Major depressive episodes far more common than previously believed
July 30, 2020
Science Daily/Yale School of Public Health
The number of adults in the United States who suffer from major depressive episodes at some point in their life is far higher than previously believed, a new study by the Yale School of Public Health finds.
National survey data currently shows that approximately 17% of women and 10% of men report having a history of major depressive episodes (MDEs) in their lifetimes. But these data are subject to "recall error," or the tendency of people to forget or misreport their health histories when taking a survey.
Researchers led by Jamie Tam, Ph.D., assistant professor in the Department of Health Policy and Management, created a simulation model to generate corrected estimates of lifetime depression. They found that the proportion of U.S. adults who have had MDEs is actually closer to 30% of women and 17% of men after factoring in recall error.
"Major depressive episodes are far more common than we thought," said Tam. "Our model shows that the probability of someone having a first major depressive episode is especially high during adolescence. We also know from other research that having a first major depressive episode increases the likelihood you'll have a second one. This means that anything we can do to prevent or treat episodes among young people could lead to larger health benefits over the course of their life."
The findings are published in the American Journal of Preventive Medicine.
A major depressive episode is defined as a period of two weeks or longer in which a person experiences feelings of intense sadness and hopelessness, fatigue, weight gain or weight loss, changes in sleeping habits, loss of interest in activities and thoughts of suicide or attempts at suicide. These persistent symptoms cannot be easily changed, even if they are contradictory to a person's circumstances. Depressive episodes typically recur periodically in people diagnosed with major depression.
The study shows that mental health programs that screen for, prevent and treat depression could benefit a much larger segment of the population than previously thought, Tam said.
"If you think about chronic health conditions like heart disease, we do a lot to identify people who might be at risk for additional health events like heart attacks because that group would benefit from maintenance treatment and clinical monitoring," Tam said. "We don't do such a great job when it comes to mental health conditions. So, if we're able to assess how many people actually have histories of depression, that also tells us that more people are at risk of experiencing more depressive episodes."
The researchers also found that older adults are especially likely to under-report their history of having depressive symptoms. Among adults 65 years and older, underreporting for depression was as high as 70%. Older adults often experience what is referred to as "minor depression," where they still report significant depressive symptoms but don't always meet clinical requirements for major depression. Tam said there may be a tendency for older adults to downplay negative experiences of depression from when they were younger, classifying them as "growing pains" rather than major depression.
"Unfortunately, many people with depression or with histories of depression don't access, or don't have access to, treatment or support," Tam said. "There's a broader problem in our society of mental health not receiving the same attention and investment of resources compared to physical health conditions."
https://www.sciencedaily.com/releases/2020/07/200730132813.htm
Anti-inflammatory agents can effectively and safely curb major depressive symptoms
Effects even stronger when added to antidepressant treatment, pooled data analysis shows
October 28, 2019
Science Daily/BMJ
Anti-inflammatory agents, such as aspirin/paracetamol, statins, and antibiotics, can safely and effectively curb the symptoms of major depression, finds a pooled analysis of the available evidence, published online in the Journal of Neurology Neurosurgery & Psychiatry.
And the effects are even stronger when these agents are added on to standard antidepressant treatment, the results show.
Around a third of people who are clinically depressed don't respond well to current drug and talking therapies, and drug side effects are relatively common.
An emerging body of evidence suggests that inflammation contributes to the development of major depression, but the results of clinical trials using various anti-inflammatory agents to treat the condition have proved inconclusive.
The researchers therefore set out to review the available evidence and pool the data to see if anti-inflammatory agents work better than dummy (placebo) treatment either alone or when used as add-on therapy to standard antidepressant treatment.
Anti-inflammatory agents included: non-steroidal anti-inflammatory drugs (NSAIDs); omega 3 fatty acids; drugs that curb production of inflammatory chemicals (cytokine inhibitors); statins; steroids; antibiotics (minocyclines); a drug used to treat sleep disorders (modafinil); and N-acetyl cysteine, known as NAC, and used to loosen the excess phlegm of cystic fibrosis and COPD and also taken as an antioxidant supplement.
The researchers trawled research databases to find suitable studies published up to January 2019. They found 30 relevant randomised controlled trials, involving 1610 people, which reported changes in depression scales. They pooled the data from 26 of these studies.
The pooled data analysis suggested that anti-inflammatory agents were better than placebo and enhanced the effects of standard antidepressant treatment.
These agents were 52% more effective in reducing symptom severity, overall, and 79% more effective in eliminating symptoms than placebo, as measured by an average fall in depression scales of 55.
More detailed analysis indicated that NSAIDs, omega 3 fatty acids, statins, and minocyclines were the most effective at reducing major depressive symptoms compared with placebo.
And the effects were even greater when one or other of these agents was added to standard antidepressant treatment.
But anti inflammatory agents didn't seem to improve quality of life, although this might have been because of the small number of studies which looked at this aspect, say the researchers.
No major side effects were evident, although there were some gut symptoms among those taking statins and NACs, and the trials lasted only 4 to 12 weeks, so it wasn't possible to track side effects over the longer term.
The researchers also point out that not all studies tracked changes in depression scores over the entire study period. The depression scales used in the studies differed, and those involving statins and minocyclines included only small numbers of patients.
Nevertheless, they conclude: "The results of this systematic review suggest that anti-inflammatory agents play an antidepressant role in patients with major depressive disorder and are reasonably safe."
https://www.sciencedaily.com/releases/2019/10/191028213923.htm
Weighing risks and benefits of drug treatment for major depression
June 12, 2019
Science Daily/American Geriatrics Society
For some people, medication is an effective part of treatment for depression. However, when considering whether to prescribe antidepressant medication for older adults, healthcare providers must weigh the safety risks these medications pose against the often modest benefits they can provide compared to other options.
Depression is a common and serious problem for older adults. Some 15 to 20 percent of people aged 65 and older who live independently deal with symptoms of major depressive disorder. For residents of nursing homes, the rates of depression may be as high as 50 percent.
For some people, medication is an effective part of treatment for depression. However, when considering whether to prescribe antidepressant medication for older adults, healthcare providers must weigh the safety risks these medications pose against the often modest benefits they can provide compared to other options.
For example, tools like the American Geriatrics Society (AGS) Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults recommended that healthcare providers avoid prescribing certain antidepressant medications to older adults who have a history of falls or fractures. These include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). That's because these medications may actually increase the risk of falls and fractures.
Understanding these and other risks associated with "potentially inappropriate medications" is key to building better care for us all as we age. That's why a team of researchers recently reviewed and analyzed studies to learn more specifically about the harmful effects of antidepressants for treating major depressive disorder in adults 65 years of age or older. Their study was published in the Journal of the American Geriatrics Society.
The systematic review was performed at the University of Connecticut Evidence-based Practice Center (EPC). The researchers reviewed studies that examined how many older adults experienced a harmful event during the study.
The researchers looked at patients 65 years of age or older who are prescribed serotonin and norepinephrine reuptake inhibitors (SNRIs) to treat the acute phase of major depressive disorder (the earliest stage of the condition, when the goal is to address the symptoms associated with an episode of depression). They found that taking SNRIs led to a greater number of harmful events compared to people who took a placebo (a harmless sugar pill that has no effect on health and is prescribed to some study participants to help with comparing their results to results from people who were treated with actual medication). Older adults who took SSRIs experienced about the same number of harmful events as did people who took a placebo.
The researchers said that taking either SSRIs or SNRIs led to a greater number of people leaving the study due to harmful events of the drugs compared to placebos. They also noted that the drug duloxetine, an SSRI, increased the risk of falls.
"Some of the antidepressants have not been studied in older patients with major depression, and studies don't often describe specific side effects. Future research in this field is critical to better inform how the safety profiles of different antidepressants compare in older adults," said study co-author Diana M. Sobieraj, Pharm.D., FCCP, BCPS, Assistant Professor, University of Connecticut School of Pharmacy.
https://www.sciencedaily.com/releases/2019/06/190612141302.htm
How stimulant treatment prevents serious outcomes of ADHD
July 23, 2019
Science Daily/Massachusetts General Hospital
An analysis of three previous studies of children and young adults with attention-deficit hyperactivity disorder (ADHD) quantifies for the first time the extent to which stimulant treatment reduces the development of mood disorders, school problems, conduct disorders, substance use disorders and other problems. The study led by Massachusetts General Hospital investigators is being published online in the Journal of Adolescent Health.
"Our study documents that early treatment with stimulant medication has very strong protective effects against the development of serious, ADHD-associated functional complications like mood and anxiety disorders, conduct and oppositional defiant disorder, addictions, driving impairments and academic failure," says Joseph Biederman, MD, chief of the Pediatric Psychopharmacology and Adult ADHD Program at MGH and MassGeneral Hospital for Children. "In quantifying the improvement seen with stimulant treatment, it measures its potency in mitigating specific functional outcomes."
Previous studies of stimulant treatment for ADHD have had limitations, such as only investigating outcomes in boys or not calculating the magnitude of the protective effects of treatment. The current study determined the number needed to treat (NNT) statistic, often used to show the effectiveness of an intervention. As the title indicates, NNT reflects the number of individuals receiving a medication or other treatment needed to prevent a specific unwanted outcome -- the lower the NNT, the more effective the treatment.
The investigators analyzed data from three separate studies they had previously published to calculate the NNT needed to prevent specific outcomes. Two of these were long-term, prospective studies of children with and without ADHD -- one of boys, one of girls -- some of those diagnosed with ADHD were treated with stimulants, some were not. The third study was a randomized, double blind study of young adults with ADHD that compared their performance on a driving simulation upon entering the study with their performance after six weeks of treatment with either a stimulant medication or a placebo. Participants in the long-term studies averaged age 11 upon study entry and 20 at follow-up, and the current investigation focused only on those with ADHD. Participants in the driving study were ages 18 to 26.
The NNTs for the outcomes of interest were found to be quite low:
· three participants with ADHD needed to be treated to prevent one from repeating a grade or developing conduct disorder, anxiety disorders or oppositional-defiant disorder.
· four participants with ADHD needed to be treated to prevent one from developing major depression or experiencing an accident during the driving simulation.
· five participants with ADHD needed to be treated to prevent one from developing bipolar disorder, six to prevent one from smoking cigarettes, and ten to prevent one from developing a substance use disorder.
Adjustments for the sex of participants and several other factors did not change the impact of treatment on those outcomes, except that the protection against substance use disorders was stronger in younger participants.
"Now we have the evidence allowing us to say that stimulant treatment of ADHD prevents the development of several very serious functional outcomes," says Biederman, a professor of Psychiatry at Harvard Medical School. "However, the impact on other serious outcomes -- such as post-traumatic stress disorder, traumatic brain injury, suicide risk and employment success -- still needs to be investigated." (is your team planning any such studies?)
https://www.sciencedaily.com/releases/2019/07/190723085959.htm
Half of Those Diagnosed with PTSD Also Suffer from Depression
June 4, 2013 —
Science Daily/Case Western Reserve University
About one of every two people diagnosed with posttraumatic stress disorder (PTSD) also suffer symptoms of depression, according to new research by Case Western Reserve University's Department of Psychological Sciences.
The analysis also concludes that both genders diagnosed with PTSD equally suffer from depression. Since women tend to report more symptoms of depression than men, this contradicts a general belief that women are more inclined to struggle with both.
The findings were based on an analysis of 57 peer-reviewed studies, representing data on 6,670 people (civilians and military personnel) who suffered from PTSD. Researchers conclude that 52 percent of the PTSD cases also reported symptoms of depression.
Before the study, estimates for individuals having both major depression disorder (MDD) and PTSD had ranged anywhere from 20 to 80 percent.
The research represents the first comprehensive analysis of peer-reviewed literature on people with PTSD and MDD.
PTSD is an anxiety disorder resulting from a traumatic incident in which flashbacks or unshakable thoughts about the trauma are common. MDD is characterized by an overwhelming and lingering sense of sadness and hopelessness. Symptoms can range from "feeling the blues" to thoughts of suicide.
"If individuals do not get a comprehensive assessment of what's bothering them, one or the other can be missed," said Case Western Reserve research associate Nina Rytwinski, the study's lead investigator and a researcher with the National Institute of Mental Health-funded PTSD project directed by Norah Feeny, PhD, from Case Western Reserve University and Lori Zoellner, PhD, from the University of Washington. "This high co-occurrence rate accentuates the importance of routinely assessing for both disorders."
The findings also suggest important implications for improving how men with PTSD are treated. Health-care providers tend to identify depression more frequently in women, while men can exhibit symptoms of depression that are misattributed to PTSD, Rytwinski said.
"The biases against men with PTSD symptoms put them at risk for under diagnosis and under treatment of a major depressive disorder," she said.
Researchers narrowed about 1,500 studies on PTSD and MDD to the 57 published peer-reviewed studies. They focused on research about individuals who had experienced some physical or sexual assault trauma.
By recognizing how frequently people experience both disorders, clinicians may better address barriers to completing therapy, personalized treatment and overall care, the researchers report.
http://www.sciencedaily.com/releases/2013/06/130604153515.htm