Depression linked to preemies. Why?

November 4, 2008

Depression symptoms early in pregnancy foreshadow preterm delivery

Among nearly 800 pregnant women in a study from California’s Kaiser Permanente program, those who experienced depressive symptoms early in their pregnancies were more likely to deliver preterm babies. The report is published early online in the journal Human Reproduction.

The likelihood of preterm delivery was exacerbated by:

* obesity
* lower education levels and
* a history of fertility problems

This echoes a smaller prospective study published last year. UCLA researchers found the same phenomenon, but they linked it to the medication rather than to the symptoms.

Enter “pregnancy depression” in the search box, and scroll down the page. You’ll see another new study in the American Journal of Psychiatry suggesting that this is fundamentally a circadian rhythm problem, which might be solved by a benign strategy: light therapy.

Psychiatric Times

Which antidepressants are safest in pregnancy? Find the answer in a recent review in Psychiatric Times by clicking on the dedicated link in the left column that searches this publication only.

Complementary Medicine

How about starting with the alternative remedy St. John’s wort? A search on “St. John’s wort pregnancy” in this category reveals that the herbal treatment for depression may not be innocuous to the fetus

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Can MRI tingle the blues away?

October 28, 2008

Transcranial magnetic stimulation approved for major depression

The FDA has reversed itself and has approved transcranial magnetic stimulation (TMS) for major depressive disorder after a first medication trial has failed. The device delivers MRI-like pulses to the brain.

A new randomized trial of 164 patients showed significant symptom improvement compared with placebo. The device will be available only at a few centers for now. It is approved only as a second-line treatment for this one indication, although it has been tested for many.

Earlier studies showed TMS to be less effective than ECT for depression, but also less invasive.

Research/Reviews

What is TMS exactly, and what has it been used for? A timely set of reviews appeared in the Canadian Journal of Psychiatry only last month.

Patient Education

Look in this category for reliable take-home information for patients who may ask about the therapeutic option.

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New cardiac test for primary care: Depression screening

October 14, 2008

AHA, APA advise depression screening for all with coronary heart disease

People who have coronary heart disease should all be screened for depression, the American Heart Association and the American Psychiatric Association advise in new recommendations published in Circulation.

The report offers substantial information about links between heart disease and depression. Using SearchMedica, you can quickly locate many of the supporting documents listed in the references.

Recent evidence suggests that young women may be at particularly high risk of depression after myocardial infarction.

Numerous studies link depression and depressive symptoms with poor outcomes in patients with coronary heart disease. Find them using the query “depression cardiac risk factor”.

Or you can retrieve a particular study in the reference list by using words from the title as your search term.

Depression and anxiety predict onset of cardiac events, according to a recent report in the Archives of General Psychiatry, located with the search term “depression anxiety predictors 2-year cardiac events”.

An earlier article in the same journal pinpointed a direct link between depression and the onset of coronary events.

There’s plenty of evidence that people with depression have poor adherence to treatment for cardiac conditions.

On the other hand, cardiac rehabilitation improves depression.

So, primary care physicians should be looking for, and probably treating, depression in heart patients.

Which screening instruments should they use?

Way back in 2000, the New England Journal published an article identifying ways to manage depression in outpatient practice.

In this case, even using its exact title (”Managing depression in medical outpatients”), that article appears far down the list, on page 3.

That’s not good! Why isn’t it at the top of the list?

(Because the article is so old, and SearchMedica’s default setting ranks newest articles highest.)

Try de-selecting the option “Prioritize results by publication date” just beneath the search box, making relevance to your search term rank higher than publication date. The eight-year-old article appears at the top of the list.

Practice Guidelines

Find a new guideline for treatment of depression in adults in primary care using this article category.

CME

Find a new CME course about treating depression in primary care, from an authoritative source.

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Intensive psychotherapy validated (while vanishing)

October 14, 2008

Long-term psychodynamic therapy proves best for some disorders

It must be a challenge to do even one randomized controlled trial of long-term psychotherapy. But German researchers found 11 of them published since 1960, added 12 observational studies, and carried out a meta-analysis which appears in the October 1 edition of the Journal of the American Medical Association.

Psychodynamic psychotherapy continued for at least a year was better than other treatments for

* complex depression or anxiety
* personality disorders, and
* chronic and multiple psychiatric disorders

Only 8 of the trials had sufficient power to be authoritative. And a lack of randomization prevented firm conclusions about whether adding medication to long-term therapy improves the outcomee.

Despite its flaws, a companion editorial asked, does the meta-analysis satisfy the demand for evidence of long-term therapy’s efficacy? Its assessment was a “qualified yes”.

The editorial points out that psychotherapy actually produces changes in brain structure and function, according to the results of recent research.

Evidence that the most challenging of patients can respond to intensive therapy comes at a time when ever fewer psychiatrists offer psychotherapy.

Evidence-based Articles

Use this article category to find rigorous evidence about the effects of long-term psychodynamic psychotherapy.

Psychiatric Times

Last month’s edition of Psychiatric Times featured a review of the effects of psychotherapy on brain function.

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Sunshine is an antidepressant

September 30, 2008

New data explain why winter causes blues and summer lightens the mood

The amount of circulating serotonin available to the brain correlates with number of daylight hours, which should help to explain why people get the blues during the winter months.

This information comes from a new study that used improved biological methods to test healthy volunteers with no history of depression.

Daylight correlated with a reduction in regional serotonin transporter binding potential, which is related to the amount of serotonin available to the brain. Levels were higher in fall and winter for all volunteers, meaning that more serotonin was bound to the transporter and unavailable.

Then what about the evidence that suicides are most common in the spring, when there’s more daylight? A good question for further research, the authors say.

Maybe it has something to do with the sudden shift in serotonin transporter levels, or with differences in brain regionalization as they change.

Life events also affect levels of this molecule, according to previous studies.

Depression also correlates with time of sunrise, according to a 2003 study from Quebec. The author suggested manipulating daylight savings time with this in mind.

Clinical Trials

The relationship between light and depression is the subject of numerous clinical trials now underway.

Related searches

melatonin seasonal depression

light therapy SAD

photoperiod depression

Seasonal Pattern Assessment Questionnaire

Seasonal Health Questionnaire SAD

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Don’t blame her mood on her condition

July 22, 2008

New underserved population in psychiatry: Moms-to-be

Pregnancy per se is not associated with new or recurrent Axis I mental disorders, according to the first nationally representative sampling to address the question by comparing pregnant and non-pregnant women. And in general, pregnant women are less likely to abuse drugs or alcohol.

The exception was major depressive disorder, which was more prevalent among women who had given birth within the past year. (The study did not assess psychotic disorders.)

Pregnant women who did have psychiatric disorders were significantly less likely than other women to seek professional help (perhaps in part fearing medication risks to the fetus). The report in Archives of General Psychiatry suggests looking into barriers to care for this population group.

Related searches

pregnancy psychosis

psychopharmacology pregnancy risks fetus

Evidence-based Articles

Are there any proven non-drug interventions for postpartum depression?

Clinical Trials

What’s being tested now in clinical trials of postpartum depression?

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For resistant depression: Rewire brain

July 8, 2008

Deep brain stimulation shows promise for treatment-resistant depression

Deep brain stimulation (DBS) is back in the news, after an Emory University speaker reviewed evidence for its efficacy in treatment-resistant depression at the APA meeting. Patients remain awake during the procedure, and some report an immediate lift.

The FDA has approved DBS for Parkinsonism and then for tremor caused by a number of neurologic disorders.

Investigators are trying the procedure on a host of other illnesses, and more headlines are sure to appear.

Related searches

Helen Mayberg (the speaker at APA)

Brodmann area 25 (the affected cortical region).

Evidence-based Articles

Ponder this: A recent meta-analysis by Johns Hopkins researchers finds a “high rate of suicide” among Parkinson’s patients treated with DBS.
You have the option to purchase full text by clicking the link “View Medline

Clinical Trials

You can learn from information about clinical trials where the procedure is being tested.

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One in five Iraq vets has hidden combat wounds

April 29, 2008

New surveys count psychological toll on returning veterans — and treatment shortfall

Echoing recent results from a survey by the U.S. Army, a new report from the RAND Center for Military Health Policy Research finds that one in five veterans returning from Iraq or Afghanistan suffer from post-traumatic stress disorder, major depression, traumatic brain injury, or a
combination of these conditions.

Only about half seek treatment (fearing stigma), and only half of those get “minimally adequate”
care, according to RAND. (Many prefer to get their medical care “on the economy”.)

The Department of Veterans Affairs has set up a telephone hotline to prevent suicide among recent veterans.

A recent top-level review maintains that treatments for the mental health problems of returning veterans are not backed by solid research.

A new patient urgently needs help. You urgently need authoritative guidance. You can turn to SearchMedica.

Practical Articles/News
How have others been treating PTSD among new veterans?treating PSD among Iraq war veterans?

Clinical Trials
Two new clinical trials are testing exposure therapy for Iraq war veterans with PTSD.

Related searches

PTSD

depression

TBI

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Parkinson relatives shown at high risk of anxiety, depression

January 17, 2008

The risk of anxiety and depression are increased among first-degree relatives of people with Parkinson’s disease. The evidence comes from a huge medical-records database affiliated with the Mayo Clinic.

Is this part of the Parkinson’s spectrum due to genes or to the situation? An epidemiological report like this one in Archives of General Psychiatry can say nothing about the relative contributions of heredity and environment.

Only last October the same group reported increased risk of cognitive impairment and dementia in close relatives of Parkinson’s patients.

Studies about the burden on Parkinson’s caregivers give solid reason to suspect that environment may contribute to mood disorders in the spouse.

Now you’ve learned a little something. Look beyond the main search results to the specific article categories, and know a lot more.

Clinical Trials for Patients
Perhaps entering a clinical trial on the subject might give families a fresh perspective on their situation.

Evidence Based Articles and Meta-Analyses
What are the most effective ways to address the stress on a relative who acts as a caregiver?

Practical Articles & News
What insights can you gain from articles by colleagues who found ways to help these families cope?

No Comments » | Depression, Nervous System, Parkinson | Tagged: , , , | Permalink
Posted by Cranky Aged Mama