Depression

Major depression is twice as likely to develop in post-stroke patients (approximately 20%) than in nonstroke patients of the same age.1 Other psychiatric symptoms that are also more common in post-stroke patients include minor depression, anxiety, anger, and inappropriate or excessive laughing or crying (emotional incontinence).2

Cumulative research with animal, normative, and clinical populations over several decades shows that the mechanisms underlying anxiety disorders differ from those of the normal emotion of anxiety. In persons with anxiety disorders, fear and tension are disproportionate to the actual threat and may be present when no real threat exists, thereby generating an expectation of danger and distorted perceptions related to danger and various types of threats. The most common anxiety disorders are social anxiety disorder (SAD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Persons with SAD can experience a wide range of social fears as well as severe functional consequences, whereas persons with GAD tend to experience emotional, interpersonal, and somatic symptoms of high levels of chronic anxiety. Persons with PTSD have vivid memories of and thoughts about a terrifying event or ordeal that lead to the development of anxiety, depression, and functional impairment. Effective treatment options-pharmacotherapy; psychotherapy, particularly cognitive-behavioral therapy; or a combination-can be discussed openly with the patient to make a collaborative, informed decision. A variety of medications can be used to successfully manage anxiety disorders, of which SSRIs and serotonin-norepinephrine reuptake inhibitors are the most effective. When properly used, medications can enhance a patient's own efforts to master anxiety; overcome fearful avoidance; and address troubling behaviors, patterns, or memories. (Drug Benefit Trends. 2008;20:101-113)

Depression was diagnosed 6 years earlier in a 37-year-old woman; it has been successfully managed since then with fluoxetine and outpatient psychotherapy. Since her teenage years, the patient has also experienced sporadic (fewer than 3 or 4 per year) mild or occasionally severe headaches, which she has usually self-treated with over-thecounter (OTC) agents or "just slept off."

An analysis of data from the National Comorbidity Survey, a nationally representative sample of persons aged 15 to 54 years (N = 8098), suggests that those who exercise regularly are less likely to report being depressed or having an anxiety disorder.1 The association between regular physical activity and lower prevalence of major depression (odds ratio [OR], 0.75) is fairly specific. Dysthymia, for example, was only minimally responsive to exercise, and there was no correlation between regular exercise and reduced risk of bipolar disorder. Psychotic disorders and substance abuse also were not substantially affected by regular physical activity. However, certain anxiety disorders, particularly panic attacks and phobias, were found to be less prevalent among self-reported exercisers.

The American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) renewed their 2004 call for a mandatory public clinical trial registry to be established and overseen by the federal government. This is in response to a study that showed that research on antidepressants is published selectively-effectively suppressing trials deemed negative and overstating the benefits of antidepressant therapy. The study was published in the January 17 issue of the New England Journal of Medicine.

Adherence is a complex behavioral process strongly influenced by environmental factors. Six posters designed to improve medication adherence were displayed in a medical clinic, with each poster displayed for 1 month. These posters were seen by clinic patients but, as passive measures, required no additional time on the part of clinicians. Medication adherence to antidepressant therapy was assessed for two 18-month periods. Days of therapy and median gap (the number of days a patient goes without medication before filling the next prescription) were similar between the periods. Medication possession ratio (MPR) was increased in the intervention period (0.974 vs 0.994 days). During the 6-month period that the adherence posters were displayed, persistence decreased by only 10% (versus 22% for the nonintervention period). Use of passive measures may improve patient medication adherence. In this prospective study, both the MPR and persistence were improved. (Drug Benefit Trends. 2008:20:17-24)

Premenopausal women with major depressive disorder (MDD) have less bone mineral density (BMD) than those without MDD, according to findings of a study published in the November 26 issue of Archives of Internal Medicine. Researchers reported that the level of bone loss in premenopausal women with MDD was at least as high as that associated with recognized risk factors for osteoporosis. The study was funded by the National Institute of Mental Health, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center for Complementary and Alternative Medicine, and the Warren Magnuson Clinical Center of the NIH.

An 81-year-old woman with a history of moderate Alzheimer dementia, depression, coronary artery disease, hypertension, and type 2 diabetes mellitus was accompanied to the office by her son for a routine follow-up appointment.

PITTSBURGH, Oct. 15 -- About 1% of bariatric surgery patients die within a year of surgery, researchers here found, and the cumulative case fatality rate approaches 6% after five years.

PITTSBURGH -- There is strong evidence suggesting -- but not proving -- the existence of a causal link between psychological stress and chronic conditions such as depression, cardiovascular disease, and HIV/AIDS, asserted researchers here.

INDIANAPOLIS -- Olanzapine (Zyprexa) labeling will be altered to include stronger warnings about weight gain, hyperlipidemia, and hyperglycemia, according to a statement from Lilly.

LONDON -- Stormy relationships may increase long term wear and tear on the heart physically as well as emotionally, leading to a modestly increased risk of coronary events.

SAN DIEGO -- Adolescents and teenagers with perinatally acquired HIV infection have high rates of neurologic, psychiatric, and cognitive problems that can confound attempts to treat them, investigators reported here.

BOSTON -- Panic attacks may be an independent risk factor for cardiovascular events in older women, researchers said.

DURHAM, N.C. -- The combination of fluoxetine (Prozac) and cognitive behavior therapy for depressed teens may accelerate treatment response and protect against suicidality.

For 2 weeks, a 31-year-old man has had a nonhealing, painful abscess on his left shoulder. A week before presentation, he sought treatment at a walk-in clinic; the abscess was incised and drained, and he was given gatifloxacin.

Here: a look at the many possible causes of poorly controlled blood glucose levels, and steps to overcome them.

OAKLAND, Calif. -- About one in seven women were depressed before, during, or after childbirth, according to a study of more than 4,300 women enrolled in the Kaiser Permanente health plan.

SALT LAKE CITY -- Forecasts that physician-assisted suicide and euthanasia would be practiced disproportionately on vulnerable groups, such as the poor, the elderly, and women, did not prove accurate, according to researchers here.

ANN ARBOR, Mich. -- The reason that opioids seem to fizzle for fibromyalgia may be because of reduced receptor activity in regions of the brain that process and dampen pain signals, researchers here found.

BETHESDA, Md. -- An aggressive workplace program for identifying and treating depression is both good medical practice and good business, investigators here said.

AMSTERDAM -- Type 2 diabetes may be linked to mental health disorders, but age and gender may be contributing factors, according to two separate studies.

EDINBURGH, Scotland -- Breathing diesel fumes during exercise, even for a brief period, promoted myocardial ischemia in men who've had a heart attack, researchers here reported.

BETHESDA, Md. -- Tamoxifen significantly decreased symptoms of acute mania beginning as early as five days in patients with bipolar disorder in a small pilot study.

GENEVA, Switzerland -- No individual chronic disease - not angina, not arthritis, not asthma, not diabetes -- is more disabling than depression, according to a World Health Organization study.

ATLANTA -- Suicide rates among children and young adults in the United States rose by 8% from 2003 to 2004, the largest increase in 15 years, CDC investigators reported.

MONTREAL -- Antidepressants that directly enhance serotonin signaling appear to have a much faster onset of action in animal models of depression than selective serotonin reuptake inhibitors (SSRIs), said investigators here.

MONTREAL -- Vivid dreams of babies in peril are common to pregnant women and newly delivered mothers, often inspiring wakefulness and a postpartum need to check on the infant.

Common eye diseases such as glaucoma, cataract, and age-related macular degeneration (ARMD) (Figure) can have significant systemic ramifications. Recent studies have found that these eye diseases may herald the onset of various types of physical and mental impairment, especially in elderly persons.

For 2 weeks, a 67-year-old obese woman has had episodes of diffuse, nonradiating abdominal pain that last for several hours and are slightly relieved by famotidine/antacid. She rates the pain as 7 on a scale of 1 to 10.