Antidepressants and Depression

Not getting enough sleep can be detrimental to consumers’ well-being, and now a new study conducted by researchers from the University of Ottawa has explored how sleeping habits can affect teens’ mental health.

Their work revealed that adolescents who struggle with chronic sleep issues are more likely to also struggle with depression.

“Our findings suggest that significant sleep delays during adolescence may increase the likelihood of depression onset in both males and females,” said researcher Nafissa Ismail, PhD. “Additionally, sleep delay may sensitize adolescent females to other stressors and increase the likelihood of mood disorder development.”  

Less sleep leads to more stress

To understand what effect sleep can have on depression risk, the researchers conducted a sleep experiment on 40 adolescent and 40 adult mice. While some mice slept normally for seven nights, other mice were disrupted for the first four hours of their sleep each night for seven nights. To assess their depression following this sleep cycle, the researchers exposed the mice to a stress-inducing activity.

The researchers learned that the adult mice responded differently than the adolescent mice after losing sleep for seven consecutive nights. Despite both groups experiencing sleep disruptions, only the adolescent mice reacted poorly to a new stressor, which indicates that they could be at a greater risk for depression. 

“When exposed to a new stressor following seven days of repeated sleep delay, only adolescent male and female mice showed increased activity in the prelimbic cortex of the brain -- not the adults,” Dr. Ismail said. “The prelimbic cortex is associated with stress coping strategies and can be damaged from overreaction following sleep deprivation.” 

The study also revealed that the female adolescent mice produced a greater stress hormone response than the male adolescent mice. The researchers explained that female teenagers may be more susceptible to depression than their male counterparts, and poor sleep only exacerbates that issue.

“A popular theory suggests that depression originates in adolescents overexposed to stress, and that differences between male and female depression rates are attributed to an increased female vulnerability to chronic stress,” said Dr. Ismail. 

“Sleep disruption is a common stressor during adolescent development,” she added. “Its repeated exposure could partially be responsible for adolescent female susceptibility to depression.”

Sleep and COVID-19

As the COVID-19 pandemic continues to affect consumers’ sleep, stress, and mental health, the researchers worry about how these current circumstances will affect rates of teen depression moving forward. 

“As COVID-19 quarantine requirements -- such as remote learning, limited in-person social interactions, and increased screen time -- have removed some pressure to adhere to regular sleep schedules, adolescents could be at a higher risk than ever before for developing depression and other mood disorders,” Dr. Ismail said.

Depression affects consumers young and old, and now a new poll is exploring how the latter deals with mental health struggles. 

According to responses to the GeneSight Mental Health Monitor, nearly two-thirds of older consumers reported that they wouldn’t seek professional help for their depression. 

“The ‘pull yourself up by your bootstraps’ mindset of some seniors and reluctance to talk about mental health are hindering them from getting the help they need -- especially now when the pandemic is having an enormous impact on the mental health of older Americans,” said researcher Dr. Mark Pollack. “People will seek treatment for conditions like heart disease, high blood pressure, or diabetes. Depression is no different. It is an illness that can and should be treated.” 

Why are seniors avoiding treatment?

The GeneSight Mental Health Monitor polled consumers aged 65 and older across the country to determine their attitudes about depression. Their findings revealed that more than 60 percent of older consumers wouldn’t seek out mental health treatment for depression. 

Survey respondents hadn’t been formally diagnosed with depression, but they did have concerns that they were exhibiting depression-related symptoms. Despite that, they still reported that they wouldn’t get help for those concerns. Ultimately, over 30 percent of the participants believed that they could handle their depression themselves, and nearly 40 percent were confident that they didn’t need a doctor’s help. 

More than 30 percent of the participants also reported that they noticed their depression had affected their lives in tangible ways; they struggled to enjoy activities that normally brought them joy, and they had difficulties interacting with the people closest to them. Having strong, supportive connections is an important aspect when it comes to protecting against depression. 

“In my experience, there is a commonly held view that depression is a normal part of aging; it is not,” said researcher Dr. Parikshit Deshmukh. “I’ve found older adults have a very difficult time admitting that they have depression. When they do acknowledge it, they are still reluctant to start treatment for a wide variety of reasons.” 

The researchers explained that there is a stigma around mental health and depression for many older consumers, and finding the right treatment can be time-consuming and ultimately ineffective. However, the researchers hope that older consumers treat their mental health concerns the same way they’d treat their physical health concerns. They encourage seniors to take time to find a treatment plan that works for them. 

As cases of depression continue to grow nationwide, researchers are always looking for ways to treat the condition. A new study conducted by researchers from Massachusetts General Hospital found that having a strong social network could help protect against depression. 

“Depression is the leading cause of disability worldwide, but until now researchers have focused on only a handful of risk and protective factors, often in just one or two domains,” said researcher Karmel Choi, PhD. “Our study provides the most comprehensive picture to date of modifiable factors that could impact depression risk.” 

Staying socially engaged

To understand potential risk factors associated with depression, the researchers evaluated data from the U.K. Biobank. This study included responses from over 100,000 participants and assessed depression-related risks like screen time, physical activity, and sleeping habits, among several others. 

Of all of the risk factors they looked at, the researchers learned that having strong social connections was the most effective in terms of protecting against depression. Participants reported better mental health outcomes when they had cherished relationships in their lives, regardless of whether it was with friends or family. Having that network of people around for support and social engagement was crucial to reducing depression-related symptoms. 

“Far and away the most prominent of these factors was frequency of confiding in others, but also visits with friends and family, all of which highlighted the important protective effect of social connection and social cohesion,” said researcher Dr. Jordan Smoller. “These factors are more relevant now than ever at a time of social distancing and separation from friends and family.” 

While depression affects everyone differently, and there’s no single approach to improving such symptoms, these findings are an important piece of the puzzle when thinking about mental health. The researchers hope that more work can be done in this area to better understand the risks and protective factors associated with depression. 

“Depression takes an enormous toll on individuals, families, and society, yet we still know very little about how to prevent it,” said Dr. Smoller. “We’ve shown that it’s now possible to address these questions of broad public health significance through a large-scale, data-based approach that wasn’t available even a few years ago. We hope this work will motivate further efforts to develop actionable strategies for preventing depression.” 

Burnout affects consumers in every area of the workforce, and the ripple effects can reach beyond just those feeling overworked. 

Now, according to researchers from the Medical University of South Carolina, symptoms of burnout could be closely linked to symptoms of depression. 

“There is a longstanding thought that burnout is associated with workplace factors and that depressive symptoms are associated with workplace factors but also heavily influenced by personal factors,” said researcher Dr. Lisa Rosenstein. “We found that the factors that drive burnout are much more closely related to the factors that drive depressive symptoms than previously realized.” 

Understanding the connection

To better understand the connection between feelings of depression and feelings of burnout, the researchers surveyed over 1,500 medical interns across the country. The participants answered questions about their overall mental health to give the researchers a baseline understanding of their depressive symptoms, while other questions touched on feelings of emotional exhaustion. 

The researchers explained that it’s been hard for experts to pin down a proper set of criteria for burnout, which is why many consumers who experience it have had trouble reporting it to their employers. However, this study revealed that several similarities exist between symptoms of depression and those of burnout. 

The researchers explain that because of this link, resources for depression can be used for those struggling with burnout, and vice versa. Overall, looking at depression and burnout side by side can be beneficial in trying to manage both conditions. 

“Previous to this work, depression and burnout were conceptualized as separate entities with different factors contributing to these outcomes,” said Dr. Constance Guille. “This work suggests there is substantial overlap between both workplace and personal factors that contribute to an increase in both depressive symptoms and burnout.” 

While personal factors did come into play, including the participants’ own history of depressive symptoms, the researchers hope that these findings can be beneficial for those struggling with these incredibly common feelings. Having a more concrete understanding can help create more thorough treatment plans and relieve consumers of the overwhelming stress of both daily life and work. 

Many consumers struggle with anxiety and depression, and now researchers from Ohio State University found one practice that may not be helpful for those coping with mental health issues: gratitude. 

While incorporating a gratitude practice is certainly beneficial for other reasons, the researchers found that when it comes to anxiety and depression, gratitude may not help in improving related symptoms. 

“For years now, we have heard in the media and elsewhere about how finding ways to increase gratitude can help make us happier and healthier in so many ways,” said researcher David Cregg. “But when it comes to one supposed benefit of these interventions -- helping with symptoms of anxiety and depression -- they really seem to have limited value.” 

Limitations of a gratitude practice

To better understand what effect a gratitude practice can have on anxiety or depression, the researchers analyzed nearly 30 different studies that included over 3,600 participants. 

In the studies the researchers evaluated, participants completed a daily activity related to gratitude. Most of these activities had participants reflect on what in their lives they’re grateful for. After assessing the participants’ mental health, the researchers learned that the gratitude practices weren’t effective in helping them cope with anxiety or depression. 

“Based on our results, telling people who are feeling depressed and anxious to be more grateful likely won’t result in the kind of reductions in depression and anxiety we would want to see,” said researcher Jennifer Cheavens. “It might be that these sort of interventions, on their own, aren’t powerful enough or that people have difficulty enacting them fully when they are feeling depressed or anxious.” 

Better treatments

The researchers recommend more rigorous treatments that could better benefit those struggling with anxiety and depression. Similarly, recent studies have found that remaining hopeful is a key component to coping with anxiety and depression. 

However, the team doesn’t want to downplay the positives associated with practicing gratitude. Though it wasn’t so effective in improving anxiety and depression, there is an upside to being more grateful. 

“It is good to be more grateful -- it has intrinsic virtue and there’s evidence that people who have gratitude as a general trait have a lower incidence of mental health problems and better relationships,” said Cregg. 

While previous studies have revealed the countless outside factors that can contribute to mothers’ postpartum depression, including exposure to natural light and the gender of the baby, a new study found that there could be a biological push behind such depressive symptoms. 

Researchers from the Van Andel Research Institute discovered that heightened levels of inflammation throughout the body during pregnancy can be the catalyst for depressive symptoms in women. 

“Pregnancy-related depression is common yet poorly understood,” said researcher Dr. Lena Brundin. “Biologically speaking, pregnancy is a major inflammatory event that can upend many of the body’s day-to-day molecular processes. If we can better understand these irregularities, it could lead to new ideas about how best to treat prenatal depression.” 

Effects of inflammation

Recent studies have shown how inflammation can have negative effects on both physical and mental health, including increasing the risk for depression. To understand how it affects pregnant women, the researchers looked at blood samples from 165 women, analyzing the levels of several types of hormones and the effects they could be having on women during and after pregnancy. 

The study revealed that pregnancy affects the body’s processes in ways that many may not have realized before, including levels of hormones and inflammatory chemicals -- two factors that can contribute to severe depressive symptoms that can last beyond pregnancy. 

Higher levels of inflammatory chemicals were at the heart of the pregnant women’s depressive symptoms. The researchers learned that when these levels are raised, it prevents the body from creating serotonin, which helps to boost mood. 

Not only were serotonin levels found to be lower in most of the women tested, but their depression symptoms were more severe when serotonin levels were lower.

Proper treatment

While pregnant women are flooded with information on how to combat pregnancy-related depression, this condition can be difficult to pin down for medical professionals. Moving forward, the researchers hope that these findings highlight the severity of this condition so women can receive proper treatment.

“Inflammation is an important and normal part of the immune system and, in early pregnancy, prevents the mother’s immune system from attacking the fetus,” said researcher Dr. Eric Achtyes. 

“However, when the inflammatory reaction is protracted or more intense than is optimal, it may lead to worsening depression in a subset of vulnerable women. Hopefully, this study will allow us to develop treatments that more specifically target those who are at risk for an ‘inflammatory prenatal depression.” 

Introducing drugs as a treatment option for patients experiencing serious depression can come with mixed feelings, and now researchers are exploring the risks and benefits that could arise when older patients are prescribed the drugs.

While antidepressants are certainly a viable and life-changing option for many patients, that’s not the case with all patients, and researchers from the American Geriatrics Society looked into how mental health professionals can best help their older patients.

What are the risks?

To see how medication affected older patients who were struggling with depression, the researchers conducted a study in which participants aged 65 and older took either an antidepressant or a placebo sugar pill for 24 weeks.

Those who were given the medication were prescribed either a serotonin and norepinephrine reuptake inhibitor (SNRI) or a selective serotonin reuptake inhibitor (SSRI), both of which are typically prescribed in the early stages of depression.

However, the researchers noted that over the course of the study, those who were given the sugar pills were doing better overall than those who had taken either SNRIs or SSRIs.

The participants who took the prescribed drugs were more likely to experience harmful incidents as a result of the medication, and many had to remove themselves from the study.

Though just one aspect of the researchers’ study, it’s important for both healthcare professionals and consumers to be aware of the potential risks associated with antidepressants.

Moreover, the researchers explained that certain depression medications can be harmful to the older demographic, as they can increase the likelihood of falls and subsequent injuries, particularly if patients have experienced dangerous falls in the past.

“Some of the antidepressants have not been studied in older patients with major depression, and studies don’t often describe specific side effects,” said researcher Diana M. Sobieraj. “Future research in this field is critical to better inform how the safety profiles of different antidepressants compare in older adults.”

Finding the best treatment option for depression can be difficult, and the researchers encourage patients and healthcare professionals to review the American Geriatric Society’s Beers Criteria, a comprehensive list of medications that may be harmful for older adults, before starting an antidepressant.

Staying informed

With over two million adults over the age of 65 suffering with depression, it’s important for consumers to know the warning signs, as well as what they can do to better their mental health.

Older adults who are in poor physical health, poor mental health, or experience other health complications are at an increased risk of depressive symptoms.

Adopting healthy habits such as exercising, sleeping well, eating healthy, and avoiding tobacco were found to leave lasting mental health benefits, while researchers also recently found that a change in scenery can be effective as well.

Much research has been done recently that shows the relationship between teens’ social media use and the likelihood of a depression diagnosis.

Now, researchers are turning that notion on its head, finding that there is no conclusive evidence that shows the correlation between social media use and depression for teenagers.

“You have to follow the same people over in time in order to draw the conclusion that social media use predicts greater depressive symptoms,” said lead researcher Taylor Heffer. “By using two large longitudinal samples, we were able to empirically test that assumption.”

The findings

The researchers followed sixth, seventh, and eighth grade students for two years, having them answer questions about their social media use and time spent in front of screens. The team used the Center for Epidemiological Studies Depression Scale to measure depression symptoms.

Additionally, the researchers had undergraduate students report their own social media and screen time use, as well as depressive symptoms, over the course of six years. The results were broken down by gender and age to get the most precise picture of whether or not social media is affecting the rate of depression.

The researchers found that spending time on social media was not an indication of developing depression later on, though teen girls were found to seek solace in social media after experiencing depressive symptoms.

“There may be different groups of people who use social media for different reasons,” said Heffer. “For example, there may be a group of people who use social media to make social comparisons or turn to it when they are feeling down, while another group of people may use it for more positive reasons, such as keeping in contact with friends.”

With these findings, the researchers hope parents gain a greater understanding of what their children are going through, and don’t jump to conclusions if their teens are spending a lot of time on their phones.

“When parents read headlines such as ‘Facebook Depression,’ there is an inherent assumption that social media leads to depression,” Heffer said. “Policymakers also have recently been debating ways to tackle the effects of social media use on mental health.”

Contradicting research

While people of all ages are being diagnosed with depression at higher rates, many researchers are pointing their fingers at more time being spent on electronic devices -- which young people struggle with the most.

With suicide rates among young girls at an all-time high, researchers from Timberline Knolls Residential Treatment Center are also placing the blame on social media.

According to the researchers, social media can fuel the fire for the need to be perfect at all times, which can have damaging effects on mental health.

“There continues to be a lot of pressure on young women to be perfect,” said Melissa O’Neill, LCSW, director of the program at Timberline Knolls. “This is definitely increased due to social media and the perception that everyone has the perfect clothes, body, relationship, grades, and life.”

Regardless of age, staying connected with friends and family is key to ensuring positive mental health. However, many older adults may find it hard to keep in touch with loved ones, particularly when they live far away, which researchers say can lead to depressive symptoms.

A new study conducted by researchers at Oregon Health & Science University found that older adults that regularly use video chatting apps -- such as Skype or FaceTime -- were less likely to experience symptoms associated with depression when compared to those who used other social media apps.

“Video chat came out as the undisputed champion,” said Dr. Alan Teo. “Older adults who used video chat technology such as Skype had significantly lower risk of depression.”

Positive power of social media

The researchers had over 1,400 participants, with an average age of 65 years old. Each person completed a survey about their social media and technology use so the researchers could gauge how often they used email, instant messaging, video chat, or social media platforms like Facebook.

Two years later, the participants were asked to take another survey measuring their symptoms associated with depression, if they had any.

Perhaps the biggest finding was the power that video chatting seemed to have on the participants’ development of depressive symptoms. Those that used Skype or FaceTime were half as likely to be depressed compared with those that primarily used email, instant messaging, or social media.

The researchers believe their study is the first of its kind that links the positive relationship between video chatting and reduced risk of depression symptoms in older adults.

Despite these positive results, Dr. Teo still encourages people of all ages to engage face-to-face with as many people as possible to ensure a healthy mind.

“If we’re looking at the reality of modern American life, we need to consider these communication technologies,” Dr. Teo said. “And when we do consider them and compare them, our findings indicate that I’m better of Skyping with my dad in Indiana than sending him a message on WhatsApp.”

Finding a balance

Recently, researchers have found both positives and negatives associated with social media. As powerful a tool as it is, it’s important that consumers find the balance that works for them.

Last month, researchers found that words users post in their Facebook status could be used to detect depression. Researchers created an algorithm that was successful in predicting depression up to three months before a formal diagnosis, based entirely off what words users’ put in their Facebook statuses.

Instagram rolled out a new feature a few years ago that could help those suffering from eating disorders, depression, and other mental illnesses. Users can anonymously flag posts if they come across one that they think was posted by someone in need of help. Once a photo is flagged, the poster will receive a notification from Instagram advising them that a follower is concerned, and provide them with several different ways they can get help.

On the other hand, social media has been found to be the cause of some negative emotions. Many reports look to social media as one of the primary causes of the increase in depression among young people.

Researchers also found that social media can create an exclusionary effect for many users who see their friends interacting without them. Though this oftentimes occurs unintentionally, the damage is done.

“We’re using these technologies daily and they’re pushing information to users about their networks, which is what the sites are designed to do, but in the end there’s negative effects on people’s well-being,” said Michael Stefanone.

“It happened to me the other night. I see my friends are doing something while I’m sitting at home. It’s not devastating, but that’s the moment when I felt badly.”

Social media has evolved tremendously over the years, and its capabilities are ever-growing and changing. While still a way for people to keep in touch and connect with their friends, social media has also grown to do much more than that.

A new study, conducted by researchers from the University of Pennsylvania and Stony Brook University and recently published in Proceedings of the National Academy of Sciences of the United States of America, explores a new algorithm that can predict a depression diagnosis based off of language used in people’s Facebook posts.

“There’s a perception that using social media is not good for one’s mental health, but it may turn out to be an important tool for diagnosing, monitoring, and eventually treating it,” said lead researcher H. Andrew Schwartz. “Here, we’ve shown that it can be used with clinical records, a step toward improving mental health with social media.”

Words matter

The University of Pennsylvania’s Positive Psychology Center and Stony Brook University’s Human Language Analysis Lab have been working on the World Well-Being Project since 2012. The initiative strives to make breakthroughs in psychological wellness based on language used on social media.

The researchers involved in this study wanted to take the World Well-Being Project to the next level and see if social media could be an effective tool in diagnosing depression. Over 1,000 people joined the study -- 114 of whom had depression diagnoses in their medical records -- and gave the researchers full access to their Facebook statuses and medical records.

To compare the participants with depression to a control group, the researchers used five participants without depression for every one participant with depression for a total of 683 study participants. The researchers then used the participants’ Facebook statuses -- which totaled over 500,000 posts -- to determine the words and phrases that they deemed “depression-associated language markers.”

In putting the algorithm to the test, the researchers found that it was successful in predicting depression up to three months before a formal diagnosis, based entirely off of language used in Facebook posts.

The authors concluded that the users most likely to develop depression were found to use language expressing loneliness, anger, sadness, and self-reflection in their Facebook statuses.

“The hope is that one day, these screening systems can be integrated into systems of care,” said researcher Johannes Eichstaedt. “This tool raises yellow flags; eventually the hope is that you could directly funnel people it identifies into scalable treatment modalities.”

Bipolar disorder affects 2.6 percent of the United States population, and many professionals in the mental health field struggle with finding the proper treatment or appropriate medication for their patients.

Individuals with bipolar disorder experience intense mood swings -- shifting from episodes of mania to episodes of depression -- and it’s this balancing act between the two that often presents difficulties in treatment plans.

However, based on a new study conducted by researchers from Germany, Australia, and America, individuals’ who have a healthy diet and/or low body mass index (BMI) may be on the right track to a more effective treatment for the condition.

Finding the right diet

The study consisted of 133 participants, and before the testing began, the researchers recorded each participant’s BMI and measured their ability to function on a day-to-day basis based on their depression level.

To get a sense of the participants’ regular diet, they filled out questionnaires based on what they typically eat, and the researchers used that information to calculate a quality diet score for each participant. Those who consumed higher levels of fat, alcohol, or carbs were given lower scores, while those with higher intakes of fruits and vegetables were given higher scores.

The researchers then had each participant randomly assigned to start taking either:

• a combination of nutraceuticals -- a vitamin or mineral-based supplement used to treat or prevent disease;

• n-acetylcysteine -- an anti-inflammatory amino acid, commonly referred to as NAC; or

• a placebo pill for 16 weeks, in addition to whatever bipolar treatments they were already receiving.

The researchers then monitored each participant’s progress over the course of the study.

According to lead researcher Melanie Ashton of Deakin University in Australia, the nutraceutical treatment proved to be more beneficial for the group with the healthier diets.

“We found that people who had a better-quality diet, a diet with anti-inflammatory properties, or a lower BMI, showed better response to add-on nutraceutical treatment than did those who reported a low-quality diet, or a diet including foods that promote inflammation, or who were overweight,” Ashton said.

The researchers recently presented their findings at the European College of Neuropsychopharmacology Conference in Barcelona and noted that should these findings hold up over future tests, diet and weight would need to be factors in the treatment of bipolar disorder.

“If we can confirm these results, then it’s good news for people with bipolar disorder, as there is great need for better treatments for the depressive phase of bipolar disorder,” Ashton said.

A new U.S. study shows that more than one-third of American adults take prescription drugs that have the potential to cause depression.

The researchers found that more than 200 commonly used medications include depression as a possible side effect. The list includes certain proton pump inhibitors (PPIs) used to treat acid reflux, beta blockers, painkillers (including ibuprofen), anti-convulsant drugs, ACE inhibitors used to treat high blood pressure, and anxiety drugs. The risk for depression also increases when taking several of these drugs at the same time.

“The more of these medications you’re taking, the more likely you are to report depression,” says Mark Olfson, author of the study and professor of psychiatry at Columbia University.

“It was both surprising and worrisome to see how any medications have depression or suicidal symptoms as a side effect, given the burden of depression and suicide rates in the country, said Dima Mazen Qato, an assistant professor and pharmacist at the University of Illinois at Chicago and lead author of the study.

A look at the study

The study was published on Tuesday in the Journal of the American Medical Association, and featured the results of 26,192 adults who participated in the National Health and Nutrition Examination Survey.

At the time of the survey, all participants listed the medications they were taking and completed a depression screening that measured mood, sleep, and appetite.

Over one-third of participants were taking medications that had depression as a possible side effect. The goal of the study was to determine whether these individuals were more or less likely to experience depression compared to those who didn’t take any of these medications.

The study found that not only are individuals on these medications more likely to experience depression, but when taking multiple medications, they are three times more likely to be depressed.

Fifteen percent of participants who used three or more of these drugs at once were depressed compared to lower rates for those who only used one. Conversely, only five percent of participants who didn’t use any of these medications were depressed.

Despite the results, the researchers say they didn’t prove the medications cause depression.

“We didn’t prove that using these medications could cause someone who was otherwise healthy to develop depression or suicidal symptoms. But we see a worrisome dose-response pattern: the more of these medications that have these adverse effects that you’re taking concurrently, the higher the risk of depression,” said Dr. Qato.

The researchers also accounted for other risk factors that can cause depression when doing the study, including marital status, unemployment, poverty, and medical conditions like chronic pain.

“The study is an important reminder that all medicines have risks, and most medicines have rare but serious risks -- yet another reason that even commonly used medicines such as beta-blockers or proton pump inhibitors should not be used cavalierly,” said Dr. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health.

What the study means for the future

The researchers hope that the findings from this study urge people to have important conversations with their healthcare providers when taking medication.

“People should always be ready to ask, ‘What are the risks and benefits of me taking this medication?’” says Don Mordecai, a psychiatrist with Kaiser Permanente. “People who don’t have a history of depression and then, suddenly, start to have symptoms of depression should be concerned that it’s potentially due to a side effect, or potentially, an interaction.”

“With depression as one of the leading causes of disability and increasing national suicide rates, we need to think innovatively about depression as a public health issue,” Dr. Qato said.

In recent years, there have been several studies which show that getting physical exercise can help counteract the development of depression. However, researchers have predominantly focused on adults and adolescents when conducting trials.

To widen the scope, researchers from the Norwegian University of Science and Technology (NTNU) and NTNU Social Research have tested how exercise can affect children's mental health. The findings show that allowing children to run around and actively play lowers the risk of depression as well.

"Being active, getting sweaty and roughhousing offer more than just physical health benefits. They also protect against depression," said first author Dr. Tonje Zahl.

Protecting against depression

The researchers analyzed 800 children over a four-year period between the ages of six and ten. At three intervals, children’s physical activity levels were measured with accelerometers. Parents were also interviewed to gauge children’s mental health.

The results showed that physically active six- and eight-year-olds had fewer signs of depression when they were reassessed two years later. The researchers believe this correlation could be important for parents when it comes to encouraging certain hobbies and activities.

"This is important to know, because it may suggest that physical activity can be used to prevent and treat depression already in childhood," said co-author Silje Steinsbekk.

Less active kids may not be depressed

While the study does corroborate past research that extolls the benefits of physical activity, it also differs in some respects. Perhaps most notable is the finding that depressed children tend to also be less active; previous studies on adults had correlated a sedentary lifestyle with depression, but that did not seem to be the case with children.

"We also studied whether children who have symptoms of depression are less physically active over time, but didn't find that to be the case,” said Steinsbekk.

So, what can parents take away from all of this? The researchers say encouraging physical activity is the main thing to keep in mind, but limiting TV and computer time may also be wise.

The full study has been published in Pediatrics.

Maintaining a healthy heart is vital to having good overall health, but there are many issues that can get in the way. Being obese or smoking, for example, can stress the heart and lead to cardiovascular problems, but a new study shows that there is another condition that can be just as harmful.

Researchers from Helmholtz Zentrum München, along with colleagues from the Technical University of Munich and the German Center for Cardiovascular Disease, have found that depression poses just as great a risk to heart health. Further, they believe that finding how it interacts with other risk factors is of paramount importance.

“There is little doubt that depression is a risk factor for cardiovascular diseases,” said group leader Karl-Heinz Ladwig. “The question now is: What is the relationship between depression and other risk factors like tobacco smoke, high cholesterol levels, obesity or hypertension – how big a role does each factor play?”

Comparable risk factor

For the purposes of the study, Ladwig and his colleagues analyzed data from nearly 3,500 male patients between the ages of 45 and 74 for a total of 10 years. During that time, they tracked how depression impacted four other major risk factors for cardiovascular health.

The results indicated that depression led to the development of a fatal cardiovascular disease just as often as elevated cholesterol levels or obesity. The only risk factors that had a greater association were high blood pressure and smoking. Across the entire sample, the researchers say 15% of cardiovascular deaths could be attributed to depression.

“That is comparable to the other risk factors, such as hypercholesterolemia, obesity and smoking,” said Ladwig, pointing out that other risk factors caused between 8.4% and 21.4% of cardiovascular deaths.

The researchers believe that their work may have large implications on how the medical community evaluates depression as a condition. They point out that the findings indicate that the disorder has a “medium effect size within the range of major, non-congenital risk for factors for cardiovascular diseases.”

Ladwig says diagnostic investigation of co-morbid depression should become an industry standard, especially for high-risk patients.

The full study has been published in Atherosclerosis.

Depression – it’s a condition that has affected millions of people all around the world, and it can manifest itself in so many different ways. However, one common feeling that is often associated with it is one of hopelessness; it can often be hard for depressed individuals to imagine that things can ever get better.

But a new study shows that this is not necessarily the case. A team of researchers have found that 39% of individuals who have experienced a form of major depression are able to recover and achieve complete mental health. The team has also identified factors that both aid and detract from an individual’s ability to overcome the condition.

“This research provides a hopeful message to patients struggling with depression, their families and health professionals. A large number of formerly depressed individuals recover and go on to reach optimal well-being,” said lead author Esme Fuller-Thomson.

Full recovery never out of reach

While the phrase “complete mental health” may seem murky, the researchers clearly define it as a state that is reached when a person is able to achieve almost daily happiness or life satisfaction, positive social and psychological well-being, and are also free of depression, anxiety, suicidal thoughts, and substance abuse for at least one full year.

The study utilized a sample of over 2,500 participants who had shown symptoms of major depressive disorder at some time in their life. After collecting data on each participant, the researchers found that 39% of them were able to overcome their depression and achieve complete mental health.

Additionally, they found that the length of the depressive episode had no bearing on whether or not a participant was able to achieve complete mental health. For example, those who had long depressive episodes (lasting over two years) were able to overcome their depression just as often as those who experienced a depressive episode for one month.

“In other words, there is no need for individuals and families to lose hope that a full recovery is beyond reach,” remarked study co-author Senyo Agbeyaka.

Social support is key

While the length of the depressive episode had no bearing on a participant’s ability to achieve complete mental health, there were some factors that the researchers identified as being important to recovery.

Perhaps the most influential of these factors was the presence of social support. The researchers found that participants who had close ties to the people around them were much more likely to overcome their depression.

“Formerly depressed adults who had emotionally supportive and close relationships were four times more likely to report complete mental health than those without such relationships,” said co-author Mercedes Bern-Klug. “Having at least one trusted friend was critical to cultivating complete mental health.”

Inhibiting factors

On the flip side, the researchers found that certain factors stopped participants from achieving complete mental health. Some of these included poorer physical health, functional limitations, and insomnia. The researchers believe that these findings should inform how health care professionals treat depression.

“Clearly, this underlines the importance for health professionals to consider strategies that address both physical health problems and social isolation when treating those with depression,” said co-author Deborah LaFond.

The full study has been published in the journal Psychiatry Research.

Everyone knows we're more likely to be depressed in the winter. Only problem is, everyone may be wrong, according to a new study.

The large-scale survey of U.S. adults found no evidence that levels of depressive symptoms vary from season to season, contradicting the widespread believe that seasonal affective disorder -- often referred to as "SAD" -- is a real phenomenon.

"In conversations with colleagues, the belief in the association of seasonal changes with depression is more or less taken as a given and the same belief is widespread in our culture," says Steven LoBello, a professor of psychology at Auburn University at Montgomery and senior author on the new study, published in Clinical Psychological Science, a journal of the Association for Psychological Science.

"We analyzed the data from many angles and found that the prevalence of depression is very stable across different latitudes, seasons of the year, and sunlight exposures," LoBello said.

SAD was officially added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1987. But more recent studies have challenged the validity of earlier SAD research, including the fact that SAD is typically identified by asking patients to recall past depressive episodes over the course of the previous year or more.

Data examined

LoBello and lead study author Megan Traffanstedt decided to investigate whether they could find evidence for seasonal variation in depressive symptoms using data from a large-scale survey of U.S. adults.

They examined data from a total of 34,294 participants ranging in age from 18 to 99. Using geographic location for each participant, the researchers also obtained season-related measures including the actual day of the year, the latitude, and the amount of sunlight exposure.

The results showed no evidence that symptoms of depression were associated with any of the season-related measures. That is, people who responded to the survey in the winter months, or at times of lower sunlight exposure, did not have noticeably higher levels of depressive symptoms than those who responded to the survey at other times.

And the researchers did not find any evidence for seasonal differences in symptoms when they specifically looked at the subsample of 1,754 participants who scored within the range for clinical depression.

"The findings cast doubt on major depression with seasonal variation as a legitimate psychiatric disorder," the researchers conclude.

Emptiness. It is a word that many people with depression are familiar with. It is characterized by a distinct feeling of being lacking – lacking in feeling, lacking in motivation, lacking essential internal components that can make you feel “normal.” Ironically, researchers have found that it is an excess of a certain protein in the brain that may be a major factor in the development of depression in individuals.

The protein in question is called fibroblast growth factor 9, or FGF9 for short. When researching the protein, scientists found that people with major depression had 32% more of this protein in certain parts of their brain.

Testing the theory

Researchers from many organizations and universities, including the University of Michigan Medical School and the Pritzker Neuropsychiatric Disorders Research Consortium, developed their theory on FGF9 after years of studying brain tissue samples. They found that, along with increased levels of FGF9, the section of the brain called the hippocampus was smaller in brain samples of depressed individuals. They theorize that this is the result of FGF9 blocking cell growth and development in the brain.

In order to get a firm grasp on what FGF9 does to the brain, researchers used rats to see how changing the levels of the protein in their brains modified behavior. First, they exposed the rats to increased social stress for a week-long period. They found that FGF9 levels did increase, and the subjects became more socially withdrawn.

Next, the researchers injected FGF9 into the brains of an experimental rat group; the control group was given a placebo. The rats that received the real injection became much more anxious and less motivated to move around. These symptoms only worsened with more injections.

Finally, the researchers created a virus that would interfere with FGF9 production in the brain. They injected it into an experimental group of rats and found that FGF9 levels decreased by 30%. These rats became much less anxious as a result.

Better treatment

If we take a cue from the last experiment mentioned, then we can begin to see what some of the benefits of this research could be. It has already gone a long way in proving that depression is a physical illness, which has been debated in the medical community for many years.

“Fixing depression is not easy, because it’s a disorder at the level of the circuits that connect brain cells, and many regions of the brain are involved,” said Elyse Aurbach, co-author of the paper. “Still, this is the first time FGF9 has been identified as related to depression, and found to be active in a critical area of the brain for the disorder. We and others need to study it further to determine what is going on. It’s very exciting.”

As Aurbach says, there is still much research to be done on FGF9 before any sort of antidepressant can be developed. But when antidepressants can be developed, they would be much safer. Because the new medication would work at inhibiting FGF9 levels, instead of decreasing levels of something else in the brain, the risk of side effects would be greatly reduced. This thought will no doubt spur researchers on and keep them cautiously optimistic. 

Overcoming depression can be a major challenge for people who experience it every day. There are currently over 120 million people who suffer from it worldwide, and the existing therapies and prescriptions do not work for everyone. Luckily, recent research has found that elevating the levels of a signaling molecule in the brain can alter a person’s response to stress. This discovery could provide a new approach to treating depression.

The study was conducted by researchers from the UT Southwestern Medical Center. They found that mice changed their stress-induced behaviors when cyclic adenosine monophosphate (cAMP) levels in their brains were increased. This is extremely relevant to depression because other studies have showed that depressed people often have impaired cAMP signaling in their brains. Most antidepressants work by attempting to turn this signaling system on.

“This is the first step in the development of a treatment for patients with major depressive disorder using this new strategy,” said Dr. James Bibb, who is the lead author the study and a professor of psychiatry, neurology, and neurotherapeutics at UT Southwestern.

Changing responses to stressors

The cAMP levels in the brain correlate with feelings of pleasure, motivation, and reward. They are controlled by a variety of other molecules, which include an enzyme called phosphodiesterase-4 (PDE4). By disrupting PDE4 levels in the brain, scientists found that cAMP levels were able to elevate higher within the mice, which changed their behavioral responses to different stressors.

The researchers have already developed a drug-like peptide that they hope can selectively block PDE4 function. If successful, it could provide a new way for people with depressive disorders to deal with their condition and the stressors that cause it.  

“These exciting findings could help us develop very novel treatments to reduce stress response and prevent or treat depression effectively in the future," saidDr. Madhukar Trivedi, who is the Director of the Center of Depression Research and Clinical Care. The full study has been published in the journal Nature Neuroscience.

What makes someone depressed? The question becomes more urgent as the number of cases of clinical depression increases.

The Centers for Disease Control and Prevention (CDC) estimates depression at some point affects about 9% of U.S. adults, leaving them with feelings of hopelessness, despondency, and sometimes guilt. The agency says major depression is the leading cause of disability for Americans between the ages of 15 and 44.

Researchers have turned out study after study trying to better understand the condition. At the University of Washington a recent study suggested stress is a major trigger.

A recent British study found over-achievers are more at risk of depression, becaise they become addicted to the Internet. Companies fail to notice the depression, the researchers conclude, because the sufferers are all successful.

Since many of the cases of depression have appeared in the wake of the financial crisis, some researchers looked for – and found – a link to long-term unemployment. Nearly 1 in 5 Americans who have been unemployed for a year or more say they currently have or are being treated for depression.

Physical illness

Here's a new theory. Major depressive disorder (MDD) is actually an infectious disease and not always caused by external influences.

Turhan Canli, a psychology professor at Stony Brook University, suggests that major depression may result from parasitic, bacterial, or viral infection. He thinks depression needs to be reclassified from a mental illness to a physical one while research continues into its causes.

“Future research should conduct a concerted effort search of parasites, bacteria, or viruses that may play a causal role in the etiology of MDD,” he said.

Canli offers 3 arguments why reconceptualizing MDD as an infectious disease may pay off.

For starters, patients with MDD exhibit physical symptoms like a loss of energy. Beyond that, inflammatory biomarkers associated with depression also suggest an illness-related origin.

Viruses can alter behavior

Canli says there is plenty of evidence that parasites, bacteria and viruses that infect humans can alter their emotional behavior. Finally, he cites the concept of the human body as an ecosystem for microorganisms and the role of genetics.

There's enough there, says Canli, to justify large-scale studies with depressed patients to see if there actually is a causal relationship between infectious disease and depression. A Northwestern University study, published in September, just might provide some ammunition.

Researchers developed a blood test that measures the levels of 9 RNA blood markers which seem to be different in patients diagnosed with clinical depression, suggesting some kind of physical link.

Depression symptoms

The CDC says symptoms of depression can range from a sad mood and diminished interest in activities to dramatic weight gain or loss, fatigue and excessive and unjustified feelings of guilt.

The condition also poses a substantial burden to the sufferer and friends and family. Interpersonal relationships are particularly likely to suffer when someone is depressed and the CDC says data suggest that few families or networks of friends are likely to remain unaffected.

When major depression goes unrecognized and untreated the results can turn tragic. Consequences can range from ruined marriages to damaged careers to suicide.

The CDC says this disorder is still misconstrued as a sign of weakness rather than being recognized as an illness.

Teen suicide is the third-leading cause of death for people in the U.S. between the ages of 15 and 24. Only homicide and accidents claim more lives.

The statistics from the U.S. Centers for Disease Control and Prevention also show as many as 20% of teens consider suicide at some point during the year.

But help may be available from an unexpected source.

In many instances, young people appear too reliant on digital communication, sending hundreds of texts and spending hours posting on social media sites. Some say it's not healthy. Now, mental health officials say what looks like a negative might actually turn out to be beneficial if it can be harnessed to provide a teen suicide early warning system.

After all, young people tend to be quite revealing when they send out a text or post something online. What if someone just paid closer attention?

Analyzing posts

A research team based at Ohio State University (OSU) began monitoring posts on MySpace. In one month they found 64 comments in which adolescents expressed a wish to die.

The researchers then conducted a follow-up survey of young adults and found that young people were highly likely to use text messages when they felt very depressed, reaching out to family and friends. They were least likely, the researchers found, to call a suicide-prevention hotline, which is probably the most common prevention strategy among existing suicide-prevention initiatives.

Obvious tool

Together, the data from the two studies told the researchers that an obvious tool was right in front of them. They conclude that teen suicide-prevention efforts should employ social networking and other types of technology.

“Obviously this is a place where adolescents are expressing their feelings,” said Scottye Cash, associate professor of social work at OSU and lead author of the studies. “It leads me to believe that we need to think about using social media as an intervention and as a way to connect with people.”

The team focused on MySpace and not Facebook because most Facebook profiles are private and not accessible. The challenge was finding expressions that met the test of a real suicide threat, not an easy task considering the age group.

“There’s a lot of drama and angst in teenagers so in a lot of cases, they might say something ‘will kill them’ but not really mean it. Teasing out that hyperbole was an intense process,” Cash said.

Song lyrics often a clue

Sometimes a post would reference a song lyric that was about suicide. According to Cash, the three most common phrases within the final sample were “kill myself,” referenced in 51.6 percent of the posts, “want to die,” mentioned 15.6 percent of the time, and “suicide,” mentioned 14.1 percent of the time.

Cash and her colleagues determined that 42 percent of the posts referred to problems with family or other relationships – including 15.6 percent that were about break-ups – and 6.3 percent were attributable to mental health problems or substance abuse.

A report by the National Institute of Mental Health, issued in 2004, determined that risk factors for suicide include depression and other mental disorders, and substance-abuse disorders. Sometimes these factors combined with other mental disorders. According to the report, more than 90 percent of people who die by suicide have these risk factors.

On top of the risk factors, mental health experts point to additional stressors, such as disciplinary problems, interpersonal losses, family violence, sexual orientation confusion, physical and sexual abuse and being the victim of bullying.

Researchers at UC San Francisco (UCSF) and Baystate Medical Center in Massachusetts have found that that Prozac and other selective serotonin reuptake inhibitors (SSRIs) can cause all types of problems when taken close to surgery.

The researchers came to this conclusion after examining over 530,000 medical records of patients who underwent surgery in the U.S. between the years of 2006 and 2008.

The 2012 AGS Beers Criteria showed SSRIs were potentially harmful for some seniors because they caused fall and balance issues.

More evidence found

Andrew D. Auerbach, MD, MPH, a professor of medicine at UCSF and lead author of the research, said past studies showed small signs of SSRIs being potentially harmful.

“There have been small studies that suggested there was a problem, but it has never been well-proven,” said Auerbach. “With this huge data set, we feel confident in saying that SSRIs are associated with about a 10% increased risk for these adverse outcomes.”

Auerbach and his team said if taken around the time of a surgery, SSRIs could cause hospital readmission, bleeding, transfusion and death.

Furthermore, the research team said many patients taking SSRIs already have conditions that could cause surgeries to go wrong, like chronic pulmonary disease, rapid weight gain and depression, so they took that into consideration.

Some factors eliminated

Some of the patients reviewed in the study were prescribed SSRIs for the first time, which Auerbach thought might be a contributor to some surgeries going wrong. But after looking closer, he said that argument didn't hold up. 

To make sure SSRIs actually did increase the chances of bleeding, transfusions and death during surgeries, researchers looked at patients who were on the antidepressant and patients who were not. Afterwards, they still found the same higher risk.

Auerbach said further research needs to be done involving actual patients on SSRIs at the time of surgery. For this current study only past medical records were used.

“A prospective observational study, in which patients are randomly assigned to take SSRIs around the time of surgery is still needed,” he said.

Autism link?

Surgery patients aren’t the only ones who might face potential harm from taking SSRIs. A new report out of Sweden indicates the antidepressant could cause autism in newborn babies too.

‘In utero exposure to both selective serotonin reuptake inhibitors and nonselective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increase risk of autism spectrum disorders, particularly without intellectual disability,” wrote the researchers.

After looking at the medical records of women during the early stages of pregnancy, researchers discovered the potential link between the antidepressant drug and autism.

The new evidence adds weight to concerns raised by a 2011 study in California, in which researchers also found that SSRI use in pregnancy was associated with increased risks of autism in the exposed children.  Furthermore, they showed that the association was with the SSRI use and not depression (that is, the depression-only group did not have an increased risk of autism.)  

Both studies found about a three-fold (or 300%) increased risk. 

“Future, larger studies, with access to both diagnostic and treatment data at multiple stages of pregnancy may help disentangle the role of maternal depression and the individual drugs used to treat it in the risk of autism spectrum disorder,” the Swedish researchers wrote.

A new study from the Centre for Addiction and Mental Health (CAMH) found meditation provides the same protection against depression and depressive relapse as traditional antidepressant medication.

"With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives," said Dr. Zindel Segal, Head of the Cognitive Behaviour Therapy Clinic in the Clinical Research Department at CAMH.

Recent studies have shown about half of depressed people on antidepressants stop taking them, sometimes within two to four months, well before the medication has had a chance to work.

Segal said this could be due to side effects or an unwillingness to take medication for years.

"Mindfulness-based cognitive therapy is a non pharmacological approach that teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance," said Segal.

For the study, participants who were diagnosed with major depressive disorder were all treated with an antidepressant until their symptoms remitted.

They were then randomly assigned to come off their medication and receive MBCT, come off their medication and receive a placebo, or stay on their medication.

Participants in MBCT attended 8 weekly group sessions and practiced mindfulness as part of daily homework assignments.

Clinical assessments were conducted at regular intervals, and over an 18 month period, relapse rates for patients in the MBCT group did not differ from patients receiving antidepressants (both in the 30% range), whereas patients receiving placebo relapsed at a significantly higher rate (70%).

"The real world implications of these findings bear directly on the front line treatment of depression. For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse," said Segal.

"Sequential intervention -- offering pharmacological and psychological interventions -- may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder."

The study was published in the current issue of the Archives of General Psychiatry.

For decades, some physicians have suspected that patients' risk of suicidal thoughts and behavior increased when pediatric patients first begin taking antidepressants. Research indicates that there is no such association in adults.

In 2003, a report submitted to the Food and Drug Administration (FDA) suggested a link between the antidepressant paroxetine and suicidality in pediatric patients. The FDA then requested pediatric data from the manufacturers of eight other antidepressant drugs, the authors report.

Tarek A. Hammad, M.D., Ph.D., and colleagues at the FDA performed a meta-analysis of data from 23 short-term clinical trials received in response to the request, as well as one trial funded by the National Institute of Mental Health (NIMH). The 24 studies included 4,582 pediatric patients taking one of nine antidepressant medications for depression, anxiety or other psychiatric disorder.

No children committed suicide in any of the trials. Although the NIMH-funded trial was the only individual trial to show a significant increase in suicidality among children taking antidepressants, the analysis of all the trials together showed a higher risk of suicidal ideation and behavior for children taking the drugs compared with those who were not.

"When considering 100 treated patients, we might expect one to three patients to have an increase in suicidality beyond the risk that occurs with depression itself owing to short-term treatment with an antidepressant," the authors write.

The FDA now requires warnings regarding the risk of suicidality in children on antidepressant labeling and the distribution of a patient medication guide to patients, families and caregivers, the authors write.

"Although there remain differences of opinion in the clinical community about the strength of this signal for antidepressant druginduced suicidality in pediatric patients and the implications for clinical practice, it is important to be clear that the FDA has not contraindicated any of the antidepressant drugs for pediatric use," they conclude.

"The FDA recognizes that depression and other psychiatric disorders in pediatric patients can have significant consequences if not appropriately treated. The new warning language recognizes this need but advises close monitoring of patients as a way of managing the risk of suicidality."

FDA has also directed Eli Lilly and Company, manufacturer of Strattera, to develop a Medication Guide for patients and caregivers.

FDA is advising health care providers and caregivers that children and adolescents being treated with Strattera should be closely monitored for clinical worsening, as well as agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior, especially during the initial few months of therapy or when the dose is changed (either increased or decreased).

Patients and caregivers who have concerns or questions about these symptoms should contact their healthcare provider.

The actions follow a review and analysis of 12 clinical trials conducted in children with ADHD and one trial in children with enuresis (bedwetting) that identified an increased risk of suicidal thinking for Strattera.

There was one suicide attempt by a patient who received Strattera among the approximately 2,200 patients in the trial.

As part of a larger evaluation of psychiatric drugs and suicidality, FDA had requested that the manufacturer conduct a review of its database and clinical trials, which included more than 2200 patients -- 1350 patients receiving Strattera (atomoxetine) and 851 receiving a placebo.

The analysis showed that 0.4% of children treated with Strattera reported suicidal thinking compared to no cases in children treated with the placebo.

Strattera, manufactured by Eli Lilly, has been on the market since 2002 and has been used in more than two million patients.

Patients requesting specific medications can have a profound effect on physicians prescribing medications for major depression, according to a new study in the April 27 issue of the Journal of the American Medical Association.

Critics charge that direct-to-consumer (DTC) advertisements lead to overprescribing of unnecessary, expensive, and potentially harmful medications. Proponents counter that they can serve a useful educational function and encourage patients to treat conditions that may be poorly recognized or highly stigmatized.

The study noted that antidepressant medications consistently rank among the top DTC advertising categories -- with $3.2 billion spent on consumer ads for antidepressants in 2003.

Richard L. Kravitz, M.D., M.S.P.H., from the University of California, Davis, and colleagues conducted a randomized trial using trained actors as standardized patients to determine the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms. The patients were middle-aged, white, non-obese women, most with professional acting experience.

They were trained to portray six roles and represented two clinical conditions: symptoms consistent with major depression or adjustment disorder, and three request types: a brand-specific drug request, a general drug request, or no request (control condition).

The scenarios included patients telling their doctor that they had seen an advertisement for Paxil on TV and asked for that drug by name; or patients saying they had watched a program on TV about depression and asking the physician if medication might help them.

The researchers chose Paxil because at the time of the study, it was widely promoted, priced higher than the generic fluoxetine, and available through the participating health care organizations in all three cities. In the control scenario, the patients reported the same symptoms but made no request for medication.

"Antidepressant prescribing rates were highest for visits in which standardized patients made general requests for medication (76 percent), lowest for visits in which standardized patients made no requests for medication (31 percent), and intermediate for visits in which standardized patients made brand-specific requests linked to DTC advertising (53 percent)," the authors found.

"Among standardized patients portraying major depression, paroxetine was rarely prescribed (approximately 3 percent) unless the standardized patient specifically requested Paxil; if Paxil was requested by name, 14 (27 percent) of 51 received Paxil/paroxetine, 13 (26 percent) received an alternative antidepressant, and 24 (47 percent) received no antidepressant," they said.

For standardized patients portraying adjustment disorder, physicians were less likely to prescribe antidepressants.

"These results underscore the idea that patients have substantial influence on physicians and can be active agents in the production of quality," the authors write. "The results also suggest that DTC advertising may have competing effects on quality, potentially averting underuse, while also promoting overuse."

"The results of this trial sound a cautionary note for DTC advertising but also highlight opportunities for improving care of depression (and perhaps other chronic conditions) by using public media channels to expand patient involvement in care," the study's authors said. "Furthermore, physicians may require additional training to respond appropriately to patients' requests in clinically ambiguous circumstances."

In an accompanying editorial, Matthew F. Hollon, M.D., M.P.H., from the University of Washington, Seattle, writes, "Relying on emotional appeals, most advertisements provide a minimal amount of health information, describe the benefits in vague, qualitative terms, and rarely offer evidence to support claims."

More than 80 percent of physicians believe that DTCA does not provide balanced information, he added.

The Food and Drug Administration (FDA) has issued an update of its previous analysis of a possible link between some anti-depressant medication used by children and suicidal tendencies. The agency said it is preparing to issue new warnings.

"FDA has completed a new analysis of pediatric suicidality (suicidal thoughts and actions) data submitted to the agency and will be posting its analysis on its web site. FDA will also be posting on its web site additional summaries of pediatric efficacy studies from drugs that have been studied in depression in pediatric patients. Although specific new labeling language has yet to be developed, FDA will assure that the labels of the antidepressants used in pediatric patients reflect the most recent information obtained from these studies and analyses," the agency said in a news release.

The update may alarm some parents whose children are on anti-depressants, especially since FDA was not specific about which medications may be the subject of the warning.

In 2003 British health authorities published a list of commonly prescribed anti-depressants that might increase the risk of suicidal behavior in young people, and declared only Prozac as suitable for children.

FDA says it has been closely reviewing the results of antidepressant studies in children since June 2003, after an initial report on studies with paroxetine (Paxil) appeared to suggest an increased risk of suicidal thoughts and actions in the children given Paxil, compared to those given placebo. Later reports on studies of other drugs supported the possibility of an increased risk of suicidal thoughts and actions in children taking these drugs. There were no suicides in any of the trials.

In mid September, the agency said, FDA officials will be discuss this issue at a public meeting of its Psychopharmacologic Drugs and Pediatric Advisory Committees, at which time the agency will hear from the public and solicit the advice of the committees on these labeling changes and other possible regulatory actions.

Earlier this year the FDA urged medical professionals to closely monitor patients of all ages for warning signs of suicide, especially when they first start the pills or change a dose. Researchers believe starting medication may cause agitation, anxiety and hostility in some patients who may be sensitive to rare side effects.

Doctors say it's hard to tell if medication triggers suicide or if it's a product of the depression the medication is designed to treat. So far, Prozac is the only FDA-approved drug for pediatric depression.