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Social media posts could be used to diagnose depression in advance

Posts made on platforms like Facebook can serve as warning signs

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.”

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...
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One in three adults in the U.S. take medications linked to depression

Researchers say taking more of these medications increases the risk of the condition

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.

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...
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Depression can be just as bad for heart health as smoking or obesity, researchers say

A long-term study found that 15% of cardiovascular deaths were attributed to the condition

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.

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,...
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Nearly two in five adults are able to overcome depression and lead happy lives

One study shows that full recovery is never out of reach

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.

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...
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Depression more common in the winter? New study says it's not

Large-scale survey finds no evidence of seasonal affective disorder

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.

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...
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Discovery of a new brain protein sheds light on depression

Researchers believe that their discovery could lead to better treatment for the disease

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. 

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...
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Altering molecules that control motivation, pleasure, and reward can help those suffering from depression

Researchers have found that increasing cAMP levels in the brain may change our behavioral response to stressors

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.

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 world...
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As cases rise, doctors try to better understand depression

Latest theory suggests there may be a physical cause

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.

What makes someone depressed? The question becomes more urgent as the number of cases of clinical depression increases....
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Social media could be teen suicide prevention tool

Young people are reaching out, researchers say, but someone needs to pay attention

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.

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 s...
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Meditation: The New Antidepressant?

Study finds regular meditation as effective as medication for many depressed patients

For people suffering from depression, meditation might be a viable way to treat it, instead of medication.

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.

Meditation: The New Antidepressant? Study finds regular meditation as effective as medication for many depressed patients...
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FDA Issues Suicide Warning on ADHD Drug

The Food and Drug Administration (FDA) is issuing a Public Health Advisory to alert physicians of reports of suicidal thinking in children and adolescents associated with Strattera, a drug approved to treat attention deficit hyperactivity disorder (ADHD).

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.

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Consumer Drug Ads May Influence Doctors' Rx Decisions

Doctors tend to give patients what they ask for

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.

Consumer Drug Ads May Influence Doctors' Rx Decisions...
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FDA Updates Analysis of Prozac in Children

Explores link to suicidal tendencies

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.

FDA Updates Analysis of Prozac in Children...
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