Depression in the News 2003

December 29, 2003. Eli Lilly received U.S. regulatory clearance to sell a combination drug to treat the depressive phase of bipolar disorder. The drug, Symbyax, combines two widely used Lilly medicines, Prozac for depression and Zyprexa for the manic episodes of bipolar disorder. Lilly said Symbyax is the first medication approved to treat the depressive phase of bipolar disorder. The company said patients spend more than three times longer in the depressive phase than in the manic phase of the disorder. Taking antidepressants alone can make patients wildly manic, adding Zyprexa is supposed to calm the mania. 

Some doctors expressed skepticism over the efficacy of Symbyax. David Printz, director of the Bipolar Disorder Research Clinic at New York State Psychiatric Institute,  said neither Prozac nor Zyprexa would be near the top of his list for treating bipolar depression. Prozac stays in the body longer than some other antidepressants in its class, raising the risk that the patient will swing from depression to mania, he said. Because of the weight gain associated with Zyprexa it would be last on his list of atypical antipsychotics. Some researchers believe the Zyprexa induced weight gain has led to diabetes among some patients. 

Symbyax will be available in four dosage combinations of the two drugs. The price of the drug is expected to be comparable to Zyprexa. It should be available sometime in January 2004. 

• FDA OKs New Lilly Bipolar Disorder Drug The Associated Press December 29, 2003 
• FDA OKs Lilly Drug, Doctors Skeptical Reuters December 29, 2003
• FDA Likely to Approve Drug For Bipolar Depression Psychiatric News December 19, 2003

How Genes Affect Moods Insights from Harvard Medical School By Michael C. Miller, M.D. in Newsweek magazine. December 8, 2003 issue. For every 100 people born, one ends up with schizophrenia, one develops bipolar disorder and 20 experience some form of depression. Heredity may account for as much as 80 percent of the risk for these illnesses, but we still know little about how, exactly, genes affect our risk. Fortunately, scientists are starting to find clues. 

Going Beyond Prozac Depression: 10 million American adults suffer from a major depressive disorder By Michael C. Miller, M.D. in the same issue of Newsweek. Dr. Miller is editor in chief of the Harvard Mental Health Letter.

On NPR radio, the Talk Of The Nation show on Friday, December 19, 2003 was about depression. You can listen to an archive of the show on your computer. From the NPR web site: 
Depression affects millions of adults -- and children -- in the United States. What are the causes, and might there one day be a cure that works for all sufferers? In this hour, we'll get an update on the science of depression -- including what scientists are learning about the genetic components of the disease. Will we one day be able to test for a depression gene? Is enough research being done on children? Plus, one father's battle to find treatment for his children. The guests on the show:

• Paul Raeburn Former science editor for Business Week and the Associated Press, Author of the forthcoming Acquainted With the Night
• Dr. George Zubenko Professor of psychiatry, University of Pittsburgh School of Medicine
• Dr. Brian Doyle Psychiatrist in private practice, Clinical professor of psychiatry and family medicine, Georgetown Medical School
• Dr. David Brent Academic chief, child and adolescent psychiatry, Professor of psychiatry, pediatrics, and epidemiology, Endowed chair, suicide studies, University of Pittsburgh Medical School 

On January 30, He Nearly Killed Himself. On April 16, He Did. A 17-Year-Old's Suicide and the Questions Left Behind by Jennifer Gonnerman in the Village Voice. October 29, 2003. Every year, 30,000 people in the United States die by their own hands. While murders receive more attention in the media, a far greater number of people take their own lives than end somebody else's. The vast majority of suicide's victims are male, and among 15- to 24-year-olds, suicide is the third leading cause of death. In the last six weeks, three students at New York University have jumped to their deaths.

Wyeth warned doctors that tests showed its antidepressant Effexor caused an increased risk of suicidal behavior in children. Even though Prozac is the only antidepressant approved for treating children some doctors are prescribing other medicines for patients under 18. Clinical studies of the long-acting version, Effexor XR, found a higher incidence in children of "hostility and suicide-related adverse events, such as suicidal ideation and self-harm." No children in the tests committed suicide. The studies did not show Effexor relieves depression or anxiety in children. Associated Press. September 4, 2003. 

November 4, 2003. The The Kojo Nnamdi Show on WAMU did a segment on Children and Anti-depressants that was prompted be a warning from the Federal Drug Administration about possible linkages between anti-depressants drugs and suicide in young children. The guests were Michael Brody, child psychiatrist; Medical Director, The Psychiatric Center of Washington DC and Sheila Matthews, National Vice President, Ablechild.org. You can listen to the show on your computer.  

A just released study found that Zoloft is effective for treating moderate to severe depression in children and adolescents. In the study, 69 percent of the subjects who took the drug improved significantly, compared with 59 percent of those who took a dummy (placebo) pill. Experts not involved in the study, said the 10-percentage-point improvement afforded by the drug over the placebo, though statistically significant, was not substantial. On the other hand, because children often appear more susceptible to the "placebo effect" than adults, others consider the difference significant. The study was done between December 1999 to May 2001 and was financed by Zoloft's maker, Pfizer Inc. 

• Popular Antidepressant Effective in Children, Researchers Say The New York Times August 27, 2003 By Erica Goode
• Study: Antidepressant Zoloft Safe For Kids Prozac Only Antidepression Drug Approved For Children The Boston Channel August 26, 2003
• Depression Drug Works in Kids, Too Associated Press in Newsday September 2, 2003 
• Zoloft Found Safe, Effective in Children  By Amanda Gardner HealthDay Reporter at Dr. Koop.com
• The actual study: Efficacy of Sertraline in the Treatment of Children and Adolescents With Major Depressive Disorder in the Journal of the AMA
  

Unpublished studies about Paxil, one of the world's most prescribed antidepressants, show that it carries a substantial risk of prompting teenagers and children to consider suicide. GlaxoSmithKline has acknowledged that just one of its nine studies of Paxil in children and adolescents has been published. The studies also found that Paxil was no more effective than a placebo in treating young people's depression. 

Many experts say that all S.S.R.I.'s act similarly in the body, so concerns about one could apply to all. S.S.R.I.'s are the most prescribed type of drug for depression.  

Some experts suspect that in the first few weeks of therapy, drugs like Paxil can shove a small number of patients toward a mental precipice, perhaps because they can cause a severe form of restlessness known as akathisia. Patients who make it through the first weeks of drug therapy uneventfully do fine on the medication on the long term. The drugs are widely prescribed by general practitioners, who do not have the same training in depression and treatment as psychiatrists.
Debate Resumes on the Safety of Depression's Wonder Drugs The New York Times Page 1 August 7, 2003. By Gardiner Harris. (Alternate Link)

Regarding the effectiveness of antidepressants, our medical advisor, Dr. Ivan Goldberg, suggests reading Are Antidepressants as Ineffective as They Look? from Prevention & Treatment magazine July 2002. 

People with a certain form of the 5-HTT gene are twice as likely to get depressed in response to stressful life events. This is the conclusion of a study in the July 18, 2003 issue of the journal Science (Volume 301 Number 5631). This is the first study to show a direct genetic link between emotional stress and depression. The 5-HTT gene regulates the movement of Serotonin between the neurons of the brain. Prozac, and other Selective Serotonin Re-uptake Inhibitors, affect the same serotonin pathways as the 5-HTT gene. Studies have show than SSRIs work better in patients with a specific form of the 5-HTT gene. People with a specific type of the 5-HTT gene were almost three times more likely to contemplate or attempt suicide than those with another form of the gene. It is hoped that further research may help determine which anti-depressant drugs and therapies work best for different people. Also, there might some day be a genetic test for susceptibility for depression, leading to preventative treatments. 

The article is available on the magazine's web site, but not for free 
Gene study links stress, depression Associated Press in the Boston Globe July 18, 2003
The University of Wisconsin (which participated in the study) released a Press Release and an article July 17, 2003 
Gene More Than Doubles Risk Of Depression Following Life Stresses from NIH/National Institute Of Mental Health July 18, 2003  
Gene Is Linked to Susceptibility to Depression By Mary Duenwald in the New York Times July 18, 2003
Gene Variant Helps Stop Stress from Becoming Depression Scientific American July 18, 2003 
Variation in One Gene Linked to Depression The Washington Post July 18, 2003 (front page story) 
Gene Is Linked to Depression Newsday July 18, 2003 

Lamictal was approved by the FDA for the long term treatment of adults with Bipolar Disorder. It is the first drug approved for Bipolar Disorder since Lithium. The approval was based on two random, placebo-controlled 18 month studies. The manufacturer, GlaxoSmithKline, has a web site for the drug www.lamictal.com. The MDSG medical advisor, Dr. Ivan Goldberg, has a web page devoted to Lamictal on his web site FAQ: Psychiatric Uses of Lamotrigine (Lamictal).

From Aetna InteliHealth, March 2003. Topics include: Genes, Brain Function And Mood, Neurotransmitters And Hormones, Human Development And Temperament, Early Loss And Stress and Medical Illnesses And Drug Treatment.  

On page 2 of the Daily News on Monday June 30th there was a story (She jumps for joy) about Miss New York State, Jessica Lynch, who will represent New York in the upcoming Miss America Pageant. She spent a month a children's psychiatric hospital when she was 14, suffering from depression and anorexia. Quoting: "As Miss New York State, Lynch, 24, said her mission is to show that depression is a flaw in chemistry, not character."

On June 23, 2003, the NPR radio show Fresh Air with Terry Gross interviewed Dr. Samuel Barondes the author of a new book, Better than Prozac: Creating the Next Generation of Psychiatric Drugs. The book traces the history and analyzes the effectiveness of the current crop of antidepressants and considers the drugs of the future. Dr. Barondes is a professor and director of the Center for Neurobiology and Psychiatry at the University of California. See the web page devoted to the June 23rd show. You can listen to the show on the Internet.  As of June 2003, the book sold for $18.20 on Amazon.com (the price can change at any time).  

From the New York Times. Science Times section. June 24, 2003 By Susan Gilbert. Only about 40 percent of people in treatment for depression get adequate care, according to a survey of more than 9,000 Americans. Combined with statistics from the article below, this means that only 24% of people suffering from depression are getting adequate care. Seventy percent of the people who seek help for depression are treated by general medical doctors. These doctors are not as well informed about depression as mental health specialists and are more likely to undertreat it — prescribing either too little medication or an inappropriate one, like an anti-anxiety drug. More general practitioners are treating depression now because the newer SSRI antidepressants are safer and easier to prescribe than older drugs. On the other hand, a psychiatrist is quoted as saying "The notion that everybody with depression should be treated by a mental health professional is ridiculous." Still, the article goes into more reasons why general practitioners are not well suited for treating depression. 

MDSG is mentioned in the article and our own Howard Smith contributed the fact that the side effects of an antidepressant can start within a day of two, but the benefits often take a few weeks to show up. Quoting Howard: "So patients call their doctors and complain that they feel sicker, and the doctors tell them to stop the medication or they prescribe something else." Howard notes that if doctors took the time to explain that the side effects were often temporary, many more people would continue treatment.  This is one way in which MDSG can help. 

From the New York Times. Front Page. June 18, 2003. Nearly 60% of people being treated for depression do not receive adequate care. One reason for this is that people seek help from family doctors who often do not treat depression aggressively. Family doctors are often not up to speed to give good quality care for depression. More than half of Americans suffering from depression now seek treatment. Ten years ago, only a third did. In any given year, 13 to 14 million people, about 6.6% of the population, experience depression. Depression costs employers lost productivity, people sometimes show up but do no work, a condition now referred to as "presenteeism". 

This article is a summary of reports in the Journal of the American Medical Association which just release a theme issue on Depression (Vol. 289 No. 23, June 18, 2003). Most articles have only a summary available for free. The Epidemiology of Major Depressive Disorder Results From the National Comorbidity Survey Replication (NCS-R) is no longer freely available, reading it costs $12. 

The National Institute of Mental Health (NIMH) has a web site devoted to Depression in Men with personal stories. The site also covers the signs and symptoms of depression, the available treatments and getting help. You can also order publications about Men and Depression.

Weighed Down When a man is depressed, taking the first step to get help may seem almost impossible By Irene S. Levine in The Chicago Tribune September 2, 2003. Men are far less likely than women to acknowledge the symptoms of depression or to ask for help on their own. Men initially have symptoms that are different from the "classical textbook symptoms" of depression. Among the initial symptoms are back pain, headaches,  general musculoskeletal problems and irritability. 

Dr. Michael C. Miller, our June 2003 lecturer, wrote Stop Pretending Nothing’s Wrong in the June 16, 2003 issue of Newsweek magazine. The article is about how it is hard for men to admit or even recognize their own depression, and how to get help.  

On May 28, 2003, the Larry King show on CNN was about recognizing and treating depression. The guests were former first lady Rosalynn Carter; actresses Mariel Hemingway and Mariette Hartley, Dr. Kay Jamison, professor of psychiatry at Johns Hopkins University and former CNN CEO Tom Johnson who ran the network while secretly battling depression. The panel took an in-depth look at depression and the agonizing effect the disease has on millions of people across around the world. The transcript is available on-line for free from CNN. Recommended links: the Rosalynn Carter Institute and the National Mental Health Association.

The Kojo Nnamdi Show on WAMU. May 13, 2003. Hear Laurie Flynn, the National Director of Positive Action for Teen Health and Marilyn Benoit, MD, President of the American Academy of Child and Adolescent Psychiatry. This link is to the audio of the show: How to screen your teen for the risk of depression and suicide. They also sell tapes of the shows. 

Four-time Super Bowl-winning quarterback and Fox NFL Sunday co-host Terry Bradshaw has gone public about his depression. He said: "I didn't understand that after every Super Bowl victory, I could never find pleasure in what I'd done ... I didn’t realize I had a problem.” Bradshaw said he had probably suffered from depression for most of his life. One way he tried to cope was to spend lots of money to feel better, buying things such as horses for his ranch. After the breakup of his marriage he finally sought help, starting therapy and taking an antidepressant. Two weeks later, his symptoms began to improve. Speaking at a news conference kicking off National Mental Health Awareness Month, Bradshaw said "No one likes to admit there's something wrong - but you can get help. And you'll say, 'God, why didn't I do this 30 years ago?'" Depression affects one in 10 adults, but is significantly under-treated.  Football Stars Talk About Downs Off the Gridiron May 2, 2003. A drug company set up a web site to promote the story of Terry Bradshaw and Ricky Williams. 

When Kay Redfield Jamison, Ph.D., appeared before more than 500 residency training directors at the annual meeting of the American Association of Directors of Psychiatric Residency Training in March 2003, she relayed some humorous but poignant lessons she’d learned from years of taking lithium to stabilize her moods. Rules for the Gracious Acceptance of Lithium Into Your Life  Psychiatric News April 18, 2003. Volume 38 Number 8. 

April 16, 2003. The connection between heart disease and depression is profound, complex and multilayered. A research psychiatrist at Columbia University says: "Depression is a risk factor for developing heart disease in the same way that smoking and high cholesterol are. If you have depression earlier in life - before any sign of heart disease - it's a predictor for coronary heart disease and stroke later." Depression as a risk factor and companion illness affects both male and female heart patients, but the relationship is particularly relevant for women who experience twice as much depression as men. Depression Can Be Key Factor For Woman Heart Patients

MDSG facilitator David Barabas married Patricia Rotter in March 2003. They met thru MDSG and discussed the group at length in the New York Times Sunday Styles section on March 30, 2003. She is quoted in the newspaper as saying: "When I first started going to the New York Mood Disorder Support Group and heard that some members date one another, I thought they were really crazy!. Who wants someone more messed up than they are?" In the summer of 1999, Mr. Barabas related an especially disturbing personal conflict to the support group. Afterward, as a gesture of support, Ms. Rotter asked if he would like company or to go to a movie. One thing led to another, and now they are married. Mr. Barabas said he had no fear about becoming involved with someone with bipolar illness. "The fact that we both share the illness makes it easier to communicate. "Besides," he added, "I knew the worst side of her. But I also saw that the best side of her far outweighed the worst." 

March 7, 2003. Depressed patients are 64% more likely than others to have a first heart attack. Among patients with known heart disease or one heart attack already behind them, the depressed are two to four times more likely than the non-depressed to have a heart attack. Depression prompts many people to gain weight. New evidence points to the extra weight as a key link between depression and inflammatory substances that can block coronary arteries. A study found that the blood of depressed people had 54% more interleukin-6 and 41% more C-reactive protein. Both molecules promote inflammation and the growth of artery-blocking plaque, along with blood clots that cause heart attacks. 
New dangers from a heavy heart USA TODAY. March 5, 2003.  By Marilyn Elias. 
Depression Adds Weight, Which Can Clog Arteries A reprint of the USA Today article at InteliHealth. March 7, 2003

Depression hinges on longer drug course. February 22, 2003. The Sydney Morning Herald. A new study published in The Lancet, says that people who take antidepressants should stay on them for up to 18 months to avoid becoming depressed again. Taking the drugs for a year to 18 months halves the risk of falling into another depression - from 41 per cent to 18 per cent - compared with the more standard course of less than six months. It did not seem to matter which antidepressant was used. Some people should consider staying on them for life. These conclusions apply only to people who respond well to the medication. It should be noted that most of the patients in the study were severely depressed and treated through teaching hospitals and universities - meaning they might not be typical. Less severely depressed people treated by their GP might not be less prone to relapse. Alternatively, their risk might be reduced with non-drug approaches such as cognitive behavior therapy.

The Boston Globe carried the Reuters version of the story February 21, 2003: Antidepressants prevent relapses, study finds.  The Associated Press write-up was carried by CBS News Depression's Long Shadow and the Cleveland Plain Dealer: Long-term treatment of depression recommended on February 21, 2003.

Finding Happiness: Cajole Your Brain to Lean to the Left. The New York Times. By Daniel Goleman. February 4, 2003. On practicing mindfulness to reduce stress and develop more positive outlook on life.   

In recent research at the Laboratory for Affective Neuroscience at the University of Wisconsin, using functional M.R.I. and advanced EEG analysis, an index for the brain's set point for moods has been identified. The functional M.R.I. images reveal that when people are emotionally distressed — anxious, angry, depressed — the most active sites in the brain are circuitry converging on the amygdala, part of the brain's emotional centers, and the right prefrontal cortex, a brain region important for the hypervigilance typical of people under stress. By contrast, when people are in positive moods — upbeat, enthusiastic and energized — those sites are quiet. The researcher has discovered what he believes is a quick way to index a person's typical mood range, by reading the baseline levels of activity in these right and left prefrontal areas. That ratio predicts daily moods with surprising accuracy. The more the ratio tilts to the right, the more unhappy or distressed a person tends to be, while the more activity to the left, the more happy and enthusiastic. 

By taking readings on hundreds of people, a bell curve distribution has been established, with most people in the middle, having a mix of good and bad moods. Those relatively few people who are farthest to the right are most likely to have a clinical depression or anxiety disorder over the course of their lives. For those lucky few farthest to the left, troubling moods are rare and recovery from them is rapid.

After studying meditation, the results suggest that the emotion set point can shift, given the proper training. In mindfulness, people learn to monitor their moods and thoughts and drop those that might spin them toward distress. For more, see www.investigatingthemind.org/ 

Note: This article is no longer freely available on the web site of the New York Times. To read it, you have to purchase a copy on-line. 

Mental Health: Lifting Men's Fog of Depression. New York Times. VITAL SIGNS column. By JOHN O'NEIL. January 7, 2003. Men whose depression does not respond to medication should have their testosterone levels checked according to a new study. However, the results were too inconsistent and the study size was too small to draw any real conclusions. Screening for the study found that among men whose depression had failed to respond to treatment, almost half of them had low testosterone levels. It was suggested that psychiatrists should order tests of testosterone levels for men who do not respond to antidepressants and consider a course of supplements while more research is conducted.

Testosterone Gel Could Help Depressed Men With Low Testosterone Levels. A DGReview of :"Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial." American Journal of Psychiatry January 8, 2003

Prozac OKd for kids, but worries linger  Chicago Sun Times. January 5, 2003. The FDA declared that Prozac should be made available for depression in children 7 to 17 years of age. Doctors have prescribed Prozac and similar drugs for children even though these medications were only approved for adults. Up to 25 percent of children in the U.S. and 8 percent of teenagers suffer from depression. Manufacturers have little incentive to study adult drugs in children if they expect desperate pediatricians will use the medicines anyway. The FDA pointed to two recent studies that concluded Prozac is "statistically effective," but at the same time acknowledged that there could still be long-term dangers. Prozac becomes the first drug among the newer antidepressants, which boost serotonin levels, to win official government approval. Lilly does not intend to actively market Prozac for children. 

Prozac approved in US to treat depression in kids  Reuters. In Forbes magazine. January 3, 2003. Prozac's sales have plunged since it lost patent protection in August 2001 and faced generic competitors.

FDA OKs Prozac for Depressed Children Associated Press. In Newsday. January 4, 2003. 

FDA Approves Prozac for Children, Teens  Reuters Health  January 3, 2003