According to a report in the December issue of Archives of General Psychiatry, young adults with higher blood levels of lead appear to be more likely to also have major depression and panic disorders.
Maryse F. Bouchard, Ph.D., M.Sc., of the Université de Montreal, Canada, and Harvard School of Public Health and her colleagues examined data from 1,987 adults between the ages of 20 and 39 years who participated in the National Health and Nutrition Examination Survey between 1999 and 2004. The participants underwent a diagnostic interview to identify depression, panic disorder and generalized anxiety disorder. They also had a blood sample collected and analyzed for lead.
Bouchard's team found that the one-fifth of the participants with the highest levels of lead in their blood (2.11 micrograms per deciliter or more) had a 2.3 times greater chance of having major depressive disorder and nearly five times the risk of having panic disorder compared to those in the lowest one-fifth (0.7 micrograms per deciliter or less).
"These findings suggest that lead neurotoxicity may contribute to adverse mental health outcomes, even at levels generally considered to pose low or no risk," conclude the authors. "These findings, combined with recent reports of adverse behavioral outcomes in children with similarly low blood lead levels, should underscore the need for considering ways to further reduce environmental lead exposures."
Patients taking an antidepressant may experience changes in their personality separate from the alleviation of their depression, according to a report in the December issue of Archives of General Psychiatry.
In the background material provided in the article, the authors write that two personality traits - neuroticism and extraversion - have been related to depression risk. Those with depression tend to be more neurotic and less extraverted. People who are neurotic tend to experience negative emotions and emotional instability, while those who are extraverted tend to be socially outgoing and have a tendency to experience positive emotions. Both are traits which are believed to be linked to the brain's serotonin system.
Tony Z. Tang, Ph.D, of Northwestern University, and his colleagues studied the effects of one antidepressant in particular, paroxetine (Paxil), in a placebo-controlled trial involving 240 adult patients with major depressive disorder. Of these patients, 120 were randomly assigned to take paroxetine, 60 were given cognitive therapy and 60 received a placebo. Their personality traits and depression symptoms were checked before, during and after treatment.
All participants experienced an improvement in their depression symptoms, however, those taking paroxetine also experienced a significantly greater decrease in neuroticism and an increase in extraversion than the other two groups.
These findings seem to disprove a theory called the state effect hypothesis, say the authors. According to this theory, personality changes during treatment with an SSRI like paroxetine should occur only because of improved depression symptoms. These results seem to indicate that personality changes that occur are actually separate from this alleviation of depression symptoms.
"One possiblity," say the authors, "is that the biochemical properties of SSRIs directly produce real personality change. Furthermore, because neuroticism is an important risk factor that captures much of the genetic vulnerability for major depressive disorder, change in neuroticism (and in neurobiological factors underlying neuroticism) might have contributed to depression improvement."
While there is still much to learn about what causes depression and how antidepressants relieve it, examining how the personality traits of neuroticism and extraversion are affected by SSRIs may lead to "a more parsimonious understanding of the mechanisms of SSRIs," the authors conclude.
According to Sanofi-Aventis, maker of the antidepressant desipramine (Norpramin), a new warning have been added to the drug's label indicating that the drug may be potentially lethal in patients with a family history of certain heart conditions. In addition, new language regarding overdosage has been added.The drug maker has issued a "Dear Healthcare Provider" letter describing these new changes in labeling, although no explanation has been given as to what prompted the changes.
The letter urges doctors to use extreme caution in prescribing desipramine to patients with a familial history of sudden death, cardiac dysrhythmias and cardiac conduction disturbances. It also notes that seizures may occur prior to cardiac dysrhythmias and death.
Regarding overdose, the label now includes additional information about signs of and treatment of overdose.
The full letter is available through the FDA's website.
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