Recreational Drugs for Depression?

A horse tranquiliser could hold the key to treating depression.

Ketamine, which is used as an anaesthetic for humans and animals, and is also sold as a street drug to induce a "high", is being considered as a possible treatment for depression in those that have not responded to conventional treatments.

Researchers may be able to develop an antidepressant which takes effect almost immediately by directly targeting novel molecules in the brain instead of taking a less direct route, which can lead to longer times for medication to take effect, according to a study presented this week at the American College of Neuropsychopharmacology (ACNP) annual meeting.

The antidepressant is also thought to be effective in people for whom previous treatments have been ineffective. This human and rodent research is among the first to examine the effects of rapid antidepressant strategies.

Lead researcher and ACNP member Husseini Manji, M.D., director of the mood and anxiety disorders program at the National Institute of Mental Health (NIMH), says one of the major limitations in existing pharmacological treatments for major depression is the time between starting to take the medication, and when it starts to alleviate the depression, often a period of one month or longer. He adds that strategies that work at much faster rates would have a tremendous impact for Americans who suffer from depression – nearly 21 million annually, according to NIMH.

"Today's antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we've shown what the key targets are and that we can get at them rapidly," says Dr. Manji. “This research is leading to some very real possibilities for a whole new generation of antidepressant medications."

The study looked at patients in a “difficult to treat” group, meaning individuals who had not responded to other treatments including psychotherapy, traditional antidepressants or electroconvulsive therapy.

Researchers treated the depressed patients intravenously with ketamine, a general anesthetic usually used for minor surgical procedures in which muscle relaxation is not required. The doses of ketamine used in this study were considerably lower than when it is used as an anesthetic. These tests are part of an ongoing study

Ketamine produced results much more quickly than traditional antidepressants because it acted directly upon critical molecules in important neuronal circuits instead of having to bypass multiple locations en route to those circuits. Typically, currently available antidepressant medications work via serotonin or norepinephrine, neurotransmitters which act within the brain to help regulate emotion and cognition.

The results showed that patients responded after only two hours, and within 24 hours, 71% had responded. Patients were followed over time, and 35% maintained their response for up to one week. Traditional antidepressants usually take many weeks, or even months, to begin to work. “This is intriguing data which suggests that targeting these important molecules in critical circuits would be extremely helpful in treating depression more quickly, before it worsens and becomes more severe,” Dr. Manji said.

The researchers also studied rodents to determine whether they could get medication to highly responsive brain areas more quickly. By looking at different biomarkers – specific physical features used to measure the progress of a disease or condition – in mice and rats, researchers came closer to identifying at what point in the biochemical process medication might become effective, which would ultimately lead to faster treatment.

Treating patients with rapid strategies is essential since some patients who suffer from depression are tempted to stop their medication if it doesn’t work quickly enough.

Ongoing human studies using magnetoencephalography (MEG) are also helping to identify the specific brain circuits through which these rapid antidepressant effects occur. Identifying these precise circuits may lead to the development of molecules with even more precise effects, and therefore fewer side effects.

It's unclear whether Ketamine can be developed as a commercially viable antidepressant due to its side-effects. However, by identifying the underlying actions of the components of Ketamine and correlating these to biomarkers, scientists hope to develop fast-acting safe treatments for depression.

Sources:
American College of Neuropsychopharmacology (ACNP) press release
National Institute of Mental Health (NIMH)press release

Myth of Holiday Suicides Perpetuated By the Media

Most of us have a common belief that people with depression have a difficult time during the holidays. I can only speak to what I've seen in my therapy practice - patients with a depressive disorder often struggle more with symptoms during the holidays, but it isn't always the case. What about suicide? We often read in the news that the number of suicides increases during the holiday season. But not only have studies proved that to be an inaccuracy, the media is now acknowledging that they have been in error.

I first saw this reported in the Wall Street Journal Health Blog. Shirley S. Wang reports,

"Between late ‘99 and early ‘06 more than 40% of newspaper stories that reported on suicide during the holidays perpetuated the myth that the holiday season led to a rise in the suicide rate, according to an analysis released yesterday by the Annenberg Public Policy Center of the University of Pennsylvania."

According to a NYU Medical Center article, True or False: Depression and Suicide Rates Rise During the Holiday Season, the opposite is true: Suicide rates actually drop in the winter months and rise in the spring.

Another organization, Suicide and Mental Health Association International (SMHAI) has an in-depth report on the press's reporting inaccuracies.

It is heartening, however, that the press is acknowledging it's role in perpetuating this myth. In a particularly astute opinion piece from 2005, USA Today's DeWayne Wickman chides his colleagues for linking the suicide of a famous football coach's son to the Christmas holiday.

This does not mean that we all shouldn't be more watchful of those we care about who display depression symptoms this time of year. It is simply a reminder that when it comes to mental health, the media often gets it wrong and that we should do more of our own research when we see these headlines.

What Topics Interest You? Let Us Know!

As Talia mentioned when she posted her "month-away" notice, we'd love to hear what topics you'd like us to cover.

With that in mind, I thought I'd list my areas of expertise and interest to jump-start the process.

Mental Health/Wellness

• Mood disorders - depression and anxiety


• Stress Management - job-related stress, anger management, school stress and lifestyle issues


• Family relationships - parenting, couples' issues, dysfunctional family concerns


• Women's Issues - Gender-specific issues for women


• Work/Family/Personal Life balance

Substance Abuse/Dependency

• Adults, adolescents struggling with chemical abuse/dependency


• Treatment options - Spectrum of care available


• Family members of substance abusers and substance dependent people


• Women's issues - issues specific to women in addiction and recovery


• Celebrities and addiction/treatment/recovery

Related Topics/General Interest

• Healthy/Unhealthy Lifestyle Trends


• Relaxation and Leisure


• Pets


• Media portrayal/reporting of the above

So there are many, many things listed about which I can share my expertise and experiences. Please leave me a comment or two about your areas of interest. And if you don't see an area that interests you, let me know. I'll try hit on those topics while covering the blog this month.

I look forward to hearing from you!

Depression in Older Adults - How is it Different?

"Doesn't everyone get depressed as they get older?" It's a common misconception that becoming depressed is a natural part of the aging process. This and other age-specific beliefs often result in depression going under-diagnosed and untreated in this population.

I encountered this in my own life when I asked my mother if she was depressed awhile after my father died. I was concerned that she might need medication. Her response was, "I'm not depressed, I'm just unhappy." Although I found her answer confusing, it underscored to me that there are profound differences in her generation's concept of depression. We of the Dr. Phil/talk show/self-help book generation just assume everyone understands and shares our belief system about mental illness. Because depression is so common in older adults and their high risk of suicide, it's important for us to understand the signs and symptoms. According to NAMI (National Alliance on Mental Illness), depression affects as many as 6.5 million of the 35 million adults 65 and older and that older white males have the highest suicide rate in the U.S.

How do symptoms differ in older adults?

In addition to the usual depressive symptoms of lethargy, sadness, feelings of hopelessness, older people often have memory deficits, confusion and social withdrawal and they may even experience hallucinations or delusions. Often, these symptoms are misdiagnosed as dementia. It is also very difficult to gauge things like social withdrawal as many older adults live alone and may have mobility difficulties that restrict socializing.

Social/Cultural differences

It's important to also factor in that this generation grew up in a culture that doesn't support sharing "personal" things with strangers, may view depression as a "weakness" or believe that focusing too much on oneself is "selfish." This makes recognizing depression in older adults more challenging as they may not share their symptoms with you. Often older people will complain about physical ailments repeatedly. Recognize that this may be their way of seeking attention for depressive symptoms that they can't articulate.

Treatment options

Fortunately, depression in older adults is very treatable. Unfortunately, suggesting therapy may not be the best way to engage these patients in treatment. Starting with a family physician is what I call a "back door" approach. If the doctor has a trusting relationship with the patient, they may be more likely to see therapy as a way to get better if the doctor recommends it.

Antidepressants are often affective for treating older adult depression. But there are risks not evident in younger populations. WebMD discusses some of these concerns, such as the risk of side effects and other reactions with other medications the older patient may be taking. Also, some of the older types of antidepressants, such as imipramine and amitriptyline can be dangerously over-sedating or cause a drastic drop in blood pressure. It is often a good idea to have the patient referred to a psychiatrist who is skilled in medicating geriatric patients.

Older adults can also benefit from psychotherapy, support groups and informal peer-social groups.

What can you do to help a family member or friend who has been diagnosed with depression?

Make an extra effort to visit, call and spend time with them. If you are a family member, ask if they will sign a release so you can have contact with their doctor if needed. Assure them that this is simply to offer all the support you can, not to "pry" into their business.

Check out local resources like a local hospital, mental health facility or senior center to educate yourself on what is available in their community. Encourage them to participate in therapy or support groups, etc. and help facilitate getting them transportation if needed.

Sleep Deprivation Causes Emotional Instability

Anyone who has experienced sleep deprivation knows the impact that it can have on your mind and body. Now researchers from UC Berkeley and Harvard Medical School have found a neural link between lack of sleep and emotional instability.

Using brain imaging in the first neural investigation into what happens to the emotional brain without sleep, results suggest that:

• a good night's rest can regulate our mood and help us cope with the next day's emotional challenges
• sleep deprivation excessively boosts the part of the brain most closely connected to depression, anxiety and other psychiatric disorders

"It's almost as though, without sleep, the brain had reverted back to more primitive patterns of activity, in that it was unable to put emotional experiences into context and produce controlled, appropriate responses," said Matthew Walker, director of UC Berkeley's Sleep and Neuroimaging Laboratory and senior author of the study, which will be published Oct. 22 in the journal Current Biology.

"Emotionally, you're not on a level playing field," Walker added.

That's because the amygdala, the region of the brain that alerts the body to protect itself in times of danger, goes into overdrive on no sleep, according to the study. This consequently shuts down the prefrontal cortex, which commands logical reasoning, and thus prevents the release of chemicals needed to calm down the fight-or-flight reflex.

"The emotional centers of the brain were over 60 percent more reactive under conditions of sleep deprivation than in subjects who had obtained a normal night of sleep," Walker said.

The study's findings lay the groundwork for further investigation into the relationship between sleep and psychiatric illnesses. Clinical evidence has shown that some form of sleep disruption is present in almost all psychiatric disorders. The next step for researchers is to use brain imaging as a tool to identify whether the root problem is a sleep disorder or a mental health disorder.

October 11th US Depression Screening Day

The United States has a free screening day to help people who suspect they may be depressed.

National Depression Screening Day was created to raise awareness of anxiety and mood disorders, such as Depression. It operates throughout the United States to help people get assessed for mental health disorders and to provide resources for people seeking help.

If you would like to visit a screening centre, you can find a map of locations here

A separate initiative by a research institute offers free treatment. If you are based in New York you could be eligible to participate in research and receive free outpatient treatment. Check out the current studies on depression and bipolar for more details.

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If you think you or a loved one may have depression, but live outside the US or are unable to attend a screening session you can complete an online depression screening test.

We also have a directory of telephone numbers in most places if you would like to contact a support agency in your country.

John Kirwan talks about Depression

In this video ex All Black John Kirwan talks about his personal battle with depression and his role fronting a New Zealand depression awareness campaign. His openness has directly contributed to a higher awareness of depression, breaking down stereotypes about depression, particularly among men.

John Kirwan’s contribution to the depression campaign has been significant, and initial feedback from pre-testing results are confirmed by a national survey showing 78% of those surveyed recalled the advertisements, and of these 98% were positive about them. Both the survey and 0800 helpline callers have identified his personal honesty and openness as a key factor in the success of the campaign.



John Kirwan has since been appointed an Officer of the New Zealand Order of Merit for his services to mental health awareness.

Shorter Fall Days = SAD Symptoms Kick In

It doesn't take many days of sunsets at 7:50 p.m. for my own mild SAD to kick in. Even though the daytime temperatures are still hitting the 80s, I'm pulling out the wool throws and thinking about making a vat of mac and cheese. This is a common response as we head into Fall. Most of us occasionally suffer from the "Winter Blues," but SAD or Seasonal Affective Disorder is more than that.

According to Mental Health America (formerly National Mental Health Association) , a diagnosis of Seasonal Affective Disorder can be made after 3 consecutive winters of the following symptoms if they are followed by complete remission of those symptoms in the spring and summer months:

• Depression
• Anxiety
• Mood changes: extremes of mood and in some, periods of mania in spring and summer
• Sleep problems: desire to oversleep and difficulty staying awake or disturbed sleep and early morning awakening
• Lethargy
• Overeating: craving for starchy and sweet foods resulting in weight gain
• Social problems: irritability and desire to avoid social contact
• Sexual problems: decreased libido and decreased interest in physical contact

Causes

SAD may be a result of seasonal light variation. As seasons change, there is
a shift in our "biological internal clock" or circadian rhythm due partly to
these changes in sunlight patterns. This can cause our biological clock to
be out of step with our daily schedules.

There has also been research linking the sleep-related hormone, melatonin to SAD. Results of some of these findings can be found on NIMH's (National Institute of Mental Health) site.

Treatment

An excellent resource, for both health professionals and lay people is Winter Blues: Seasonal Affective Disorder: What Is It and How to Overcome It by Norman E. Rosenthal, MD. Dr. Rosenthal explores several treatment options, including the most popular, light therapy, but also herbal, vitamin and antidepressant options. Light therapy is usually recommended, utilizing a 10,000 lux light box, which contains fluorescent light tubes covered with a plastic screen blocking ultraviolet rays. The Cleveland Clinic offers a more extensive exploration of light therapy for SAD. This article also has a list of sources for light boxes. The model shown below is from goLITE.

Most cases of SAD are mild to moderate. But with any possible diagnoses, if you believe you are experiencing symptoms of SAD, you should see your doctor or a mental health professional. Many of the symptoms of SAD can also be indicators of a more severe depression or other disorder.

Relapse from antidepressant medication may be lack of response to medication

Have the depression meds stopped working? Or did they never work in the first place? This question is now being raised by researchers who suggest that patients who have an initial response to antidepressants, and then relapse, may have been experiencing the placebo effect.



This is a different issue to "Prozac Poop-Out", a term coined to describe the problem long-term users of SSRI anti-depressants have when they suddenly stop being effective. When this happens the problem can usually be remedied by changing anti-depressants, increasing the dose of the existing anti-depressant or stopping and restarting the anti-depressant.

A new study by Rhode Island Hospital researchers indicates that a relapse during antidepressant continuation treatment may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.). The study was published in the August issue of the Journal of Clinical Psychiatry.

Historically, the treatment of depression is divided into three phases – initial/acute, continuation and maintenance. During the initial phase, the goal is to reduce symptoms and psychosocial impairment. During the continuation phase, usually six months to one year after initial treatment response, the goal is to maintain the gains and prevent a relapse. In the maintenance phase, which occurs after a sustained period of improvement, the goal is to further maintain the gains and prevent recurrence of the disorder.

Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at the Warren Alpert School of Medicine at Brown University, is the paper’s lead author. Zimmerman, along with his colleague Tavi Thongy, MD, also of Rhode Island Hospital and Brown University, conducted a meta-analysis of continuation studies of new generation antidepressants that began as placebo-controlled acute phase studies. Treatment studies of depression have found that approximately 50 to 65 percent of patients respond to medication and that approximately 25 to 35 percent respond to placebo.

Past studies have indicated that a number of patients who respond to treatment in the initial phase experience a relapse or recurrence despite ongoing pharmacotherapy during the two latter phases of treatment. This return of symptoms is often interpreted as a loss of efficacy of antidepressant activity, and is referred to as tachyphylaxis or the “poop-out” effect.

Zimmerman says, “When a patient improves after being prescribed an antidepressant medication you do not know if they got better because of the medication or because they had a placebo response.”

The researchers used formulas developed by Quitkin and colleagues more than a decade ago to calculate the relapse rate attributable to relapse in presumptive placebo responders. “Our study suggests that the return of symptoms despite ongoing treatment during the continuation and maintenance phases of treatment may not represent a loss of drug effect because the patient may not have experienced a true drug response in the first place.”

Zimmerman also notes, “While our conclusion is limited to the continuation phase of treatment, our results suggest that these findings probably also apply to the maintenance phase of treatment.”

I love New York! But...

I hate the memories of 9/11. It plays on my depression and my GAD. I knew some of the firefighters that were killed that awful day. I have friends who lost loved ones there as well. It's awful to head into Lower Manhattan and see a large crater where thousands used to work. It's truly heartbreaking to see what once was a gorgeous skyline forever lost.


And yet, we're heading to New York City tomorrow to celebrate our youngest's birthday. This is a tradition for our family for quite a few years now. My daughter's love the American Girl dolls so that's where we head. To Midtown Manhattan, two blocks from Times Square, to what my girls consider heaven....the almighty American Girls Place. We go into NYC at least once a month so you'd think I'd be ok with it by now. But, I'm not.

I panic when I see the Holland Tunnel because enclosed spaces and I do not get along well. Then I start thinking about how much of a target that tunnel is for terrorists. Then I start thinking about how nearly everything in this city is a target for terrorists or some other tragedy. There's the Empire State Building, Rockefeller Center, many bridges, and OH YES, the very famous Times Square. I could easily just skip going to the city for those reasons and many more I don't want to bore you with. But then I think about my girls and how much they love going. My husband would be extremely disappointed too. He sees Ground Zero as a place to pay our respects to the lost. I see it as pain, sadness, and broken hearts. Which makes my depression start to spin an evil web.

I actually sit with a pillow covering my eyes and holding my breath as we enter the Holland Tunnel. Is this therapeutic and medically endorsed? Probably not, but it works for me at that particular time. I do lean on my anxiety medication to help me through the rest of the day. Usually one will do it. Calming me enough so I can not be the person standing in the middle of Times Square having a full on panic attack and yelling about possible terrorism. LOL No I've never done that, but I've come close a few times. :)


I look forward to heading off tomorrow. I can't wait to see my daughter's faces light up when they see the Statue of Liberty. Which is just before I catch site of the dreaded tunnel. It's their joy and happiness that gets me through along with a little help from my old friend Mr. Xanax.

Have a great weekend everyone! I'll be back to post about how the trip went for me on Tuesday.

Get free help for your depression

The Department of Neuroscience at Columbia University and The New York State Psychiatric Institute is looking for people to participant in mental health research relating to depression, bipolar and PTSD and more.

If you are based in New York you could be eligible to participate in research and receive free outpatient treatment. Check out the current studies on depression and bipolar for more details.

The Exercise Prescription for Depression

After decades of investigation, there is now indisputable evidence that regular physical exercise can relieve and perhaps even prevent stress, anxiety, and depression. Johns Hopkins Mood Disorders Center, offers six practical exercise tips to help you ease depression or anxiety with exercise.

Personalised meds for depression and other illnesses

One of the goals of the Human Genome Project is to identify the interaction between medications and the genetic makeup of individuals. Scientists hope to be able to predict which medications will work best for each individual depending on their genetic markers.

Researchers studied DNA provided by patients participating in a recently completed NIMH clinical trial, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. The trial showed that depressed patients who don't benefit from the first medication they try have a fair chance of being helped by others.

After the trial, researchers spelled out the DNA codes contained in 68 genes suspected of being involved in depression, collected from 1,297 of the patients who had participated in STAR*D. The genetic material included the occasional variations that occur from person to person. Comparing the DNA codes of those who had responded to citalopram (Celexa) and those who hadn't, the scientists found that responders were more likely to have a variation in a gene called HTR2A. Results of that study were published in May 2006.

In the newest study, researchers examined the genetic material of more of the patients who had participated in STAR*D, for a total of 1,816 samples, and repeated the comparison of DNA from citalopram responders and nonresponders. They discovered that people with the variation in the GRIK4 gene had a higher likelihood of response, and again found that the variation in the HTR2A gene also made people more likely to respond. The results were reproduced, strengthening their validity.

"We know that a number of biological mechanisms underlie depression and affect treatment. Findings like this one are building a picture of what they are and how they interact, and can reveal potential molecular targets for faster-acting and more effective medications," said McMahon.

Researchers have now concluded that a variation in a gene called GRIK4 appears to make people with depression more likely to respond to the medication citalopram (Celexa) than are people without the variation, a study by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, has found. The increased likelihood was small, but when people had both this variation and one in a different gene shown to have a similarly small effect in an earlier study, they were 23 percent more likely to respond to citalopram than were people with neither variation.

The finding addresses a key issue in mental health research: the differences in people's responses to antidepressant medications, thought to be based partly on differences in their genes. Some patients respond to the first antidepressant they attempt, but many don't. Each medication takes weeks to exert its full effects, and patients' depression may worsen while they search for a medication that helps. Genetic studies, such as the one described here, may lead to a better understanding of which treatments are likely to work for each patient.

Results of the study are in the August issue of The American Journal of Psychiatry, reported by lead researcher Francis J. McMahon, M.D., Silvia Paddock, Ph.D., of NIMH, and colleagues. Scientists from the National Human Genome Research Institute, the National Institute on Alcohol Abuse and Alcoholism, Mount Sinai School of Medicine, and University of Texas Southwestern Medical Center also contributed to the research.

"We're moving steadily closer to being able to personalize treatments based on patients' genetic variations. This is a crucial need for the millions of Americans who suffer from depression," said NIMH Director Thomas R. Insel, M.D. "New techniques have led to advances that would have been inconceivable a few years ago and are making individualized treatment an achievable goal."

Bibliotherapy: Can Reading Alleviate Your Depression?

An article in Tuesday's Wall Street Journal, Bibliotherapy: Reading Your Way to Mental Health made me chuckle. The article discussed something "surprising" therapists are suggesting to their patients - read a book and the recently-published science behind this approach. What amuses me was that it was presented as a new thing. We non-scientist types have been suggesting this to our patients for years! I was reminded of some studies that came out in the last year or so recommending exercise for depressed patients. Common sense tells us that physical exercise would be good for depression. But in the age of supermodels and celebrities writing books about lifestyle change, coping with stress, etc., it would seem we need some scientific review of those self-help books!

Years ago, one of the first books I had my patients read was psychiatrist David D. Burn's Feeling Good: The New Mood Therapy. What I like about this book is the lack of psychobabble terminology and self-help cliches. There are easy to read explanations of depression and other mood disorders and excellent examples of cognitive behavioral techniques (CBT) that can be practiced at home.

I'm a visual learner. You can tell me something, but if I read it, I will digest the information quicker and better. Many people tell me they also process new material better when they read it. It also gives them something to work on between therapy sessions. I've found that reading about psychiatric disorders also takes the patient out of the emotional/psychological mode and into the intellectual. It's often less threatening to read objective, factual information.

Medical and behavioral health journals divide these bibliotherapy books into two categories: those with proven clinical trials behind them and self-help books (that are often on the best-seller lists) that don't and that are often written by people without credentials in the mental health field. These trials are often conducted the way drug research is done, comparing the patients' depressive symptoms who read the books with patients who don't ("placebo") and haven't received any treatment in a "before treatment and after treatment" format.

The Journal article cites a helpful guide composed by John Norcross, a University of Scranton professor of psychology and researcher on the effectiveness of self-help books - The Authoritative Guide To Self-Help Resources in Mental Health. The book is based on five acclaimed national studies involving over 2,500 mental health professionals and it reviews and rates 600+ books.

Proponents of bibliotherapy suggest that it is effective on mild to moderate depressive and mood disorder symptoms and best done in conjunction with traditional visits to a credentialed therapist. It also shouldn't be considered as a substitute for medication if your health practitioner has prescribed that as part of your treatment.

Take Time for Gratitude Every Day

There has been a lot written recently about the so-called "happiness/positive psychology" movement. I'm not sure why, but that has provoked a negative reaction in me; maybe because some of the literature has presented it as an innovative, ground-breaking thought - "be happy!" I think most of us would agree, achieving some level of happiness in our lives is a fundamental goal. But it concerns me that much like the latest fad diet, achieving happiness is presented as a simplistic 1-2-3-step formula in a typical pop-psychology, self-help format.

A blogging colleague, TherapyDoc, expressed a similar opinion re: positive psychology in this post: The Sunny Side of Therapy: :) :) :). I agree with one very important point - the pow