by — Robert Preidt
(HealthDay News)

THURSDAY, May 22 (HealthDay News) - Workers and volunteers involved in recovery efforts at the World Trade Center following the 9/11 terrorist attacks have much higher levels of psychological distress than the general population, new research shows.

NEW YORK (Reuters Health) - The results of a study in the current issue of the journal Stroke suggest that there is an association between depression and an increased risk of having a first stroke in elderly patients.

New data from a study of patients with treatment-resistant depression who underwent deep brain stimulation (DBS) in the subcallosal cingulate region (SCG or Cg25) of the brain shows that this intervention is generally safe and provides significant improvement in patients as early as one month after treatment. The patients also experienced continued and sustained improvement over time.

The study, led by Helen S. Mayberg MD, and collaborators neurosurgeon Andres Lozano, MD, PhD, and psychiatrist Sidney Kennedy MD, is reported in Biological Psychiatry. This clinical trial is the culmination of Mayberg's 20 years of research using brain imaging technology that has worked to characterize functional brain abnormalities in major depression and to identify the mechanisms of various antidepressant treatments.

A report on the first six patients in the study was published in the Journal Neuron in 2005. The new paper reports on an expanded sample of patients and an extended period of clinical follow-up.

Deep brain stimulation uses high-frequency electrical stimulation targeted to the specific areas of the brain involved in neuropsychiatric disease. Twenty patients received deep brain stimulation of the SCG region for 12 months. Twelve of 20 patients experienced a significant decrease in depressive symptoms (defined by a 50 percent decrease in the Hamilton Depression rating scale) by six months, with seven patients essentially well with few remaining symptoms (remission, defined as a Hamilton Depression Rating Scale score <8). Benefits were largely maintained at 12 months with continued stimulation. No long-term side effects were reported.

Each study patient was implanted with two thin wire electrodes (one on each side of the brain) in the white matter adjacent to SCG. The other end of each wire was connected under the skin of the neck to a pulse generator implanted in the chest — similar to a pacemaker — that directs the electrical current. The researchers regulated the intensity of the current according to the response of the patient. Only patients who were unable to get better with most other types of antidepressant treatment — including medication, psychotherapy and electroconvulsive therapy — were included in the study.

"In previous studies using brain imaging, we found the subcallosal cingulate region was a key region in an emerging emotion regulation circuit implicated in major depression," explains Mayberg.

"We postulated that if stimulation worked for the treatment of other neurological disorders where abnormal function of specific circuits was well established, such as Parkinson's disease, then stimulation of the Cg25 region within this apparent depression circuit might provide significant benefit for patients with treatment-resistant depression."

The researchers were able to track the clinical response of the patients over a 12-month period using standard depression rating scales as well as various quantitative measures of behavior and general functioning, neuropsychological testing and scanning of both regional brain blood flow and glucose metabolism using positron emission tomography (PET).

PET imaging of these patients demonstrated that metabolic activity changed locally at the site of stimulation but also throughout the previously identified depression network, providing evidence that modulating the circuit and not just a single region was likely responsible for the antidepressant effects. "We see depression as a complex disturbance of the specific circuits in the brain responsible for regulating mood and emotions," Mayberg says. "We hypothesized that if deep brain stimulation could locally modulate a critical central location within this mood circuit, such modulation would result in clinical improvement — and it appears it does."

Mayberg initiated an expanded version of her Toronto study at Emory in 2007 with psychiatrist Paul Holtzheimer, MD, and neurosurgeon Robert Gross, MD, PhD. The clinical trial is tackling a number of unanswered issues including the testing of patients with bipolar II depression and refinement of the targeting and selection of the electrodes using new imaging techniques. The study will enroll 20 patients and will be conducted over a period of at least three years.

The Emory study is support by grants from the Woodruff Fund, The Stanley Medical Research Institute and the Dana Foundation. The Toronto study was funded in part by a Distinguished Investigator Award from National Alliance for Research in Schizophrenia and Depression (HSM).

Declaration of interests: Dr Mayberg is an inventor on patents covering the technology discussed in this article. Dr Mayberg is also a paid consultant for ANS, which has licensed the technologies. Dr Holzheimer is also a paid consultant for ANS. These relationships have been reviewed and approved by Emory University in compliance with its policies on conflicts of interest.

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Lozano AM, Mayberg HS, Giacobbe P, et al. Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression. Biol Psychiatry. 2008 Jul; doi:10.1016/j.biopsych.2008.05.034   [Abstract]

Patients with accident or trauma related chronic pain often have post-traumatic stress disorder (PTSD) and depression. What isn't clearly, however, is how PTSD relates to mood disorders and pain severity in chronic pain patients.

To find out University of Michigan researchers examined the contribution of PTSD to the pain experience, functional disability and frequency of depressive symptoms. They studied 241 patients referred to the university hospital's pain rehabilitation program who reported their pain began after a traumatic injury. The subjects completed the McGill Pain Questionnaire and were administered the Pain Disability Index and the Post-traumatic Chronic Pain Test.

Results showed PTSD and depression are significantly correlated and both disorders are associated with perceived disability attributed to chronic pain. Therefore, in cases of disabling accident-related chronic pain with comorbid depression, symptoms of PTSD may be critical to understanding both disorders.

The authors concluded that increased attention to treating PTSD as a primary focus in the rehabilitation of patients with chronic pain and comorbid depression is important when prior treatment efforts for pain and depression have not been successful.

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Roth RS, Geisser ME, Bates RB. The Relation of Post-traumatic Stress Symptoms to Depression and Pain in Patients with Accident-related Chronic Pain J Pain. 2008 Jul;9(7):588-96.   [Abstract]

Millions of people with mental illness are unable to do everyday things like going shopping, making new friends or applying for jobs, according to a survey conducted by the British mental health charity Rethink.

The survey of more than 3,000 people with mental disorders reveals that this includes people you expect to love you unconditionally, your family, (36%), closely followed by employers (35%), neighbors (31%), friends (25%) and family doctors (23%).

At the other end of the discriminators' league table, children (5%), teachers (8%), retailers (10%), and public transport workers (10%) are revealed as the groups who are most accepting of people with mental health problems.

The findings, which will shape a high-profile £18 million mental health anti-stigma campaign, reveal that:

• Nearly nine out of 10 people with mental health problems have been affected by stigma and discrimination, with two thirds saying they have stopped doing things because of the stigma they face. Stigma stops people with mental health problems from doing everyday things such as applying for jobs, making new friends, and going out to pubs and shops. It can even prevent people from reporting a crime.



• People with mental health problems want the anti-stigma campaign to target schools and the media to change attitudes and reduce prejudice.



• Carers of people with mental health problems also stop doing things because of the stigma and discrimination that they face.

Paul Corry, Rethink's director of public affairs, says: "Our research clearly shows that stigma and discrimination are ruining people's lives. People with mental health problems have enough on their plates without facing additional pressure caused by other people's archaic and bigoted opinions.

Janey Antoniou, who has schizophrenia, recalls one example of the stigma she encountered: "I had a neighbor who used to run inside when she saw me because she had once seen me taken to the hospital by the police in my dressing gown. The fact that I'd walked down the road with a briefcase thousands of times seemed irrelevant."

"The Moving People anti-stigma campaign will lay firm foundations for ending mental health discrimination in the UK, but long term it is essential that the government ploughs hefty resources into tackling the problem, as has been done in Scotland and New Zealand. As an employer, the government could also lead by example and employ more people with mental health problems within its departments, and encourage other public sector bodies to do the same," said Mr Corry.

The 'Moving People' anti-stigma campaign will be launched in January 2009 with funding from the Big Lottery Fund and Comic Relief and will be evaluated by the Institute of Psychiatry at King's College, London.

Full survey results/additional information... ()