Friday March 19, 2010
According to a systematic review conducted by British scientists, antidepressants can help with depression associated with certain physical illnesses and should be prescribed more often by physicians for these conditions.
The researchers analyzed 51 studies on various antidepresants versus placebos. Most of the studies looked at selective serotonin reuptake inhibitors (e.g. Paxil) or tricyclic antidepressants (e.g. Norpramin). Around 3600 patients were involved.
The study found that the drugs were more effective than placebos at treating depression in patients with physical illnesses, including stroke, HIV/AIDS, Parkinson's disease and certain types of cancer.
"This research is important for millions of patients and families who are experiencing physical illness, " said Irene Higginson of the Cicely Saunders Institute at King's College London who worked on the study. "Until now many doctors and nurses were worried that these treatments did not work well in people with physical illness. This result shows that they are usually of benefit. "
The review appears in The Cochrane Library, which is published by The Cochrane Collaboration, an international organization that evaluates the current body of medical research on particular topics and draws conclusions about medical practice based upon that research.
Wednesday March 17, 2010
More and more doctors are prescribing multiple psychiatric drugs to their patients, including combinations with unknown efficacy and side effects, according to a new study.
Researchers from the department of psychiatry at Johns Hopkins University and New York State Psychiatric Institute studied physicians' prescribing patterns, beginning in 1996, looking at a range of medicines including antidepressants, antipsychotics, mood stabilizers and sedatives.
The study authors found that antidepressants were the most commonly prescribed medications, while the most common combinations were antidepressants combined with either another antidepressant, a sedative or a mood stabilizer.
During the study period, the number of office visits where two or more drugs were prescribed jumped from about 43% to 60%, a "substantial increase" according to the authors.
Insured women aged 45 to 64 years old and on a repeat office visit were the most likely to get two or more prescriptions. Patients with major depression, bipolar disorder, anxiety disorders or schizophrenia were also likely to receive multiple prescriptions. In addition, patients with more than one diagnosis were likely to be given multiple prescriptions.
The study found that the increase in the number of drugs prescribed was not due to an increase in the number of people with mental illness, but rather was accounted for by a change in how psychiatry is practiced.
The authors expressed concern about the trend, citing studies where some drug combinations have been found to increase side effects, such as weight gain and increased cholesterol levels.
The study appears in the Archives of General Psychiatry
Tuesday March 16, 2010
A combination of sertraline (Zoloft) plus naltrexone may help depressed alcoholics stop drinking better than either treatment alone, says a new study.
In a 14-week study of 170 patients, University of Pennsylvania researchers found that 54% of the patients who received the combination treatment were able to stop drinking, compared to 21-28% of those who received placebo, Zoloft only or naltrexone only.
Those who received the combination treatment also were able to go longer without a relapse (61 days vs. 15 days)
"When depression and alcohol dependence occur together," wrote the researchers, "each condition has a negative influence on the outcome of the other, so not only does this pairing of illnesses affect a lot of patients, it also makes the individual disorders worse. Combining sertraline and naltrexone could be a practical approach for these patients because both have (U.S. Food and Drug Administration) approval.
The study appears in the March 15 issue of The American Journal of Psychiatry.
Monday March 15, 2010
While many look forward to Daylight Saving Time and having more light at the end of the day, others, especially those with seasonal affective disorder (SAD), may find themselves slipping back into depression at this time of year.
SAD, according to experts, is caused by a disturbance in our circadian rhythm. Light entering into the eye controls this rhythm; but, during the winter months when days are shorter we may not be exposed to sufficient light during the morning hours, throwing our circadian rhythm off-balance and creating the symptoms of SAD (depression, fatigue and a craving for sweets).
For those with SAD, the longer days of spring bring relief from depression. The arrival of Daylight Saving Time, however, may cause a temporary return of these symptoms as you are forced to once again wake when it is still dark and may not receive adequate exposure to morning light.
The best treatment for SAD? According to SAD researcher Dr. Michael Terman bright light therapy has the best data supporting it. Bright light therapy involves sitting in front of a device designed for this purpose called a light box for about 30 minutes each morning to simulate the light you would normally get by being outside in sunlight.
Do you fall into a season long slump each winter that lifts as spring approaches? Speak with your doctor about the possibility that you may be experiencing seasonal affective disorder.
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