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Clinical Review

Long term treatment of depression with selective serotonin reuptake inhibitors and newer antidepressants


Published 26 March 2010

BMJ 2010;340:c1468

Steven Reid, consultant psychiatrist1, Corrado Barbui, lecturer in psychiatry2

1 Department of Liaison Psychiatry, St Mary’s Hospital, London W2 1PF, 2 Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, 37134 Verona, Italy

Correspondence to: S Reid steve.reid@nhs.net

The rise in the prescribing of antidepressants is largely accounted for by an increase in long term treatment.

Half of people with a diagnosis of major depression will go on to have a further episode, and risk of recurrence increases with each episode.
Evidence for the benefits of long term prescribing of antidepressants comes almost exclusively from secondary care settings.
Continuing antidepressant treatment roughly halves the absolute risk of relapse.
The increased risk of suicidal behavior associated with selective serotonin reuptake inhibitors (SSRIs) is restricted to people aged under 25.
People with risk factors for relapse of depression should be advised to continue with SSRIs for at least 12 months and consider long term treatment.
The introduction of fluoxetine in 1987 marked the arrival of the selective serotonin reuptake inhibitors (SSRIs) for the treatment for depression.  In the United States antidepressant prescriptions accounted for 2.6% of primary care visits in … [Full text of this article]

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‘Slow treatment cost me my marriage’

21 March 2010

A majority of doctors say they can “rarely” offer psychological therapy to depression sufferers within two months of referral, a study claims. Leigh Bailey, 34, says delays in his treatment had a dramatic effect on him and his family.

“I initially had a nervous breakdown in 1998. I took numerous overdoses that year. It took six months for me to get cognitive behavioural therapy.

“More recently I have had problems accessing group analytical therapy. On one occasion this took around two years from initial conversations with my doctor.

“When you need the therapy you’re at a crisis point and you’ve got nowhere else to turn. What are you supposed to do while you are waiting?

“It really makes you lose faith in the system. I even started to deny that I had mental health problems and I wouldn’t take my medication, which made things worse.

“The only people I had around me at that time was my family, and it was heart-wrenching for them. You need someone who is detached emotionally, who can look at things from a professional point of view.

“Once I actually got the service it was excellent and really has helped change me.

“There have been other periods of hardship since, which, because of the therapy I received I have been able to cope with. I haven’t fallen down and that has made me stronger and more confident.

“I have also benefited from regular exercise. The mental health charity Mind put me 10-week fitness course focussing on Boxercise, which incorporates a number of boxing moves and techniques, without the physical contact. I am now a qualified gym instructor.

“I honestly believe that the time it took for me to receive the therapy and help I needed had an impact on my wife and family leaving me.

“If I had had access to psychological services within 28 days, everything could have been completely different.

“I might still be married now and things would be normal.”

Source:  http://news.bbc.co.uk/1/hi/health/8578125.stm

Depression Care Slowed by Cultural Stigma 


By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 29, 2010

A study finds that appropriate mental health care is hindered by an individual’s cultural bias.

Failure to recognize or appreciate mental illness impedes appropriate disease management and includes behaviors such as noncompliance with medication regimens and a failure to attend scheduled appointments.

The findings could help physicians develop a series of question to identity patients who might especially be resistant to care and then help them understand how treatment works, said lead study author William Vega.

“Unfortunately, mental-health stigma turns out to be one of the most serious barriers for people receiving care or staying in care,” said Vega, professor of medicine and social work at the University of Southern California.

Many cultures have stereotypes about depression and mental illness, he said, with some viewing it as something that will brand a family for generations.

Latinos, in particular, value resilience and think, “it’s a cultural value to be able to handle your own affairs,” he said. “If you can’t, it implies that you’re weak.”

While it might not be surprising that Latinos stigmatize mental illness, “like many things, it’s all anecdotes and innuendo until you do something more solid, like a research study, and start finding out what the issues are,” said Vega, who worked on the study with fellow researchers while at the University of California at Los Angeles.

In the new study, published in the March/April issue of the journal General Hospital Psychiatry, researchers surveyed 200 poor, Spanish-speaking Latinos in Los Angeles. They all had visited local primary care centers; 83 percent were women. All had shown signs of depression in an initial screening.

Another screening found that all but 54 of the 200 individuals were mildly to severely depressed. Researchers deemed 51 percent as those who stigmatize mental illness, based on responses to questions about things like the trustworthiness of a depressed person.

The researchers found that those who stigmatized mental illness were 22 percent less apt to be taking depression medication, 21 percent less likely to be able to control their depression and about 44 percent more likely to have missed scheduled mental health appointments.

The findings “shows evidence that stigma does exist, and it’s related to things that are important to provide as part of proper treatment,” Vega said.

Jamie Walkup, a Rutgers University associate professor of psychology who studies mental health and stigma, said the key is to find ways to “push back against these negative ideas, hoping that a person with depression will no longer let an aversion to being a person with depression stop them from doing what they may need to do to get help.”

It might be worth asking, he said, “whether it may sometimes make more sense to switch gears with a patient who, for whatever reason, finds it intolerable to think of themselves as having depression.”

In such cases, doctors could find other ways to work with these patients without insisting that they acknowledge their diagnosis.

Source: Health Behavior News Service



Top 10 Signs of Depression


By John M. Grohol, Psy.D.

Depression is a real, but often misunderstood, mental disorder that can be readily treated with both medications and psychotherapy.

Not everyone who is depressed experiences every symptom. Some people experience a few symptoms, some many. The severity of symptoms varies with individuals and also varies over time.

  1. 1.  Persistent sad, anxious, or “empty” mood
  2. 2.  Feelings of hopelessness or pessimism
  3. 3.  Feelings of guilt, worthlessness, or helplessness
  4. 4.  Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  5. 5.  Decreased energy, fatigue, or feeling “slowed down”
  6. 6.  Difficulty concentrating, remembering, or making decisions
  7. 7.  Insomnia, early-morning awakening, or oversleeping
  8. 8.  Appetite and/or weight loss or overeating and weight gain
  9. 9.  Thoughts of death or suicide or actual suicide attempts
  10. 10.  Restlessness or irritability


Some people may also experience certain persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

A person who suffers from a major depressive disorder (sometimes also referred to as clinical depression or major depression) must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person’s normal mood.

Learn more about depression here.

Source:  http://psychcentral.com/lib/2007/top-10-signs-of-depression/

New Health Bill Helps Postpartum Depression (PPD)

By John M Grohol PsyD

The historic passage of the federal health care legislation last week included a provision for a new national postpartum depression (PPD) program. It leaves out the federal screening program so feared by the bill’s opponents, but it includes more money for greater education outreach and more research into this condition. The Melanie Blocker Stokes Mother’s Act passed in watered down form.

Postpartum depression (PPD) is a condition suffered by a minority of women who just gave birth. It is characterized by severe depression and sadness, and often either a lack of interest or even thoughts of harming one’s newborn baby. There is also often the feeling that one will not be a good mother. Postpartum depression may be called the “baby blues,” and sometimes an obstetrician or doctor will minimize the symptoms of this concern by suggesting it is “normal” or something most mothers experience that the woman just needs to “snap out of” or it’ll resolve on its own given time. It may very well indeed, but it may also worsen and like any mental health condition, should be taken seriously.

The federal legislation is named the Melanie Blocker Stokes Mother’s Act, for an Illinois woman whose story has been on the Oprah Winfrey Show and in Jet and Ebony Magazine. A month after giving birth in 2001, the once-vibrant career woman and doctor’s wife was in a depression so profound she stopped eating and drinking. Medication and other treatments failed her. Stokes jumped to her death from the 12th floor of a Chicago hotel.

There is a crying need to look for causes, methods of prevention and better treatment for PPD, and to implement nationwide the kind of education New Jersey has been doing.

There’s not a lot of federal money devoted to the act — just a few million dollars for the education component, according to the article. Hopefully with the passage of the new law, however, the estimated 800,000 mothers who suffer from this concern each year will get better care and be taken seriously by their health care provider.

Postpartum depression is a very real and very serious mental health concern that can affect both the health and well-being of mother and baby. It’s nice to finally see the passage of a solid first step in helping the mothers who may suffer from this concern in silence, and either fear or don’t know how to ask for help for it.

Read the full article: Postpartum depression: Health bill helps mothers in crisis


Anesthesia Drugs, A Possible Cure For Depression?


Article Date: 28 Mar 2010 – 0:00 PDT

A small study has indicated that anesthesia may relieve depression in some patients. This is one of many trends that Kalorama Information is noticing in the dynamic $4.1 billion market for anesthesia drugs. The healthcare market research publisher’s new report, “The World Anesthesia Drug Market,” notes that although a rather mature market, growth is being driven by more surgeries as a result of an aging population, with the general anesthesia segment expected to enjoy the highest annual growth at 4.8% through 2014. According to the report’s analysis, new therapeutic applications may drive additional sales long-term.

Researchers at the National Institute of Mental Health discovered that administering a single low dose of an anesthesia drug produced almost immediate relief from depression in a small study group of patients that did not respond to any other type of depression therapy. The positive effects lasted several weeks for many participants. This is one of the first studies to look at the effect of Ketamine on depression in humans, though earlier animal studies did show some promising results.


This is a potentially exciting area of research for anesthesia products because currently available antidepressants can take weeks to work. Ketamine is novel not only for the speed at which it takes effect, but also because it targets a different system in the brain. All currently available antidepressants work on monoamine neurotransmitters such as serotonin and dopamine. But Ketamine involves the main excitory neurotransmitter in the brain called glutamate. Ketamine functions by blocking glutamate’s action on the N-methyl-D-aspartic acid (NMDA) receptor.


However, due to possible severe side effects, including psychosis, Ketamine is unlikely to be approved for use in the treatment of depression. Nevertheless, the study did reveal a potentially promising method for combating depression and opens up an important new area for future research.


“With millions of people suffering from chronic and debilitating depression and not responding to existing treatment options, the possibility of finding a different, more effective avenue towards relief is very appealing,” said Melissa Elder, analyst for Kalorama Information and author of the report. “If low doses of Ketamine, or another form of anesthesia, can be achieved with minimal side effects, it would open up a vast new market opportunity for anesthesia producers.”


Ongoing research is focusing on reducing the side effects of Ketamine as well as on the use of other anesthesia products.


“The World Anesthesia Drug Market” analyzes this market, and provides key information including market data and forecasts, product reviews, trends and issues, and detailed company profiles. The report is available here.


Source Kalorama Information


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