By Nick Triggle
Health reporter, BBC News

Employers need to pay more attention to the levels of stress and anxiety in the workplace, key NHS advisers say.

The National Institute for Health and Clinical Excellence said the cost of work related mental illness was £28bn - a quarter of the UK's total sick bill.

Pham X, Sun C, Chen X, van den Oord EJ, Neale MC, Kendler KS, Hettema JM.

Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia; Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia; Department of Pharmacy, Center for Biomarker Research and Personalized Medicine, Virginia Commonwealth University, Richmond, Virginia

Background: Human anxiety disorders are complex diseases with relatively unknown etiology. Dysfunction of the Gamma-aminobutyric acid (GABA) system has been implicated in many neuropsychiatric conditions, including anxiety and depressive disorders. In this investigation, we explored four GABA receptor genes for their possible associations with genetic risk for anxiety disorders and depression.

Methods: Our study sample consisted of 589 cases and 539 controls selected from a large population-based twin registry based upon a latent genetic risk factor shared by several anxiety disorders, major depression, and neuroticism. We subjected these to a two-stage protocol, in which all candidate genetic markers were screened for association in stage 1 (N=376), the positive results of which were tested for replication in stage 2 (N=752). We analyzed data from 26 single nucleotide polymorphisms (SNPs) from four GABA receptor genes: GABRA2, GABRA3, GABRA6, and GABRG2.

Results: Of the 26 SNPs genotyped in stage 1, we identified two markers in GABRA3 that met the threshold (P.1) to be tested in stage 2. Phenotypic associations of these two markers failed to replicate in stage 2.

Conclusions: These findings suggest that common variation in the GABRA2, GABRA3, GABRA6, and GABRG2 genes does not play a major role in liability to anxiety spectrum disorders.

(Text has been reformatted for online visual clarity, links added; ed.)

Rachel Feldman - University of Haifa

Use of cannabinoids, the active chemicals in cannabis (marijuana), could assist in the treatment of post-traumatic stress disorder patients according to a recent study published in the Journal of Neuroscience.

In most cases, the result of experiencing a traumatic event - a car accident or terror attack - is the appearance of medical and psychological symptoms that affect various functions, but which pass. However, some 10%-30% of people who experience a traumatic event develop post-traumatic stress disorder, a condition in which the patient continues to suffer stress symptoms for months and even years after the traumatic event. Symptoms include reawakened trauma, avoidance of anything that could recall the trauma, and psychological and physiological disturbances. One of the problems in the course of treating trauma patients is that a person is frequently exposed to additional stress, which hinders the patient in overcoming the trauma.

The present study, conducted by Dr Akirav and research student Eti Ganon-Elazar of the Learning and Memory Lab at the University of Haifa's Department of Psychology, aimed to examine the efficiency of cannabinoids as a medical treatment for coping with post-traumatic stress. The researchers used a synthetic form of marijuana, which has similar properties to the natural plant, and they chose to use a rat model, which presents similar physiological responses to stress to that of humans.

The first stage of the research examined how long it took for the rats to overcome a traumatic experience, without any intervention. A cell colored white on one side and black on the other was prepared. The rats were placed in the white area, and as soon as they moved over to the black area, which they prefer, they received a light electric shock. Each day they were brought to the cell and placed back in the white area. Immediately following exposure to the traumatic experience, the rats would not move to the black area voluntarily, but a few days later after not receiving further electric shocks in the black area, they learned that it is safe again and moved there without hesitation.

Next, the researchers introduced an element of stress. A second group of rats were placed on a small, elevated platform after receiving the electric shock, which added stress to the traumatic experience. These rats abstained from returning to the black area in the cell for much longer, which shows that the exposure to additional stress does indeed hinder the process of overcoming trauma.

The third stage of the research examined yet another group of rats. These were exposed to the traumatic and additional stress events, but just before being elevated on the platform received an injection of synthetic cannabinoids in the amygdala area of the brain - a specific area known to be connected to emotive memory. These rats agreed to enter the black area after the same amount of time as the first group - showing that the cannabinoids cancelled out the symptoms of stress. Refining the results of this study, the researchers then administered synthetic cannabinoids injections at different points in time to additional groups of rats, and found that regardless of when exactly the injection was administered, it prevented the surfacing of stress symptoms.

Dr Akirav and Ganon-Elazar also examined hormonal changes in the course of the experiment and found that the synthetic cannabinoids prevent increased release of the stress hormone that the body produces in response to stress.

According to Dr Akirav, the results of this study show that cannabinoids can play an important role in stress-related disorders. "The results of our research should encourage psychiatric investigation into the use of cannabinoids in post-traumatic stress patients," she concludes.

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Ganon-Elazar E, Akirav I. Cannabinoid receptor activation in the basolateral amygdala blocks the effects of stress on the conditioning and extinction of inhibitory avoidance. J Neurosci. 2009 Sep 9;29(36):11078-88   [Abstract]

Jared Wadley - University of Michigan

The elderly are less likely to feel depressed if their relatives keep them updated about important family matters, according to a new study in the journal Research on Aging.

Researchers at the University of Michigan and Kyungpook National University looked at how stress and depression affected elders over age 85. Changes in positive life events-such as a new baby in the family, a personal achievement by a relative, or improvement in a family member's health-were significantly associated with changes in depression.

"It is important to examine the issues of stress and depression among elders over the age of 85 as they are the fastest growing age group," said Ruth Dunkle, a U-M professor of social work. "Understanding mental health issues among the very old, allows us to design services targeted to help this specific age group."

Elders aged 85 and older are more vulnerable to stress and depression than any other age groups, as they lose relationships with family and friends.

The new study used responses from 193 elderly people living in the Midwest. Interviews were conducted in four sessions, starting in 1986. They rated their depression, daily hassles, positive and negative life events, and psychosocial resources.

Examples of negative life events include hearing loss, death of a friend, relative or pet, major illness or loss of favorite object. These life events, however, were not significantly associated with depression.

The study also included responses regarding the participants' feelings about daily hassles, such as declining health, forgetting things, too much time on hands, not enough energy and inner conflict.

"Ongoing daily hassles are persistent annoyances that could have cumulative effects leading to an increase in depressive symptoms," said Dunkle, co-director of the National Institute of Aging (NIA) training program in Social Research on Applied Issues of Aging and the Geriatric Fellowship Program.

Among these very old people, these researchers found that issues of stress and depression vary over time. Many elders who displayed faster increase in a sense of command-or mastery-resulted in slower increase in depression than those with a slower increase in sense of mastery.

The authors noted several limitations to their findings, including the respondents did not live in institutional or assisted living communities. People who live in the community are more likely to function better than their institutional counterparts.

Dunkle conducted the study with lead author Hae-Sook Jeon, a lecturer in the Department of Social Welfare at Kyungpook National University, South Korea.

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Jeon HS, Dunkle RE. Stress and Depression Among the Oldest-Old: A Longitudinal Analysis. Res. Aging 2009 Nov;31:661-687   [Abstract]

By Reuters

NEW YORK (Reuters Health) - Longer-term treatment of depression for adolescents is associated with persistent benefits, even after treatment ends, according to results of the Treatment for Adolescents with Depression Study (TADS).

Deutsch SI, Rosse RB.

Department of Psychiatry, Eastern Virginia Medical School; Georgetown University School of Medicine

When the authors were in their residencies 30 years ago, the academic discipline of psychiatry was often presented in a dualistic or dichotomized fashion. A notion prevailed that there were "psychological problems" for which psychotherapeutic/psychological interventions were best, and "biological" problems for which medications and other organic therapies, such as ECT, were best.

Fortunately, these are now antiquated notions. We know now that psychotherapeutic and behavioral interventions can cause changes in neurons and neuronal networks and influence gene expression in neurons.

Kocsis JH, Gelenberg AJ, Rothbaum BO, Klein DN, Trivedi MH, Manber R, Keller MB, Leon AC, Wisniewski SR, Arnow BA, Markowitz JC, Thase ME, for the REVAMP Investigators

Context: Previous studies have found that few chronically depressed patients remit with antidepressant medications alone.

Objective: To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial.

Design: This trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone.

Setting: Eight academic sites.

Participants: Chronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years.

Interventions: Phase 1 consisted of open-label, algorithm-guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs).

Main Outcome Measures: Proportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores.

Results: In all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 received MEDS only). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores.

Conclusions: Although 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing.