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Despite Successful Antidepressant Treatment, Despair Can Remain

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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)

Cognitive Impairment Among Older Americans Decreasing

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A recent study shows a downward trend in the rate of cognitive impairment among people aged 70 and older. The study was led by two University of Michigan Medical School physicians and their colleagues, and is based on data from the Health and Retirement Study (HRS), a national survey of older Americans funded by the National Institute on Aging and based at the U-M Institute for Social Research (ISR).

"From these results, we can say that brain health among older Americans seems to have improved in the decade studied, and that education and wealth may be a big piece of the puzzle," says lead author Kenneth Langa, M.D., Ph., an associate professor of internal medicine who also holds appointments in ISR and the VA Ann Arbor Healthcare System.

Between 1993 and 2002 the incidence of cognitive impairment in this age group decreased by 3.5%, or hundreds of thousands of people. The reasons for this decline are not yet known, but the authors of the survey state that older people today have had more formal education, higher economic status and better care for risk factors—high blood pressure, high cholesterol, and smoking – that can endanger their brains. Of the 11,000 people in the study, those with more formal education and personal wealth were less likely to have cognitive problems.

The study was publishe in the the online edition of the journal Alzheimer’s and Dementia.

Source: Alzheimer’s & Dementia, Feb 18, 2008, online edition.

Study Suggests Folate Deficiency Increases Dementia Risk Three-Fold

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Recent research suggests that the risk of dementia in elderly people is increased three times by a lack of folate.

518 people were monitored for the development of dementia during the years 2001 through 2003. All subjects were aged 65 and over and lived in either a rural or urban community in the southern part of the country. Tests were carried out at the beginning and end of the 2-year period to check for any dementing illnesses. Blood tests were also conducted to measure levels of folate, vitamin B12, and the protein homocysteine, and how these changed over time. High levels of homocysteine have been associated with cardiovascular disease.

At the beginning of 2001, almost 20% of people monitored hd high levels of homocysteine, 3.5% were folate deficient, and 17% had low vitamin B12 levels.The higher the beginning levels of folate, the higher were vitamin B12 levels, and the lower were those of homocysteine.

By the end of 2003, 45 people had developed dementia, and of these 34 had Alzheimer’s disease, 7 had vascular dementia and 4 had other types of dementia. It was observed that dementia was more probable in the older, poorly educated and inactive subjects, and among those who had deposits of th protein ApoE.

People whose folate levels fell during the 2-year period were significantly more likely to develop dementia, while their homocysteine levels rose. People who were folate deficient to begin with, were almost 3.5 times more likely to develop dementia.

The research was published in the Journal of Neurology Neurosurgery and Psychiatry.

Source: J Neurol Neurosurg Psychiatry 2008; doi 10.1136/jnnp.2007.131482

Rate of Memory Loss Greater in Dementia Patients With More Education

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According to a recent study in the journal Neurology, while higher education levels initially delay the onset of dementia, once dementia starts, the rate of memory loss is more rapid than in less educated individuals.

According to study author Charles B. Hall, PhD of the Albert Einstein College of Medicine, "our study showed that a person with 16 years of formal education would experience a rate of memory decline that is 50% faster than someone with just four years of education."

The study started in the 1980s, and monitored 488 people born between 1894 and 1906, with study findings based on the 117 members of the sample who eventually developed Alzheimer’s or some other form of dementia. Study participants ranged from people with postgraduate education to people with less than three years of elementary school education.

Dr. Hall believes that this rapid decline in the more educated people might be explained by their having a greater cognitive reserve, or the brain’s ability to maintain function in spite of damage. This meant that while patients are often diagnosed with dementia at a later date, once the cognitive reserve is no longer able to compensate for the damage that has occurred, then the symptoms emerge.

The study is valuable, says Dr. Hall, because it examines memory loss before a formal diagnosis of Alzheimer’s.

The study was supported by the National Institute on Aging. Other researchers from the Einstein Aging Study involved in the research included Carol Derby, PhD; Aaron LeValley, MA; Mindy J. Katz, MPH; Joe Verghese, MD; and Richard B. Lipton, MD.

Source: Neurology, October 23, 2007

Researchers Find Major Clues on How Schizophrenia Develops

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Scientists have found some major clues in learning more about why schizophrenia develops. The new research may lead to better medications to correct gene-related problems that can lead to schizophrenia.

The researchers found that a gene called GAD1, which makes an enzyme essential for production of the chemical messenger called GABA, is turned on at increasingly high rates during normal development of the prefrontal cortex, but that this normal increase may not occur in people with schizophrenia. The prefrontal cortex is involved in higher functions like thinking and decision-making.

While scientists have known that abnormalities in brain development and in GABA synthesis play a role in schizophrenia, this study shows that defects in specific biochemical reactions that regulate gene activity—such as turning genes on and off so that they can make substances like the GAD1 enzyme—are also involved.

"This discovery opens a new area for exploration of schizophrenia," said NIMH Director Thomas R. Insel, MD. "Studies have yielded very strong evidence that schizophrenia involves a decrease in the enzymes, like GAD1, that help make the neurotransmitter GABA. Now we’re starting to identify the mechanisms involved, and our discoveries are pointing to potential new targets for medications."

The researchers also found that people with three different variations of the GAD1 gene that have been associated with schizophrenia also were more likely to have indicators of a malfunction in brain development. Among them were indicators of altered epigenetic actions related to GABA synthesis.

Clozapine and other antipsychotic medications are effective for many patients, but some patients choose to discontinue treatment because of the side effects they experience on these drugs. For this reason, scientists are working to find more precise molecular targets for the development of new medications that can correct the epigenetic flaws.

"We’ve known that schizophrenia is a developmental disease, and that something happens in the maturation of the prefrontal cortex during this vulnerable period of life. Now we’re beginning to find out what it is, and that sets the stage for better ways of preventing and treating it," says the study’s lead author, Schahram Akbarian, MD, PhD.

Results of the research were published in the October 17 issue of the Journal of Neuroscience, by Schahram Akbarian, MD, PhD, Hsien-Sung Huang, PhD student, and colleagues at the University of Massachusetts Medical School and Baylor College of Medicine. The study was funded by the National Institutes of Health’s National Institute of Mental Health (NIMH) and National Institute of Child Health and Human Development.

Sources:

  • National Institutes of Health
  • Journal of Neuroscience, October 17, 2007

Study Shows Brain Mechanism May Help Some Deal With Stress Better Than Others

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Some cope with stress much better than others, and a new study of mice shows that a naturally occurring mechanism in the brain promotes resilience to psychological stress.

Why is this important? In humans, stress is often associated with the development of some mental health issues such as post-traumatic stress disorder (PTSD) and depression. Results of the study, published online in the journal Cell, show that resistance to stress is not just a passive absence of stress vulnerability mechanisms as had been previously thought, but a biologically active process that results in specific adaptations in the brain’s response to stress.

The results are encouraging because a greater understanding of the brain’s function in regards to stress may help scientists discover how to enhance a naturally occurring mechanism in the brain that promotes resilience to psychological stress.

"We now know that the mammalian brain can launch molecular machinery that promotes resilience to stress, and we know what several major components are. This is an excellent indicator that there are similar mechanisms in the human brain," says Thomas R. Insel, MD, Director of the National Institute of Mental Health (NIMH).

In the study, smaller mice were put in cages with larger and more aggressive mice. Their vulnerability to stress was measured through such behaviors as social withdrawal after these encounters. While most mice adapted and continued social interactions after the stress event, some mice were overwhelmed by the interaction to the point that even after 30 days they were still avoiding social interaction with other mice.

The mice that were more traumatized by the stress showed more impulse firing by the cells that make dopamine, while the mice that were able to adapt maintained normal rates of impulse-firing due to a a protective mechanism—increased activity of channels that allow potassium to flow to the cells, which dampens the firing rate.

The higher firing rates in the traumatized mice led to more activity of a protein called BDNF, which had been linked to vulnerability in previous studies by the same researchers. With their comparatively lower rates of impulse-firing, the resistant mice did not have this increase in BDNF activity, another factor that contributed to resistance.

The scientists found that these mechanisms occurred in the reward area of the brain, which promotes repetition of acts that ensure survival. The areas involved were the VTA (ventral tegmental area) and the NAc (nucleus accumbens). In genetic experiments on the stress-resistant mice, many more genes in the VTA than in the NAc went into action in stressful situations, compared with vulnerable mice. Gene activity governs numerous biochemical events in the brain, and the results of this experiment suggest that genes in the VTA of resilient mice are working hard to offset mechanisms that promote vulnerability.

Another component of the study revealed that mice with a naturally occurring variation in part of the gene that produces the BDNF protein are resistant to stress. The variation results in lower production of BDNF, consistent with the finding that low BDNF activity promotes resilience.

The scientists also examined brain tissue of deceased people with a history of depression, and compared it with brain tissue of mice that showed vulnerability to stress. In both cases, the researchers found higher-than-average BDNF protein in the brain’s reward areas, offering a potential biological explanation of the link between stress and depression.

"The fact that we could increase these animals’ ability to adapt to stress by blocking BDNF and its signals means that it may be possible to develop compounds that improve resilience. This is a great opportunity to explore potential ways of increasing stress-resistance in people faced with situations that might otherwise result in post-traumatic stress disorder, for example," said Eric J. Nestler, MD, PhD, one of the study’s authors.

"But it doesn’t happen in a vacuum. Blocking BDNF at certain stages in the process could perturb other systems in negative ways. The key is to identify safe ways of enhancing this protective resilience machinery," Nestler added.

The study was published by Vaishnav Krishnan, Ming-Hu Han, PhD, Eric J. Nestler, MD, PhD, and colleagues from the University of Texas Southwestern Medical Center, Harvard University, and Cornell University, and was funded by the National Institute of Mental Health (NIMH).

Sources:

  • National Institutes of Health
  • Cell, October 18, 2007

Vision and Hearing Impairment May Contribute to Depression in Seniors

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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

Donepezil Shows Promise for Severe Alzheimer’s

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In a study released last week published in the Journal of the American Academy of Neurology, the drug donepezil has improved the cognitive functioning and memory of individuals with severe Alzheimer’s disease.

 
The study, funded by Eisai Inc. and Pfizer, makers of the drug, took place over six months and studied 343 individuals.Half of the group took donepezil and the other half received a placebo.

The results showed that over 63% of the individuals demonstrated memory stabilization or increased function, compared to 39% on the placebo.

Angry Men at Higher Risk for Heart Disease, Diabetes

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It’s not healthy to be hostile, according to a recent study from Duke University.

Steven Boyle, Ph.D., a researcher at Duke University Medical Center, says men who regularly exhibit strong feelings of anger or depression may face increased risk of coronary heart disease.

The study was conducted on 313 men who were given a standard psychological test that measures hostility, anger and depression.

Men whose psychological screening showed the highest level of hostility, depressive symptoms and anger had a 7.1 percent increase in levels of an immunity protein known as C3, while men with lower levels of hostility, depression and anger showed no during the decade-long study.

According to the study’s co-author, Edward Suarez, Ph.D., the lifestyle of individuals with a hostile attitude, "often leads to greater stress and possibly changes in the way the body functions that could lead to disease.”

The study appears in the August issue of the journal Brain, Behavior, and Immunity.

Source: Health Behavior News Service

Study Claiming Cannabis – Schizophrenia Link Fuels Debate

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A controversy has been sparked by a Swiss study, which claims that a link has been established between smoking canabis and developing schizophrenia.

The study concludes that there was an increase in occurrences of schizophrenia during the 90s, which is considered to be a liberal period, and corresponds to higher canabis usage. The critics, however, have pointed out that the study is inconclusive as it is does not take into consideration the individual patients’ drug usage.

Researchers claim that there is a direct relationship between the development of the disease and the rate of canabis consumption. They add that regular smokers of cannabis are at increased risk of developing schizophrenia by two to three times.

Experts on drug issues have welcomed the report, but they also remain cautious. They believe that the hypothesis may indeed be true, but that the results are not conclusive.