptations, Centre National de la Recherche Scientifique, Unite Mixte de Recherche 5531, Universite Victor Segalen Bordeaux 2, Bordeaux, France.

(Full text of the article is available from the APA Public Affairs Office and at: Feeding Behavior:
apa.org/journals/releases/bne11951244.pdf)

2."Combined Dieting and Stress Evoke Exaggerated Responses to Opioids in Binge-Eating Rats;" Mary M. Boggiano, PhD, Paula C. Chandler, M.A., Jason B. Viana, B.S., Kimberly D. Oswald, B.S., Christine R. Maldonado, B.S., and Pamela K. Wauford, B.S.; University of Alabama at Birmingham.

(Full text of the article is available from the APA Public Affairs Office and at Dieting and Stress:
apa.org/journals/releases/bne11951207.pdf)

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

Pam Willenz
public.affairs@apa.org
American Psychological Association
apa.org
reade more... Résuméabuiyad

Depression treatment requires persistence - Please Don't Give Up!

"Nothing in the world can take the place of Persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan 'Press On' has solved and always will solve the problems of the human race."



Calvin Coolidge
reade more... Résuméabuiyad

Is BipolarGenetic? Evidence Says YES!

Evidence linking bipolar disorder to two chromosomal regions in the human genome


An international team of 53 researchers has offered the most convincing evidence so far linking bipolar disorder, also known as manic depression, to two chromosomal regions in the human genome. The finding gives scientists refined targets for further gene studies.

"Even though bipolar disorder affects millions of people around the world--sometimes throughout their lifetimes--what we understand to be biologically relevant at the genetic level is not terribly characterized," said Matthew McQueen, lead author and postdoctoral fellow in the Department of Epidemiology at the Harvard School of Public Health (HSPH). "This research can help focus the field to identify viable candidate genes."

The study will appear in the October issue of the American Journal of Human Genetics.

More than two million American adults have bipolar disorder, according to the National Institute of Mental Health. Patients typically experience dramatic mood swings from episodes of euphoria and high energy to feelings of intense sadness, fatigue, and even suicide. Psychiatrists have identified two primary forms of the illness: bipolar I disorder, which is the classic form of recurring mania and depression, and bipolar II disorder, which has less severe episodes of mania. Treatment often includes medication.

The exact cause of the illness remains unknown, but scientists suspect the involvement of several genes, coupled with environmental influences. A number of individual studies have suggested genomic regions linked to bipolar disorder, but their results have been inconsistent and difficult to replicate, leaving the field "standing at a crossroads, wondering in which direction to go next," said McQueen.

To establish more definitive research, McQueen and his colleagues did something unusual. They secured and then combined original genome scan data from 11 independent linkage studies, instead of relying on the more common approach of using summary data from such studies.

"The use of original data made a significant difference in our ability to control for variation in several factors among the different data sets and to make the overall analysis much more consistent and powerful," said Nan Laird, HSPH Professor of Biostatistics and senior author on the paper.

The resulting analysis involved 1,067 families and 5,179 individuals from North America, Italy, Germany, Portugal, the UK, Ireland, and Israel, who had provided blood samples and family medical histories. The research team combined the data into a single genome scan and found strong genetic signals on chromosomes 6 and 8. The team now hopes to narrow the search to find associations between specific genes and the mental illness.

The analysis was funded through the Study of Genetic Determinants of Bipolar Disorder Project at the National Institute of Mental Health. Other researchers on the analysis team represented Massachusetts General Hospital, The Broad Institute, and the University of Pittsburgh.

Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights.

Christina Roache
croache@hsph.harvard.edu
617-432-6052
Harvard School of Public Health
reade more... Résuméabuiyad

Does Bipolar Affect Memory and Attention?

Does Bipolar Illness Affect Attention And Memory?

A report published in the September issue of Psychotherapy and Psychosomatics by a group of investigators of the University of Barcelona suggests that cognitive deficits may occur in bipolar disorder.

In clinical practice, bipolar patients complain of cognitive deficits such as attentional or memory disturbances. The main aim of this study was to determine whether subjective cognitive complaints were associated with objective neuropsychological impairments.

Sixty euthymic bipolar patients were assessed through a neuropsychological battery. A structured clinical interview was used to determine subjective cognitive complaints in patients. Thirty healthy controls were also included in the study in order to compare the neuropsychological performance among groups. Bipolar patients with a higher number of episodes, especially the number of mixed episodes, longer duration of the illness and the onset of the illness at an earlier age showed more subjective complaints.

Furthermore, bipolar patients with subjective complaints showed lower scores in several cognitive measures related to attention, memory and executive function compared with the control group. Nevertheless, patients without complaints also performed less well than controls in some neuropsychological measures.

Bipolar patients who were aware of cognitive deficits were more chronic, had presented more previous episodes, especially mixed type, and their illness had started at an earlier age compared with patients who did not complain about cognitive problems. Moreover, patients with good cognitive insight also had a poorer social and occupational functioning as well as a poorer neuropsychological performance.

However, the bipolar group without complaints also obtained lower scores in several tests compared with healthy controls. Cognitive status of bipolar patients should be routinely assessed, regardless of the patients awareness about their cognitive deficits.

reade more... Résuméabuiyad

Know For Certain If You're Depression Is Cured

Curing Depression? 7-item questionnaire to determine if you are recovered.

Determining when treatment of a depressed patient can safely be discontinued is important but difficult for clinicians; until now, no tests have been available that are simple to administer in a doctor's office.

Roger McIntyre and colleagues developed a brief 7-item questionnaire to determine if a patient with depression has recovered, and have now evaluated it for use in primary care.

In a randomized controlled trial involving 454 patients with major depressive disorder across 47 medical practices in 4 provinces, outcomes of antidepressant therapy were determined with the brief HAMD-7 questionnaire or the standard longer questionnaire (the HAMD-17) that is used in research and specialty settings.

Results from the 2 study instruments showed good agreement, which suggests that the shorter version is accurate and could be used in clinical practice by physicians.

p. 1327 Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale -- R.S. McIntyre et al

Find PDF of study here - http://www.cmaj.ca/cgi/data/173/11/1327/DC2/1


Dr. Roger McIntyre
Canadian Medical Association Journal
reade more... Résuméabuiyad

Phone Counseling Study Shows Good Results

Phone-Based Psychotherapy Helps Ease Depression



** CounselingPros has been offering online and phone counseling since 1998!!

Telephone-administered psychotherapy may help relieve the depression of patients battling multiple sclerosis (MS), according to a new study.

Researchers at the University of California, San Francisco, found that 16 weeks of therapy by phone helped ease feelings of depression, particularly sessions focusing on what psychologists call cognitive-behavioral therapy. In this type of therapy, patients are taught to manage the thoughts and behaviors that contribute to depression.

Therapy delivered by telephone could prove a key way to combat depression, the researchers said in an article in the September issue of Archives of General Psychiatry.

Although two-thirds of depressed patients prefer psychotherapy to antidepressants, just 10 percent to 45 percent ever make a first appointment, and half will drop out by the end of treatment, experts say. Reasons driving this poor turnout include physical impairments, transportation problems, proximity of services and lack of time or financial resources.

Phone-based therapy gets around many of those problems, but the researchers say further research is necessary "to examine if the outcomes of telephone-administered therapies are equivalent to face-to-face interventions."

reade more... Résuméabuiyad