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January 2011



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Abstract: An open trial in the NHS of Blues Begone®: A new home based computerized CBT program

Purves DG, Bennett M, Wellman N.

London Metropolitan University, UK; Berkshire Healthcare Foundation Trust, UK; Thames Valley University, London, UK

Background: Computer based treatment for depression and anxiety has been available for several years and has demonstrated useful clinical effects. Most existing computerized CBT products in the UK that are designed to treat depression and co-morbid anxiety require patients to visit a clinic and require staff input to manage the process. Such intervention adds to the costs and bottlenecks in delivering a clinically effective treatment with mass availability. Internet treatment options are becoming more readily available, although data to support use are not yet strong, and most still require human assessment and telephone support. Blues Begone® is a new computerized CBT program that has been designed to be used at home with minimal human support.

Method: This pilot project provides data from an open trial of Blues Begone® with both primary and secondary care patients.

Results: One hundred patients started Blues Begone®, 58 completed the program, 72% (n = 42) of completers achieved reliable change and (n = 36) 62% achieved both reliable and clinically significant change, and may be considered to have recovered by the end of the program.

Conclusion: These data provide the first demonstration of the potential viability of Blues Begone® as a home based computerized treatment for depression and anxiety.

Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

Abstract+: Antidepressant dosing for the acute treatment of unipolar depression

Solvason HB, DeBattista C.

Antidepressants are among the most commonly prescribed medications.

The treatment of major depressive disorder can be challenging even in those without comorbid medical or psychiatric illness.

The majority of people treated for a major depressive episode do not achieve complete remission after treatment with a single antidepressant. Achieving an adequate dose and duration of treatment is important to achieve maximal response and remission rates.

The selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are separate classes of antidepressants with unique characteristics reflected in the differing dosing strategies used, the need for blood monitoring, and dose-drug tolerability relationships. SSRIs have a relatively flat dose-response curve.

Among the SNRIs, venlafaxine has a marked dose-response relationship, whereas duloxetine and milnacipran do not.

Blood monitoring with bupropion and several TCAs can be important in achieving the best clinical response.

MAOIs are often used for treatment-resistant depression and doses for these medications may exceed the Food and Drug Administration-approved dose.

These concerns are addressed as well as clinical concerns in the initiation and dosing of these medications.

Source + Full text…
© 2009 Primary Psychiatry a Publication of MBL Communications


Primary care physicians urged to screen all adults for depression

Michele Surricchio – American College of Preventive Medicine

The American College of Preventive Medicine (ACPM) supports the recommendations of the US Preventive Services Task Force (USPSTF) that primary care providers should screen all adults for depression, and further recommends that all primary care providers should have systems in place to ensure the accurate diagnosis and treatment of this condition. The earliest and best opportunities to identify depression are in the clinics of primary care providers and all primary care practices should have such systems of care in place.

According to Dr Michael T. Compton, one of the lead authors of ACPM’s recommendation, “Depressive disorders are common in primary care settings and are associated with substantial morbidity and disability for individuals, as well as direct and indirect costs to society. Yet, depression is a highly treatable condition, and the goal of treatment is complete recovery. We believe that all primary care providers should be equipped to screen for depression and to assure timely and adequate treatment, either in their own practices or through an established system of referral to mental health professionals.

Depression is a potentially life-threatening disorder that affects approximately 14.8 million Americans 18 years of age and older in a given year. Depression also affects many people younger than age 18. The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study found that nearly 40% had their first depressive episode before the age of 18.

According to Dr Mark B. Johnson, President of ACPM, “Depression is a major concern in the United States that leads to devastating consequences in many families. ACPM will continue to monitor emerging evidence on ways to prevent, screen for and treat this disease.

Nimalasuriya K, Compton MT, Guillory VJ, Prevention Practice Committee of the American College of Preventive Medicine Screening adults for depression in primary care: A position statement of the American College of Preventive Medicine. J Family Practice 2009 Oct;58(10) [Full text]

Does depression cause inflammation, or is it caused by it?

Cindy Fox Aisen – Indiana University School of Medicine

Which comes first, depression or inflammation?

To help solve this long standing chicken and egg conundrum, researchers led by Jesse Stewart, PhD, assistant professor of psychology at Indiana University-Purdue University Indianapolis asked two critical questions. Does depression lead to elevated inflammatory proteins in the human body? Or does an increase in these proteins lead to depression?

They found that the answer to the first question appears to be “yes,” and the answer to the second question may be “no” among healthy adults.

The researchers report that depressive symptoms are associated with increases over time in interleukin-6, an inflammatory protein that predicts cardiovascular events. In contrast, levels of interleukin-6 were not related to later increases in depressive symptoms.

The new study, published in the October 2009 issue of the journal Brain, Behavior and Immunity, is the first to examine both directions of the depression-inflammation connection and to measure the physical symptoms of depression, such as fatigue and sleep disturbance, in addition to the cognitive-emotional symptoms, such as pessimism and sadness.

Several previous studies have linked depression to increased inflammatory protein levels measured at the same time. These studies, however, cannot speak to which is the cause and which is the effect. “There is two-way communication between the brain and the immune system, so we had to determine whether activation of the body’s immune system sent a signal to the brain to affect mood and behavior or whether the depression activated the immune system,” said Dr Stewart, a clinical health psychologist in IUPUI’s School of Science and an IU Center for Aging Research affiliated scientist.

Participants in the study were 263 healthy men and women aged 50-70 years at the start of the study. They were tested at baseline and again six years later to determine their levels of depressive symptoms and interleukin-6. Levels of C-reactive protein, another inflammatory protein, were also measured but were not related to depression.

The strength of the association of depression with future heart disease is similar to that of traditional risk factors like smoking, high blood pressure and elevated cholesterol, according to Dr Stewart.

Promotion of inflammation may be one pathway through which depression may ‘get under the skin’ to negatively influence cardiovascular health. The link to cardiovascular disease demonstrates that there may be physical as well as mental health reasons to treat depression,” said Dr Stewart.

The study was funded by the U.S. National Heart, Lung, and Blood Institute.

Stewart JC, Rand KL, Muldoon MF, Kamarck TW. A prospective evaluation of the directionality of the depression-inflammation relationship. Brain Behav Immun. 2009 Oct;23(7):936-944   [Abstract]

Mediterranean diet may reduce risk of depression


Individuals who follow the Mediterranean dietary pattern-rich in vegetables, fruits, nuts, whole grains and fish-appear less likely to develop depression, according to a report in the October issue of Archives of General Psychiatry.

The lifetime prevalence of mental disorders has been found to be lower in Mediterranean than Northern European countries, according to background information in the article. One plausible explanation is that the diet commonly followed in the region may be protective against depression. Previous research has suggested that the monounsaturated fatty acids in olive oil-used abundantly in the Mediterranean diet-may be associated with a lower risk of severe depressive symptoms.

Almudena Sánchez-Villegas, B.Pharm., PhD, of University of Las Palmas de Gran Canaria and Clinic of the University of Navarra, Pamplona, Spain, and colleagues studied 10,094 healthy Spanish participants who completed an initial questionnaire between 1999 and 2005. Participants reported their dietary intake on a food frequency questionnaire, and the researchers calculated their adherence to the Mediterranean diet based on nine components (high ratio of monounsaturated fatty acids to saturated fatty acids; moderate intake of alcohol and dairy products; low intake of meat; and high intake of legumes, fruit and nuts, cereals, vegetables and fish).

After a median (midpoint) of 4.4 years of follow-up, 480 new cases of depression were identified, including 156 in men and 324 in women. Individuals who followed the Mediterranean diet most closely had a greater than 30 percent reduction in the risk of depression than whose who had the lowest Mediterranean diet scores. The association did not change when the results were adjusted for other markers of a healthy lifestyle, including marital status and use of seatbelts.

The specific mechanisms by which a better adherence to the Mediterranean dietary pattern could help to prevent the occurrence of depression are not well known,” the authors write. Components of the diet may improve blood vessel function, fight inflammation, reduce risk for heart disease and repair oxygen-related cell damage, all of which may decrease the chances of developing depression.

However, the role of the overall dietary pattern may be more important than the effect of single components. It is plausible that the synergistic combination of a sufficient provision of omega-three fatty acids together with other natural unsaturated fatty acids and antioxidants from olive oil and nuts, flavonoids and other phytochemicals from fruit and other plant foods and large amounts of natural folates and other B vitamins in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression,” the authors write.

The study was supported by Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias and the Navarra Regional Government project.

Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean Dietary Pattern With the Incidence of Depression. Arch Gen Psychiatry. 2009;66(10):1090-1098   [Abstract]


Depression is a dilemma for women in pregnancy



When Sherean Malekzadeh Allen of Marietta, Ga., learned she was pregnant, she was 43, had been married for two years, had gone through two miscarriages and had all but given up hope of having a baby.

But instead of being overjoyed, Ms. Allen was immobilized: panic-ridden, nauseated, listless and thoroughly depressed. She could not rouse herself to go to work in the marketing business she founded and ran, or even get through the newspaper.

And she faced the pregnant woman’s quintessential dilemma: take drugs that might pose a risk to the developing baby, or struggle through an anguishing pregnancy that could harm the baby in other ways?


Copyright 2009 The New York Times Company

Post-Partum Psychosis – Rare but Real

By T. A. McNamee, MD

The existence of post-partum psychosis and post-partum depression has been hotly contested publicly. Tom Cruise’s denouncement of Brooke Shields’ diagnosis of post-partum depression is perhaps the most visible example of the controversy among laypeople, but in the medical literature the reality of both post-partum depression and post-partum psychosis is much more well-established.

Read in Full:  http://brainblogger.com/2009/10/01/post-partum-psychosis-rare-but-real/

Abstract: Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms

Vaaler AE, Morken G, Linaker OM, Sand T, Kvistad KA, Brathen G.

Background: In psychiatric acute departments some patients present with brief depressive periods accompanied with fluctuating arrays of other psychiatric symptoms like psychosis, panic or mania. For the purpose of the present study we call this condition Acute Unstable Depressive Syndrome (AUDS). The aims of the present study were to compare clinical signs of organic brain dysfunctions and epilepsy in patients with AUDS and Major Depressive Episode (MDE).

Methods: Out of 1038 consecutive patients admitted to a psychiatric acute ward, 16 patients with AUDS and 16 age- and gender-matched MDE patients were included in the study. Using standardized instruments and methods we recorded clinical data, EEG and MRI.

Results: A history of epileptic seizures and pathologic EEG activity was more common in the AUDS group than in the MDE group (seizures, n=6 vs. 0, p=0.018; pathologic EEG activity, n=8 vs. 1, p=0.015). Five patients in the AUDS group were diagnosed as having epilepsy, whereas none of those with MDE had epilepsy (p=0.043). There were no differences between the groups regarding pathological findings in neurological bedside examination and cerebral MRI investigation.

Conclusions: Compared to patients admitted with mood symptoms fulfilling DSM 4 criteria of a major depressive disorder, short-lasting atypical depressive symptoms seem to be associated with a high frequency of epileptic and pathologic EEG activity in patients admitted to psychiatric acute departments.

Source |Full text (PDF)

Less than half those affected seek treatment for depression

Research finds even for those hospitalized for severe depression, many receive little follow-up

Julie Saccone – St. Michael’s Hospital

Less than half of men and women in Ontario, Canada who may be suffering from depression see a doctor to treat their potentially debilitating condition, according to a new women’s health study by researchers at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES).

What’s more, many hospitalized for severe depression fail to see a doctor for follow-up care within 30 days of being discharged, and many head to hospital emergency departments for care.

The findings suggest the need for a comprehensive care model involving a multidisciplinary team of health-care professionals, including family doctors and mental health specialists, to help women and men and better manage depression and improve their quality of life.

As a leading cause of disease-related disability among women and men, depression puts a tremendous emotional and financial burden on people, their families and our health-care system,” says Dr Arlene Bierman, a physician at St. Michael’s Hospital and principal investigator of the study Project for an Ontario Women’s Health Evidence-Based Report (POWER). “Many Ontarians with depression are not treated for their condition and those who are often receive less than desired care. While there is a lot that is known about how to improve depression, we need to apply this to our work with patients if we want to improve the diagnosis and management of depression. This involves better co-ordination among primary care and mental health-care professionals in both community and hospital settings,” added Dr Bierman, a ICES researcher.

Nearly half a million Ontarians, aged 15 and older, suffer from depression. Worldwide, an estimated 154 million people are afflicted by the condition, which is responsible for lost productivity, increased disability claims and greater use of health-care services.

Key findings of the POWER study released today include:

  • *Less than 50% of men and women with depression visited a doctor for care for their condition
  • *33% of men and women discharged from hospital for severe depression did not see a doctor for a follow-up visit within 30 days
  • *17% visited a hospital emergency room within 30 days of discharge from hospital while about 8% were readmitted to hospital
  • *Many older adults started on antidepressant medication did not receive the recommended number of follow-up visit


U.S. family doctors prescribe most mental health drugs

By David Morgan

WASHINGTON (Reuters) – Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, not psychiatrists, raising concerns about the quality of some treatments, according to a study released on Wednesday.

Researchers from Thomson Reuters and the U.S. Substance Abuse and Mental Health Services Administration examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007.


© Thomson Reuters 2009

The darker side of therapy – Ten ways to deal with dependency

There is a dark side to therapy that nobody wants to talk about; even therapists, especially therapists. It’s a Catch-22 where emotionally-promiscuous clients quickly fall into dependency with their therapists and problems occur when dependency, instead of the original problem, becomes the main issue. Weaning yourself off your substitute mother/therapist can be like trying to forcibly remove a security blanket from a two-year-old or an attempt to separate the ingredients of a corrupt Hollandaise sauce after the egg has curdled.


Copyright © 1992-2009 Psych Central. All rights reserved.

Providing Mental Health Care To The Underserved

Article Date: 09 Oct 2009 – 2:00 PDT

The Robert Wood Johnson Foundation (RWJF) has announced its selection of Satira Streeter, Psy.D., clinical psychologist and executive director of Ascensions Community Services in the District of Columbia, to receive a Community Health Leaders Award. She is one of 10 extraordinary Americans who received the RWJF honor for 2009 at a ceremony at the Mayflower Hotel in Washington, D.C.

Streeter is being honored for her efforts to deliver culturally relevant, family-focused psychological services to children and families living in the economically challenged Anacostia community (Wards 7 and 8) of the District of Columbia. Working without a salary for more than two years, Streeter founded Ascensions Community Services to ensure that Anacostia’s children and their families would have the mental health services that they so desperately need.

Read in Full:  http://www.medicalnewstoday.com/articles/166773.php

Childhood Trauma May Shorten Adult Life

By Psych Central News Editor
Reviewed by John M. Grohol, Psy.D. on October 8, 2009

Exposure to trauma early in a child’s life — such as being exposed to physical or verbal abuse, witnessing domestic violence, or even just having parents who have divorced — can harm a child’s brain and nervous system development.

Such harm can then reverberate throughout the child’s life, making them more prone to future health problems and diseases. Such problems can ultimately lead to a premature death, according to new research led by David W. Brown., D.Sc., an epidemiologist at the Centers for Disease Control and Prevention (CDC).

Brown and his colleagues found that children who were exposed to six or more adverse childhood experiences were at double the risk of premature death compared to children who had not suffered these experiences.

On average, the children at highest risk eventually died at age 60, compared to low-risk children who lived to age 79.

The research looked at the long-term effects of these childhood experiences: undergoing verbal or physical abuse, having a battered mother and witnessing domestic violence, living in a household with substance abuse or mental illness, having an incarcerated household member or having parents who separated or divorced.

Read in Full:  http://psychcentral.com/news/2009/10/08/childhood-trauma-may-shorten-adult-life/8852.html

Psychiatrists lay down the rules for prescribing to kids

A psychiatrist contemplating the prescription of psychotropic medications to a kid should open communications to the child’s pediatrician. He should ensure that the child and her family grasp the objectives, side effects and benefits of the proposed medication, and agree it’s needed. The psychiatrist should have a detailed plan to monitor the effects of the medication and change if it’s not getting the job done or has untoward side effects.


© 2009 LA Times

Mike hopes his recovery from depression will inspire others

Thursday 8th October 2009

An estimated one in four people will experience a mental health problem in the next 12 months.

It is now 10 years since Mike Wilson’s world fell apart.

He had, unbeknown to him, been suffering from depression and had a complete mental breakdown on October 7, 1999.

He spent more than two months in hospital, contemplating suicide on several occasions because he felt he could not go on.

But over the last decade he has gradually turned his life around.

Mr Wilson, aged 50, of Ash Grove, Heaton, now does volunteer work, including helping other mental health patients with charity MhIST, Mental Health Independent Support Team.

He said: “I was frightened. Like a lot of people, I thought if you had a mental health problem you were a lunatic and got locked away for good. But it wasn’t like that.

“There is still a lot stigma around mental health problems. People don’t talk about them although they are very common. We talk about cancer, why not mental health?

“I’m very open about it, depression is part of who I am and will always be with me. I’m learning to live with it and I say I am on the road to recovery.”

In the summer of 1999, Mr Wilson started to feel unwell, with symptoms including hearing voices, panic attacks, not eating and being unable to sleep.

By the October, Mr Wilson, who has been married to Lesley for 28 years and has an autistic daughter, Danielle, aged 25, saw his doctor and was admitted to the Royal Bolton Hospital.

After eight weeks he returned home and, with medication, community support and MhIST, he slowly rebuilt his life.

He is passionate about helping others going through similar experiences, and also does church and youth work.

Mr Wilson said: “There is help out there, so please seek it as soon as possible. You might not get cured, but you can get better. But you’ve got to take the first step and get help.

“For me life really did begin at 40.”


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