Does Publication Bias Make Antidepressants Seem More Effective at Treating Anxiety Than They Really Are?

By Craig Williams, Professor of Pharmacy at Oregon State University

In scientific literature, studies with “good” results are more likely to be published than studies with results that are unclear or negative. A study with a new, exciting finding (a positive result) is likely to see the light of day, even if the finding is not in line with the authors hypothesis. But a study that doesn’t have a new finding (a negative result), or has an unclear finding is far less likely to be published. [Read more…]

Depression Among Low Income Latinos

A new, small study of low-income, depressed Latinos finds that those who stigmatize mental illness are less likely than others are to take medication, keep scheduled appointments and control their condition.

The findings could help physicians develop a series of question to identity patients who might especially be resistant to care and then help them understand how treatment works, said lead study author William Vega.

“Unfortunately, mental-health stigma turns out to be one of the most serious barriers for people receiving care or staying in care,” said Vega, professor of medicine and social work at the University of Southern California.

Many cultures have stereotypes about depression and mental illness, he said, with some viewing it as something that will brand a family for generations. Latinos, in particular, value resilience and think, “it’s a cultural value to be able to handle your own affairs,” he said. “If you can’t, it implies that you’re weak.”

While it might not be surprising that Latinos stigmatize mental illness, “like many things, it’s all anecdotes and innuendo until you do something more solid, like a research study, and start finding out what the issues are,” said Vega, who worked on the study with fellow researchers while at the University of California at Los Angeles.

In the new study, published in the March/April issue of the journal General Hospital Psychiatry, researchers surveyed 200 poor, Spanish-speaking Latinos in Los Angeles. They all had visited local primary care centers; 83 percent were women. All had shown signs of depression in an initial screening.

Another screening found that all but 54 of the 200 individuals were mildly to severely depressed. Researchers deemed 51 percent as those who stigmatize mental illness, based on responses to questions about things like the trustworthiness of a depressed person.

The researchers found that those who stigmatized mental illness were 22 percent less apt to be taking depression medication, 21 percent less likely to be able to control their depression and about 44 percent more likely to have missed scheduled mental-health appointments.

The findings “shows evidence that stigma does exist, and it’s related to things that are important to provide as part of proper treatment,” Vega said.

Jamie Walkup, a Rutgers University associate professor of psychology who studies mental health and stigma, said the key is to find ways to “push back against these negative ideas, hoping that a person with depression will no longer let an aversion to being a person with depression stop them from doing what they may need to do to get help.”

It might be worth asking, he said, “whether it may sometimes make more sense to switch gears with a patient who, for whatever reason, finds it intolerable to think of themselves as having depression.”

In such cases, doctors could find other ways to work with these patients without insisting that they acknowledge their diagnosis.

Source: Vega W, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry 32(2), 2010.

Overtime Work Can Lead to Anxiety and Depression

Overtime work habits can lead to anxiety and depression, according to a study conducted by Norweigan researchers.

Using a standard screening questionnaire to measure symptoms of anxiety and depression, Elisabeth Kleppa and colleagues at the University of Bergen, Norway, analyzed data on hours worked by a large sample of Norwegian men and women. Scores for anxiety and depression were compared for 1,350 workers putting in 41 to 100 hours of overtime a week, and some 9,000 workers working regular hours (40 or less) without overtime.

Overtime work was linked to higher anxiety and depression scores among both men and women, while “possible” depression rose from about 9% for men working regular hours to 12.5% for those working overtime. “Possible” depression rates in women rose from 7% to 11% and for men and women the “possible” anxiety and depression rates were higher among workers with lower incomes and for less—skilled workers.

The relationship between overtime and anxiety/depression was strongest among men who worked the most overtime—49 to 100 hours per week. Men working such very long hours also had higher rates of heavy manual labor and shift work and lower levels of work skills and education.

Health and safety concerns have been raised in previous studies, but these concentrated on shift work rather than overtime. European Union work rules allow employees to refuse to work more than 48 hours per week. These latest results show increased rates of anxiety and depression among overtime workers, supporting the European Union directive.

Even moderate overtime hours appear to increase the risk of ‘mental distress’, although the study offers no conclusions as to how working long hours results in increased anxiety and depression. It is surmised that working overtime leads to increased “wear and tear,” or that individuals with characteristics predisposing to anxiety and depression (such as low education and job skills) are more likely to take jobs requiring long work hours.

Source: Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM), June, 2008.

Alzheimer’s Disease Risk Different for Men and Women

Recent research suggests that the chances of developing Alzheimer’s Disease are different for men and women, with stroke in men and depression in women being key elements.

The research was conducted in France, among 7,000 people aged 65 and over, drawn from the general population. While none of the participants had dementia, some 40% had mild cognitive impairment. Four years later 6.5% of those displaying mild cognitive impairment had developed dementia, while no change was noted in just over half. About one third returned to normal cognitive ability.

The move from cognitive impairment to dementia however, was marked among subjects taking anticholinergic drugs for depression. A variation in the ApoE gene, a known risk factor for dementia, was also more common among those whose mild cognitive impairment progressed.

The results demonstrated that men with mild cognitive impairment were probably overweight and diabetic, and to have suffered a stroke. In fact, male stroke victims were three times as likely to progress from cognitive impairment to dementia.

Women with mild cognitive impairment had poorer general health, were disabled, and suffered from insomnia, besides having an inadequate support group. They were also unable to perform the daily tasks that would enable them to live alone without assistance. It was judged they were 3.5 times as likely to develop dementia, while those suffering from depression were twice as likely to do so. Stroke was not a risk factor for women, although there was similar rate of occurrence in men and women.

Source: Journal of Neurology, Neurosurgery, and Psychology, 2008; doi 10.1136/jnnp.2007.136903

Despite Successful Antidepressant Treatment, Despair Can Remain

While antidepressants can successfully treat depressive symptoms, despair can remain; and this may result in the patient not taking the medication any longer, according to a study that tbe journal, General Hospital Psychiatry.

For many in the study, feelings of hopefulness did not improve until several weeks, or even months, after depressive symptoms lifted, says lead author James E. Aikens, Ph.D., associate professor in the Department of Family Medicine at the University of Michigan Health System.

"The finding suggests that some patients may become unduly pessimistic and stop adhering to an already-helpful therapy," he notes. This finding is troubling, he says, because hopelessness is a strong risk factor for suicide.

573 patients from 37 practices suffering from depression were studied by Aikens and his team, and given either fluxotine (Prozac), paroxetine (Paxil), or sertraline (Zoloft). Patients were then reviewed one, three, six and nine months after treatment began. Patient response to medication was fast: 68% of improvement was achieved by the end of the first month, 88% by three months. Areas of major improvement were positive emotions, work functioning and social functioning.

There was little improvement recorded in head, back and stomach pain after the first month, and Aikens said that if these physical complaints persisted after the first few weeks of treatment, physicians should consider treatments that directly affect pain in depressed patients.

Where hopefulness was concerned improvement noted was more gradual, and Aikens recommended that physicians teach patients to recognize and fight the pessimistic thoughts that often accompany depression, and encourage patients to get involved in mood-lifting activities.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and Research at the University of Michigan; Donald E. Nease Jr., M.D., of the Department of Family Medicine at the U-M Health System; Michael S. Klinkman, M.D., M.S., of the departments of Family Medicine and Psychiatry at the U-M Health System; and Kurt Kroenke, M.D., of Indiana University.

With hopefulness, however, the improvement was much more gradual. Physicians may want to consider cognitive-behavioral strategies, such as teaching patients to identify and challenge the pessimistic thoughts that usually accompany depression, and encouraging them to engage in activities that may improve their mood, Aikens says.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and

Source: General Hospital Psychiatry, (January-February, 2008)

Vision and Hearing Impairment May Contribute to Depression in Seniors

It is commonly known that hearing and vision impairment are much more pronounced in the elderly population. With the gradual onset of hearing and vision loss, certain tasks become more difficult for seniors.

In addition to the direct difficulties, such as having trouble reading smaller type or understanding conversations, hearing and vision loss is also associated with the development of mood disorders, according to Dennis Norman, Chief of Psychology at Massachusetts General Hospital.

"Vision and hearing loss are major public health issues because they affect so many older individuals, and because they have an adverse impact on mental health," says Norman. "If the senses are limited, everything is affected, including interaction with surroundings, relationships, activities, and feelings of self-worth. Impairment can lead to depression, anxiety, social isolation and many other problems."

According to the Centers for Disease Control, approximately 3.6 million Americans over the age of 70 have impaired vision, and 6.7 million older adults report impaired hearing.

The CDC also indicates that these individuals also are more likely to experience problems in other activities of daily life, such as walking, going outdoors, getting in and out of chairs or bed, or managing their prescription medications. They are also less likely to socialize than individuals without sensory impairment.

A recent study reported in Archives of Ophthalmology (April 2006) also suggests that there’s a significant link between visual problems and thinking, memory and learning.

Hearing impairment has also been linked to cognitive decline. Brandeis University researchers suggest that mental resources are expended toward efforts to hear, at the expense of memory.

Preventive Measures to Protect from Hearing and Vision Impairment

  • Wear sunglasses to reduce exposure to UV radiation
  • Protect ears by avoiding loud noises, wearing earplugs, and keep earphone volume down
  • Stay healthy with regular medical checkups, quitting smoking, and managing conditions such as diabetes and high blood pressure that can damage eyes and/or ears.
  • Maintain a healthful diet: Get plenty of vitamin C through citrus fruits and juices; eat carrots and dark-green leafy vegetables such as spinach for beta-carotene; eat whole grains, nuts, and eggs for vitamin E; and get needed zinc from fish, meats, whole grains and dairy products. For nutrients that strengthen or protect hearing, eat foods rich in: vitamin D (fortified dairy products, seafood, fortified cereals); vitamin B12 (meat, poultry, eggs, dairy products and shellfish); and folate (liver, eggs, beans, fortified cereals, leafy green vegetables, and fruits).
  • Consider supplements. Ask your doctor about taking supplements such as bilberry (huckleberry), ginkgo biloba and vinpocetine.

Helpful Resources
These groups offer support and information to help people cope with hearing and vision impairment:

Source: Newswise