Jill Stein

July 8, 2009 (Paris, France) – While omega-3 supplements are only nominally better than placebo as a treatment for major depression, they provide significant benefit in depressed patients without comorbid anxiety. In addition, the supplements are well tolerated, according to results of the Omega-3D trial reported here at the 9th World Congress of Biological Psychiatry (WCBP).

“We believe our findings are important because depressed patients without comorbid anxiety disorder account for about half of all depressed patients,” Francois Lesperance, MD, professor of psychiatry at the University of Montreal, in Quebec, told Medscape Psychiatry.

Berk M, Jeavons S, Dean OM, Dodd S, Moss K, Gama CS, Malhi GS.

Department of Clinical and Biomedical Sciences at the University of Melbourne, Australia; Mental Health Research Institute, Melbourne, Australia; Discipline of Psychological Medicine, University of Sydney, Australia; Laboratório de Psiquiatria Molecular, Centro de Pesquisas, Hospital de Clínicas de Porto Alegre, Brazil

N-acetyl cysteine (NAC) is a widely available nutraceutical with a variety of actions. As a precursor of cysteine and glutathione, it has antioxidant properties that may impact on mood and contribute to an effect on impulsivity and obsessive behaviour. Via its additional effect on glutamate via the cystine-glutamate exchange system, NAC has been shown to mediate impulsivity in preclinical models of addiction, reduce craving, and cue extinction. Further, by boosting glutathione, NAC acts as a potent antioxidant and has been shown in two positive, large-scale randomized placebo-controlled trials to affect negative symptoms in schizophrenia and depression in bipolar disorder.

We describe three cases in which its actions specifically on nail-biting and associated anxiety may offer a potential treatment. The spontaneous findings are reported as part of an ongoing treatment trial examining the utility of NAC in bipolar disorder. Its actions, if robustly replicated, also point to potential treatment targets in glutathione or glutamate pathways in the brain.

Binkley CJ, Beacham A, Neace W, Gregg RG, Liem EB, Sessler DI.

Background: Red hair color is caused by variants of the melanocortin-1 receptor (MC1R) gene. People with naturally red hair are resistant to subcutaneous local anesthetics and, therefore, may experience increased anxiety regarding dental care. The authors tested the hypothesis that having natural red hair color, a MC1R gene variant or both could predict a patient’s experiencing dental care-related anxiety and dental care avoidance.

Methods: The authors enrolled 144 participants (67 natural red-haired and 77 dark-haired) aged 18 to 41 years in a cross-sectional observational study. Participants completed validated survey instruments designed to measure general and dental care-specific anxiety, fear of dental pain and previous dental care avoidance. The authors genotyped participants’ blood samples to detect variants associated with natural red hair color.

Results: Eighty-five participants had MC1R gene variants (65 of the 67 red-haired participants and 20 of the 77 dark-haired participants) (P < .001). Participants with MC1R gene variants reported significantly more dental care-related anxiety and fear of dental pain than did participants with no MC1R gene variants. They were more than twice as likely to avoid dental care as were the participants with no MC1R gene variants, even after the authors controlled for general trait anxiety and sex.

Conclusion: Dental care-related anxiety, fear of dental pain and avoidance of dental care may be influenced by genetic variations.

Clinical Implications: Dentists should evaluate all patients, but especially those with naturally red hair, for dental care-related anxiety and use appropriate modalities to manage the patients’ anxiety.

Elaine Bible

A new study of Chinese-American youth has found that family obligation, for example caring for siblings or helping elders, plays a positive role in the mental health of Chinese-American adolescents and may prevent symptoms of depression in later teenage years.

Published in the June edition of the Journal of Family Psychology, the study found that 14-year-olds who reported a greater sense of family obligation reported fewer depressive symptoms by the time they reached 16. The findings suggest that family obligation may be protective against depressive symptoms. The authors suggest that a greater sense of family obligation in the early teenage years could provide teenagers with a strong family bond that makes them feel secure even when they move through adolescence and become more autonomous.

The longitudinal study surveyed 218 Chinese-American teenagers over a two-year period. As participants grew older, their actions to help and support their families decreased. However, their attitude and respect toward their families remained stable, indicating that immigrant adolescents continue to endorse their traditional cultural values even when their behaviors suggest they are becoming less traditional. 

Juang LP, Cookston JT. A longitudinal study of family obligation and depressive symptoms among Chinese American adolescents. J Fam Psychol. 2009 Jun;23(3):396-404 [Abstract]

Maletic V, Raison CL, Jain R, Draud JW.

As we begin this brief review of the neurobiology of major depressive disorder (MDD), we face these fundamental questions:

• Will the provided information be clinically relevant?
• Can current scientific research provide us with a coherent, comprehensive, and relatively accurate description of the underlying neurobiology of MDD?

Major depression, bipolar disorder (BD), and generalized anxiety disorder (GAD) are all characterized by a significant genetic contribution to their etiopathogenesis.

Laura Bailey 

College students with depression are twice as likely as their classmates to drop out of school according to new research to be published in a future edition of the online journal B.E. Journal of Economic Analysis and Policy.

However, the research also indicates that lower grade point averages depended upon a student’s type of depression, according to Daniel Eisenberg, assistant professor in the University of Michigan School of Public Health and principal investigator of the study.

There are two core symptoms of depression-loss of interest and pleasure in activities, or depressed mood-but only loss of interest was associated with lower grade point averages.

“The correlation between depression and academic performance is mainly driven by loss of interest in activities,” Eisenberg said. “This is significant because it means individuals can be very depressed and very functional, depending on which type of depression they have. I think that this can be true for many high achieving people, who may feel down and hopeless but not lose interest in activities.

“Lots of students who have significant depression on some dimension are performing just fine, but may be at risk and go unnoticed because there is no noticeable drop in functioning.”

Students with both depression and anxiety had especially poor academic performance.

“If you take a student at the 50th percentile of the GPA distribution and compare them to a student with depression alone, the depressed student would be around the 37th percentile-a 13 percent drop,” Eisenberg said. “However, a student with depression and anxiety plummets to about the 23rd percentile, a 50 percent drop.”

In the study, Eisenberg and his colleagues conducted a Web survey of a random sample of approximately 2,800 undergraduate and graduate students about a range of mental health issues in fall 2005, and conducted a follow-up survey with a subset of the sample in fall 2007.

The dropout rate for University of Michigan students is about 5 percent per year, which is much lower than the national average, Eisenberg says. This likely reflects the type of high-achieving students Michigan attracts, along with U-M’s support network for students experiencing emotional problems or depression.

“Michigan does seem to be a leader in many respects in terms of things the university has done related to student mental health,” said Eisenberg, who noted that the next step in the research is a large scale study. “I see this study as suggesting that there is value in a large randomized trial of screening and treating depressed students, in which the academic outcomes are measured carefully. That’s what it will take to really see what the value is in reducing the dropout rate and improving GPA. As far as I know this has not been done.”

Many students with depression-as with the general population-remain untreated.

“Maybe the biggest reason is only about 50 percent of people with depression say they think they need help,” Eisenberg said. “College students in particular may feel that stress is normal.”

According to Eisenberg’s research, certain types of students have higher levels of stigma. Males, students from lower-income backgrounds and Asian students, in particular, report higher levels of stigma about mental health. 

Eisenberg D, Golberstein E, Hunt J. Mental Health and Academic Success in College. BE J Economic Analysis Policy, 2009 [Full text ()