Wednesday January 25, 2012
The American Psychiatric Association is in the process of revising its Diagnostic and Statistical Manual of Mental Disorders (DSM) , a handbook used by clinicians when making diagnoses of conditions such as depression, and some believe it may be going too far.
A new report by researchers at Columbia and New York universities argues that the newly proposed definition of depression, which includes grief after the loss of a loved one under the umbrella of depression, is opening the door for false-positive diagnosis of depression and the unnecessary treatment of people who are simply going through the normal process of grieving.
Other experts, however, argue that clinical depression can and often does occur as a result of grief. These proponents of the proposed changes feel that changing the criteria for a depression diagnosis will aid these people in getting the help that they need.
The 5th edition of the DSM, which is the first major update the manual has undergone since 1994, is due to be published in May 2013.
If you would like to learn more about the proposed changes, please visit http://www.dsm5.org/.
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Saturday January 21, 2012
Nursing home patients with dementia who were taking a class of antidepressants called serotonin reuptake inhibitors - which includes such drugs as Prozac, Paxil, Lexapro, Zoloft and Celexa - were three times more likely to experience a fall than other dementia patients, according to a new study out of the Netherlands.
Falls are a problem for patients with dementia, said the study authors, because about one-third of these falls will result in an injury.
The effect of SSRIs was examined because depression is very common in dementia patients and SSRIs are the most commonly prescribed antidepressant type in this population.
Lead author Carolyn Shanty Sterke and her team found that the increased risk for falls was present even at low doses and increased proportionately as the dose rose.
Concurrent use of antidepressants with certain other drugs, such as hyponotics or sedatives, increased the risk even more.
Sterke says that doctors should be careful about prescribing SSRIs to older patients with dementia and suggests that they should develop new treatment protocols that take into account the risk of falls.
The study was published online in the British Journal of Clinical Pharmacology on January 18, 2012.
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Monday January 9, 2012
According to a study conducted by UT Southwestern Medical Center psychiatrists, low levels of vitamin D have been linked with depression.
When the researchers looked at the results gathered from 12,600 participants in the Cooper Center Longitudinal Study between 2006 and 2010, they found that low levels of vitamin D were associated with depressive symptoms, especially in those with a history of depression. High vitamin D levels, however, were associated with a significantly decreased risk for current depression.
The study did not attempt to assess whether vitamin D supplementation would reduce depression symptoms.
Nor is it known exactly what the relationship is between vitamin D and depression. It could be that low vitamin D levels trigger depression or that depression in some way lowers vitamin D levels.
"Our findings suggest that screening for vitamin D levels in depressed patients - and perhaps screening for depression in people with low vitamin D levels - might be useful," said senior author Dr. E. Sherwood Brown, "but we don't have enough information yet to recommend going out and taking supplements."
Vitamin D is a fat-soluble vitamin that is produced by natural processes within the body when ultraviolet radiation from the sun hits the skin. It can be obtained in the diet by eating foods such as cod liver oil, salmon, mackerel, tuna, sardines and vitamin D fortified milk. The current recommended dietary allowance for vitamin D is 600 IU for persons between the ages of one and 70.
The study was published in Mayo Clinic Proceedings.
Monday January 9, 2012
According to a study out of Rutgers University, significant differences exist in the diagnosis and treatment of depression in older patients, with the differences being divided along racial and ethnic lines.
In particular, the researchers found that African Americans were less likely to be diagnosed with depression than their non-Hispanic white counterparts. And, when they were diagnosed, they were less likely to receive treatment.
Lead author Ayse Akincigil, an assistant professor in Rutgers' School of Social Work, and her team gathered data for the study from the U.S. Medicare Current Beneficiary Survey, 2001-2005, looking at 33,708 Medicare beneficiaries. When they examined rates of depression diagnosis, they found that 7.2% of Hispanics, 6.4% of non-Hispanic whites, 4.2% of African Americans and 3.8% of all others had received a depression diagnosis.
Hispanics and African Americans, however, were less likely to receive treatment for their depression.
Akincigil suggests that these differences may arise because of cultural differences in how various racial or ethnic groups seek help. For example, she says that African Americans may be more likely to turn to a pastor or lay counselor for support. They may also feel more stigma or shame associated with depression or turn to more dysfunctional means of coping with the illness due to income restraints.
Akincigil also notes that whites tend to have higher incomes and live in neighborhoods where mental health professionals are more likely to be located, possibly making it easier for them to access professional care.
Due to the diverse makeup of the Hispanic community, it is more difficult to draw conclusions about why they might be undertreated.
The study authors suggest that ethnic minorities could be better served if universal depression screening and access to treatment for low-income and minority neighborhoods was ensured. Increased reimbursement of case management services for depression treatment might also be helpful, they add.
The study appears online ahead of print on the American Journal of Public Health website. It will appear in print February 2012.
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