Emily Smith

As childhood obesity rates continue to increase, experts agree that more information is needed about the implications of being overweight as a step toward reversing current trends.

Now, a new University of Missouri study, published in the journal Applied Developmental Science, has found that overweight children, especially girls, show signs of the negative consequences of being overweight as early as kindergarten.

"We found that both boys and girls who were overweight from kindergarten through third grade displayed more depression, anxiety and loneliness than kids who were never overweight, and those negative feelings worsened over time," said Sara Gable, associate professor of human development and family studies in the MU College of Human Environmental Sciences. "Overweight is widely considered a stigmatizing condition and overweight individuals are typically blamed for their situation. The experience of being stigmatized often leads to negative feelings, even in children."

MU researchers used the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K) to examine the social and behavioral development of 8,000 school-age children from kindergarten entry through third grade. The researchers evaluated factors that have not been studied previously: age at becoming overweight and length of time being overweight.

"Girls who were consistently overweight, from kindergarten through third grade, and girls who were approaching being overweight were viewed less favorably than girls who were never overweight," said Gable, an MU State Extension Specialist. "Teachers reported that these girls had less positive social relations and displayed less self-control and more acting out than never-overweight girls."

The results indicate that larger than average children, especially girls, experience social and behavioral challenges before they reach the 95th percentile of the Body Mass Index and are classified as being overweight. More research is needed to develop alternative approaches for categorizing children's weight and creating effective intervention programs, Gable said.

"Most appearance-based social pressure likely originates in the eye of the beholder," Gable said. "Therefore, intervention and prevention efforts should be designed for everyone. All kids should learn what constitutes a healthy weight and healthy lifestyle."

MU researchers will continue to use the ECLS-K to study the implications of being overweight for children's development.

The study was funded by the United States Department of Agriculture, Food Assistance and Nutrition Research Programs.

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Sara Gable S, Krull JL, Chang Y. Implications of Overweight Onset and Persistence for Social and Behavioral Development Between Kindergarten Entry and Third Grade. Appl. Developmental. Sci. 2009;13(2):88-103   [Abstract]

Andersohn F, Schade R, Suissa S, Garbe E.

OBJECTIVE: Use of antidepressants has been reported to cause considerable weight gain. The aim of this study was to assess the risk of diabetes mellitus associated with antidepressant treatment and to examine whether the risk is influenced by treatment duration or daily dose.

METHOD: This was a nested case-control study in a cohort of 165,958 patients with depression who received at least one new prescription for an antidepressant between January 1, 1990, and June 30, 2005. Data were from from the U.K. General Practice Research Database. Patients were at least 30 years of age and without diabetes at cohort entry.

RESULTS: A total of 2,243 cases of incident diabetes mellitus and 8,963 matched comparison subjects were identified. Compared with no use of antidepressants during the past 2 years, recent long-term use (>24 months) of antidepressants in moderate to high daily doses was associated with an increased risk of diabetes (incidence rate ratio=1.84, 95% CI=1.35-2.52). The magnitude of the risk was similar for long-term use of moderate to high daily doses of tricyclic antidepressants (incidence rate ratio=1.77, 95% CI=1.21-2.59) and selective serotonin reuptake inhibitors (incidence rate ratio=2.06, 95% CI=1.20-3.52). Treatment for shorter periods or with lower daily doses was not associated with an increased risk.

CONCLUSIONS: Long-term use of antidepressants in at least moderate daily doses was associated with an increased risk of diabetes. This association was observed for both tricyclic antidepressants and selective serotonin reuptake inhibitors.

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Cougnard A, Verdoux H, Grolleau A, Moride Y, Begaud B, Tournier M.

University Victor Segalen Bordeaux 2, INSERM U657, IFR of Public Health, Bordeaux, France; Faculty of Pharmacy, Université de Montréal, Montréal, Canada

Background The impact of antidepressant drug treatment (ADT) on the risk of suicide is uncertain. The aim of this study was to determine in a real-life setting whether ADT is associated with an increased or a reduced risk of suicide compared to absence of ADT (no-ADT) in patients with depression.

Method A decision analysis method was used to estimate the number of suicides prevented or induced by ADT in children and adolescents (10-19 years old), adults (20-64 years old) and the elderly (≥65 years) diagnosed with major depression. The impact of gender and parasuicide history on the findings was explored within each age group. Sensitivity analyses were used to assess the robustness of the models.

Results: Prescribing ADT to all patients diagnosed with depression would prevent more than one out of three suicide deaths compared to the no-ADT strategy, irrespective of age, gender or parasuicide history. Sensitivity analyses showed that persistence in taking ADT would be the main characteristic influencing the effectiveness of ADT on suicide risk.

Conclusions: Public health decisions that contribute directly or indirectly to reducing the number of patients with depression who are effectively administered ADT may paradoxically induce a rise in the number of suicides.

(Emphasis added; ed.)

Sleep may act as a moderator between risk factors for depression and the onset of depression in women vulnerable to sleep changes during the postpartum period

Kelly Wagner - AASM

A study in the July 1 issue of the journal SLEEP suggests that postpartum depression may aggravate an already impaired sleep quality, as experiencing difficulties with sleep is a symptom of depression. Twenty-one percent of depressed postpartum women included in the study reported having also been depressed during pregnancy and 46 percent reported at least one previous depressive episode prior to conception, suggesting that new mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation.

Results indicate that two months after delivery, poor sleep was associated with depression when adjusted for other significant risk factors, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression. Overall, nearly 60 percent of the postpartum women experienced poor global sleep quality, and 16.5 percent had depressive symptoms.

According to lead author Karen Dørheim, MD, PhD, psychiatrist at Stavanger University Hospital in Norway, depression after delivery is often not identified by new mothers, whereas tiredness and lack of sleep are common complaints. These symptoms may be attributed to poor sleep, but the tiredness could also be caused by depression.

"It is important to ask a new mother suffering from tiredness about how poor sleep affects her daytime functioning and whether there are other factors in her life that may contribute to her lack of energy," said Dørhei. "There are also helpful depression screening questionnaires that can be completed during a consultation. Doctors and other health workers should provide an opportunity for postpartum women to discuss difficult feelings."

Data were collected between October 2005 and September 2006 from 2,830 women who gave birth to a live child at Stavanger University Hospital in Norway. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The mean self-reported nightly sleep duration was 6.5 hours, and sleep efficiency was 73 percent. The mean age of the mothers at the time of reply was 30 years, and the mean age of the infants was 8.4 weeks.

Depression, previous sleep problems, being a first time mother, not exclusively breastfeeding or having a younger or male infant were factors associated with poor postpartum sleep quality. Better maternal sleep was associated with the baby sleeping in a different room.

According to authors, the first three months after delivery are characterized by continually changing sleep parameters. Women who are tired during this period may attribute this to poor sleep, but the tiredness could alternatively be caused by depression; thus talking about sleep problems may provide an entry point for also discussing the woman's overall well-being. Individual women may react differently to shorter sleep duration and lower sleep efficiency during the postpartum period, and that the sleep of women with a history of depression may be more sensitive to the psychobiological (hormonal, immunological, psychological and social) changes associated with childbirth.

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Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and Depression in Postpartum Women: A Population-Based Study. SLEEP 2009;32(7):847-855   [Abstract]

Study finds hormone reduces emergence delirium rates

Tom Vasich

A scary unknown for many children, the prospect of surgery can cause intense preoperative anxiety. While some amount of stress is normal, what many parents do not know is that extreme anxiety before surgery can contribute to the occurrence of emergence delirium, a distressing incidence of acute behavioral changes experienced when "waking up" from anesthesia.

Now in a study published in the July issue of Anesthesiology, physicians focused on reducing anxiety in children and their families report that oral treatment with melatonin before surgery can significantly reduce the occurrence of emergence delirium in children.

Affecting up to 20 percent of children who undergo surgery, emergence delirium in the post-anesthesia care unit (PACU) consists of acute behavior changes including crying, thrashing and need for restraint. According to researchers, this can also lead to the development of behavioral changes outside the recovery suite with the onset of nightmares, bed wetting and separation anxiety.

"Studies conducted in adults have revealed that oral administration of melatonin before surgery beneficially reduced anxiety levels, but relevant similar treatment data for children undergoing anesthesia and surgery are limited," said study lead author Zeev N. Kain, MD, MBA, Chair of UC Irvine Anesthesiology and Associate Dean for Clinical Research at the UC Irvine School of Medicine.

Seeking confirmation of additional options for anxiety management, researchers first set out to determine if melatonin could decrease anxiety levels when compared to midazolam, a sedative widely used to ease preoperative anxiety. Melatonin is a hormone secreted by the pineal gland, regulates sleep, moods and reproductive cycles. Secretions of melatonin increase during exposure to light.

In a study group that consisted of 148 subjects between the ages of 2 and 8 undergoing outpatient surgery under general anesthesia, children were randomly assigned to receive midazolam or melatonin orally before surgery. Children were followed throughout their surgical experience as researchers measured anxiety and secondary study outcomes of anesthesia administration compliance and emergence behavior. Behaviors were measured using the Yale Preoperative Anxiety Scale (mYPass), the Induction Compliance Checklist and the Keegan scale.

"Results indicated that preoperative melatonin administration did not effectively reduce anxiety levels," said Dr Kain. "However, it was found that melatonin significantly reduced the incidence of emergence delirium in these children. As 3 million children undergo surgery in the U.S. each year, these findings reveal noteworthy health care and treatment implications."

Melatonin showed a direct dose dependent effect on emergence delirium. Children in the melatonin premedication group received any of three doses of melatonin: 0.05 mg/kg, .2 mg/kg and 0.4 mg/kg, while the incidence of delirium at each dose was 25 percent, 8.3 percent and 5.4 percent.

Midazolam remains the recommended premedication for anxiety reduction in children scheduled for surgery.

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Kain ZN, MacLaren JE, Herrmann L, et al. Preoperative Melatonin and Its Effects on Induction and Emergence in Children Undergoing Anesthesia and Surgery. Anesthesiology. 2009 Jul;111(1):44-49   [Full text]

By Joene Hendry

NEW YORK (Reuters Health) - Among children showing high levels of stress in reaction to exposure to community violence, researchers found stress hormone responses similar to children diagnosed with posttraumatic stress disorder.

Patten SB, Williams JV, Lavorato DH, Brown L, McLaren L, Eliasziw M.

Department of Community Health Sciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alta.; School of Public Health, University of Alberta, Edmonton, Alta., Canada

Background: Cross-sectional studies have reported an association between major depressive episode (MDE) and obesity. The objective of this longitudinal analysis was to determine whether MDE increase the risk of becoming obese over a 10-year period.

Method: We used data from the Canadian National Population Health Survey (NPHS), a longitudinal study of a representative cohort of household residents in Canada. The incidence of obesity, defined as a body mass index (BMI) of 30, was evaluated in respondents who were 18 years or older at the time of a baseline interview in 1994. MDE was assessed using a brief diagnostic instrument.

Results: The risk of obesity was not elevated in association with MDE, either in unadjusted or covariate-adjusted analyses. The strongest predictor of obesity was a BMI in the overweight (but not obese) range. Effects were also seen for (younger) age, (female) sex, a sedentary activity pattern, low income and exposure to antidepressant medications. Unexpectedly, significant effects were seen for serotonin-reuptake-inhibiting antidepressants and venlafaxine, but neither for tricyclic antidepressants nor antipsychotic medications.

Conclusions: MDE does not appear to increase the risk of obesity. The cross-sectional associations that have been reported, albeit inconsistently, in the literature probably represent an effect of obesity on MDE risk. Pharmacologic treatment with antidepressants may be associated with an increased risk of obesity, and strategies to offset this risk may be useful in clinical practice.

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Researchers say expectant mothers should relax

Lucy Goodchild

Visitors can see how maternal stress levels can affect the heart rate of unborn babies and find out why pregnant women should reduce their anxiety, at a new exhibit at the Royal Society Summer Science Exhibition, which is open from June 30 to July 4 at the London headquarters of the Society.

The Imperial College London researchers behind the exhibit hope that it will raise awareness of the importance of reducing levels of stress and anxiety in expectant mothers. They say that reducing stress during pregnancy could help prevent thousands of children from developing emotional and behavioral problems.

Visitors to the free Exhibition will be able to play a game which demonstrates how a mother's stress can increase the heart rate of her unborn baby. They will also be able to touch a real placenta, encased safely in plastic. The placenta is crucial for fetal development and it usually protects the unborn baby from the stress hormone cortisol. However, when the mother is stressed, the placenta becomes less protective and maternal cortisol may begin to affect the fetus.

The research found that maternal stress and anxiety can alter the development of the baby's brain. This in turn can result in a greater risk of emotional problems such as anxiety or depression, behavioral problems such as Attention Deficit Hyperactivity Disorder, and being considerably slower at learning. Some studies have even suggested that it may increase the likelihood of later violent or criminal behavior. Their findings have suggested that the effects of stress during pregnancy can last many years, including into adolescence.

Professor Vivette Glover, lead researcher behind the exhibit from the Institute of Reproductive and Developmental Biology at Imperial College London, said: "We all know that if a mother smokes or drinks a lot of alcohol while pregnant it can affect her fetus. Our work has shown that other more subtle factors, such as her emotional state, can also have long -term effects on her child. We hope our exhibit will demonstrate in a fun way why we all need to look after expectant mothers' emotional wellbeing."

"Our research shows that stress due to the mother's relationship with her partner can be particularly damaging. We want fathers visiting our exhibit to see how they can help with the development of their child even before the birth, by helping their partner to stay happy," added Professor Glover.

The researchers say that the stress hormone cortisol may be one way in which the fetus is affected by maternal anxiety during pregnancy. Usually the placenta protects the unborn baby from its mother's cortisol, by producing an enzyme that breaks the hormone down. When the mother is very stressed, this enzyme works less well and lets her cortisol through the placenta. By studying the amount of cortisol in the amniotic fluid, the researcher findings suggests that the higher the level of cortisol in the womb, the lower the toddler's cognitive development or "baby IQ" at 18 months.

Simoncelli M.

Centre IMAGe - Info-Médicaments en Allaitement et Grossesse, CHU Sainte-Justine/Faculty of Pharmacy, University of Montreal, Montréal, Québec, Canada

Over the past 15 years, the number of studies investigating the potential teratogenic effects of antidepressants has drastically increased. Prescribing antidepressants during pregnancy is becoming a challenge for health care providers because of conflicting data on their teratogenic potential.

A critical systematic review of studies describing the relationship between antidepressant use during pregnancy and its impact on congenital malformations, prematurity, low birth weight (LBW), and child development was undertaken to summarize the current evidence-based findings.

Most antidepressants do not pose a major teratogenic risk, although the data supporting this conclusion vary from one type to another. While SSRIs and tricyclics have been examined in a considerable number of studies, only scarce data is available on new antidepressants. The use of paroxetine during organogenesis has been linked to a small increase in the risk of cardiovascular malformations, although data are conflicting.

The impact of prenatal exposure to antidepressants on prematurity and LBW remains controversial, and most studies evaluating these outcomes are limited by their small sample size and lack of adequate reference group.

Finally, information on the long-term effects of gestational antidepressant use on child development is only starting to emerge, and existing information is too limited to determine the risk.

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By Steven Reinberg
HealthDay Reporter

TUESDAY, June 30 (HealthDay News) — Don't automatically blame mom: A crying, colicky baby can be just as much the result of dad's state of mind, Dutch researchers report.

Other studies have found that depression among mothers can be related to excessive crying or colic, a common problem with newborns, but the researchers said that little was known about whether fathers' emotions and behavior also have an effect.

Trouble concentrating may add to stress levels, researcher says

MONDAY, June 29 (HealthDay News) — Anxious people have more difficulty tuning out distractions and require more time to shift their attention from one task to another, a new study from British researchers has found.

Kim YW, Lee SH, Choi TK, Suh SY, Kim B, Kim CM, Cho SJ, Kim MJ, Yook K, Ryu M, Song SK, Yook KH.

Department of Psychiatry, Bundang CHA Hospital, Pochon CHA University School of Medicine, Seongnam, Republic of Korea; POSCO Research Institute, Seoul, Republic of Korea

Background: Mindfulness-based cognitive therapy (MBCT) has been widely used to treat patients with depressive disorder to prevent relapse. The objective of this study was to examine the effectiveness of newly developed MBCT program as an adjuvant to pharmacotherapy in the treatment of patients with panic disorder or generalized anxiety disorder.

Methods: Forty-six patients with panic disorder or generalized anxiety disorder were assigned to either MBCT or an anxiety disorder education (ADE) program for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Symptom Checklist-90-Revised (SCL-90-R) were used to assess the patients at 0 week and after the two programs had been running for 2, 4, and 8 weeks.

Results: The MBCT group demonstrated significantly more improvement than the ADE group according to all anxiety (HAM-A, p<0.01; BAI, p<0.01; anxiety subscale of SCL-90-R, p=0.01) and depression (HAM-D, p<0.01; BDI, p<0.01; depression subscale of SCL-90-R, p<0.01) scale scores. The obsessive-compulsive and phobic subscales of the SCL-90-R also showed significantly more improvement in the MBCT group. However, no significant improvement was observed in the MBCT group versus the ADE group in terms of the somatization, interpersonal sensitivity, paranoid ideation, or psychoticism subscale scores of the SCL-90-R.

Conclusions: MBCT may be effective at relieving anxiety and depressive symptoms in patients with panic disorder or generalized anxiety disorder. However, well-designed, randomized controlled trials are needed.

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Akhondzadeh S, Jafari S, Raisi F, Nasehi AA, Ghoreishi A, Salehi B, Mohebbi-Rasa S, Raznahan M, Kamalipour A.

Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Psychiatry, Zanjan University of Medical Sciences, Zanjan, Iran; Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran

Background: The pathophysiology of depression is associated with the hyperactivity of immune inflammatory responses. Cyclooxygenase-2 inhibitors such as celecoxib [Celebrex^®] reduce the production of pro-inflammatory cytokines. The purpose of the present investigation was to assess the efficacy of celecoxib as an adjuvant agent in the treatment of major depression in a six-week double blind and placebo controlled trial.

Methods: Forty adult outpatients who met the DSM-IV-TR criteria for major depression participated in the trial. Patients have a baseline Hamilton Rating Scale for Depression score of at least 18. Patients were allocated in a random fashion: 20 to fluoxetine 40 mg/day plus celecoxib 400 mg/day (200 mg bid) (morning and evening) and 20 to fluoxetine 40 mg/day plus placebo. Patients were assessed by a psychiatrist at baseline and after 1, 2, 4, and 6 weeks after the medication started.

Results: Although both protocols significantly decreased the score of Hamilton Rating Scale for Depression over the trial period, the combination of fluoxetine and celecoxib showed a significant superiority over fluoxetine alone in the treatment of symptoms of major depression. There were no significant differences in the two groups in terms of observed side effects.

Conclusion: The results of this study suggest that celecoxib may be an effective adjuvant agent in the management of patients with major depression and anti-inflammatory therapies should be further investigated.

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John Murphy

Pioneering therapeutic trials to investigate the effectiveness of deep brain stimulation (DBS) in hard-to-treat depression, obsessive-compulsive disorder (OCD) and Tourette's syndrome are underway at multiple medical centers around the world, according to a review in the June 2009 issue of Mayo Clinic Proceedings.

"Deep brain stimulation has long been seen as valuable for controlling movement disorders," according to the review, written by Susannah Tye, PhD, Mark Frye, MD, from the Mayo Clinic Department of Psychiatry and Psychology, and Kendall Lee, MD, PhD, Mayo Clinic Department of Neurosurgery. "It now is being investigated for hard-to-treat psychiatric disorders," according to the authors.

"Early results indicate the effect on depression and obsessive compulsive disorder is beneficial, but the therapy needs further study," Dr Lee says. The potential for this breakthrough treatment is enormous in reducing the toll of mental illness on patients, their families and society, according to the review.

Unlike electroshock therapy (ECT), which stimulates the entire brain, DBS stimulates specific parts of the brain. DBS is thought to be functionally equivalent to creating a lesion on the brain, but with the advantage of being adjustable and reversible.

"It is like implanting a pacemaker for the brain," says Dr Lee. The patient is awake during deep brain stimulation surgery while a neurosurgeon implants the electrodes. Patients are able to give immediate feedback. Additionally, patients do not feel any pain during the implantation procedure since the brain is without pain receptors.

In the developed world, major depression is second only to cardiovascular disease in premature mortality and time lived with disability according to the review. In persons aged 15 to 44 years, depression is the most disabling medical illness in the United States. The prevalence of major depression, known to be a chronic and relapsing illness, is approximately 17 percent, affecting almost 1 in 5 persons.

Medications and psychiatric therapy can effectively treat many patients with major depression; however, up to 20 percent of these patients fail to respond to these non-surgical therapeutic interventions.

"DBS is not a miracle cure and should not be used to treat all depression," says Dr Lee. "It should be reserved for those patients who have treatment-resistant depression and approved by a multi-disciplinary team." Ongoing advances in DBS technologies represent an important new field that could greatly advance the understanding of psychiatric neurobiology, according to the review.

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Tye SJ, Frye MA, Lee KH. Disrupting Disordered Neurocircuitry: Treating Refractory Psychiatric Illness With Neuromodulation. Mayo Clin Proc. 2009 Jun;84(6):522-532   [Abstract]

Two new studies show effects on angina and mortality

By Ed Edelson
HealthDay Reporter

MONDAY, June 29 (HealthDay News) — Two new studies show that problems with the mind can play a significant role in problems of the heart.

One study found that anxiety and depression can increase the incidence of angina, the chest pain that sends many people to the doctor, said Dr Mark Sullivan, professor of psychiatry and behavioral sciences at the University of Washington, and senior author of one of the reports in the June 29 online issue of Circulation.

Holshoe JM.

University of South Alabama College of Nursing, Mobile, AL, USA.

PURPOSE. Insomnia is one of the most common symptoms seen in both primary and psychiatric care. Sleep hypnotics and benzodiazepines are the drugs of choice for insomnia but are not appropriate for all patients.

CONCLUSION. The sedating tricyclics, the serotonin-2A receptor antagonist/serotonin-reuptake inhibitor antidepressants, and the atypical antidepressants can improve sleep and return sleep architecture to its restorative function. The serotonin/norepinephrine reuptake inhibitors and selective serotonin-reuptake inhibitors, with the possible exception of escitalopram, derange sleep architecture and decrease restorative sleep.

PRACTICE IMPLICATIONS. Although most antidepressants cause sedation, not all antidepressants are equal in their effects on producing restorative sleep.

Hélène Murphy

Research co-led by Professor Keith Laws at the School of Psychology, University of Hertfordshire, UK, concludes that Cognitive Behavior Therapy (CBT) is of no value in schizophrenia and has limited effect on major and bipolar depression.

The meta-analytical review of well-controlled trials has been published online in the journal Psychological Medicine.

The paper reviews the use of CBT in schizophrenia, bipolar disorder and major depression. The results of the review suggest that not only is CBT ineffective in treating schizophrenia and in preventing relapse, it is also ineffective in preventing relapses in bipolar disorder. The review also suggests that CBT has only a weak effect in treating clinical depression, but it has a greater effect in preventing relapses of this disorder.

The authors focused particularly on methodologically rigorous trials that compared CBT to a 'psychological placebo' and also investigated the impact of 'blinding', i.e. whether or not the people who assessed the patients knew if they were receiving active treatment or not. Both factors are considered essential before a drug treatment is approved for use in psychiatric disorders.

The authors noted that not a single trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia and surprisingly few well-controlled studies of CBT in depression.

"The results of this review are important because in March NICE (National Institute for Health and Clinical Excellence) re-approved CBT for use in all people with schizophrenia. The Government is also investing millions of pounds to provide CBT for depression and anxiety in 250 dedicated therapy centers across England," said Professor Laws. "Yet the evidence here is that the effectiveness of this form of therapy may be less than previously thought, to the point of being non-existent in schizophrenia."

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Lynch D. Laws KR, McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychol Med. 2009; doi:10.1017/S003329170900590X   [Abstract]

Brandon Bryn - AAAS

A  ligand, or binding molecule, of the translocator protein (18 kDa) seems to quickly counteract anxiety and panic attacks in mice as well as humans-and without the negative side effects associated with other current remedies, researchers say. This finding suggests that this ligand, XBD173, might be a good candidate for use as a safe and fast-acting anti-anxiety agent.

Anxiety disorders are highly prevalent and can be very disabling, frequently turning into chronic clinical conditions. Current treatments like the benzodiazepines (eg: Valium^®, Xanax^®) often have unwanted side effects such as sedation, tolerance, or symptoms of withdrawal after chronic use. Antidepressant drugs are also sometimes administered to treat anxiety, but their beneficial effects only occur after several weeks of treatment.

The new research suggesting a naturally occurring ligand as a candidate for a fast and effective anti-anxiety agent is published in the 19 June 2009 issue of the journal Science.

Dr Rainer Rupprecht, MD, from Ludwig Maximilian University and the Max Planck Institute of Psychiatry, along with colleagues from institutes and universities across Germany and Switzerland, performed a series of experiments with rats and human subjects.

Looking for something new to counteract anxiety, Rupprecht and colleagues administered XBD173 to laboratory rats and observed that it prevented panic behavior almost immediately-without the rats building tolerance or any other unwanted side effects.

They then performed a study among 70 healthy human men, involving a placebo group, and found that XBD173 initiated a fast anti-anxiety response without any withdrawal symptoms after prolonged use.

"The number of side effects reported with XBD173 was comparable to the incidence in the placebo group," Rupprecht writes in his report. "No serious adverse event occurred during the entire study and there was no need for treatment of withdrawal symptoms... Thus, ligands of the translocator protein (18 kDa) such as XBD173 may represent a pharmacological mechanism to treat anxiety disorders."

These researchers say that XBD173 promotes these calming effects through its modulation of the inhibitory neurotransmitter, GABA, and they recommend the ligand be considered for use in future clinical applications.

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Rupprecht R, Rammes G, Eser D, et al. Translocator Protein (18 kD) as Target for Anxiolytics Without Benzodiazepine-Like Side Effects. Science. 2009 Jun;doi:10.1126/science.1175055   [Abstract]

Niccolai V, van Duinen MA, Griez EJ.

School of Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands; Institute of Experimental Psychology II, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany

Objective: To provide a systematic review of studies investigating respiration in PD and comments on relative inconsistencies.

Method: A Medline search of controlled studies focusing on pCO2, respiratory rate, tidal volume, and minute volume in PD patients was conducted for baseline/resting condition, challenge, and recovery phase. Respiratory variability and comparisons between panickers and non-panickers were also examined.

Results: Lower pCO2 levels in PD subjects are a consistent finding during the baseline/resting condition, the challenge, and recovery phases. Tidal volume and minute volume are increased in PD subjects relative to controls during the baseline/resting condition. However, the most robust finding is a higher than normal respiratory variability, which appears to be a promising factor for the identification of respiratory etiopathological pathways in PD.

Conclusion: Respiratory variability might be a candidate for a biological marker of PD: an abnormal breathing pattern as found in panic disorder (PD) patients compared with controls might indicate instability of the respiratory homeostasis.

Turner C, Heyman I, Futh A, Lovell K.

South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, King's College London, UK; Institute of Psychiatry, King's College London, UK; University of Manchester, UK

Background: Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may be limited by a number of factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialized service. Telephone delivery of CBT represents one way of overcoming some of these accessibility issues. This pilot study describes outcomes for a telephone-based cognitive-behavioural treatment for obsessive-compulsive disorder (OCD) in young people.

Method: Ten participants, aged 13 to 17 years, and their parents received up to 16 sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using multiple informants and a repeated measures design. Assessments were conducted at pre-treatment, post-treatment, and at 6- and 12-month follow-up.

Results: Improvements were found for OCD symptoms across all informants. Family satisfaction with treatment over the telephone was high.

Conclusions: The findings suggest that TCBT is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people. TCBT requires further evaluation in randomized, controlled trials to compare effectiveness with face-to-face CBT, which currently represents the usual care model.

Danielle Moore - ESRC

The effect of anxiety on academic performance is not always obvious but new research suggests that there may be hidden costs. The research found that anxious individuals find it harder to avoid distractions and take more time to turn their attention from one task to the next than their less anxious peers.

The researchers, Professor Michael Eysenck and Dr Nazanin Derkshan, designed several experiments to explore the effects of anxiety on our ability to perform tasks such as avoiding distractions on a computer screen, when reading a story, or solving a series of simple mathematics problems.

According to Professor Eysenck, these findings have clear practical implications in the classroom. "A lot of the negative effects of anxiety appear to be caused by difficulties with controlling attention. This suggests that training techniques designed to enhance attentional control - the ability to ignore distractions and to switch attention from one task to another - could help anxious students to achieve their academic potential," he explains.

In addition, the study showed that anxious individuals often perform at a comparable level to non-anxious ones but only do so at a greater cost in terms of effort or perhaps long term stress.

"This shows that it is important that teachers focus not only on whether a student's academic performance seems to be OK but also on how much effort the student had to put in to achieve that level. Anxious students may be trying desperately hard just to keep up and this could be at great psychological cost," says Professor Eysenck.

In one of these experiments, participants' eye movements were recorded as they read a story that included a few 'distracter' words that were unrelated to the story. The researchers found that anxious participants took longer to read the story because they tended to dwell on the irrelevant words, particularly when they thought that their comprehension would be evaluated by others.

In another experiment, participants performed two arithmetical tasks such as multiplication and division either in separate blocks (all the problems requiring multiplication grouped together and kept separate from the division problems) or with one task alternating with the other.

In this experiment, anxiety levels did not appear to affect the number of correct answers given but anxious participants took longer to complete the task, particularly when they had to keep switching from one type of mathematical calculation to another.

Overall, the experiments showed that anxiety had more effect on how much effort it took to perform a task than on how well the task was actually performed. In other words, anxiety often produced "hidden costs" that were not apparent in performance.

The study was funded by the Economic and Social Research Council, the UK's largest organization for funding research on economic and social issues.

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Eysenck M, Derakshan N. Anxiety, Attention and Cognitive Performance. ESRC 2009, End of Award Report, RES-000-23-1529 Swindon   [Summary]

Holly Korschun

The widely used antidepressant and pain medication amitriptyline (Elavil^®, Endep^®, Tryptanol^®) — but not other closely related drugs — can impersonate the brain's own growth factors, researchers at Emory University School of Medicine have shown.

The results are published online in the journal Chemistry & Biology.

Amitriptyline, a tricyclic antidepressant first introduced in the 1960s, and other tricyclics are thought to exert their effects by increasing the levels of the messenger chemicals serotonin and norepinephrine (noradrenaline) in the brain.

But the delay before antidepressants begin to work has led scientists to the idea that a secondary effect, pushing neurons to survive and grow, must occur indirectly.

The finding that amitriptyline can directly stimulate molecules that help neurons grow and resist toxins suggests a separate mechanism by which some antidepressant and pain relief compounds may function.

Keqiang Ye, PhD, associate professor of pathology and laboratory medicine at Emory University School of Medicine, and his colleagues were looking for chemicals that could imitate a protein in the brain known as NGF (nerve growth factor).

NGF has been used experimentally to treat Alzheimer's disease and the degeneration of nerves in the extremities caused by diabetes. However, NGF cannot cross the blood-brain barrier and has puzzled investigators with its side effects, such as increased sensitivity to pain.

Working in Ye's laboratory, postdoctoral fellow Sung-Wuk Jang sorted through a library of chemicals to find those that could stimulate one of NGF's "receiver dish" molecules on nerve cells, called TrkA. The way NGF works is to pull together two TrkA molecules on the cell surface.

"We were surprised to find that amitriptyline has these same properties," Ye says. "This is an antidepressant that has been used for decades."

Doctors also prescribe amitriptyline for chronic pain such as migraine headaches or the nerve damage caused by diabetes, he notes.

In laboratory tests, amitriptyline could protect neurons from oxygen and glucose deprivation or the toxin kainic acid. Only amitriptyline, and not other antidepressants, could duplicate NGF's ability to stimulate neurons to send out "neurites," small projections thought to be the beginnings of connections to other neurons.

Amitriptyline directly binds TrkA and a related molecule called TrkB, the authors found. Amitriptyline could also bring together a mismatched pair of TrkA and TrkB - a phenomenon not seen before, Ye says.

Also surprising was the finding that other tricyclic antidepressants, even those with a similar molecular structure such as imipramine (Tofranil^®), could not match amitriptyline's ability to stimulate cells through TrkA.

In a model of antidepressant function called a "forced swim test," amitriptyline's effects do not depend on TrkA, because it still works on mice with modified TrkA genes, the authors found.

Recent studies have indicated that the presence of TrkB is necessary for antidepressants to function in mouse models. The relationship between amitriptyline's ability to directly stimulate TrkA and TrkB and its antidepressant and pain-relief properties needs to be explored further, Ye says.

The research was supported by a U.S. National Institutes of Health grant.

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Jang SW, Liu X, Chan CB, et al. Amitriptyline is a TrkA and TrkB Receptor Agonist that Promotes TrkA/TrkB Heterodimerization and Has Potent Neurotrophic Activity. Chem Biol. 2009 Jun 26;16(6):644-656   [Abstract]

Depression may be linked to how willing someone is to give up his goals

CLINICAL depression is a serious ailment, but almost everyone gets mildly depressed from time to time. Randolph Nesse, a psychologist and researcher in evolutionary medicine at the University of Michigan, likens the relationship between mild and clinical depression to the one between normal and chronic pain. He sees both pain and low mood as warning mechanisms and thinks that, just as understanding chronic pain means first understanding normal pain, so understanding clinical depression means understanding mild depression.

Tel Aviv University researches twins to find a biological door to the bright side

George Hunka

The pursuit of happiness characterizes the human condition. But for those suffering from stress, money trouble or chronic illness, a positive outlook on life can be difficult to find. Now, a Tel Aviv University researcher says we should look to our genes.

Prof Yoram Barak of Tel Aviv University's Sackler School of Medicine is engaged in the "attempt to find the happiness gene, the genetic component of happiness," which may be 50% responsible for an optimistic outlook. The research is a collaboration between Tel Aviv University and its affiliated research hospital, the Chaim Sheba Medical Centre at Tel Hashomer, the largest hospital in Israel.

Initial research findings have made Prof Barak optimistic about their ability to succeed. "If something is genetic, it should have a large concordance among twins," he says. "And the twin studies we are looking at show that 50% of happiness is genetically determined." Prof Barak is now working with Prof Anat Achiron of the Sheba Medical Center to identify the specific genes that are associated with happiness.

Dr Barak's current findings in the hunt for the happiness gene were presented at The World Congress on Treatment and Research in Multiple Sclerosis in Montreal, Canada in 2008, and recently published in the journal Expert Review of Neurotherapeutics.

We may be a long way off from being able to genetically engineer happiness, Prof Barak says, but we can start by thinking positively. Much of his work is based on positive psychology, which is the "fastest and largest growing area of psychology in the United States — and in the world," he says.

For the 50 percent of happiness that is not genetic, Prof Barak is working on a program of positive psychology workshops, with exercises he recently tested in a one-day workshop for 120 participants at the Multiple Sclerosis Society of Israel. Early results indicate that the workshops improved the happiness level of participants by as much as 30 percent.

This work is dedicated to finding "practical and intervention oriented research and the application of psychology into medicine," says Prof Barak. His research into the physical affects of mental state on patients with neurological diseases is an attempt to bridge the gap between psychology and clinical medicine.

Prof Barak says that the psychological benefits of the program were accompanied by physical benefits as well. "We were able to raise levels of happiness in these patients so they were just about equal to those of healthy subjects," he says. "If we can apply positive psychology, we can better their adherence to their treatment regime. And we have been able to show that there is a stabilization of the neurological disability as well."

For healthy individuals, Prof Barak says that his happiness exercises can enrich their lives, too. Meanwhile, his search for the happiness gene goes on.

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Barak Y, Achiron A. Happiness and neurological diseases. Expert Rev Neurother. 2009 Apr;9(4):445-59   [Abstract]

Lena Olson

A good partner relationship can act as a buffer for those exposed to work-related stress.

"The relationship reduces the negative effects of this kind of stress on our health. But poor relationships will amplify the negative effects", say Ann-Christine Andersson Arntén in a doctoral dissertation presented at the University of Gothenburg, Sweden.

"A positive approach and successful stress-management techniques also help to reduce the negative effects of work-related stress", explains Ann-Christine Andersson Arntén, who presented her dissertation in psychology.

"But when there are stressful experiences both at work and in the relationship, the risk of burn-out and poor health increases dramatically.

About 900 people took part in her survey. Those who felt they had a good relationship experienced that they enjoyed better health than those who had a more problematic relationship. Women with a poorly-functioning relationship experienced more anxiety, mental stress reactions and sleeping difficulties than women who had a good relationship. Men who had a mediocre relationship had a higher incidence of depression, anxiety, psychological and somatic stress reactions than men with worse or better relationships.

One explanation may be that people living with a mediocre relationship take more responsibility to improve the relationship, while those with poor relationships just admit it, and don't feel they can do anything about it.

Although the study shows some gender differences, differences amongst individuals were much greater than the difference between the genders.

After having been exposed to stress, the body must recover and recharge itself. If there is no opportunity to recover because the work doesn't allow for breaks and lunches, the body's reserves are emptied, and poor health ensues. The same principle applies when a person takes work home, frequently works overtime or has recurring quarrels and problems in his or her relationship.

The effects of the sometimes small but recurring stress situations of everyday life sneak up on a person, who at first does not even notice them. The person under stress adapts and tries to accommodate the demands and changes he or she face, until one day, there is such a great imbalance, that massive efforts are needed just to manage everyday life.

The risk is that we don't realize things are not right until we get to that point. Our work and required social interactions demand much too much of us. Our relationship is strained to the breaking point, and we've used the last drop of the energy reserves we once had. According to Andersson Arntén, not taking time to recover can lead to impaired physical and mental health and cognitive and concentration problems, which reduce performance and problem-solving ability. "And this leads to consequences both at home and at work," says Ann-Christine Andersson Arntén.

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Andersson Arntén AC. Partnership Relation Quality Modulates the Effects of Work-Stress on Health. Doctoral dissertation 2009 Jun 5; Department of Psychology, Faculty of Social Sciences, Göteborgs University, Sweden   [Abstract () | Full text ()]