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Responding to Violence, Suicide, Psychosis and Trauma

How effective are Anti-depressants?

One of the problems in assessing the efficacy of drugs is that the assumption that patients don’t know in a double-blind study if they are taking the active medicine or a placebo. However, all medicines have side-effects and placebos have none, so in fact most trialists know if they are taking sugar pills because they don’t notice any physical changes. Consequently when trials show, for example, fluoxetine to be better than placebos, they may show nothing of the kind.

In this light, the study below is even more surprising in that it suggests that anti-depressants, placebo and a talk therapy are all equally (in)effective! It would be even more alarming if they had chosen fluoxetine as the antidepressant (although recent studies have suggested that even this is only more effective than placebos for the most severe forms of depression) and CBT in place of supportive-expressive therapy.

Antidepressant, Talk Therapy Fail to Beat Placebo

By Amy Norton

NEW YORK (Reuters Health) Dec 22 – Neither antidepressants nor “talk therapy” were able to outperform placebo pills in a new clinical trial on depression treatment — although there were hints that the effects varied by gender and race, researchers report.

The findings, published November 29 in the Journal of Clinical Psychiatry, add to evidence that people receiving “real” depression treatment in studies — from antidepressants to St. John’s wort — often do no better than people given a placebo.

A recent review found that a minority of antidepressant users even fared worse than placebo users.

In this latest study, researchers randomly assigned 156 patients with major depression to either take sertraline daily for 16 weeks; take a placebo for the same period, or undergo supportive-expressive therapy twice a week for four weeks and then weekly for 12 weeks.

The three groups did similarly overall.

In the antidepressant group, 31% responded (as judged by improvements on the Hamilton Rating Scale for Depression). The same was true of about 28% of patients in the talk-therapy group, and 24% in the placebo group.

“I was surprised by the results. They weren’t what I’d expected,” said lead researcher Dr. Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York.

Still, he stressed in an interview, the lack of benefit over placebo does not mean that depression therapies are pointless.

For one, Dr. Barber said, receiving a placebo in a clinical trial “is not the same as getting no treatment.”

Study participants in placebo groups have contact with health professionals who are asking about their symptoms and well-being, he said. And for some people, that attention can make a difference — and may help explain the placebo response seen in studies.

In addition, at least some people in placebo groups believe they are getting the real treatment – and people’s beliefs about their therapy can play a key role in whether they get better.

But apart from that, different people may respond differently to a given type of depression therapy. Dr. Barber’s team found some evidence of that.

The study had an unusually large minority population for a clinical trial on depression: Forty-five percent of the patients were African American.

The researchers found that African-American men tended to improve more quickly with talk therapy than with medication or placebo. In contrast, white men fared best on placebo, while black women showed no differences in their responses to the three treatments.

Only white women, Dr. Barber said, showed the expected pattern: a quicker response to both medication and talk therapy than to the placebo.

But all of that is based on fairly small numbers of people, and more research is needed to see if the gender and racial differences are real, according to Dr. Barber.

A psychiatrist not involved in the study agreed. “Those findings are interesting, but need to be interpreted with a grain of salt,” said Dr. David Mischoulon from Harvard Medical School.

As for the overall lack of benefit from the real treatments over placebo — in this and other studies – Dr. Mischoulon cautioned against reading that as “nothing works for depression.”

“I think it’s the opposite,” he told Reuters Health, “It’s more that, everything seems to work to some degree.”

Like Dr. Barber, Dr. Mischoulon said that the placebo condition in clinical trials is not really “no treatment.”

Instead, he said, “I try to offer as broad a menu of options as possible, because all may potentially help.” Dr. Mischoulon has also studied alternative depression remedies, like fish oil and acupuncture.

Another caveat from the current study, he noted, is that it looked only at two types of medication. (Some patients were switched to venlafaxine if they did not respond to sertraline after eight weeks). And it tested just one type of talk therapy.

Supportive-expressive therapy is a short-term form of psychoanalysis that aims to help people understand how their personal relationships are related to their symptoms.

It’s different from cognitive behavioral therapy, the best-studied form of talk therapy for depression. Both Dr. Barber and Dr. Mischoulon said it’s not clear if the current findings would extend to psychotherapies other than supportive-expressive therapy.

“This is one type of psychotherapy, and it’s two antidepressants,” Dr. Mischoulon said. “It would be wrong to conclude that psychotherapy doesn’t work, and antidepressants don’t work.”

The study was funded by the National Institutes of Health. Some of Dr. Barber’s co-researchers have received funding from the pharmaceutical industry.

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Filed under: Other Mental Health, ,

Are the Clinically Depressed Just More Realistic?

It is often reported that we all tend to delude ourselves and actively distort our assessments of the probability of events occurring about us, but only one group of people are able to predict the likelihood of those events occurring better than the rest of us, the clinically depressed! A recent study seems to bear this out (J Behav Ther Exp Psychiatry. 2011 Oct 5; vol. 43(2) pp. 699-704 Confidence judgment in depression and dysphoria: The depressive realism vs. negativity hypotheses. Zu-Ting Fu T, Koutstaal W, Poon L, Cleare AJ). See the abstract below (I have edited out the methodology as if you are interested in that you would need to examine the original and full text.

BACKGROUND AND OBJECTIVES: According to the negativity hypothesis, depressed individuals are over-pessimistic due to negative self-concepts. In contrast, depressive realism suggests that depressed persons are realistic compared to their nondepressed controls. However, evidence supporting depressive realism predominantly comes from judgment comparisons between controls and nonclinical dysphoric samples when the controls showed overconfident bias. This study aimed to test the validity of the two accounts in clinical depression and dysphoria. CONCLUSION: The present study confirms depressive realism in dysphoric individuals. However, toward a more severe depressive emotional state, the findings did not support depressive realism but are in line with the prediction of the negativity hypothesis. It is not possible to determine the validity of the two hypotheses when the controls are overconfident. Dissociation between item-by-item and retrospective confidence judgments is discussed.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Affiliation: Institute of Biomedical Sciences, Academia Sinica, 6F, No. 16, Alley 10, Lane 437, Pa-The Rd Sec 2, Taipei 10552, Taiwan.

Filed under: Other Mental Health, ,

Depressed People Have Trouble Learning ‘Good Things In Life

ScienceDaily (Mar. 19, 2009) — While depression is often linked to negative thoughts and emotions, a new study suggests the real problem may be a failure to appreciate positive experiences.


Researchers at Ohio State University found that depressed and non-depressed people were about equal in their ability to learn negative information that was presented to them.

But depressed people weren’t nearly as successful at learning positive information as were their non-depressed counterparts.

“Since depression is characterized by negative thinking, it is easy to assume that depressed people learn the negative lessons of life better than non-depressed people – but that’s not true,” said Laren Conklin, co-author of the study and a graduate student in psychology at Ohio State.

The study appears in the March issue of the Journal of Behavior Therapy and Experimental Psychiatry.

Researchers tested 34 college students, 17 of whom met criteria for clinical depression and 17 of whom were not depressed.

This study is one of the first to be able to link clinical levels of depression to how people form attitudes when they encounter new events or information, said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State.

Strunk said the key to conducting this study was the use of a computer game paradigm co-developed at Ohio State in 2004 by Russell Fazio, a professor of psychology and co-author of this new study.  Fazio and his collaborators, Natalie Shook, a PhD graduate of Ohio State now at Virginia Commonwealth University and J. Richard Eiser of the University of Sheffield (England) have used the game in many studies examining differences in the development of positive and negative attitudes.

The developers affectionately call the game “BeanFest.”  It involves people encountering images of beans on the computer screen.  The beans could be good or bad, depending on their shape and the number of speckles they had.

Good beans earned the players points, while bad beans took points away.  The goal was to earn as many points as possible.

While the game may seem trivial to a naive audience, Strunk said it offers a unique and powerful way to measure how people learn new attitudes.

“Before, if researchers wanted to investigate how people formed new attitudes, it was very difficult to do,” Strunk said.  If researchers asked about real-life issues, the problem is that prior learning and attitudes may impact how people respond to new information.  But in this game, participants don’t have any prior knowledge or attitudes about the beans so researchers could learn how they formed their attitudes in a novel situation, without interference from past experiences.

In the game phase of this study, participants had to choose whether they would accept a bean when it appeared on the screen.  If they accepted the bean, the points were added or deducted from their total.  If they rejected the bean, they were still told how many points they would have earned or lost if they had accepted it.

Each of the 34 beans was shown three times during the game phase, giving the participants a good opportunity to learn which beans were good and which were bad.

Then, in the test phase, participants had to indicate whether beans they learned about in the game phase were “good” (choosing it would increase points) or “bad” (choosing it would decrease points).  The researchers tallied how well participants did in correctly identifying positive and negative beans.

The non-depressed students correctly identified 61 percent of the negative beans, which was about the same as the depressed students, who correctly identified 66 percent of the “bad” beans.

But while the non-depressed students correctly identified 60 percent of the positive beans, depressed students correctly classified only 49 percent of these good beans.  Non-depressed students identified the good beans better than the depressed students, who failed to identify good beans better than chance.

“The depressed people showed a bias against learning positive information although they had no trouble learning the negative,” Strunk said.

One of measures researchers used in the study classified whether the depressed participants were currently undergoing a mild, moderate or severe episode of depression.  In the study, those undergoing a severe depressive episode did more poorly on correctly choosing positive beans than those with mild depression, further strengthening the results.

While more research is needed, Conklin and Strunk said this study suggests possible ways to improve treatment of depressed people.

“Depressed people may have a tendency to remember the negative experiences in a situation, but not remember the good things that happened,” Conklin said. “Therapists need to be aware of that.”

For example, a depressed person who is trying out a new exercise program may mention how it makes him feel sore and tired – but not consider the weight he has lost as a result of the exercise.

“Therapists might focus more on helping their depressed clients recognize and remember the positive aspects of their new experiences,” Strunk said.


Adapted from materials provided by Ohio State University.

Filed under: Other Mental Health, Suicide, , ,

Regular Exercise Reduces Depressive Symptoms, Improves Self-esteem In Overweight Children

ScienceDaily (Mar. 18, 2009) — Less than an hour of daily exercise reduces depressive symptoms and improves self esteem in overweight children, Medical College of Georgia researchers say.


The study included 207 overweight, typically sedentary children ages 7-11 randomly assigned to either continue their sedentary lifestyle or exercise for 20 or 40 minutes every day after school for an average of 13 weeks. The 40-minute group sustained the most psychological benefit, according to research published online in the Journal of Pediatric Psychology.

The MCG researchers were the first to demonstrate this dose response benefit of exercise – meaning the more the better – on depressive symptoms and self worth in these children. Benefits came despite the fact that the children’s weight did not change much over the three months.

“Just by getting up and doing something aerobic, they were changing how they felt about themselves,” says the study’s first author, Dr. Karen Petty, postdoctoral fellow in psychology at MCG’s Georgia Prevention Institute. “Hopefully these children are taking home the idea: Hey, when we do this stuff, we feel better.”

The study focused on fun activities that increase heart rate, such as running games, jumping rope, basketball and soccer and typically included short bursts of intense activity interspersed with lower-activity recovery periods.

Participants in these activities reported feeling better about themselves. “If you feel better about yourself, maybe you are going to do better in school, maybe you are going to pay more attention,” Dr. Petty says. MCG is compiling a mound of evidence that supports the case that these go hand-in-hand.

Dr. Petty works with Dr. Catherine Davis, clinical health psychologist at the Georgia Prevention Institute, who has shown that regular physical activity not only improves fitness and reduces fatness but also reduces insulin resistance (diabetes risk), improves cognition and reduces anger expression. “This adds to the evidence that exercise is great for people of all ages, physically and mentally,” Dr. Davis says of the latest finding. “Our physical and mental well being are intimately interwoven.”

One exception was that even a longer daily exercise regimen did not impact the general self esteem of black adolescents although it did improve their depressive symptoms and how they felt about how their appearance. The researchers noted previous evidence that the black culture is more accepting of obesity. Their study, one of a few to test race as a moderator of psychological risk in overweight children, appears to support that. However a better way to measure self esteem in blacks also may be needed, say the researchers who call for more study on race’s influence on the psychosocial consequences of obesity and exercise.

For this study, children filled out the Self-Perception Profile for Children and the Reynolds Child Depression Scale reports before and after the13-week period.  “We asked them about feelings of sadness, how they sleep – most don’t sleep well when depressed – and their appetite – some eat more, others less when depressed,” Dr. Petty says. As with most children, most of the study participants had some symptoms associated with clinical depression but few would be given a diagnosis of clinical depression.

There’s some irony in that depression and low self esteem may decrease the chance you’ll feel like moving yet moving decreases depressive symptoms. Dr. Petty, a runner, experiences that herself. “Even if it’s hard and I don’t want to go, 15 or 20 minutes after I do, I feel so good I could go for another run.”

Acknowledging running isn’t for everyone, she suggests a more festive family affair that could include a walk in a park or around the neighborhood, a game of pickup basketball or tennis. Peer group activities may work better for some children, she says, such as study participants who could routinely be found in the Georgia Prevention Institute, laughing and joking as they exercise.

“There’s a message here for all of us that taking some time out of our day to do something physical helps make us better mentally,” says Dr. Petty, whose postdoctoral fellowship is supported by a National Institutes of Health training grant to MCG’s Vascular Biology Center.

The researchers already are following another group of children for eight months to determine the longer term impact of exercise. They also are bringing the control subjects to the Georgia Prevention Institute each day to ensure that it’s exercise, not just the extra attention from participating in an after-school program, that’s making the difference.

About 37 percent of children in the U.S. are overweight and about 16.3 percent of children age 2-19 are obese, according to the Centers for Disease Control and Prevention.  Animal studies have shown exercise may help regulate genes that increase levels of brain chemicals that combat depression.


Adapted from materials provided by Medical College of Georgia.

Filed under: Other Mental Health, , , ,

Reducing Suicidal Behaviors Among Adolescents

ScienceDaily (Mar. 15, 2009) — Adolescent girls who view themselves as too fat may display more suicidal behaviors than those who are actually overweight, according to a study by Inas Rashad, an assistant professor of economics at Georgia State University.

Although studies have shown a link between obesity, depressive disorders and suicidal behaviors, Rashad and Dhaval Dave of Bentley University, analyze these indicators in conjunction with an individual’s perception of their weight. The study, which was accepted for publication in February, will be published in Social Science and Medicine.

“Both obesity and suicide have been highlighted by the Surgeon General as areas of focus for adolescents and areas of great concern,” Rashad said. “We find that the role perception has independently of actual overweight status is an important one, which has implications in terms of any solutions to the obesity epidemic that are put forth.”

The researchers utilized data from 1999 to 2007 from the Youth Risk Behavioral Surveillance System, which indicated that 17 percent of high school students have seriously considered committing suicide. The data were used to not only investigate whether overweight status or perception are causal factors affecting suicidal thoughts and attempts among high school students, but also to estimate the potential economic costs.

“If being overweight not only imposes the usual health care and labor market costs, but also increases the risk of suicide, we need to take these costs into account when offering solutions,” Rashad said.

The study revealed that body dissatisfaction had a strong impact on all suicidal behaviors for girls and was generally insignificant for males. For instance, any perception of being overweight by girls raised the probability of suicidal thoughts by 5.6 percent, the probability of a suicide attempts by 3.2 percent, and the probability of an injury causing suicide attempts by 0.6 percent. The researchers also state that the risk of suicide by adolescent females could potentially add about $280 to $350 million to the costs of adolescent obesity, which includes the direct cost of illnesses and associated health care and indirect costs such as productivity losses, reduced income and premature mortality.

Rashad hopes more research will be done on the topic, but she recommends efforts aimed at preventing youth suicides focus on educating youths and fostering healthy attitudes with regard to weight.

“The prevalence of body dissatisfaction, among special populations of youths such as non-black girls, is significantly higher than the general youth population, even when the underlying weight is in a healthy range,” Rashad said. “Interventions that identify and assist these youths and educate them regarding a healthy body image will succeed in lowering suicide attempts.”
Adapted from materials provided by Georgia State University, via EurekAlert!, a service of AAAS.

Filed under: Suicide, , , , ,

Risk Factors For Suicidal Events Found Among Adolescents With Treatment-Resistant Depression

19 Feb 2009
Family conflict, drug or alcohol use and pre-existing suicidal thoughts were the strongest predictors of suicidal events among adolescents whose depression treatment was changed after a lack of response to a previous medication.

The findings were reported today in the article “Predictors of Spontaneous and Systematically Assessed Suicidal Adverse Events in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study,” at AJP in Advance, the online advance edition of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association.

In the study, 334 adolescent patients who had not responded to a selective serotonin reuptake inhibitor (SSRI) were switched to a different SSRI or to venlafaxine, with or without cognitive-behavioral therapy. Forty-eight patients experienced a suicidal event-suicidal ideation (new or worsening), a suicidal threat or a suicide attempt. The median time from a suicidal threat to a suicidal event was three weeks. In the AJP article, lead author David Brent, M.D., and colleagues recommend careful monitoring of more severely depressed adolescent patients who have high levels of suicidal thoughts or family conflict.

Treatments that target family conflict and emotion regulation early may help reduce suicidal events. Likewise, since the predictors of suicidal events also predict poor treatment response, targeting family conflict, suicidal ideation and drug use may hasten response and help to reduce the incidence of these events. TORDIA is sponsored by the National Institute of Mental Health. Any other funding the authors may have received is disclosed in the article itself.

The American Journal of Psychiatry is the official journal of the American Psychiatric Association. Statements in this press release or the articles in the Journal are not official policy statements of the American Psychiatric Association.

About the American Psychiatric Association

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

Filed under: Other Mental Health, Suicide, , , , ,

Vitamin D and mental disorders linked

Kate Benson October 8, 2008

A lack of vitamin D has long been linked to depression, but researchers believe it may contribute to psychiatric conditions such as personality disorders and post-traumatic stress disorder.

A study of more than 50 patients at a private psychiatric clinic in Geelong found that almost 60 per cent were suffering a severe vitamin D deficiency and 11 per cent were moderately deficient, prompting researchers to question whether vitamin D supplements could reduce mental illness across the board.

The study, published in the Australian And New Zealand Journal Of Psychiatry, found the 53 patients, who suffered bipolar disorder, depression, post-traumatic stress disorder or schizo-affective disorder, had vitamin D serum levels about 29 per cent lower than a group with no mental illness.

This story was found at: http://www.smh.com.au/articles/2008/10/07/1223145432802.html

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