Risk Of Death In The Very Elderly Increased By Anemia

Anemia in very elderly people aged 85 and older appears to be associated with an increased risk of death, according to a new study in CMAJ (Canadian Medical Association Journal).



The study was part of the Leiden 85-plus study that looked at 562 people aged 85 years in the Netherlands and followed them until age 90. Twenty-seven per cent of participants had anemia at the start of the study (prevalent anemia) and, in the follow up period, incident anemia developed in 24% of the people without anemia at the start of the study.



Anemia in elderly people is generally associated with increased death as well as decreased mobility, cognitive impairment, depression, falls and fractures, hospital admission and diminished quality of life. It can significantly affect health care needs and costs in ageing Western societies.



In the study group, the risk of death was similar among men and women, and among people in long-term care facilities and in the community.



"We found a strong, independent association between prevalent anemia in participants at age 85 years and risk of death," write Ms. Wendy den Elzen of the Leiden University Medical Center and coauthors, confirming results of previous studies of people in the Netherlands and North America. "We found that incident anemia in participants beyond the age of 85 years had an even stronger impact on mortality than prevalent anemia at age 85."



After adjusting for other illnesses, the negative effect of anemia on cognitive ability and physical function was neutralized. The authors conclude that the associated functional decline appears to be mainly attributed to comorbid illnesses.



In a related commentary, Dr. Mark Clarfield of Ben-Gurion University and Dr. Ora Paltiel of Hadassah-Hebrew University in Israel write "for unexplained anemia in elderly patients, we may never be able to disentangle whether the underlying cause or the anemia is responsible for death." They caution that proof is needed that routinely correcting unexplained anemia is more beneficial than harmful.

The High Percentages Of Depression Have Been Greatly Exaggerated

According to widely reported community-based research, almost half the U.S. population suffers from depression. But research by two sociologists indicates that percentage is greatly exaggerated or is a misrepresentation.



The extraordinarily high rates of untreated mental illness reported by community studies are false, say Allan V. Horwitz, a sociology professor in the Institute of Health at Rutgers University, and Jerome Wakefield, a professor in the School of Social Work at New York University. Community studies rely on standard, closed-format questions about symptoms with no context provided to differentiate between reactions to normal life stress (i.e., a death, a romantic break up, work or school stress) and pathological conditions that indicate clinical mental illness.



"These numbers are largely a product of survey methodologies that, by nature, overstate the number of people with mental illness." Reporting the findings in Contexts magazine (Winter 2006), published by the American Sociological Association, the authors state, "Moreover, because people experiencing normal reactions to stressful events are less likely than the truly disordered to seek medical attention, such questions are bound to inflate estimates of the rate of untreated disorder."



In the past, diagnoses relied on treatment studies, but it became apparent that the number of treated patients understated the problem for a variety of reasons such as lack of access to treatment and reluctance to seek appropriate help. Today tightly structured questions are used in community studies to allow researchers to better diagnose a population.



The problem is that the criteria used in the community surveys are not necessarily valid for diagnosing mental disorders. One reason for this is that people self-select when seeking treatment and use their judgment to decide if their feelings exceed normal responses to stressful events. Second, clinicians make contextual judgments when they diagnose patients because some depressive symptoms might occur as a normal response to a loss of a job or a marriage unraveling. In surveys, interviewers are forbidden to judge the validity of a response or discuss the intent of a question. In addition, the duration criteria of community surveys only require that symptoms last at least two weeks, causing transient and self-correcting problems to be counted as disorders.



"In contrast to clinical settings," say Horwitz and Wakefield, "symptom-based diagnoses in community studies consider everyone who reports enough symptoms as having the mental disorder of depression. Symptoms that would not require treatment may nevertheless qualify as a disorder in a community survey."



"Community surveys could more adequately separate normal responses to stressful situations from mental disorders by including questions about the context in which symptoms develop and persist," say Horwitz and Wakefield. The decision not to include contextual criteria in community surveys, they speculate, might have to do not only with efficiency and practicality but also with resistance to change by groups that benefit from high rates of mental health problems.



There are a number of reasons that these high rates are perpetuated. One is that political support is more likely for an agency devoted to preventing and treating a widespread disease such as the National Institute of Mental Health. Another reason is that pharmaceutical companies capitalize on these survey findings to broaden their markets. The explosive growth in sales of antidepressants may indicate its effectiveness. Lastly, advocacy groups lay claim to the prevalence of mental disorders. They equate the millions of people that surveys identify with disorders with the serious mental disorders in order to reduce the social distance between the mentally disordered and others, thereby lowering the stigma. This may only hinder the truly disabled by shifting resources from where it is truly needed.







Contexts magazine, a peer-reviewed publication, seeks to apply new knowledge, stimulate fresh thinking, and disseminate important information produced by sociologists. It received the "Best Sociology Journal of 2002" award from the Association of American Publishers, Scholarly Publishing Division and was named "One of the Best New Magazines of 2002" by Library Journal.



The American Sociological Association, founded in 1905, is a non-profit membership association dedicated to serving sociologists in their work, advancing sociology as a science and profession, and promoting the contributions and use of sociology to society.



Contact: Johanna Olexy

pubinfoasanet

American Sociological Association

Depression intensifies from one generation to the next - Columbia study shows

20-year study at Columbia University Medical Center is first to highlight increased risk of depression across three
generations -


NEW YORK, NY, January 10, 2005 - Nearly 60 percent of children whose parents and grandparents suffered from depression have a
psychiatric disorder before they reach their early teens, according to a new study by researchers at Columbia University
Medical Center (CUMC) and the New York State Psychiatric Institute (NYSPI). This is more than double the number of children
(approx. 28 percent) who develop such disorders with no family history of depression.


The study, published in the January issue of the Archives of General Psychiatry, is the first to follow three generations of
high-risk families and has taken more than two decades to complete. The CUMC/NYSPI research team began studying 47 first
generation family members in 1982; then interviewed 86 of their children several times as they grew into adulthood. The team
has collected data from 161 members of the third generation, whose average age is 12.


Results found that most of the prepubescent grandchildren with a two-generation history of depression developed anxiety
disorders that developed into depression as they aged into adolescence. This trend was also found when the researchers
previously followed the children's parents through adolescence and adulthood.


"We have shown that the risk of depression is carried through several generations and that it intensifies as more generations
are affected," said the study's lead author, Myrna Weissman, Ph.D., Professor of psychiatry and epidemiology at Columbia
University Medical Center and Chief of the Department of Clinical & Genetic Epidemiology at New York State Psychiatric
Institute. "Children with a two-generation family history of depression develop anxiety disorders earlier than other children
and tend to experience more impairment." Other investigators involved included Priya Wickramaratne, Ph.D. and Virginia
Warner, MPH.


Previous studies have shown that the children of a depressed parent are at greater risk of mood and anxiety disorders, but
the Columbia study is the first to illustrate how the risk intensifies across three generations.


"Children of parents and grandparents with depression are at extremely high risk for mood and anxiety disorders even when
they're very young," Dr. Weissman says. "They should be considered for treatment if they develop anxiety disorders, or at
least monitored very closely."


Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, medical
education, and health care. The medical center trains future leaders in health care and includes the dedicated work of many
physicians, scientists, nurses, dentists, and other health professionals at the College of Physicians & Surgeons, the School
of Dental & Oral Surgery, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the
Graduate School of Arts and Sciences, and allied research centers and institutions. With a strong history of some of the most
important advances and discoveries in health care, its researchers are leading the development of novel therapies and
advances to address a wide range of health conditions.


Contact: Craig LeMoult

cel2113columbia

Columbia University College of Physicians and Surgeons

Lexapro(R) Demonstrated Significance On Prospectively Defined Efficacy Parameter And Was Better Tolerated Than Cymbalta(R) In Treatment Of Depression

Forest Laboratories, Inc.,
(NYSE: FRX) today announced the results of a new study demonstrating that
Lexapro (escitalopram oxalate) provided a greater reduction in MADRS
scores, (p=0.040), utilizing an LOCF approach and was better tolerated than
Cymbalta (duloxetine), based on the percentage of patients discontinuing
treatment due to adverse events, in the treatment of patients with moderate
to severe major depressive disorder (MDD).



Dr. Arif Kahn, Medical Director of Northwest Clinical Research Center
and investigator in this study said, "These findings add to a number of
studies that demonstrate the clinical value of Lexapro in the treatment of
depression."



Study details



Patients (aged 18-80 years) with DSM-IV diagnosed MDD as determined by
a Montgomery-Asberg Depression Rating Scale (MADRS) score of 26 or greater
were randomized to eight weeks of double-blind treatment with Lexapro 10-20
mg/day (dose fixed at 10 mg/day for the first four weeks with optional
up-titration to 20 mg/day thereafter) or Cymbalta 60 mg/day. Dosing of the
two antidepressants was consistent with information in the FDA-approved
package inserts of both drugs. The primary, prospectively-defined, efficacy
endpoint was the change from baseline at week eight in the MADRS total
score, using the last observation carried forward (LOCF) approach. At the
start of the study, 137 patients were enrolled in the Lexapro arm of the
study and 133 in the Cymbalta arm.



At the end of the eight-week study, Lexapro patients demonstrated
greater improvement than Cymbalta patients in total MADRS score (LSMD,
least squared mean difference, -2.42 [95% CI: -4.73, -0.11]; p=0.040). The
proportion of patients responding to Lexapro treatment, as determined by a
50 percent improvement in MADRS total score, also was greater when compared
to patients in the Cymbalta group (68 percent vs 52 percent, p=0.011;
LOCF). Remission rates were 44 percent in the Lexapro group and 38 percent
in the Cymbalta group, as determined by a total MADRS score of 10 or less,
this difference was not significant. The rate of improvement on the MADRS
was similar between the groups when an observed cases analysis was
conducted. In addition, there was no difference seen between the group on a
number of measures of relief of somatic and pain-related symptoms.



More patients in the Lexapro group completed eight weeks of treatment
than patients in the Cymbalta group (87 percent vs 69 percent, p=0.001),
and fewer patients receiving Lexapro discontinued treatment due to adverse
events compared to patients receiving Cymbalta (2 percent vs 13 percent,
p=0.001).
















About Lexapro



Lexapro is a selective serotonin reuptake inhibitor (SSRI) that has
been prescribed for more than 14 million adult patients in the United
States.



Lexapro was approved by the U.S. Food and Drug Administration in August
2002 for both the initial and maintenance treatment of major depressive
disorder (MDD) in adults, and in December 2003 for the treatment of
Generalized Anxiety Disorder (GAD) in adults.



The most common adverse events reported with Lexapro (reported at rates
of approximately 5 percent or greater and 2 times or more the incidence
seen in the placebo group) were nausea, insomnia, ejaculation disorder,
somnolence, increased sweating, fatigue, decreased libido, and anorgasmia.
Lexapro is contraindicated in patients taking monoamine oxidase inhibitors
(MAOIs), pimozide, or in patients with a hypersensitivity to escitalopram
oxalate or any of the ingredients in Lexapro.



As with other SSRIs, caution is indicated in the coadministration of
tricyclic antidepressants (TCAs) with Lexapro. As with other psychotropic
drugs that interfere with serotonin reuptake, patients should be cautioned
regarding the risk of bleeding associated with the concomitant use of
Lexapro with NSAIDs, aspirin, or other drugs that affect coagulation.



Patients with major depressive disorder, both adult and pediatric, may
experience worsening of their depression and/or the emergence of suicidal
ideation and behavior (suicidality), whether or not they are taking
antidepressant medications, and this risk may persist until significant
remission occurs.



Although no causal role for such behaviors has been established,
patients being treated with antidepressants should be observed closely for
clinical worsening and suicidality, especially at the beginning of a course
of drug therapy, or at the time of dose changes, either increases or
decreases. Families and caregivers should be advised of the need for close
observation and communication with the prescriber. Lexapro is not approved
for use in pediatric patients.



Forest Laboratories licenses Lexapro from H. Lundbeck A/S, the Danish
pharmaceutical firm that developed escitalopram and citalopram.



About Forest Laboratories and Its Products



Forest Laboratories (frx) is a US-based pharmaceutical company
dedicated to identifying, developing, and delivering products that make a
positive difference in peoples' lives. Forest Laboratories' growing product
line includes Lexapro(R) (escitalopram oxalate), an SSRI indicated for
adults for the internal and maintenance treatment of major depressive
disorder and generalized anxiety disorder; Namenda(R) (memantine HCl), an
N-methyl D- aspartate (NMDA)-receptor antagonist indicated for the
treatment of moderate to severe Alzheimer's disease; Benicar(R)
(olmesartan medoxomil), an angiotensin receptor blocker, and Benicar
HCT(R) (olmesartan medoxomil- hydrochlorothiazide), an angiotenisn receptor
blocker and diuretic combination product, each indicated for the treatment
of hypertension; and Campral(R) (acamprosate calcium), indicated in
combination with psychosocial support for the maintenance of abstinence
from alcohol in patients with alcohol dependence who are abstinent at
treatment initiation.


-- Benicar is a registered trademark of Daiichi Sankyo, Inc., and Campral
is a registered trademark of Merck Sante s.a.s., subsidiary of Merck
KGaA, Darmstadt, Germany.



Except for the historical information contained herein, this release
contains "forward-looking statements" within the meaning of the Private
Securities Litigation Reform Act of 1995. These statements involve a number
of risks and uncertainties, including the difficulty of predicting FDA
approvals, the acceptance and demand for new pharmaceutical products, the
impact of competitive products and pricing, the timely development and
launch of new products, and the risk factors listed from time to time in
the Forest Laboratories' SEC reports, including the Company's Annual Report
on Form 10-K for the fiscal year ended March 31, 2006 and on Form 10-Q for
the periods ended June 30 and September 30, 2006.


Forest Laboratories, Inc.

frx/


View drug information on Benicar; Campral; Cymbalta.

Teenage depression can be enduring, but is more often short-lived

Teenage depression is widespread and can become a life-long illness, but is more often transitory, said UCLA Psychology
Professor Constance Hammen, who will discuss her research at an invited address May 27 at the American Psychological
Society's annual convention in Los Angeles.


"Adolescent depression can be as high as 20 percent or higher," said Hammen, who has studied depression for more than 30
years. "While these numbers are alarming, and depression can be impairing, most of the depressions will be short-lived and
most of these kids will not go on to have further depression.


"Many things can make teenagers depressed, but in about 60 percent of the cases, the depression does not foretell future
depression. Of those who have adolescent depression, perhaps 40 percent will have recurring depression, and many of those
will likely be life-long."


Hammen has been conducting a long-term study over the last 10 years of 800 families with children now in their 20s, along
with Patricia Brennan from Emory University in Atlanta. The subjects are among 7,000 families in Australia who have been
studied since the children were five years old by researchers from the University of Queensland.


About half of the children in the current study who showed depression by age 15 had recurring depression by age 20, and those
who did have a distinctive profile, Hammen and Brennan found. Their preliminary analysis indicates the adolescents who showed
depression by age 15 and again between 15 and 20 also had anxiety disorders and poor social relationships such as fewer
friends or more conflict in their relationships.


"We have found that the risk for recurring depression occurs in the kids who had early depression and social difficulties,"
Hammen said. "Kids depressed by 15 who function normally in social relationships did not go on to have depression by 20. Poor
social functioning by age 15, such as not having stable friendships, looks like a risk factor for recurring depression.



"The kids with depression at both 15 and 20 have a very high rate before age 15 of fears, phobias, anxiety, and panic
reactions," she said. "In many cases, they were showing anxious, fearful and distressed symptoms as early as age five."



Twenty percent of the children of depressed mothers developed depression by age 15, a rate of depression twice as high as
that of the children of non-depressed mothers.


Girls were more than twice as likely as boys to show depression at both ages 15 and 20, Hammen said.


Parents commonly do not see depression in their children, she said.


"Parents often don't pick up on inner despair or distress, and notice depression mainly as irritability or loss of enjoyment
of activities their kids used to enjoy," Hammen said. "If it goes on for a month, I think the parent should pay more
attention and not just dismiss the behavior as part of adolescence."















"Most of the time when children are depressed, there's something wrong in their lives, and the situation that's causing the
depression needs to be addressed," Hammen said. "Kids often get depressed because bad things happen to them that they don't
have the coping skills to deal with."


Women are especially at increased risk for depression from stress factors, particularly interpersonal stress, such as poor
relationships marked by as conflicts.


"Most depression, particularly for women, is triggered by negative social connections, such as relationship problems,
arguments, break-ups, and not having close friends," Hammen said.


Interpersonal stress plays a large role in women's depression, Hammen has found.


Not all depression is alike, Hammen said, noting it can be mild or severe, a single episode or recurring.


Major episodes of depression last for at least two weeks, with impairment in performing daily activities, and a combination
of symptoms such as a depressed mood, loss of enjoyment in previously pleasurable activities, changes in appetite, changes in
sleep patterns, loss of motivation and energy, difficulty concentrating, and negative thoughts about themselves and the
future, including suicidal thoughts.


People who are depressed often select themselves into stressful environments, or contribute to such environments through
difficult relationships with romantic partners or families, that may result in chronic or recurring depression for
themselves, Hammen said.


Hammen has studied depression in adolescents and adults, and has studied children of depressed mothers. Depressed mothers
often themselves had mothers who were depressed. Her research is funded by the National Institute of Mental Health.


"By age 15, the children of depressed mothers had a higher risk of depression, but the risk for depression is not just from
genetics," Hammen said. "The risk is from a cascade of events that occur in depressed families, environmental and
psychological factors that are the determinants of whether the kids become depressed.


"If the mother is depressed and had stressful family factors like a bad marriage, then the child is more likely to have
social and interpersonal problems and more likely to have stressful life events associated with depression."


In the Australia study, Hammen is testing whether it makes a difference when in the child's life the mother was depressed and
whether the mother's depression was severe or mild. Mild depression does not have much impact on the child unless it is
chronic, she said.


Hammen and Brennan plan to study the link between maternal depression and youth depression, as well as interpersonal problems
such as domestic violence and early pregnancy.


Hammen has debunked myths about depression, including this one:


"A lot of people think depression stems from a weakness in character, and that you should just keep a stiff upper lip,"
Hammen said. "It's a myth. People cannot simply will depression away. It can be a serious impairment, and may require
treatment. It's not a weakness of will."


Contact: Stuart Wolpert

stuartwcollege.ucla

310-206-0511

University of California - Los Angeles

Getting A Job Promotion Is Bad For Mental Health & Stops You Visiting The Doctor

New research by economics and psychology researchers at the University of
Warwick has found that promotion on average produces 10% more mental strain and
gives up to 20% less time to visit the Doctors.



In a research paper entitled "Do People Become Healthier after Being Promoted"
Chris Boyce and Professor Andrew Oswald of the University of Warwick questioned
why people with higher job status seem to have better health. A long-held
assumption by researchers is that an improvement to a person's job status,
through a promotion, will directly result in better health due to an increased
sense of life control and self-worth.



The researchers tested this.?  They drew upon the British Household Panel Survey
data set, collected annually between 1991 and 2005, with information on
approximately 1000 individual promotions.?  They found no evidence of improved
physical health after promotion - nor that self-assessed feelings of health
declined.



What they did find, however, was significantly greater mental strain.?  After a
job promotion, there was on average a 10% decrease in people's mental health
measured in a standardized way across the British population.?  Intriguingly,
those promoted at work also reported on average a 20% fall in their visits to a
Doctor following their promotion.?  On first sight this drop in Doctor visits
does not match the lack of change in the reported health of promoted
individuals. But the increased stress levels of promoted workers may provide an
explanation -- part of the stress on?  promoted people may be more constraints on
their time and they simply have less time to visit a doctor.



University of Warwick researcher Chris Boyce said:



"Getting a promotion at work is not as great as many people think.?  Our research
finds that the mental health of managers typically deteriorates after a job
promotion, and in a way that goes beyond merely a short-term change.?  There are
no indications of any health improvements for promoted people other than reduced
attendance at GP surgeries, which may itself be something to worry about rather
than celebrate."



The research will be presented at the Royal Economic Society's conference later
this month.?  The research paper can be found here.



Source

Peter Dunn, Press and Media Relations Manager

Communications Office, University House,

University of Warwick, Coventry, CV4 8UW, United Kingdom

Nearly 5 Percent Of The US Population Suffers From Persistent Depression Or Anxiety

Though effective treatments are available for individuals suffering from chronic depression and anxiety, very little is known about how often these treatments are used or how prevalent these conditions are among the nation's general population.



But in a first-of-its-kind study, UCLA researchers have developed estimates for both the prevalence of chronic psychiatric illness in the general population and how often individuals suffering from such illnesses receive appropriate treatment.



In the study, published in the December issue of the peer-reviewed journal Psychiatric Services and currently available online, researchers found that approximately 4.7 percent of the nation's population suffers from persistent depression or anxiety disorders, with a minority of those afflicted receiving adequate medication or counseling.



"From a policy perspective, this study indicates that we have to do much better in terms of helping people in the population and clinicians in primary care," said lead author Dr. Alexander S. Young, a UCLA professor of psychiatry and director of health services for the Department of Veterans Affairs Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC). "We need to understand that psychiatric disorders are treatable with psychotherapy and/or medication. Patients would benefit if we improved linkages between primary care and specialty mental health care so that patients are referred and accept referrals to mental health specialists, especially when they are chronically ill.



"Also, we have to improve insurance arrangements so that they encourage more intensive treatment in people who remain ill," he said.



The study was based on data from Healthcare for Communities, a nationally representative household survey of adults in the United States. The researchers analyzed responses from 1,642 adults with major depression or anxiety disorders. These surveys, conducted in 1997 and 1998, with follow-ups approximately two-and-a-half years later, assessed diagnosis, quality of life, treatment satisfaction, medical conditions, suicidal thoughts, insurance, and the use of medications and counseling.



At follow-up, the researchers found that 59 percent of the individuals no longer met the criteria for having a psychiatric disorder. But to their surprise, they found that among those who remained ill, there were only modest increases in medication use and no statistically significant increase in the use of counseling for their disorders - measures that are known to significantly improve outcomes, especially when used in combination. Among this subgroup:
87 percent had a chronic, co-morbid medical disorder.















In the prior year, 88 percent had seen a primary care practitioner, but only 22 percent had consulted a mental health specialist.


In the two-and-a-half years between baseline and follow-up, use of medication rose from 21 percent to 29 percent, and use of counseling fell from 23 percent to 19 percent.


Only 12 percent with persistent illness were getting both medication and counseling (the appropriate treatment in this situation).


51 percent had suicidal thoughts at follow-up.


Men and those with less education received less treatment.

"Persistent depressive and anxiety disorders are remarkably common in the U.S. population and are associated with substantial morbidity. There are significant problems with the quality of care received by this population, and these problems persist over time," the researchers concluded. "In the population with persistent depressive and anxiety disorders, increasing the rate of appropriate care from its current low level could result in substantial improvement in individuals' lives."







In addition to Young, study authors included Ruth Klap, Ph.D., of the Health Services Research Center at UCLA; Rebecca Shoai, M.P.H., M.S.W., affiliated with MIRECC; and Kenneth B. Wells, M.D., M.P.H., of the UCLA Department of Psychiatry and the RAND Corp.



The Robert Wood Johnson Foundation funded the study, with additional support from the National Institute of Mental Health and the U.S. Department of Veterans Affairs.



The UCLA Department of Psychiatry and Biobehavioral Sciences within the David Geffen School of Medicine is home to faculty who are experts in the origins of and treatments for disorders of complex human behavior. The department is part of the Semel Institute for Neuroscience and Human Behavior at UCLA, a world-leading interdisciplinary research and education institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders.

University seeks recruits for Parkinson's Disease study

Researchers at the University of Edinburgh are seeking people with Parkinson's Disease (PD) to help them better
understand how mood-- particularly depression-- affects their symptoms. The study will investigate the way depression impacts
on the thinking processes of those with PD, and look at how this mood disorder can be treated.


Research psychologist Anthoula Lioni said: " Depression is very common in people with PD and we believe that their problems
with elaborate thinking processes -- for example, how the brain processes abstract thought and controls inappropriate
actions--may be due to major depression.


"Previous research has shown that PD patients with major depression show significant decline in their thinking processes
after a one-year period, compared with PD patients with minor, or no depression. If we can identify and treat depression, it
may prevent or delay the appearance of these thinking process symptoms.


The team, based at the Royal Edinburgh Hospital in Edinburgh, seeks 20 people over the age of 45, fluent in English, to take
part in the study. Participants will be asked to complete a questionnaire and carry out a short ability test. Information
given to researchers will be kept confidential and only used for research purposes. Those interested in finding out more
should contact Anthoula Lioni on 44-131-537-6282 or 44-131-662-1692, or email a.lionisms.ed.ac.uk


Contact: Linda Menzies

Linda.Menziesed.ac.uk

44-131-650-6382

University of Edinburgh

Prozac: Not Just For Depression

Prozac is regularly prescribed to ease the emotional pain of patients who are being treated for cancer. But can this common anti-depressant help to fight cancer itself?



Dr. Dan Peer of the Department of Cell Research and Immunology at Tel Aviv University is proving that it can. A study he and his colleagues recently completed validates that Prozac (chemical name fluoxetine) dramatically enhances the effectiveness of a widely used anti-cancer drug.



"The good news is that the medical community won't have to wait - Prozac can be used for this purpose right away," says Dr. Peer, noting that doctors in the U.S. already prescribe it to treat depression in chemotherapy patients.



Fighting Drug Resistance in Colon Cancer Patients



"Prozac is a very interesting non-specific blocker of cancer resistance," says Dr. Peer, whose study focused on colon cancer and the anti-cancer drug doxorubicin.



In their laboratory experiments, the Tel Aviv University scientists led by graduate student Mirit Argov together with Prof. Rimona Margalit, found that Prozac enhanced doxorubicin's efficacy more than 1,000%. Prozac, in effect, worked to block the cancer drug from leaving the interior of the cancer cell and poisoning the healthy non-cancerous cells that surrounded it.



In animal models, a mild doxorubicin-fluoxetine treatment combination slowed down tumor progression significantly. These results suggest that pairing Prozac with chemotherapeutic drugs to curb drug resistance warrants further clinical study, says Dr. Peer. His research was just published in Cancer Letters, and his suggestions are now listed as recommendations in the latest version of Cancer Encyclopedia.



Working Backward to Make Great Advances



"Working with a major drug developer, we have validated Prozac's potential, and now Tel Aviv University can lead a humanitarian effort to save lives around the globe," he says.



Since it is very hard to protect this patent since any clinician can prescribe Prozac, it is impossible for Tel Aviv University to commercialize its research, says Dr. Peer. Instead, he suggests that researchers join forces internationally to implement retrospective studies of all the types of cancer treatment in which Prozac was prescribed. And further clinical experiments to validate the use of Prozac with chemotherapy is also needed, he stresses.



"The next step is to take the files of chemo patients and determine whether they received Prozac for their depression," says Dr. Peer. "This will streamline the understanding in the scientific community of whether, how and for which cancer-fighting drugs Prozac can be an effective partner. It will also give us invaluable information on how to design new drugs."



Dr. Peer's Tel Aviv University lab is also developing several new drug delivery nanotechnologies to bring novel therapeutics into breast, blood, pancreatic and brain cancers. A recent technological breakthrough to reprogram immune cells involved in ulcerative colitis and Crohn's disease was reported in Science earlier this year and it is the basis of a new platform technology developed in his group.







American Friends of Tel Aviv University (aftau/) supports Israel's leading and most comprehensive center of higher learning. In independent rankings, TAU's innovations and discoveries are cited more often by the global scientific community than all but 20 other universities worldwide.



Internationally recognized for the scope and groundbreaking nature of its research programs, Tel Aviv University consistently produces work with profound implications for the future.

Depression Can Increase Risk of Repeat Heart Disease in Heart Attack Patients

Depression can double the risk of death or repeat heart disease in heart attack patients, according to two reviews of
more than 40 studies that examine the link between depression and heart disease. The reviews are published in the journal
Psychosomatic Medicine.


In the first analysis of 22 studies, patients who were depressed after their heart attacks had a twofold increase in the risk
of dying or suffering a new heart problem two years after their heart attack, according to Joost van Melle, M.D., and
colleagues of University Hospital Groningen in the Netherlands.


In the second analysis of 20 studies by J?rgen Barth, Ph.D., of University of Freiburg in Germany and colleagues, the
researchers concluded that depressed patients were twice as likely to die within two years after their first heart disease
episode compared with non-depressed patients.


According to van Melle, post-heart attack depression is common, affecting nearly 20 percent of all heart attack patients.



The two research teams found that the relationship between depression and a higher risk of death and disease stayed
consistent despite a variety of ways to measure depression.


The finding "may have important clinical implications for the identification of post-heart attack patients with poor
prognosis, because questionnaires are easier, faster and cheaper than psychiatric interviews," van Melle says.


In their study, van Melle and colleagues also noticed a stronger link between depression and higher risk of death in studies
published before 1992.


"It may be possible that improvements in cardiac care for hospitalized and rehabilitating heart attack patients are
responsible for this finding, but this would need further research," van Melle says.


Both research teams also say they are unsure exactly how depression relates to poor health and greater risk of death in these
patients.


"It must be taken into account that sicker patients may have an increased risk to become depressed and subsequently have a
worse cardiovascular prognosis. In other words, it is possible that the observed risk is in reality caused by poor cardiac
function," van Melle says.


The van Melle study was supported by the Netherlands Heart Foundation.


By Becky Ham, Science Writer Health Behavior News Service


FOR MORE INFORMATION:

Health Behavior News Service: (202) 387-2829 or hbns.


Center for the Advancement of Health

Contact: Ira R. Allen

Vice President of Public Affairs

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FDA Approves New Extended Release Pain Medication

FDA Works with Sponsor to Develop an Effective Plan to Reduce Inappropriate Use


The Food and Drug Administration (FDA) announced today the approval of Palladone (hydromorphone hydrochloride) capsules for the management of persistent moderate to severe pain in patients requiring continuous around-the-clock opioid pain relief for an extended period of time.


Palladone is an extended-release formulation that comes in 12, 16, 24, and 32 milligram (mg.) capsules. This drug should only be used in patients who are already receiving opioid therapy and who require a total daily dose of at least 12 mg. of oral hydromorphone or its equivalent. Palladone offers a therapeutic choice for opioid-tolerant patients who might otherwise be candidates for other opioids and who do not achieve satisfactory therapeutic results with these other products.


The active ingredient in Palladone, hydromorphone, is currently a Scheduled II controlled substance, which is the highest level of control for drugs with a recognized medical use. Based on the risks associated with the drug, including the potential for abuse of Palladone, FDA has worked with the sponsor to develop a comprehensive risk management program (RMP).


The RMP was designed with three potential risk situations identified. These are the risks posed by improper dosing, indication, or patient selection; the risk posed by accidental pediatric exposure to the drug; and the risk posed by abuse or diversion of Palladone Capsules.


As a controlled substance in Schedule II of the Controlled Substances Act (CSA), Palladone also comes under the jurisdiction of the Drug Enforcement Administration (DEA), which administers the CSA. Schedule II drugs are subject to manufacturing quotas set by DEA with input on medical need from FDA, distribution tracking, import and export controls, registration of prescribers and dispensers, and written prescriptions without refills.


In addition to the protection afforded patients through the status of Palladone as a controlled substance, the RMP includes provisions for clear and appropriate labeling, and appropriate education of healthcare professionals, patients, and caregivers. In addition, the sponsor has committed to offer appropriate training to sales representatives. To guard against the inappropriate use of the drug, the RMP also establishes a multifaceted program for monitoring and surveillance of abuse. If abuse, misuse, and diversion occur the program includes an array of interventions.


As part of the RMP, a Medication Guide (FDA-approved patient information which is required to be dispensed with each prescription) has been written for patients prescribed Palladone. FDA requires a Medication Guide only when one or more of the following circumstances exists: (1) the drug is one for which patient labeling could help prevent serious adverse effects; (2) the drug is one that has serious risks of which patients should be made aware because information concerning the risks could affect patients' decision to use, or continue to use the drug; and (3) the drug is important to health and patient adherence to directions for use is crucial to the drug's effectiveness. In addition, the physician labeling for Palladone contains a "black box" warning.















FDA is also part of a larger initiative to reduce diversion and abuse of prescription drugs. On March 1, 2004, the Office of National Drug Control Policy was joined by the Surgeon General, the DEA Administrator, and the FDA Commissioner to announce the National Drug Control Strategy . The strategy emphasized new collaborative efforts at the federal, state, and local levels to prevent and reduce diversion and abuse of prescription drugs. This strategy focused on three core tactics: (1) Business Outreach and Consumer Protection, (2) Investigation and Enforcement, and (3) Protecting Safe and Effective Use of Medications. During the approval process for Palladone, FDA incorporated many of the elements of this strategy as exhibited by inclusion of the "black box" warnings on the labeling, the Medication Guide, and the implementation of a RMP.


In addition to the potential for abuse and addiction, respiratory depression is the chief potential risk associated with Palladone, if not properly dosed. Respiratory depression is manifested by a reduced urge to breathe and a decreased rate of respiration, often referred to as "shallow" breathing, and can result in severe effects or fatalities. The risk of respiratory depression is greater in patients not used to taking opiates, and in elderly or debilitated patients.


Palladone must be swallowed whole because chewing, dissolving, or crushing the contents of the capsules leads to the rapid absorption of a potentially fatal dose.


Other common side effects include nausea, vomiting, dry mouth, dizziness, urinary retention, and constipation.


Palladone is manufactured and distributed by Purdue Pharma L.P., located in Stamford, Conn.


Media Inquiries: 301-827-6242

Consumer Inquiries: 888-INFO-FDA

Stigma Surrounding Mental Illness Remains Despite Abundant Pharmaceutical Ads

The medicalization of such mental illnesses as depression and bipolar disorder, which have seen prescription drug advertisements on TV skyrocket since such advertising became permissible in 1997, has done nothing to remove the harmful stigma attached to the illnesses, according to sociologists from Indiana University and the University of North Carolina in Chapel Hill.



"The findings fly in the face of current thinking about ways that stigma can be reduced," said Peggy Thoits, Virginia L. Roberts Professor of Sociology in IU's College of Arts and Sciences.



Stigma has posed a steadfast obstacle to the treatment of many mental health illnesses. Negative perceptions of mental illness color the support and advice people get from their friends, family and even their physicians and can create a reluctance to seek help.



The study by Thoits and lead author Andrew R. Payton, graduate student at University of North Carolina in Chapel Hill, sought to see if attitudes toward mental illness have changed since the U.S. Food and Drug Administration issued new guidelines allowing pharmaceutical companies to air TV ads.



Theoretically, when a condition such as depression comes to be viewed as a treatable medical condition instead of a moral failing or spiritual condition, this should reduce the blame and stigma attached to depression. The researchers examined the Mental Health Modules in the General Social Survey during these intervening years and saw no change in attitudes toward people with mental illness, specifically when they compared depression, which was a focus of many TV commercials, to schizophrenia, for which no drugs have been advertised.



"We're making a big assumption, that marketing drugs to treat some these conditions is actually penetrating the consciousness of viewers, giving them the ability to recognize symptoms and conceptualize them as disorders and to see that these disorders can be relieved essentially with drugs," Thoits said.



The study was presented in the session Medical Institutions and Mental Health at the American Sociological Association meeting.

Targeting Depression Can Help Diabetes Patients Improve Overall Health

Frequently, depression and diabetes go hand in hand. And depression can be a major obstacle for people living with diabetes, making it less likely they'll stick to a medicine schedule or exercise regimen.


A team of researchers led by investigators at the VA Ann Arbor Healthcare System and the University of Michigan Health System worked to improve diabetes patients' health by first addressing their depression. The study evaluated a year-long program that began with behavioral therapy sessions over the telephone with a specially trained nurse and later phased in a walking program.


Their findings, published online ahead of print in Medical Care, showed the intervention was successful in lowering patients' blood pressure, increasing their physical activity by about four miles of walking per week and easing their depressive symptoms.


"Depression is a common, treatable issue for many people who have diabetes," says study lead author John Piette, Ph.D., a senior research scientist at the VA and professor of internal medicine at the U-M Medical School. "Unfortunately, most busy clinics cannot provide the level of intensive care these patients need. This study shows that telephone-delivered counseling can improve patients' access to effective depression care, improve their cardiovascular health and get them moving again."


The cognitive behavior therapy helped the study participants address negative thought processes and behaviors that made it difficult for them to manage their diabetes and make healthy lifestyle choices, Piette says.


The physical activity component of the program used pedometers to help patients set walking goals and monitor their progress. Along with physical benefits, exercise also helps boost one's mood.


Most patients entered the study with relatively good blood glucose control. So while the intervention did not lead to a drop in A1C, a common measurement of blood glucose levels, patients did see more than a 4-point improvement in their systolic blood pressure, walked about half a mile more per day and reported an improvement in their general quality of life.


At the end of the year, 58 percent of patients who received the intervention had depression symptoms that were in remission, compared to only 39 percent of the patients who did not receive counseling.


"Health systems should consider routinely offering structured telephone psychotherapy to their patients with diabetes and depression," says senior study author Marcia Valenstein, M.D., M.S., an associate professor of psychiatry at the U-M Medical School and VA research scientist. "Patients with depression and additional chronic medical conditions do better if their depression is addressed first, if it is addressed systematically, and if exercise is also encouraged. Delivering therapy by telephone makes it feasible to reach large numbers of patients who may not attend traditional in-person appointments."


Methods: 291 patients with type 2 diabetes and significant depressive symptoms completed the study; 145 received the intervention, which consisted of 12 weeks of cognitive behavioral therapy over the phone, followed by nine monthly "booster" sessions. After six weeks, a pedometer-based walking program was introduced. Depression, coping and quality-of-life measurements were taken using standardized scales.


Funding: The research was funded by grants from the National Institutes of Health, Michigan Diabetes Research and Training Center and the Michigan Institute for Clinical and Health Research.


Additional authors: Caroline Richardson, M.D., of U-M and VA; Sonia Duffy, Ph.D., of U-M and VA; Joseph Himle, Ph.D., of U-M; and Trissa Torres, M.D.; Mark Vogel, Ph.D.; and Kimberly Barber, Ph.D., all of Genesys Health System, Flint, Mich.


Citation: "A Randomized Trial of Telephonic Counseling Plus Walking for Depressed Diabetes Patients," Medical Care. doi: 10.1097/MLR.0b013e318215d0c9

Research Investigates Whether Vitamin Folate Helps To Treat Depression

New research commissioned by the NIHR Health Technology Assessment (HTA)
programme is looking into whether the vitamin folate can help in the
treatment of depression. One in five people experience depression during
their lives and only half of these people respond to antidepressant
treatment.



Folate, a vitamin found in foods such as green vegetables, helps to
produce chemicals that regulate brain functions, including mood, sleep
and appetite. A Cochrane review concluded that folate may have a role as
a supplement to other treatments for depression, but the evidence is
limited and primary research is needed to test this.



"Antidepressants work by improving the way certain chemical messengers
work in the brain and folate helps produce the chemicals needed for this
process," says Professor Ian Russell of the University of Wales Bangor.



"Low levels of folate from a poor diet or similar factors could worsen
depression and stop antidepressants from working optimally."



Researchers in Wales led by Professor Russell are set to conduct the
biggest randomised controlled trial of its kind to test whether a folate
tablet taken daily by people with depression will help their
antidepressants to work better. In addition to their antidepressants,
participants will be given either a folate tablet or a dummy tablet for
three months. Researchers will ask them about the effect this has on
their depression, and take blood samples to corroborate this.



"We welcome this research initiative into the potential of folate to
enhance the effect of anti-depressant medication," says Lindsay Foyster,
Director of Mind Cymru. "If the research proves folate to be efficacious
then an easily acquired simple supplement or an informed improvement in
diet could make a significant contribution to the self management of
depression."



For more information visit: hta.ac.uk/project.asp?PjtId=1537








Notes:



1. The HTA programme produces high quality research information
about the effectiveness, costs, and broader impact of health
technologies for those who use, manage and provide care in the NHS. This
is a programme of the National Institute for Health Research
(nihr.ac.uk) and is the largest and longest running of the national
programmes with 340 projects published since its inception in 1993.
About 50 are published each year, all available for download free of
charge from the website. It is coordinated by the National Coordinating
Centre for Health Technology Assessment (NCCHTA), based at the
University of Southampton.



Visit hta.ac.uk for more information.



2. Mind (National Association for Mental Health) is the leading
mental health charity in England and Wales and works to create a better
life for everyone with experience of mental distress.



Visit mind.uk for more information.



For further information please go to:
National Institute for Health Research And
University of Southampton

Omega-3 Fatty Acids Affect Risk Of Depression, Inflammation

A new study suggests that people whose diets contain dramatically more of one kind of polyunsaturated fatty acid than another may be at greater risk for both clinical depression and certain inflammatory diseases.


The report, published online this week in the journal Psychosomatic Medicine, suggests that we need to balance out our intake of omega-6 and omega-3 fatty acids. The current typical American diet contains 20 times more omega-6 than omega-3, a ratio that researchers say should be lowered to 4-to-1, or even 2-to-1.


This is the most recent in a long series of experiments Ohio State University researchers have conducted on the links between psychological stress and immunity. The addition of dietary questions to studies that have previously focused solely on emotional and biochemical markers may yield important new clues about the immune system.


"In this study, we're looking at the intersection of behavior, immune function and diet. In past experiments, we concentrated only on the first two," explained Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State and lead author on the paper.


"It now appears that diet is a very important variable in the equation as to how people respond to depression and stress."


The study, conducted in OSU's Institute for Behavioral Medicine Research, focused on a group of 43 middle-aged to elderly men and women, nearly half of which were the caregiver spouses of people with Alzheimer's or other dementias. By including caregivers who typically report greater stress and more depression than similar adults who are not caregiving, the researchers could look at how depression and diet might interact to affect inflammation.


Blood samples were drawn from each person in the study and tested for interleukin-6 (IL-6), tumor necrosis factor -alpha (TNF-alpha ) and the receptor molecule for IL-6. Participants also completed a survey questionnaire that gauged their level of depression.


The analysis showed that participants who had much more omega-6 -- compared to omega-3 -- fatty acids, and who also were reporting more symptoms of depression, had much higher levels of IL-6 and TNF-alpha, two cytokines which enhance inflammation.


"The data suggest that higher depression and a poorer diet in terms of omega-3 can work together to promote inflammation. Other researchers have shown that clinically depressed people -- those with more severe depression -- often have lower omega-3 levels in their blood, and several studies have shown that supplementing diets with omega-3 improves depression," Kiecolt-Glaser said, although the reason isn't clear.


"People who are depressed don't eat well, or it might be that there is something about depression that affects how well people process such foods."















In recent years, research has shown that an increase in omega-3 fatty acids in the diet has specific health benefits, especially in patients with depression, cardiovascular disease and inflammatory and autoimmune diseases.


Martha Belury, an associate professor of human nutrition, endocrinology, diabetes & metabolism at Ohio State and co-author of the study, said the design of the study was important.


"We looked at people who were experiencing real depression, not those whose depression arose as a part of some experiment, and we could clearly see a relationship between lower omega-3 fatty acids and certain markers of depression and inflammation."


Belury said that current recommendations allow up to two servings each week of cold-water fish the best source of omega-3 such as salmon or trout. This would not apply to pregnant women, she said, where concerns are greater about the heavy metal contamination such fish might contain. Omega-3 is also available as nutritional supplements


"This study has shown that even in people who did not take supplements, maybe just a little bit more omega-3, could help reduce their markers for both stress and depression," Belury said.


"The important message for consumers is that they don't have to take mega-doses of omega-3 to have some impact. It might not take a whole lot to have a significant clinical impact," Belury said.


The researchers are now starting a larger, more comprehensive randomized and controlled trial of omega-3 in adults between the ages of 50 and 80 in hopes of testing the questions raised in this pilot study.


Ron Glaser, professor of internal medicine, molecular virology, immunology and medical genetics; David Beversdorf, an assistant professor of neurology; Stanley Lemeshow, dean of the College of Public Health, and Kyle Porter, a statistician in the Center for Biostatistics, were also part of the project. The research was supported in part by the National Institutes of Health.


Ohio State University

1125 Kinnear Rd.

Columbus, OH 43212-1153

United States

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Study links brain fatty acid levels to depression

A group of researchers from Israel has discovered that rats exhibiting the signs of depression have increased levels of
the omega-6 fatty acid, arachidonic acid, in their brains. The details of their findings appear in the June issue of the
Journal of Lipid Research, an American Society for Biochemistry and Molecular Biology journal.


During recent years, omega-3 fatty acids have enjoyed increased popularity as numerous studies have shown that supplementing
diets with fish oil (a natural source of this polyunsaturated fatty acid) does everything from reducing the risk of heart
disease to preventing arthritis. There is also evidence that depression may be associated with a dietary deficiency in
omega-3 fatty acids. This "phospholipid hypothesis" of depression has been supported by research showing that omega-3 fatty
acid concentration in the blood of depressed patients is lower than that in control patients.


"The "phospholipid hypothesis" of depression postulates that decreased omega-3 fatty acid intake, and hence, perhaps
decreased brain omega-3 fatty acid content, could be responsible for the disease," explains Dr. Pnina Green of Tel Aviv
University. "In humans, because of high dietary variability and the obvious inability to examine brain tissue, the theory is
backed up mainly by indirect evidence. The availability of the Flinders Sensitive Line rat, an animal model of depression,
overcomes both these obstacles."


In the Journal of Lipid Research study, Dr. Green in collaboration with Dr Gal Yadid of Bar-Ilan University, Ramat Gan, used
the Flinders Sensitive Line rats to investigate the link between omega-3 fatty acids and depression. They examined the brains
of the depressed rats and compared them with brains from normal rats. Surprisingly, they found that the main difference
between the two types of rats was in omega-6 fatty acid levels and not omega-3 fatty acid levels. Specifically, they
discovered that brains from rats with depression had higher concentrations of arachidonic acid, a long-chain unsaturated
metabolite of omega-6 fatty acid.


Arachidonic acid is found throughout the body and is essential for the proper functioning of almost every body organ,
including the brain. It serves a wide variety of purposes, from being a purely structural element in phospholipids to being
involved in signal transduction and being a substrate for a host of derivatives involved in second messenger function.



"The finding that in the depressive rats the omega-3 fatty acid levels were not decreased, but arachidonic acid was
substantially increased as compared to controls is somewhat unexpected," admits Dr. Green. "But the finding lends itself
nicely to the theory that increased omega-3 fatty acid intake may shift the balance between the two fatty acid families in
the brain, since it has been demonstrated in animal studies that increased omega-3 fatty acid intake may result in decreased
brain arachidonic acid."


Although far less attention has been paid to dietary requirements for omega-6 fatty acids, which can be found in most edible
oils and meat, perhaps in the future depression may be controlled by increasing omega-3 fatty acid intake and decreasing
omega-6 fatty acid intake.


The American Society for Biochemistry and Molecular Biology (ASBMB) is a nonprofit scientific and educational organization
with over 11,000 members in the United States and internationally. Most members teach and conduct research at colleges and
universities. Others conduct research in various government laboratories, nonprofit research institutions, and industry.



Founded in 1906, the Society is based in Bethesda, Maryland, on the campus of the Federation of American Societies for
Experimental Biology. The Society's primary purpose is to advance the sciences of biochemistry and molecular biology through
its publications, the Journal of Biological Chemistry, the Journal of Lipid Research, Molecular and Cellular Proteomics, and
Biochemistry and Molecular Biology Education, and the holding of scientific meetings.


For more information about ASBMB, see the Society's website at asbmb.


The manuscript for the Journal of Lipid Research paper can be downloaded from the following URL: jlr/cgi/content/abstract/C500003-JLR200v1.


Contact: Nicole Kresge

nkresgeasbmb

301-634-7415

American Society for Biochemistry and Molecular Biology

asbmb

The Damaging Effects Of Discrimination

It's tough being a teen. Are you in or are you out? Are you hanging with the right crowd? Are you dressing and talking and acting the right way? For adolescents who are ethnic minorities, on top of this quest to "fit in" is the added layer - and the burden - of dealing with discrimination, say UCLA researchers.



In a new study, the researchers found that adolescents from Latin American and Asian backgrounds experienced more discrimination than their peers from European backgrounds and that the discrimination came not only from other adolescents but from adults as well. The level of discrimination also impacted these teens' grade-point averages and their health and was associated with depression, distress and lower levels of self-esteem.



The findings appear in the current online edition of the Journal of Research on Adolescence.



For the study, lead author Virginia W. Huynh, a graduate student in the laboratory of Andrew J. Fuligni, a professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA, recruited 601 high school seniors, equally divided between males and females, and asked them to maintain a daily diary for two weeks to record any discriminatory events or comments they experienced. They were also asked to separately record on a four-point scale any physical symptoms, such as headaches, stomachaches or general pain.



Among the teens in the study, nearly 60 percent reported experiencing discrimination from other teens, and 63 percent reported discrimination from adults; 12 percent reported experiencing discrimination on a daily basis. Adolescents from Latin American backgrounds reported more adult discrimination than Asian Americans, who, in turn, reported more adult discrimination than teens from European backgrounds. Latin American and Asian American teens also reported higher levels of discrimination by their peers.



The researchers found that teens who reported higher levels of peer or adult discrimination also reported more aches, pains and other symptoms, as well as a lower overall grade-point average. Thus, discrimination may not only tax adolescents' physical and psychological resources but may also affect their ability to achieve in school, the researchers said.



Although seniors in high school are close to adults in terms of their cognitive capacities and their ability to recognize discrimination when they see or experience it, they are also distinct from adults, said Fuligni, the study's senior author.



"These are the years when social identity is arguably more salient among teenagers who are struggling with defining who they are," he said. "Adding on a 'layer' of discrimination is not an easy thing for them to deal with."



By comparing the amount of discrimination the students experienced with their ratings of their physical well-being and their grades at the conclusion of the semester, the researchers were able to examine the relationship between discrimination and health among the adolescents.



The study furthers the understanding of the normal development of ethnic minority and immigrant adolescents, the researchers say, because it shows that adult and peer discrimination may have implications for adolescents' physical health.



"Discrimination significantly predicted lower GPAs, higher levels of depression, higher levels of distress, lower self-esteem and more physical complaints," Fuligni said. "So the bottom line? Discrimination is harmful."



Funding for the study was provided by a grant from the Russell Sage Foundation. The authors report no conflict of interest.

INVEGA® (Paliperidone ER) Approved As First Antipsychotic Treatment For Schizoaffective Disorder In The EU

Janssen-Cilag International NV has received approval from the European Commission for the first antipsychotic treatment for schizoaffective disorder. INVEGA® (paliperidone ER) is now indicated for the treatment of psychotic or manic symptoms of schizoaffective disorder. Effect on depressive symptoms has not been demonstrated.



The decision follows a positive recommendation by the Committee for Medicinal Products for Human Use (CHMP), the scientific committee of the European Medicines Agency. The CHMP concluded that the new therapeutic indication for INVEGA® brings significant clinical benefit in comparison with existing therapies.



Schizoaffective disorder is a chronic and disabling mental illness, characterised by both symptoms of schizophrenia and a major mood disorder, such as bipolar disorder or depression.Patients may experience the clinical symptoms of schizophrenia, such as hallucinations or delusions, as well as symptoms of mania and/or depression. Schizoaffective disorder is thought to be one-third as common as schizophrenia, with an estimated prevalence of approximately 1 in every 300 people1. Schizoaffective disorder may also account for up to one-quarter of admissions to inpatient mental health facilities2.



"Janssen is committed to helping improve the lives of people with serious mental illness and has a long history of developing innovative medicines in this field," said Dr Christophe Tessier*, Medical Affairs Director, Psychiatry, Janssen. "We are proud to be able to bring to market the first antipsychotic treatment for schizoaffective disorder in Europe - a difficult to diagnose condition associated with a high rate of hospitalisations and suicidal behaviour."



The approval is based on two international, randomised, double-blind, placebo-controlled 6-week studies in patients diagnosed with schizoaffective disorder3,4. In the first six-week study, patients (n=316) received one of two daily doses of INVEGA®: 6 mg with the option to reduce to 3 mg, or 12 mg with the option to reduce to 9 mg, or placebo3. In the second study, patients (n=311) were randomised to flexible doses of INVEGA® (3-12 mg once daily) either as monotherapy or in addition to treatment with mood stabilisers and/or antidepressants or placebo4.
















Efficacy was evaluated by the change in patients' symptoms after six weeks as measured by the positive and negative syndrome scale (PANSS). The results for INVEGA® in both studies were superior to placebo. In the first study, patients receiving the higher dose of INVEGA® had a significant decrease in their symptom score compared with those receiving placebo (-32.4 compared with -24.1, p=0.003)3. The lower dose of INVEGA® was not significantly different from placebo (p=0.187). In the second study, the mean decrease in symptom score was -20.0 in the INVEGA® group and -10.8 in the placebo group 3 (p=0.0001)4. Furthermore, among patients with prominent manic symptoms as measured by the Young Mania Rating Scale (YMRS baseline score ?‰?16) INVEGA® resulted in significant improvements in manic symptomatology compared to placebo.



"These two studies combined represent the largest set of prospective data in patients with schizoaffective disorder and provide important insights into this understudied disease", said Dr Carla M. Canuso**, Johnson & Johnson Pharmaceutical Research and Development, LLC, Titusville, NJ and lead investigator of the two studies. "INVEGA®was proven to be effective both as a monotherapy and as an adjunctive therapy in reducing psychotic and manic symptoms and provides a welcome treatment option for this debilitating condition."



About schizoaffective disorder



Schizoaffective disorder usually develops in early adulthood and is more common in women. It can affect all aspects of a person's daily life, including work, personal relationships and the ability to take care of oneself. Patients with schizoaffective disorder have a high rate of hospitalisations and a higher rate of co-morbid substance abuse than patients with schizophrenia5,6. In addition, patients with schizoaffective disorder appear to be at greater risk of suicidal behaviour than patients with schizophrenia and mood disorders5,6.



About INVEGA® (paliperidone ER)



INVEGA® (paliperidone ER), an atypical antipsychotic medication, was first approved in Europe in June 2007 for the treatment of schizophrenia. INVEGA® is a novel molecule (paliperidone) delivered via an osmotic drug delivery system (OROS®) which provides a steady, smooth release of medication over 24 hours. This reduces the peaks and troughs in drug plasma levels associated with immediate release oral formulations and leads to a low potential for increased side effects as well as ensuring consistent efficacy. INVEGA® is the first antipsychotic medication to have significantly improved personal and social performance recognised in its Summary of Product Characteristics (SPC). Further information about INVEGA® can be found here.



References:


1. Perela J et al. Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population. Arch Gen Psychiatry. 2007;64, 19 - 28.


2. Kent S, Fogarty M, Yellowlees, P. (1995). Heavy Utilization of Inpatient and Outpatient Services in a Public Mental Health Service. Psychiatr Serv. 1995;46, 12, 1254 - 1257.


3. Canuso C et al. A Randomized, Double-Blind, Placebo-Controlled Study of 2 Dose Ranges of Paliperidone Extended-Release in the Treatment of Subjects With Schizoaffective Disorder. J Clin Psychiatry. 2010;71, 5, 587 - 598.


4. Canuso C et al. Paliperidone Extended-Release in Schizoaffective Disorder: A Randomized, Controlled Study Comparing a Flexible Dose With Placebo in Patients Treated With and Without Antidepressants and/or Mood Stabilizers. J Clin Psychopharmacology. 2010;30, 5, 487 - 495.


5. Cheniaux E, Landeira-Fernandez J, Lessa Telles L, et al. Does schizoaffective
disorder really exist? A systematic review of the studies that compared schizoaffective disorder with schizophrenia or mood disorders. J Affect Disord. 2008;106, 3, 209-217.


6. Potkin SG, Alphs L, Hsu C, et al. InterSePT Study Group. Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial. Biol Psychiatry. 2003;54, 4, 444-452.



* Dr Christophe Tessier is a full time employee of Janssen, EMEA


** Dr Carla M. Canuso is a full time employee of Johnson & Johnson Pharmaceutical Research and Development, LLC, Titusville, NJ

Use Of Antidepressants In Young Adults Linked To Higher Risk Of Suicidal Behavior

Research published today on bmj reports that adults taking antidepressants are not at greater risk of suicidal thoughts or behavior. On the other hand, young adults less than 25 years of age are at an increased risk, comparable to that seen in children and adolescents.


The article elaborates on data previously made available by the US Food and Drug Administration (FDA) two years ago. It incorporates different methods, supplementary examinations of the data, and discusses at length the implications of the findings.


There is confirmation in earlier studies that antidepressant drugs are associated with an increased risk of suicidal behavior and feelings in children and adolescents. This is mostly evident in the early stages of treatment. This prompted the FDA to include a black box warning to antidepressants in 2005 and to examine trials of antidepressants in adults to search for comparable effects.


Dr Marc Stone and his collaborators from the FDA studied data on suicidal thinking and behavior from published and unpublished randomized trials on antidepressants in adults. The information was provided by eight manufacturers of antidepressant products. Records from 372 placebo controlled trials involving nearly 100,000 patients were reviewed.


The results revealed eight committed suicides, 134 suicide attempts, 10 patients who had made planning without attempting suicide, and 378 patients who had thoughts about suicide but had not acted on them.


In general, there was no distinction in drug type and diagnostic category and the effect on risk of suicidal behavior. However, there were some differences among selective serotonin reuptake inhibitors (SSRIs).


On the other hand, an increased risk was noted among adults under 25 years of age, comparable to that reported in children and adults. This amplified risk was highest in young patients with psychiatric disorders other than depression.


The authors explain: "These results suggest that, compared with placebo, the risks of suicidality associated with antidepressants are strongly age dependent - the risk is raised in people under 25, not affected in those aged 25-64, and reduced in those aged 65 and older."


The findings also sustain the suggestion that antidepressant drugs can have two different effects:


??? Adverse effect in some patients that promotes suicidal thoughts or behavior, with a risk that appears to weaken with age.

??? Protective effect in others that alleviates depression and reduces any suicidal risk.


The authors call for further research, particularly in terms of possible mechanisms for age related differences.


Meanwhile, the FDA has extended the suicide warning on antidepressant drugs with this new information, including the significant relation of the findings with age.


In an associated editorial Professor John Geddes from the University of Oxford and collaborators caution that "fundamental uncertainty" persists. They call attention to essential restrictions in the analysis, such as the very low numbers of completed suicides in the primary trials and a lack of precision in some of the methods used. In addition, they consider some significant differences in risk between individual drugs.


They add: "It is becoming apparent that antidepressants vary in both their efficacy and adverse effects." In closing they say: "The increased risk of suicidal behavior in adults taking antidepressants is probably restricted to younger people and varies greatly between individual drugs."



"Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration"

Marc Stone, medical officer, Thomas Laughren, director, division of psychiatry products, M Lisa Jones, medical officer, Mark Levenson, mathematical statistician, P Chris Holland, mathematical statistician, Alice Hughes, associate director for safety, division of neurology products, Tarek A Hammad, associate director, division of epidemiology, Robert Temple, associate director for medical policy, George Rochester, mathematical statistics team leader

BMJ 2009; 339:b2880


"Risk of suicidal behaviour in adults taking antidepressants"

John Richard Geddes,professor of epidemiological psychiatry, Corrado Barbui, lecturer in psychiatry, Andrea Cipriani, lecturer in psychiatry

doi=10.1136/bmj.b3066

bmj


Written by Stephanie Brunner (B.A.)

Impax Laboratories Receives Tentative FDA Approval For Generic Cymbalta(R) Delayed-Release 20, 30 And 60 Mg Capsules

Impax Laboratories, Inc. (NASDAQ: IPXL) confirmed that the U.S. Food and Drug Administration (FDA) has granted tentative approval of the Company's Abbreviated New Drug Application for generic version of Cymbalta® delayed-release (duloxetine hydrochloride) 20, 30 and 60 mg capsules. Eli Lilly and Company markets Cymbalta®, a serotonin and norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, and fibromyalgia.


According to Wolters Kluwer Health, U.S. sales of Cymbalta® capsules were approximately $3.0 billion for the 12 months ended September 30, 2010.

Antidepressants Double Risk Of Bone Fracture

A Canadian study suggests that people over 50 on a certain type of antidepressant are twice as likely to suffer bone fractures.


The study is published in the Archives of Internal Medicine.


The research was conducted by a team of scientists from various Canadian research centres.


They looked at data from a group of patients of average age 65.1 who were aged 50 and over who were taking SSRI antidepressants on a daily basis. These
patients were part of a larger study under the umbrella of the Canadian Multicentre Osteoporosis Study (CaMos) Research Group. The CaMos group comprises a
randomly selected, population-based cohort of 5008 adults aged 50 and over who are followed over 5 years for incident fractures.


The patients had been filling in questionnaires about their bone breakages cause by various minor events such as falling out of bed, off a chair, or similar minimal trauma incidents. All the fractures had been confirmed with radiographs.


The researchers found 137 patients within the CaMos cohort who were using SSRIs on a daily basis. The SSRIs they were using included: fluvoxamine (brand name uvox),
citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil). These were the ones that were on the market at the start of
the CaMos study.


After correlating the data from the bone fractures with the data on the SSRI intake, the results showed that taking SSRI antidepressants every day doubled the risk of "clinical fragility fracture" in adults aged 50 and over, even after
taking into account various other factors such as age, hip bone mineral density, and estrogen levels.


The also found a dosage effect, where a 1.5 increase in risk of bone fracture was linked to a doubling of daily dose of SSRI.


Since fragility fractures are already common in the over 50s, this additional risk could have significant health consequences for them.


The motive for the study came from knowing that fragility fractures and depression are not uncommon in the over 50s, and SSRIs are a commonly prescribed
medication for depression in this age group. But the researchers were not aware of any studies that had tried to link the two together.


The researchers suggest that doctors should take into account the risk of fragility fracture when they prescribe SSRI antidepressants to patients in this age
group.


Selective serotonin reuptake inhibitors (SSRIs) are antidepressants used to treat anxiety and personality disorders and depression. They increase the level
of serotonin in the brain by stopping it being reabsorbed by the presynpatic cell, which leaves more of it around to produce its mood-altering effects.


"Effect of Selective Serotonin Reuptake Inhibitors on the Risk of Fracture."

J. Brent Richards, Alexandra Papaioannou, Jonathan D. Adachi, Lawrence Joseph, Heather E. Whitson, Jerilynn C. Prior, David Goltzman.

Arch Intern Med. 2007;167:188-194.


Click here for Abstract (no subscription required).








View drug information on Celexa; Paxil CR; Prozac Weekly.

Depression common in people with chronic cough

More than half of people with chronic cough-a nagging cough that can last for months or even years-suffer from depressive
symptoms, according to a study to be presented at the American Thoracic Society International Conference on May 23.


The study of 100 people with chronic cough that had lasted an average of 9 years found that 53% suffered from depressive
symptoms. The percentage of men and women with chronic cough who suffered from depressive symptoms was similar, according to
study author Peter V. Dicpinigaitis, M.D., Director of the Montefiore Cough Center in the Bronx, NY.


Three months after the initial study, researchers have so far conducted a follow-up with two-thirds of the patients and found
that those whose cough had improved had significant reduction in depressive symptoms, while those whose cough did not improve
did not have any corresponding improvement in their depressive symptoms.


"A lot of people don't realize that cough is the single most common complaint for which patients seek medical attention in
the U.S.," said Dr. Dicpinigaitis, who is also Professor of Clinical Medicine at Albert Einstein College of Medicine and
Director of the ICU at Montefiore Medical Center. "This is the first study to look at the link between cough and depression."



Dr. Dicpinigaitis has seen more than 300 chronic cough patients in his practice, and was struck by how their cough has
affected their quality of life. "They are socially isolated and miserable. They are afraid to go out in public, go to church
or to a restaurant. Their cough affects their relationship and their jobs," he said. "Since cough doesn't kill people it
doesn't get the attention that other conditions get, but it is a tremendous quality of life issue."


Chronic cough has three main causes, either alone or in combination, Dr. Dicpinigaitis said: post-nasal drip, asthma and
gastroesophageal reflux (GERD), commonly known as acid reflux. "Often the diagnosis is difficult because in many patients,
cough is their only symptom."


Treatments include older antihistamines combined with decongestant for cough from post-nasal drip; asthma medicines for
asthmatic cough; and high doses of drugs called proton-pump inhibitors for several months, sometimes combined with other
drugs, for GERD-related cough.


By the time patients have come to see him, they generally have already seen several other doctors and have been told they
simply have to live with the cough, Dr. Dicpinigaitis said. "My message for patients with chronic cough is, 'Don't give up,'"
he said. "Continue to seek out help. Once the cause of the cough is diagnosed, it can be treated." He noted that treatment
guidelines for chronic cough will be published later this year for physicians, and he is hopeful that this will improve the
treatment of the problem.


Contact: Jim Augustine

619-525-6216

American Thoracic Society

thoracic

Clinical hypnosis can be used to treat depression

Dr Michael Yapko has, for the last thirty years, specialized in the treatment of depression with clinical hypnosis. In a climate where anti-depressant medication is still physicians' first treatment choice, Dr. Yapko's approach to clinical practice still represents cutting-edge work.


Clinical hypnosis has been directly influenced by the current push for empirically supported treatments, and in recent years substantial high-quality research has assessed the effectiveness of hypnosis and its contribution to improving therapeutic outcome.


There is also a growing body of evidence demonstrating that, when hypnosis is part of the treatment process, it catalyses positive clinical outcomes and generally increases the benefits of established treatments.


"Hypnosis offers a way to conceptualise how human beings construct their individual realities, and how to interact more effectively with others; in clinical hypnosis hypnotic processes are employed as agents of effective communication and change," says Dr. Yapko, who was chosen to write the sections on Treating Depression and Brief Therapy for the Encyclopaedia Britannica Medical and Health Annuals. "Our knowledge of depression has greatly improved in recent years, firmly establishing the essential role of psychotherapy in treatment. Whenever psychotherapy is indicated, so are specific identifiable patterns of hypnotic influence, since the two are fundamentally inseparable."


It is estimated that at any one time almost 10% of the UK general population are suffering from depression. Worldwide the figure rises to over 100 million (Paul Gilbert, Overcoming Depression 1997), and the World Health Organisation estimates that by the year 2020 depression will be the second most burdensome illness in the world.

Financially, depression costs the British nation more than ?8 billion annually; included in this cost is provision of health and medical care, lost production and social security benefits." (Depression Alliance 1999).
BIOGRAPHY


Michael Yapko, Ph.D. is a clinical psychologist and marriage and family therapist based in Solana Beach, California. He is internationally recognised for his work in depression and outcome-focused psychotherapy, and has had a special interest spanning nearly a quarter century in the intricacies of brief therapy, the clinical applications of directive methods, and in training therapists to treat the disorder of major depression. He is the author of numerous books, book chapters, and articles on these subjects, including Treating Depression With Hypnosis: Integrating Cognitive-Behavioral and Strategic Approaches; Psychological 911: Depression; Hand-Me-Down Blues: How to Stop Depression From Spreading in Families; Breaking the Patterns of Depression; and Hypnosis and the Treatment of Depressions. Dr. Yapko is a member of the American Psychological Association, a clinical member of the American Association for Marriage and Family Therapy, and a Fellow of the Royal Society of Medicine.















Dr Yapko is a charismatic and engaging speaker, whose recent London masterclasses (February 2004) elicited high praise from delegates.


Formal Education

* Doctoral: Ph.D. in Professional Psychology, Clinical Specialization, United States International University, San Diego (1980).

* Masters: M.A. in Psychology. United States International University, San Diego (1978)

* Bachelors: B.A. in Psychology. University of Michigan, Ann Arbor (1976). Received academic class honors.


ABOUT CSCT


CSCT is the UK's main provider of counselling training programmes, having trained over 50,000 students over more than two decades working in the UK, Eire and Gibraltar with the education, charity, health and private sectors. The organisation specialises in creating, administering and supporting nationally approved programmes for counselling trainees, as well as delivering continuing professional development courses to already qualified counsellors, and counselling skills training to practitioners of a range of allied health professions and the private sector. With a proven track record in its field, CSCT is committed to providing high quality training that reflects current thinking and research in the field, and meets the changing needs of the marketplace.


After hosting Dr Yapko's successful masterclasses in London in February 2004, CSCT Events will be sponsoring his renowned Six-Day Comprehensive Training Course in Clinical Hypnosis, 6-8 May and 13-15 May 2005.


Zo? Fitzgerald-Pool, a UKCP registered psychotherapist who integrates hypnosis in her clinical practice, is CSCT's Director of Training and Development.





This article comes from counsellingtraining


Contact:

CSCT Ltd

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6-8 The Highway

London, UK

E1W 2BS

t: 020 7977 7999

f: 020 7977 7990

e: infocounsellingtraining

What Does Prozac Target?

Researchers at Cold Spring Harbor Laboratory on Long Island have identified which among several different kinds of cells in the brain is the chief target of the widely prescribed antidepressant Prozac. This discovery might enable a new generation of more specific treatments for depression, with fewer side effects, to be developed.


The findings also lay the foundation for many studies of the factors that control how, when, and where new neurons are generated from stem cells in the brain. Such work could eventually lead to cell replacement therapies for neurodegenerative and other brain disorders including Alzheimer's and Parkinson's disease.


It has been known for some years that Prozac (fluoxetine) is likely to relieve the symptoms of depression by somehow causing more neurons to be present in a particular region of the brain (the "dentate gyrus"). But the origins of these neurons, and how Prozac promotes their existence, have been a mystery until now.


By profiling the telltale marker proteins produced by different kinds of cells in the brains of adult mice, the researchers first defined discrete steps in the complex process, called neurogenesis, that converts unspecialized stem cells into mature, specialized neurons.


Next, knowing that Prozac treatment somehow increases the number of neurons in the brain, the researchers tested which step in the neurogenesis pathway might be stimulated by Prozac. They found that Prozac treatment specifically stimulates the generation of a kind of cells they dubbed "amplifying neural progenitors" or ANPs--the second step in the neurogenesis pathway from stem cells to mature neurons. (Illustration available on request)


The study is published in the published in the Proceedings of the National Academy of Sciences (advance on-line this week, in print on May 23). It was led by Grigori Enikolopov and spearheaded by postdoctoral fellow Juan Manuel Encinas.


To address the controversy surrounding the use of Prozac in children and in pregnant women, Enikolopov's group is currently testing the effects of the drug on brain neurogenesis in juvenile and pregnant mice. The results of those experiments may provide valuable information for assessing the possible effects of Prozac and related drugs on fetal and adolescent brain development.


The researchers are currently using the approach and tools they've developed to explore whether other treatments for depression--including other drugs and deep brain stimulation--act in the same way as Prozac or in different ways. In addition, the scientists are screening for new drugs that expand the production of brain neurons by stimulating ANP cells to multiply.


In collaboration with NASA researchers, experiments are also under way at Cold Spring Harbor Laboratory to assess how neurogenesis in the adult brain might be influenced by long-term, Mission-to-Mars levels of exposure to a particular kind of damaging radiation that's prevalent in space.


Peter Sherwood

sherwoodcshl

Cold Spring Harbor Laboratory

cshl


View drug information on Prozac Weekly.

STAR*D Depression Study Finds Cognitive Therapy Equivalent To Medication But Selected By Fewer Patients

In the federally funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, outcomes for cognitive therapy as a second-step treatment were not different from outcomes of medication therapy. However, random assignment in this STAR*D level was based on each patient's treatment preferences, and only 26 percent of the patients accepted cognitive therapy as an option. These findings are reported in two articles in the May issue of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association (APA).


The treatment results are presented in "Cognitive Therapy as a Second-Step Treatment: A STAR*D Report," by Michael E. Thase, M.D., of the University of Pittsburgh, and other STAR*D investigators. The patients in the second treatment step had discontinued citalopram in the first treatment phase, either because it was not effective for them or because the side effects were too burdensome.


In the second step, 36 patients were switched from citalopram to cognitive therapy and 65 received cognitive therapy in addition to citalopram. The first group was compared with patients switched from citalopram to another medication, and the second group was compared with participants receiving citalopram plus a second medication.


The rates of remission over 12 weeks were 25 percent for the patients who switched to cognitive therapy and 23 percent for those who received it as augmentation. These rates were not significantly different from those for the comparison groups assigned to medication. Cognitive therapy produced remission more slowly than medication, but it produced fewer side effects.


Patients' preferences for the second treatment step in STAR*D are examined in "Which Second Step Treatments Are Acceptable to Depressed Outpatients? A STAR*D Report," by Stephen R. Wisniewski, Ph.D., of the University of Pittsburgh, and other STAR*D investigators. Patients were asked which treatments they found acceptable after the initial citalopram trial and whether they had a preference regarding a switch to a new treatment or augmentation of citalopram with another treatment. Patients' preferred treatments were considered in the random assignment of patients to the different treatment conditions.


Of the 1,439 participants who entered second-step treatment, only one percent accepted all treatment options. The 26 percent who accepted cognitive therapy were found to have more education and to be more likely to have a family history of mood disorder than patients who did not include cognitive therapy among their possible treatments. Patients with panic disorder were less likely to accept cognitive therapy. A switch from citalopram to a new treatment, rather than augmentation, was more likely to be accepted by participants in a primary care setting. Cognitive therapy was also less likely to accepted by patients with greater side effects or less reduction in depressive symptoms in the first treatment step. Those with concurrent drug abuse or recurrent depression were less likely to accept a switch strategy.















These findings are discussed in an editorial by Myrna Weissman, Ph.D., of Columbia University.


AJP Editor in Chief Robert Freedman, M.D., stated, "The lower rate of selection of cognitive therapy, despite its effectiveness and freedom from side effects, suggests that rapid, convenient treatment was foremost on patients' minds. Re-thinking psychotherapy to provide more assurance of early effect may improve its appeal to depressed people."


The STAR*D study was funded by the National Institute of Mental Health. Medications were provided at no cost by Bristol-Myers Squibb, Forest Pharmaceuticals, GlaxoSmithKline, King Pharmaceuticals, Organon, Pfizer and Wyeth Pharmaceuticals. Additional financial disclosures appear at the end of the article.


(Am J Psychiatry 2007; 164:790-799; 800-804)


About the American Journal of Psychiatry


The American Journal of Psychiatry, the official journal of the American Psychiatric Association, publishes a monthly issue with scientific articles submitted by psychiatrists and other scientists worldwide. The peer review and editing process is conducted independently of any other American Psychiatric Association components. Therefore, statements in this press release or the articles in the Journal are not official policy statements of the American Psychiatric Association. The Journal's editorial policies conform to the Uniform Requirements of the International Committee of Medical Journal Editors, of which it is a member. For further information about the Journal visit ajp.psychiatryonline.


About the American Psychiatric Association


The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at psych and HealthyMinds.