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« on: February 17, 2006, 09:03:08 pm »

Major Depression   

Definition:

Major depression is when 5 or more symptoms of depression are present for at least 2 weeks. These symptoms include feeling sad, hopeless, worthless, or pessimistic. In addition, people with major depression often have behavior changes, such as new eating and sleeping patterns. Major depression increases a person's risk of suicide.



Alternative Names:
Depression - major; Unipolar depression; Major depressive disorder


Causes, incidence, and risk factors:

The exact cause of depression is not known. Many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person's life.

Some types of depression seem to run in families, but depression can also occur in people who have no family history of the illness. Stressful life changes or events can trigger depression in some people. Usually, a combination of factors are involved in the development of major depression.

Major depression is one of the most common chronic conditions. Each year, more than 18 million Americans -- men and women of all ages, races, and economic levels -- suffer from depression. It occurs more often in women.

Women are especially vulnerable to depression after giving birth. This is a result of the hormonal and physical changes that they have experienced. While new mothers commonly experience temporary "blues", depression that lasts longer than 2-3 weeks is not normal and requires treatment.

Major depression can occur in children and teenagers, and they can also benefit from treatment.
 

Symptoms:

Major depression is when a person has 5 or more of the following symptoms for more than 2 weeks:

Trouble sleeping or excessive sleeping
A dramatic change in appetite, often with weight gain or loss
Fatigue and lack of energy
Feelings of worthlessness, self-hate, and inappropriate guilt
Extreme difficulty concentrating
Agitation, restlessness, and irritability
Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such sex)
Feelings of hopelessness and helplessness
Thoughts of death or suicide
Depression can appear as anger and discouragement rather than feelings of hopelessness and helplessness. If depression is very severe, it may be accompanied by psychotic symptoms, such as hallucinations and delusions. These are usually consistent with the depressed mood, and may focus on themes of guilt, personal inadequacy, or disease.


Signs and tests:

Major depression is diagnosed if the person reports having 5 or more depressive symptoms for at least 2 weeks. Beck's Depression Scale Inventory or other screening tests for depression can be helpful in diagnosing depression.

Medical causes that can show symptoms of depression should also be ruled out before making the diagnosis of depression.


Treatment:

Depression can be treated in a variety of ways, particularly with medications and counseling. Most people benefit from a combination of the two. Some studies have shown that antidepressant drug therapy combined with psychotherapy appears to have better results than either therapy alone.

Medications include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs), and some newer antidepressant drugs. While antidepressant medications can be very effective, some may not be appropriate for everyone. For example, in September, 2004 the FDA began considering a warning that some antidepressants may increase the risk of suicidal tendencies in children.

Lithium and thyroid supplements may be needed to enhance the effectiveness of antidepressants. For persons with psychotic symptoms, such as delusions or hallucinations, antipsychotic medications may be needed.

Electroconvulsive therapy (ECT) is a treatment that causes a seizure by means of an electrical current. ECT may improve the mood of severely depressed or suicidal people who don't respond to other treatments.

Research is now being conducted on transcranial magnetic stimulation (TMS), which alters brain functioning in a way similar to ECT, but with fewer side effects. Use of light therapy for depressive symptoms in the winter months and interventions to restore a normal sleep cycle may be effective in relieving depression.

As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements. It is important to maintain a healthy lifestyle. Eat well-balanced meals, avoid alcohol and drugs (which make depression worse and may interfere with medications), get regular exercise and sleep, and seek supportive interpersonal relationships.

Many consumers try herbal products for depression. St. John's wort has a long history of use in Germany and has gained popularity as an herbal antidepressant in the United States. Most of the German studies indicated that St. John's wort was comparable to some antidepressants. However, a large study conducted by the National Center for Complementary and Alternative Medicine found that St. John's wort was NOT effective for treating major depression.

Because herbal products can have side effects, always tell your doctor if you are using them.


[Expectations (prognosis):

The outcome is usually good with treatment. Although most depressive episodes can be effectively treated with either medication, psychotherapy, or both, depression is a recurring problem for many people. For people who have experienced repeated episodes of depression, maintenance treatment may be needed to prevent future recurrences.



Complications:

Suicide (up to 15% of people with major depressive disorder die by suicide)
Increased risk of alcohol- and drug-related problems
Increased risk of tobacco dependence
Increased risk of problems with physical health and premature death due to medical illness


Calling your health care provider:

Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.

Call your doctor right away if:

You hear voices that are not there.
You have frequent crying spells with little or no provocation.
You have had feelings of depression that disrupt work, school, or family life for longer than 2 weeks.
You think that one of your current medications may be making you feel depressed. DO NOT change or stop any medications without consulting your doctor.
You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.

[ Prevention:

Some episodes of depression can be avoided by:

Learning how to relax and manage stress
Avoiding alcohol, drugs, and caffeine
Exercising regularly
Maintaining good sleep habits
Counseling may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue.

For elderly or others who feel socially isolated or lonely, try volunteering or getting involved in group activities.

Medications and psychiatric counseling may prevent recurrences. Some episodes of depression are not preventable.[/b][/size]
« Last Edit: June 03, 2006, 08:30:11 am by Kathy » Logged


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« Reply #1 on: February 27, 2006, 02:37:46 pm »

The Neurobiology of Depression

Charles Nemeroff, MD, PhD, from the Emory University School of Medicine, Atlanta, Georgia, presented a review of the neurobiology of depression and current treatment strategies.

[1] He began by stressing the importance of continuing research in understanding depression and development of better drugs to target the disorder. Unipolar depression is currently the fourth major cause of disability in the United States and is likely to become the second major cause of disability by 2020.

[2] Antidepressant nonresponders are among the heaviest users of healthcare, highlighting the pressing need for newer and better pharmacologic approaches to the disease. Less than half of patients with major depression are recognized as being depressed and only half of patients diagnosed with depression receive treatment. Of those treated, only about a third achieve remission from all symptoms, signified by a Hamilton Depression Rating Scale score of less than 7.

[3] It is clear that physicians and scientists must make an effort to better diagnose and better treat patients with major depressive disorder.

Disturbances in neurotransmission are the neurobiologic hallmark of depression. Changes have been found in monoamine systems, such as serotonin (5-HT), norepinephrine (NE), and dopamine (DA), as well as other systems, such as corticotropin releasing factor (CRF) and somatostatin. Clinically, the 5-HT and NE systems have been the most thoroughly studied, and it is in these systems that most currently prescribed antidepressants function.

 Depletion of both 5-HT and NE has been linked to depression; all 5-HT reuptake inhibitors are highly effective antidepressants, and NE reuptake inhibitors are similarly effective for depression. Antidepressant binding to receptor targets results in both the desired clinical outcomes as well as the observed side effects.

Serotonergic pathways are believed to function largely in mood, while NE is likely involved with drive and energy state. Both systems function in appetite, sleep regulation, and anxiety. The selective serotonin reuptake inhibitors (SSRIs) are now the most common treatment for depression.

Although 5-HT depletion is related to depressive symptoms, depression is also strongly linked with stress, and stress systems in the brain are largely mediated by changes in NE transmission. A study performed by Lambert and colleagues[4] measuring monamines and their metabolites from internal jugular vein catheters showed large decreases in NE in depressed patients vs healthy subjects. Smaller changes were seen in the 5-HT measurements.

Due to the overlap between the 5-HT and NE systems, it is likely that a drug targeting both the 5-HT and NE systems would have better clinical efficacy than more selective compounds. Paroxetine and clomipramine are two currently prescribed antidepressants with strong affinity for the NE transporter (NET) that have strong 5-HT transporter (SERT) binding as well. Duloxetine, a newer compound, has greater affinity for the NET and strong SERT affinity in vitro. Microdialysis from rat frontal cortex indicates that duloxetine induces dose-dependent increases of extracellular 5-HT and NE.[5] Venlafaxine also shows a dose-effect relationship to increase synaptic NE and is effective as a dual reuptake inhibitor at high doses.

Current research in the field is aimed at developing a "throat culture" for depression using either imaging or blood markers. Positron emission tomography imaging has been used to observe changes in SERT occupancy with antidepressant treatment. Ligands specific for the SERT are injected, and decreased ligand binding following treatment suggests that the SSRI is bound to the receptor site, which is an obvious prerequisite for therapeutic efficacy.
There is currently no NET ligand available. Another method employed uses a transfected cell assay to determine how much reuptake blockade the patient has. Both techniques are still in research stages, but represent promising advances in the diagnosis and treatment of depression.

Animal Depression -- Can Rats Get Depressed?
Brian Leonard, MD,[6] from the National University of Ireland, presented an overview of animal models of depression. Most scientists hope to model some aspects of a clinical disorder in order to look for novel treatment strategies for the clinical condition.
The first, and perhaps most important, point is that animals can only model parts of complex disorders like depression and anxiety. For depression models, core features of depression such as anhedonia and behavioral despair are often the targets of behavioral models.

When evaluating behavioral models, 3 primary factors are considered: predictive, face, and construct validity. Perhaps the most important criterion, predictive validity, is based on the model's ability to detect compounds that are clinically effective antidepressants without also detecting compounds that do not have antidepressant properties (such as caffeine or amphetamine). Also, as antidepressants are generally effective after chronic, but not acute, dosing, this is often an important factor in defining predictive validity.

Face validity is based on how well the characteristic behaviors of the model mimic the human condition they are trying to model. The amount of time an animal spends exploring a novel arena may have good face validity as a model of anxiety in rodents. As an opposite extreme, a "tail suspension test" is often used to evaluate the efficacy of antidepressants, which clearly lacks any face validity to the condition it is being used to assess. Construct validity is perhaps the most difficult of the criteria to establish, since it is currently unknown what actually causes depression or anxiety disorders in humans.

The construct centers around the behavioral, breeding, or other techniques required to produce the animal model. As an example, inescapable shock is often used as a construct in that it induces decreased locomotion and anhedonia in rats; it is believed that inescapable shock is similar to depressive symptoms seen in humans following exposure to severe stressors.

Just as one example, Dr. Leonard's model focuses on olfactory bulbectomy (OB), which is induced via surgical lesion and is believed to cause gross disturbances of the amygdala (a major coordinator of affect).[7] OB animals have a hyperactive amygdala, which is implicated in depression, and animals show gross hyperactivity in stressful situations.

OB animals also hypersecrete cortisol, a finding common in depressed patients. All tested antidepressants reversed the hyperactivity of these animals, and Dr. Leonard postulated that OB produces similar changes to those seen in depression.[8] Although the current models have enhanced our understanding of the systems involved in depression, the need for better models of depression and anxiety is imperative as we move toward a better understanding of the neurobiology of affective disorders.

Neurobiologic Markers of Treatment Resistance
Although the monoamine theory of depression is still pre-eminent, it is primarily based on the fact that SSRIs and tricyclic antidepressants are effective antidepressants. However, it does not actually indicate causation. Florian Holsboer, MD,[9] of the Max Planck Institute in Germany, best exemplified this with the following clinical paradox: if blocking 5-HT reuptake is important, then why is tianeptine (which enhances 5-HT reuptake) also an antidepressant?

Dr. Holsboer summarized some of his outstanding work on the neurobiology of depression, highlighting the role of CRF. His talk focused primarily on applications of the dexamethasone (DEX)/CRF test, and its ability to detect treatment-resistant patients.

DEX/CRF Test
The DEX/CRF test was initially developed by Dr. Holsboer's group. In this test, 1.5 mg of dexamethasone is administered orally at night (23:00 h), and subjects receive an intravenous bolus of 100 mcg of human CRF at 15:00 h the following day.
Patients with HPA axis dysfunction, which is frequently encountered in depression, display a paradoxically increased release of ACTH and cortisol relative to controls.[10] These abnormalities disappear following remission of depression, and normalization of HPA axis function seems to precede full clinical remission.[10,11]

 The combined DEX/CRF test appears to have much higher sensitivity for detecting subtle alterations in HPA axis function; approximately 80% of patients with major depression exhibit an abnormal response to the DEX/CRF test. Of note, patients who do not normalize their response to the DEX/CRF test are much more likely to have a recurrence of depression. This finding is true even after taking into consideration other psychological factors that would predict treatment resistance.

The CRF Hypothesis of Depression
CRF is a 41 AA neuropeptide that ultimately controls the release of ACTH, and subsequently cortisol. CRF also acts as a neurotransmitter in various regions of the brain that modulate affect and emotionality. A growing amount of evidence indicates CRF is involved in depression and anxiety disorders.[12] Animal models, which have either overexpressed CRF peptide or deleted the CRF receptor, are consistent with a primary role for CRF in the regulation of anxiety-like behaviors. Dr. Holsboer then made the case that CRF receptor antagonists may be efficacious in treating depression.

In conclusion, the DEX/CRF test may be one of the few biological markers available in psychiatry that predicts treatment resistance and, thus, may be an important clinical tool.

References
Nemeroff CB. Unmet needs and the neurobiology of depression. Program and abstracts of the XII World Congress of Psychiatry; August 24-29, 2002; Yokohama, Japan. Abstract SS-21-1.
Agency for Healthcare Policy and Research. Depression in Primary Care Volume 1: Detection and Diagnosis. Rockville, Maryland: US Dept of Health and Human Services; 1993. Publication 93-0050.
Angst F, Stassen HH, Clayeon PJ, et al. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68:167-181.
Lambert G, Johansson M, Agren H, et al. Reduced brain norepinephrine and dopamine release in treatment-refractory depressive illness: evidence in support of the catacholamine hypothesis of mood disorders. Arch Gen Psychiatry. 2000;57:787-793.
Engleman EA, Perry KW, Mayle DA, Wong DT. Simultaneous increases of extracellular monoamines in microdialysates from hypothalamus of conscious rats by duloxetine, a dual serotonin and norepinephrine uptake inhibitor. Neuropsychopharmacology. 1995;12:287-295.
Leonard BE. Animal models of depression. Program and abstracts of the XII World Congress of Psychiatry; August 24-29, 2002; Yokohama, Japan. Abstract S-232-2.
Leonard BE, Tuite M. Anatomical, physiological, and behavioral aspects of olfactory bulbectomy in the rat. Int Rev Neurobiol. 1981;22:251-286.
Kelly JP, Wrynn AS, Leonard BE. The olfactory bulbectomized rat as a model of depression: an update. Pharmacol Therapeutics. 1997;74:299-316.
Holsboer F. Implications of molecular mechanisms of antidepressant medications. Program and abstracts of the XII World Congress of Psychiatry; August 24-29, 2002; Yokohama, Japan. Abstract S-232-3.
Heuser I, Yassouridis A, Holsboer F. The combined dexamethasone/CRH test: a refined laboratory test for psychiatric disorders. J Psychiatric Res. 1994;28:341-356.
Holsboer F. The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology. 2000;23:477-501.
Holsboer F. The rationale for corticotropin-releasing hormone receptor (CRH-R) antagonists to treat depression and anxiety. J Psychiatric Res. 1999;33:181-214.[/color]
« Last Edit: May 23, 2006, 11:20:52 am by Kathy » Logged


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« Reply #2 on: June 02, 2006, 10:15:11 am »

People with lupus often ask:
"What amount of depression is normal?"
"When should I seek professional help?"


The person with lupus is often aware that depression may be brought on:

by the lupus, itself
by the various medications used to treat lupus
by the many factors and forces in a patient's life that are unrelated to lupus.
However, there is also an uncertainty as to whether being depressed is to be expected, because of the stresses and sacrifices imposed by having a chronic illness.




UNDERSTANDING DEPRESSION
What is meant by the term "depression?"
The medical condition referred to as clinical depression is not to be confused with the transitory everyday experience of a mild mood swing that everyone experiences during difficulties. Just as we feel happy or fearful or jealous or angry, we are all "depressed" from time to time.

On the other hand, clinical depressive illness is a very disabling, unpleasant and prolonged state.


Symptoms of depression
Clinical depression may bring on a variety of physical and psychological symptoms.

Psychological symptoms may include:

sadness and gloom
spells of crying (often without a cause)
insomnia or restless sleep, or sleeping too much
loss of appetite, or eating too much
uneasiness or anxiety
irritability
feelings of guilt or regret
lowered self-esteem
inability to concentrate
diminished memory and recall
indecisiveness
lack of interest in things formerly enjoyed
fatigue
Physical symptoms may include:

headache
heart palpitations
diminished sexual interest and/or performance
body aches and pains
indigestion
constipation
diarrhea
Not all people who suffer from clinical depression have all of the above symptoms.

Patients are considered to be clinically depressed when they have:

a depressed mood
disturbances in sleep and appetite, and
at least one or two of the symptoms mentioned above which last for several weeks and are severe enough to disrupt daily life.

The challenges of diagnosing depression
Even in those individuals without chronic medical conditions, most cases of depressive illness go unrecognized and untreated until the later stages of the illness. This is when the severity of the depression becomes unbearable to the patient, and/or until the family or physician can no longer ignore it.

In fact, several studies indicate that 30-50 percent of cases of major depressive illness go undiagnosed in medical settings. Perhaps more disturbing is that many studies indicate that even when recognized, major depressive disorders in the medically ill are undertreated and/or inadequately treated.


Determining the severity of the depression
While there are many symptoms associated with clinical depression, these seven symptoms indicate the depth and degree of depression:
sense of failure
loss of social interest
sense of punishment
suicidal thoughts
dissatisfaction
indecision
crying.
Two of the most common psychological signs of clinical depression are hopelessness and helplessness.

People who feel hopeless believe that their distressing symptoms may never get better.
People who feel helpless think they are beyond help, that no one cares enough to help them or could succeed in helping, even if they tried.

Hiding depression
Many people refuse to acknowledge that they are in a depressive state and will actually deny that they are feeling unhappy, demoralized or depressed. This group of individuals often experience what physicians called "masked depression. " These people resist the notion of emotional distress, and will use various physical complaints to explain their feelings.

Physicians who are familiar with a patient's usual mood and personality, as well as their lifestyle and situation, are more likely to recognize changes associated with depressive illness. Similarly, patients are more likely to open up about their feelings when they are encouraged to do so by a physician they trust and with whom they are familiar.


DEPRESSION AND CHRONIC ILLNESS

How common is depression in people with chronic illness?
Some psychiatric and medical studies state that 15 percent of those with a chronic illness suffer from clinical depression; others place this figure as high as 60 percent. Although clinical depression is certainly more common in people with chronic medical illness, (e.g., lupus) than in the general population, not every patient with a chronic illness suffers from clinical depression.

Episodes of clinical depression usually last for only a few months in patients with a chronic illness. However, a flare of the disease can also trigger depression because a person may feel he/she is never going to be free of the illness.


Isn't having chronic illness a good reason to be depressed?
Unfortunately, all too common is a distorted notion that those with a chronic illness have "reason to feel depressed because they are sick." This belief interferes with early recognition, early treatment, and early relief of suffering from clinical depression. This belief also ignores the facts that clinical depression in people who are physically ill generally responds well to standard psychiatric treatments and that patients treated only for their physical illness can suffer needlessly from clinical depression.



DEPRESSION AND LUPUS

Is it lupus or is it depression?
Depressive illness often goes unrecognized in those who have other medical illnesses because it presents symptoms so similar to those of the underlying medical condition.
For patients with systemic lupus erythematosus (SLE), symptoms of depressive illness that quite naturally can be attributed to the lupus condition include:

inactivity
loss of energy and interest
insomnia
pain intensification
diminished sexual interest and/or performance.

What causes depression in lupus?
There is no one cause of clinical depression in lupus; rather, there are various and different factors contributing to depression in chronic illnesses such as lupus.

The most common cause is the emotional drain from the continuous series of stresses and strains associated with coping with the chronic illness and medical condition.
Other causes may be the many sacrifices and losses required by the continuous life adjustments that a patient with a chronic illness must make.
Various medications used to treat lupus, such as steroids (e.g., prednisone), may bring about depression.
Lupus involvement of certain organs (e.g., the brain, heart, or kidneys) can lead to clinical depression.
There also are many unrecognized or unknown factors (which may or may not be related to lupus) which may cause depressive illness.
Of course, there are people who would develop clinical depression whether or not they had lupus. In fact, it is the most common psychiatric condition seen in the general population-20 percent of women and 10 percent of men-as well as in medical practice.


Can depression in lupus be treated?
Today, effective treatment is available for depressive illness and usually consists of psychotropic medication, psychotherapy and, most often, a combination of both.

Effective treatment requires early diagnosis and early intervention. Fortunately, most episodes of depressive illness in people with lupus subside on their own within a few months. Just as some people with lupus can tolerate a lot of pain, some seem to be able to accept and tolerate major symptoms of depressive illness without complaint.

However, depression is very stressful and anxiety-producing, which may aggravate the lupus activity. Depressive reactions should be treated with the same aggressiveness and persistence that one would use to treat a lupus flare, or any other medical complaint. Naturally, any underlying medical condition that could contribute to the depression must be identified and controlled.

Anti-depressant medications
Anti-depressant medications are the drugs that are most often used to treat depression. The four categories of medications are:

tricyclics
newer-generation non-tricyclic anti-depressants called SSRIs-selective serotonin reuptake inhibitors. These are best known by brand name: Prozac, Zoloft, Paxil, etc.
MAO (monomine oxidase) inhibitors
lithium.
Other types of anti-depressant medications

Effexor
Serzone (nefazodone)
Wellbutrin
Remeron
Desyrel, etc.
Newer, potent anti-anxiety medications are now available and, when used in combination with the anti-depressant medications, offer significant and rapid mood stabilization and anxiety reduction.

Also, newer and safer hypnotics contribute to insomnia relief and offer uninterrupted and longer sleep.

Medication side effects
Anti-depressant medications can have side effects and may intensify various symptoms associated with lupus (e.g., increase in the drying of mucous membranes in Sjogren's Syndrome). When anti-depressant medications are effective, there is a welcome improvement in the individual's sense of well-being and overall attitude and adjustment.

Additional treatment requirements
Adequate and aggressive treatment involves many other components:

blood tests to determine the appropriate dosages of medication
open communication between the patient and treatment team
encouragement, patience, availability and perseverance between patient, physician, family and close friends
identifying and addressing any underlying medical factors that contribute to the depressive state


Cognitive changes
In people with depressive illness, there is often a general slowing and clouding of mental functions (cognition). These troublesome and not infrequent disruptions in mental functioning tend to be under-reported to physicians and are rarely confirmed to be due to any specific structural change. Fortunately, these transient alterations in mental functioning improve as the depressive condition improves.

"Lupus fog"
Changes in cognition often occur in people with lupus, including subtle changes in:

memory
concentration
other cognitive functions such as:
diminished attention
lapses in awareness
impairment in recall, problem-solving, calculations, planning, and/or visual-spatial functioning).
These are quite a nuisance and can have a profound impact upon the person's self-image, daily life and planning, and in their relationships with friends, co-workers, and loved ones.

Such changes often do not come to the physician's attention unless formal mental status testing is done. The true incidence of cognitive impairment is unknown, other than that it is common.

There is no specific or characteristic cognitive deficit found in people with SLE; rather, there is a wide spectrum, variety, and combination. These deficits, though, do not appear to be related to emotional stress or use of medication such as corticosteroids.

Occasionally in SLE patients with no overt central nervous system pathology, cognitive functioning improves with anti-malarial drugs or low doses of corticosteroids.

PROGNOSIS FOR RECOVERY

Recovery from depression is usually a gradual process. Dramatic improvements do not usually occur in a few days; however, one begins to see some progress after a few weeks.
Medication
Even when signs of clinical depression seem to clear quickly, it is not unusual for an individual to relapse when the medication is stopped. For this reason, medication should be continued for approximately six months or longer and the dosage should be tapered slowly over a 3-4 week period when treatment is discontinued.

Psychotherapy

Psychotherapy, often in combination with anti-depressant and/or anti-anxiety medication, can be very helpful. Therapists are able to assist people with clinical depression in:

working through and understanding their illness, feelings, and relationships
learning to cope more effectively with stress and their life situation.
The benefits to the patient are best attained when the primary care physician maintains a close relationship with the individual's psychiatrist or psychologist. Such a working relationship maximizes the quality of patient care and provides the most powerful approach to the management of depression.
« Last Edit: June 03, 2006, 08:24:19 am by Kathy » Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
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2) Where HOPE is a WORK In Progress
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« Reply #3 on: June 02, 2006, 01:53:47 pm »

Depression in SLE is it Primary Depression or Lupus Involving the Brain?

 

Depression is one of the more common, and commonly missed, diagnoses facing the general practitioner today. While an otherwise healthy patient can present with symptoms of primary depression, in addition, a patient with a chronic disease can become depressed due to the stress of dealing with his or her illness and its impact on his or her livelihood, self image and ability to function.

 

Yet the rheumatologist caring for the patient with lupus has another dimension to consider: the disease itself can cause symptoms of depression by affecting the neurologic system with its hallmark autoimmune processes. Thus, the treatment and management of depression in the lupus patient require a more comprehensive approach.

 

Symptoms of depression can be as subtle as a patient's family members noticing that the patient seems irritable or distracted, or as unsubtle as the patient herself confiding to her rheumatologist, “I can't sleep. I can't concentrate. I have lost interest in life, and I think I am depressed.”

Symptoms of a generalized lupus flare in the patient with established lupus can be as mild as joint pains or malaise, or as severe as eruptive skin rashes, high fevers and debilitating sharp chest pains. The challenge for the rheumatologist is twofold: first, to recognize that the patient is depressed; and, second, to determine whether the patient's depression is related to lupus disease activity.

 

Depression is largely a clinical diagnosis; that is, there are few if any tests to prove that a patient is truly depressed. There are a number of blood and other medical tests available to help determine whether the patient is having a lupus flare. The patient will have other signs and symptoms of a flare, and thus the diagnosis of depression occurs in the context of a generalized lupus flare.

 The rheumatologist will look for clues in the history and on physical examination and will sometimes even ask the patient directly, “Do you think your lupus is flaring?” Blood work (e.g., low complement levels, changes in antibody levels) can be helpful in this regard, as can other tests.

 Sometimes other signs of central nervous system or brain involvement can be present, such as an abnormal electroencephalogram (EEG or brain-wave test), magnetic resonance imaging (MRI) scan of the brain, or evoked potential testing (an electrical test of brain pathways).

The rheumatologist gathers the appropriate information and tries to determine if there is evidence of a lupus flare; if not, then he or she may decide that the patient's depression is not directly (but still may be indirectly) related to the underlying lupus.

 

If it is felt that the patient's lupus is flaring, sometimes merely treating the lupus flare itself (e. g., with increased prednisone or other medications) will improve or eliminate the depressive symptoms.
Whether due to a lupus flare or not, antidepressant medications are often used and can be very helpful in improving the patient's outlook and level of function. There are more and more products on the market and, with such a wide range of medications, several may need to be tried, sometimes with the input of a psychiatrist as well.

 

The diagnosis and treatment of depression in general is at least as much “art” as it is “science.” The diagnosis and treatment of depression in the lupus patient require even more “art” and more “science” and can prove to be a great challenge to the rheumatologist.

 

by Iredell W. Iglehartt , Ill , M.D.

Minnesota Lupus News
« Last Edit: June 03, 2006, 08:28:28 am by Kathy » Logged


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« Reply #4 on: June 09, 2006, 08:15:41 am »

Depression
Depression in Women
Contrary to popular belief, clinical depression is not a “normal part of being a woman” nor is it a “female weakness.”   Depressive illnesses are serious medical illnesses that affect more than 19 million American adults age 18 and over each year.[1]  Depression is a treatable medical illness that can occur in any woman, at any time, and for various reasons regardless of age, race or income.

Prevalence

Approximately 12 million women in the United States experience clinical depression each year.[2]
About one in every eight women can expect to develop clinical depression during their lifetime.2
Depression occurs most frequently in women aged 25 to 44.[3]
Contributing Factors

Many factors in women may contribute to depression, such as developmental, reproductive, hormonal, genetic and other biological differences (e.g. premenstrual syndrome, childbirth, infertility and menopause). [4]
Social factors may also lead to higher rates of clinical depression among women, including stress from work, family responsibilities, the roles and expectations of women and increased rates of sexual abuse and poverty.4
Gender Differences

Women experience depression at roughly twice the rate of men.3
Girls 14-18 years of age have consistently higher rates of depression than boys in this age group.[5]
PMS/PMDD

Twenty to forty percent of women may experience premenstrual syndrome and an estimated 3 to 5 percent have symptoms severe enough to be classified as Premenstrual Dysphoric Disorder (PMDD). [6]
Marriage/Childbirth

Married people have a lower rate of depression than those living alone.  However, unhappily married people have the highest rates of depression; happily married men have the lowest rates.3
Approximately 10%-15% of all new mothers get postpartum depression, which most frequently occurs within the first year after the birth of a child.[7]
 Co-occurring Illnesses

Research shows a strong relationship between eating disorders (anorexia and bulimia nervosa) and depression in women.[8]  About 90-95% of cases of anorexia occur in young females.9  Reported rates of bulimia nervosa vary from one to three out of 100 people.6
Research shows that one out of three depressed people also suffers from some form of substance abuse or dependence.[9]
 Suicide

Although men are more likely than women to die by suicide, women report attempting suicide approximately twice as often as men.[10]
An estimated 15 percent of people hospitalized for depression eventually take their own lives.[11]
 Treatment

Depression in women is misdiagnosed approximately 30 to 50 percent of the time.[12]
Fewer than half of the women who experience clinical depression will ever seek care.[13]
Fortunately, clinical depression is a very treatable illness.  More than 80 percent of people with depression can be treated successfully with medication, psychotherapy or a combination of both.3

Women’s Attitudes Toward Depression:

According to a National Mental Health Association survey[14] on public attitudes and beliefs about clinical depression:

More than one-half of women believe it is “normal” for a woman to be depressed during menopause and that treatment is not necessary.
More than one-half of women believe depression is a “normal part of aging.”
More than one-half believe it is normal for a mother to feel depressed for at least two weeks after giving birth.
More than one-half of women cited denial as a barrier to treatment while 41% of women surveyed cited embarrassment or shame as barriers to treatment.
In general, over one-half of the women said they think they “know” more about depression than men do.
For additional resources, please call 1-800-969-NMHA.

   

NMHA's Campaign for America's Mental Health works to raise awareness that mental illnesses are common, real and treatable illnesses and ensure that those most at-risk receive proper, timely and effective treatment
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« Reply #5 on: June 09, 2006, 08:24:58 am »



Antidepressants are medicines used to help people who have depression. With the help of these depression medications, most people can achieve significant recovery from depression.

Antidepressant drugs are not happy pills, and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only ever be taken under a doctor’s supervision. They are, however, one depression treatment option. Taking medications for depression is not a sign of personal weakness — and there is good evidence that they do help.
 

How Antidepressants Work

Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters (such as serotonin and norepinephrine). Neurotransmitters are needed for normal brain function and are involved in the control of mood and in other responses and functions, such as eating, sleep, pain, and thinking.

Antidepressants help people with depression by making these natural chemicals more available to the brain. By restoring the brain's chemical balance, antidepressants help relieve the symptoms of depression.


Specifically, antidepressant drugs help reduce the extreme sadness, hopelessness, and lack of interest in life that are typical in people with depression. These drugs also may be used to treat other conditions, such as obsessive compulsive disorder, premenstrual syndrome, chronic pain, and eating disorders.

Typically, antidepressants are taken for 4 to 6 months. In some cases, however, patients and their doctors may decide that antidepressants are needed for a longer time.

Types of Antidepressants
There are many different kinds of antidepressants, including:

Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants (tricyclics)
Others
Like most medicines, antidepressant drugs can cause side effects. Not all people get these side effects. Any side effects you have will depend on the medicine your doctor has chosen for you. Your doctor should talk to you about your medicine.

SSRIs
SSRIs are a group of antidepressants that includes drugs such as escitalopram (brand name: Lexapro) citalopram (brand name: Celexa), fluoxetine (brand name: Prozac), paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft). Selective serotonin reuptake inhibitors act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO inhibitors act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body.

Selective serotonin reuptake inhibitors have fewer side effects than tricyclic antidepressants and MAO inhibitors, perhaps because selective serotonin reuptake inhibitors act only on one body chemical, serotonin. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, headache and sexual problems. People taking fluoxetine might also have a feeling of being unable to sit still. People taking paroxetine might feel tired. People taking sertraline might have runny stools and diarrhea.

Tricyclics

The tricyclics have been used to treat depression for a long time. They act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. They include amitriptyline (brand name: Elavil), desipramine (brand name: Norpramin), imipramine (brand name: Tofranil) and nortriptyline (brand names: Aventyl, Pamelor). Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.

Other Antidepressants
Other antidepressants exist that have different ways of working than the SSRIs and tricylics. Commonly used ones are venlafaxine, nefazadone, bupropion, mirtazapine and trazodone. Less commonly used are the monoamine oxidase inhibitors (MAOIs).

Some of the most common side effects in people taking venlafaxine (brand name: Effexor) include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased blood pressure, increased heart rate and increased cholesterol levels can also occur.

Nefazodone (brand name: Serzone) can give people headaches, blurred vision, dizziness, nausea, constipation, dry mouth and tiredness.

Bupropion (brand name: Wellbutrin) can cause agitation, insomnia, headache and nausea. Mirtazapine (brand name: Remeron) can cause sedation, increased appetite, weight gain, dizziness, dry mouth and constipation. Some of the most common side effects of trazodone (brand name: Desyrel) are sedation, dry mouth and nausea. MAOI antidepressants like phenelzine (brand name: Nardil) and tranylcypromine (brand name: Parnate) commonly cause weakness, dizziness, headaches and tremor.

Interactions of Antidepressants
Antidepressants Can Affect Other Medications You May Be Taking
Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant. When taken together, some medicines can cause serious problems.

Taking an MAOI antidepressant at the same time as any other antidepressants or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking a MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.

Another risk of antidepressants is serotonin syndrome, a drug reaction resulting from the over-stimulation of serotonin receptors. This can occur when an antidepressant is taken either with another antidepressant, with certain recreational and other drugs (see below), or more rarely, even when one antidepressant is taken alone. Symptoms include hyperactivity, mental confusion, agitation, shivering, sweating, fever, lack of coordination, seizure, and diarrhoea.

To minimise the risk of serotonin syndrome, there must be a 'washout' period of at least two weeks when switching from one antidepressant drug to another.

Drugs that may induce serotonin syndrome when taken with antidepressants (not a complete list)
ecstasy
cocaine
lithium
St John's wort (Hypericum) - herbal antidepressant
diethylproprion - an amphetamine
dextromethorphan - found in many cough suppressants
Buspar (buspirone) - for anxiety
Selgene, Eldepryl (selegiline) - for Parkinson's Disease
anti-epileptics - Tegretol, Carbium, Teril (carbamazepine)
analgesics - pethidine, Fortral (pentazocine), Tramal (tramadol), fentanyl
anti-migraine drugs - Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
appetite suppressants - phentermine and fenfluramine
tryptophan - an amino acid
 
 
 
Because the neurotransmitters involved in the control of moods are also involved in other processes, such as sleep, eating, and pain, drugs that affect these neurotransmitters can be used for more than just treating depression. Headache, eating disorders, bed-wetting, and other problems are now being treated with antidepressants.

All antidepressant drugs are effective, but certain types work best for certain kinds of depression. For example, people who are depressed and agitated do best when they take an antidepressant drug that also calms them down. People who are depressed and withdrawn may benefit more from an antidepressant drug that has a stimulating effect.

Antidepressants Are Not A Magic Bullet

While antidepressant drugs help people feel better, they cannot solve problems in people's lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on antidepressant drugs for a "quick fix." Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.[/color]
« Last Edit: June 09, 2006, 09:38:46 am by Kathy » Logged


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« Reply #6 on: June 09, 2006, 08:33:29 am »

Depression is an illness that affects both men and women. But people working in mental health services see far fewer men with depression than women with depression. It seems likely that men suffer from depression just as often as women, but that they are less likely to ask for help. Depression is easily treatable and best treated as early as possible. Men need to know what it is and how to get effective help.

It's Different For Men
 The way that men think about themselves can be quite unhelpful. Compared with women, they tend to be far more concerned with being competitive, powerful and successful. Most men don’t like to admit that they feel fragile or vulnerable, and so are less likely to talk about their feelings with their friends, loved ones or their doctors. This may be the reason that they often don’t ask for help when they become depressed. Men tend to feel that they should rely only on themselves and that it is somehow weak to have to depend on someone else, even for a short time.

 
 
This traditional view of how men should be - always tough and self-reliant - is also held by some women. Some men find that owning up to their depression actually results in their partner rejecting them because of this. Even professionals sometimes share this view, and may not diagnose depression in men when they should.

Symptoms of Depression
Feeling sad or unhappy
High levels of anxiety
Low energy
Difficulties concentrating
Feeling worthless or hopeless
Losing interest in activities or people
Weight loss
Loss of appetite
Loss of sex drive
Lapses in personal hygiene, such as not bathing or shaving as regularly
Thoughts of suicide
The symptoms for some types of depression may also include extreme opposites of those listed above for example, unusually high or prolonged levels of energy, significant weight gain and so on.

Other people may notice that:

You are performing less well at work
You seem unusually quiet, unable to talk about things
You’re worrying about things more than usual
You’re more irritable than usual
You’re complaining more about vague physical problems

How Do Men Cope
Instead of talking about how they feel, men may try to make themselves feel better by using alcohol or drugs. This will usually make things worse in the long run. Their work will suffer and alcohol often leads to irresponsible, unpleasant or dangerous behavior. Men also tend to give their work a higher priority than their home life, which produces conflicts with their wives or partners. All of these things have been shown to make depression more likely.

Relationships
For married men, research has shown that trouble in a marriage is the most common single problem connected with depression. Men can’t cope with disagreements as well as women. Arguments actually make men feel very physically uncomfortable. So, they try to avoid arguments or difficult discussions. This often leads to the situation where a man’s partner will want to talk about a problem, but he will not and will do his best to avoid talking about it. The partner feels that they are being ignored and tries to talk about it more, which makes him feel he is being nagged. So, he withdraws even more, which makes his partner feel even more that they are being ignored . . . and so on. This vicious circle can quite easily destroy a relationship.

Separation and Divorce
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Men have traditionally seen themselves as being the leaders in their family lives. However, the process of separation and divorce is most often started by women. Of all men, those who are divorced are most likely to kill themselves, probably because depression is more common and more severe in this group. This may be because, as well as losing their main relationship, they often lose touch with their children, may have to move to live in a different place, and often find themselves hard-up for money. These are stressful events in themselves, quite apart from the stress of the break-up, and are likely to bring on depression.

Sex
Depressed men feel less good about their bodies and less sexy than when they’re not depressed. Many just go off sex completely. Several recent studies suggest that, in spite of this, men who are depressed have intercourse just as often, but they don’t feel as satisfied as usual. A few depressed men actually report increased sexual drive and intercourse, possibly as a way of trying to make themselves feel better. Another problem may be that some anti-depressant drugs will also reduce sex-drive in a small number of men who take them.

HOWEVER, the good news is that, as the depression improves, so will your sexual desire, performance and satisfaction.

It’s worth remembering that it can happen the other way round. Impotence (difficulty in getting or keeping an erection) can bring about depression. Again, this is a problem for which it is usually possible to find effective help.

Pregnancy and Children
We have known for many years that some mothers feel severely depressed after having a child. It is only recently that we have realized that more than 1 in 10 fathers also suffer psychological problems during this time. This shouldn’t really be surprising. We know that major events in people’s lives, even good ones like moving house, can bring about a period of depression. And this particular event changes your life more than any other. Suddenly, you have to spend much more of your time looking after your partner, and the children.

On an intimate level, new mothers tend to be less interested in sex for a number of months. Simple tiredness is the main problem, although you may take it personally and feel that you are being rejected. You may have to adjust, perhaps for the first time, to taking second place in your partner’s affections. You will also probably find that you have to spend less time at work. Paternity leave is still quite unusual in the most parts of the world.

New fathers are more likely to become depressed if their partner is depressed, if they aren’t getting along with their partner, or if they are unemployed. This isn’t important just from the father’s point of view. It will affect the mother and may have an important impact on how the baby grows and develops in the first few months.

Unemployment and Retirement
Leaving work, for any reason, can be stressful. Recent work has shown that up to 1 in 7 men who become unemployed will develop a depressive illness in the next 6 months. This is much more than would be expected in employed men. In fact, after relationship difficulties, unemployment is the most likely thing to push a man into a bad depression. This isn’t surprising, as work is often the main thing that gives a man his sense of worth and self-esteem. You may lose symbols of your success, such as the company car. You may have to adjust to looking after the home and children, while your wife or partner becomes the bread-winner. From a position of being in control, you may face a future over which you have little control, especially if it takes a long time to find another job.

It is more likely to happen if you are shy, if you don’t have a close relationship or if you don’t manage to find another job. Of course, if you get depressed, you may well find it harder to get another job, which may make your depression worse.

Retiring from paid employment can be difficult for many men, especially if their partner continues to work. It may take some time to get used to losing the structure of your day and contact with workmates.

Gay Men and Depression
On the whole, gay men do not suffer from depression any more than straight men. However, it seems that gay teenagers and young adults are more likely to become depressed, possibly due to the stresses associated with coming out.

Suicide
Men are around 3 times more likely to kill themselves than women. Suicide is most common amongst men who are separated, widowed or divorced and is more likely if someone is a heavy drinker. Over the last few years, men have become more likely to kill themselves, particularly those aged between 16 and 24 years and those between 39 and 54 years. We don’t yet know why this should be so, but it is very worrying.

We do know that 2 out of 3 people who kill themselves have seen their family doctor in the previous 4 weeks and nearly 1 in every 2 will have done so in the week before they kill themselves. We also know that about 2 out of 3 people who kill themselves will have talked about it to friends or family.

Asking if someone is feeling suicidal will not put the idea into his head or make it more likely that he will kill himself. So, although some men may not be very good at talking about how they are feeling, it is important to ask if you have any suspicion - and to take such ideas seriously. For a man who feels suicidal, there is nothing more demoralizing than to feel that others do not take him seriously. He will often have taken some time to pluck up the courage to tell anybody about it. If you do find yourself feeling so bad that you have thought about suicide, it can be a great relief to tell someone.

Violence
Some studies have shown that men who commit violent crimes are more likely to get depressed than men who don’t. However, we don’t know if the depression makes their violence more likely, or if it’s just the way they lead their lives.

Helping Men
Many men find it difficult to ask for help when they are depressed - it can feel unmanly and weak. It may be easier for men to ask for help if those who give that help take into account men’s special needs.

Men who are depressed are more likely to talk about the physical symptoms of their depression rather than the emotional and psychological ones. This may be one reason why doctors sometimes don’t diagnose it. If you are feeling wretched, don’t hold back - tell your doctor.

It can help to be reminded that depression is a result of chemical changes in the brain. It is nothing to do with being weak or unmanly, and it can easily be helped. Antidepressant tablets are often an important part of getting better - and it’s important to remember that this sort of medication is not addictive.

If a depressed man is married, or in a steady relationship, his partner should be involved so that she can understand what is happening. This will make it less likely for the depression to cause permanent problems in their relationship.

Some men don’t feel comfortable talking about themselves and so may be reluctant to consider psychotherapy. However, it is a very powerful way of relieving depression and works well for many men.

Helping Yourself
Don’t bottle things up - If you've had a major upset in your life, try to tell someone how you feel about it.

Keep Active - Get out of doors and get some exercise, even if it’s only a walk. This will help to keep you physically fit and you will sleep better. It can also help you not to dwell unhelpfully on painful thoughts and feelings.

Eat properly - you may not feel very hungry, but you should eat a balanced diet, with lots of fruit and vegetables. It’s easy to lose weight and run low on vitamins when you are depressed.

Avoid alcohol and drugs - Alcohol may make you feel better for a couple of hours, but it will make you more depressed in the long run. The same goes for street drugs, particularly amphetamines and ecstasy.

Don’t get upset if you can’t sleep - Do something restful that you enjoy, like listening to the radio or watching television.

Use relaxation techniques - If you feel tense all the time there are many ways of helping yourself to relax. These include exercises, audio-tapes, yoga, massage, aromatherapy etc.

Do something you enjoy - Set some time aside regularly each week to do something you really enjoy - exercise, reading, a hobby.

Check out your lifestyle - A lot of people who have depression are perfectionists and tend to drive themselves too hard. You may need to set yourself more realistic targets and reduce your workload.

Take a break - This may be easier said than done, but it can be really helpful to get away and out of your normal routine for a few days. Even a few hours can be helpful.

Read about depression - There are now many books about depression. They can help you to cope, but can also help friends and relatives to understand what you are going through.

Remember, in the long run, this might be helpful - It’s unpleasant to have it, but depression can be a useful experience, and some people emerge stronger and coping better than before. You may see situations and relationships more clearly and may now have the strength and wisdom to make important decisions and changes that you were avoiding before.

Getting More Help
The best place to start is your general practitioner / family doctor. He or she will be able to assess you and to discuss the options for treatment with you. It is true that many men are concerned that the information held by their family doctors may need to be given in medical reports, and so may damage their chances in work. In spite of this, your GP is the best person to approach. Depression may be due to physical illness, so it is important that you have a proper physical check-up. If you are already receiving treatment for some physical disorder, your GP will need to know because of the possible interactions between drugs. Any worries about confidentiality should be discussed with your GP.

If you really feel that you can’t talk about it with anyone you know, look in the phone book for a 24 hour telephone service (crisis line) which can give you the opportunity to discuss things anonymously.

Depression can be as much of an illness as pneumonia or breaking your leg. We really shouldn’t feel embarrassed or ashamed about it. The most important thing to remember is to ask for the help you need, when you need it. If you need more information, or to talk to somebody confidentially, the following lists of publications and other organisations may be helpful.

Remember - depression is easily treatable and you are entitled to the help you need.
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I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
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« Reply #7 on: June 09, 2006, 09:30:09 am »

An Unquiet Mind
by Kay Redfield Jamison


Reader Comment:
THE BOOK for all bipolars - if you are bp, you MUST own this and read it often.


The Freedom From Depression Workbook
by Frank Minirth, MD



Reader Comment:
The best depression workbook I have found to date - very simple and to the point.


Life Strategies: Doing What Works, Doing What Matters
by Phil McGraw - "Dr. Phil"



Reader Comment:
Dr. Phil tells it like it is - pushed me to take control of my life.



Who Moved My Cheese? An Amazing Way to Deal with Change in Your Work and in Your Life
by Spencer Johnson, Kenneth H. Blanchard



Reader Comment:
EVERYONE should have this book - how to adapt to life's changes - very short story to be read again and again for motivation.


In the Jaws of the Black Dogs: A Memoir of Depression
by John Bentley Mays



Reader Comment:
Brutally honest tale of one man's lifelong battle with the black dogs of depression.


 
Never Good Enough: How to Use Perfectionism to Your Advantage Without Ruining Your Life
by Monica Ramirez Basco, Phd



Reader Comment:
Many bipolars are also perfectionists, as am I.


 
Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You
by Richard O'Connor, Phd


Reader Comment:
"THE" book on clinical depression.


 
The Life Strategies Workbook: Exercises and Self-Tests to Help You Change Your Life
by Phil McGraw - "Dr. Phil"


Reader Comment:
Dr. Phil's extensive life study workbook - only if you are very serious about changing your life for the better - takes a lot of time and meditation of thought but it is worth it.


 
The Bell Jar
by Sylvia Plath

Reader Comment:
People with any form of major depression will relate to her story.


 
A Day Without Rain
by Enya

Reader Comment:
People with any form of major depression will relate to her story.


 
Coloring Mandalas: For Insight, Healing, and Self-Expression
by Susanne F. Fincher


Reader Comment:
A relaxing hobby I found by accident - there many different kinds.


Tuesdays with Morrie: An Old Man, a Young Man, and Life's Greatest Lesson
by Mitch Albom



Reader Comment:
A good cry.


 
The Noonday Demon: An Atlas of Depression
by Andrew Solomon


Reader Comment:
An incredibly personal and moving account of his own struggle with mental illness.


What to Do When Someone You Love Is Depressed
by Mitch Golant, Susan K. Golant



Reader Comment:
It is helpful. Very informational about all facets of the disorder. For a family member or friend.


 
Darkness Visible: A Memoir of Madness
by William Styron



Reader Comment:
A lean 84 pages, this is a straightforward and eloquent book.


Seasonal Affective Disorder and Beyond: Light Treatment for Sad and Non-Sad Conditions
by Raymond W. Lam, Editor



Reader Comment:
A complete summary of the available literature on light therapy.


 
On the Edge of Darkness: Conversations About Conquering Depression
by Kathy Cronkite



Reader Comment:
The stories of those who live with depression.

Hope this list is helpful to those needing help...~Kathy
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I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
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« Reply #8 on: July 18, 2006, 09:33:55 pm »

Sad Mood May Trigger Depression Relapse After Clinical Remission

 Jul 11 - Mild emotional stress or sadness can reactivate depressive thinking in patients with a history of depression, which may increase the risk of relapse, according to researchers.

"Episode remission in unipolar major depression, while distinguished by minimal symptom burden, can also be a period of marked sensitivity to emotional stress as well as an increased risk of relapse," Dr. Zindel V. Segal, of the University of Toronto, Ontario, Canada, and colleagues write in the July issue of the Archives of General Psychiatry.

The researchers examined if mood-linked changes leading to dysfunctional thinking predicted relapse in 301 adults recovering from a major depressive disorder. In the first phase of the study, the patients were randomized to antidepressant medication or cognitive behavior therapy.

In phase 2, regular clinical assessments were conducted for 18 months in the 99 patients who achieved clinical remission. The subjects subsequently underwent sad mood provocation. They were asked to recall a time in their lives when they felt sad while listening to "Russia Under the Mongolian Yoke," an orchestral introduction by Prokoliev, played at slow speed. Previous studies have found this to bring on transient dysphoria.

Compared with patients who underwent cognitive behavior therapy, those who received antidepressant medication showed greater cognitive reactivity after mood provocation.

The magnitude of mood-linked cognitive reactivity was significantly predictive of relapse during the 18 months, regardless of type of previous treatment.

"Patients whose mood-linked endorsement of dysfunctional attitudes increased by a minimum of 8 points had a significantly shorter time to relapse than those whose scores were not as elevated," Dr. Segal's team reports.

These findings suggest that "even a mild negative mood, when experienced by someone with a history of depression, can re-instate some of the cognitive features observed in depression itself," the researchers conclude.

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« Reply #9 on: July 20, 2006, 06:46:38 pm »

Mixing Migraine Drugs with Antidepressants Can be Deadly

July 20, 2006, 05:28 AM

Mixing migraine medications with some antidepressants can be a deadly mistake. Health officials say serotonin syndrome can produce a long list of symptoms, including hallucinations, fast heart beat, blood pressure changes, fever, nausea, vomiting and diarrhea.

Some of the commonly-prescribed antidepressants include Prozac, Zoloft, Paxil and Effexor. The migraine meds include Imitrex and Zomig. The FDA wants the makers of all the drugs involved to issue warnings about the potential hazards.
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« Reply #10 on: August 01, 2006, 08:19:56 pm »


Effect of music on power, pain, depression and disability
 

Effect of music on power, pain, depression and disability
Aim. This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music).

Background. Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated.

Method. A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21–65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II).

Results. The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported.

Conclusion. Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.
 

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« Reply #11 on: October 05, 2006, 08:40:01 am »

Depression
Signs of depression

Depression strikes one in four women and one in eight men sometime during their lifetimes. Yet two out of three of them don't get treatment. Are you one of them? You might be depressed if you feel:

  • Tired all the time
  • Sad most of the time
  • Guilty
  • Worthless
  • Unable to think clearly or make decisions
  • Hungry all the time


Or if you have:

  • No enjoyment in what used to be fun
  • Repeated thoughts of death or suicide
  • No appetite
  • Trouble sleeping (too little or too much)

If you notice any of these in your daily life, tell your doctor of internal medicine (internist). The problems could stem from depression or other illnesses. Your internist will determine which.

A common illness - not a personal weakness

If you think you're depressed, here's what you should know: At least 20 million American adults suffer from depression, and it is on the rise — especially among the elderly.

Depression can come from chemical imbalances in the brain, hormonal changes, medications, or things going on in your life. It is not a passing blue mood that can be wished away. Your internist can help you find out why you are feeling this way.

A treatable illness

If you think you or a family member might be depressed, ask your internist about it. There are many effective antidepressant medications — old and new — nowadays. Should you need one of them, you and your internist will team up to choose the best medication for you.

What you need to know about antidepressant medication:

Tell your internist about any store-bought medications or herbal products you are taking
Take your prescribed pills daily
Most pills take 3-4 weeks to take effect
Continue your pills even when feeling better
Some pills require regular blood checks
Do not stop the pills without checking with your internist
Ask your internist if you have any questions about your treatment
In addition to antidepressant medication, your internist might also refer you to a psychotherapist.

St. John's Wort: The jury's still out

St. John's Wort, an herbal product, has attracted a lot of attention for its antidepressant potential. It appears to be somewhat effective, at least in the short-term, and only for mild to moderate depression.

The evidence of its effectiveness is limited. Most of the studies were done in Europe, where studies are based on preparations that may not be the same as what is being sold in the United States. The FDA does not standardize or verify ingredients of herbal products.

Caution: If you are taking St. John's Wort, be sure to tell your internist. It can reduce the effect of certain prescription medications unrelated to depression or cause adverse drug interactions
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« Reply #12 on: October 06, 2006, 02:36:09 pm »

Genes Influence Response to Antidepressants

Explain to interested patients that genetic variations are known to affect how well or poorly some patients respond to a specific drug.

SEOUL, South. Korea, Oct. 3 -- The key to selecting the right antidepressant for initial treatment of late-life depression may lie in a patient's genes, according to researchers here.


The presence of certain polymorphisms in the serotonin transporter and norepinephrine transporter genes may determine whether the patients is likely to benefit more from a selective serotonin reuptake inhibitor (SSRI), norepinephrine reuptake inhibitor (NRI), or other class of antidepressants, they found.


"Initial drug treatments fail in 30% to 40% of patients with major depression,". Doh Kwan Kim, M.D., Ph.D., of Sungkyunkwan University School of Medicine, and colleagues, wrote in the Oct. 4 issue of Journal of the American Medical Association. "Pharmacogenetic prediction of response is one possibility for improving the efficiency of antidepressant treatment."


There is evidence that both drug choice and ethnic variations may influence the effects of genetics on patient responses to antidepressants, the authors noted.


"In white populations, depressed patients with the long allele 5-HTTLPR genotypes (sl and ll) generally show a greater response to SSRIs than those with a short allele genotype (ss)," they wrote. "However, studies in Japanese and Korean populations report an association in the opposite direction. The effect of this polymorphism on treatment outcome may also depend on the mechanism of antidepressant action."


To determine whether patient responses to SSRIs or NRIs are associated with genetic polymorphisms of the corresponding monoamine transporters, the authors studied 241 adult inpatients and outpatients who were being treated for major depression at the psychiatric service of the Samsung Medical Center here.


Patients were assigned to e either the NRI Aventyl (nortriptyline), or to the SSRIs Prozac (fluoxetine) or Zoloft (sertraline). Although Aventyl is technically classified as a tricyclic antidepressant, part of its mechanism of action is norepinephrine reuptake inhibition.


The decision to assign a patient to an SSRI rather than NRI was left to the discretion of the clinician, on the basis of known adverse effects of Aventyl in at-risk individuals. Patients were assigned to an SSRI if they were frail or had a history of osteoporosis, falls, or known cardiovascular disease, including a history of hypotension.


The mean patient age was 55.8 (range 22 to 76), and the mean age at depression onset was 51 years. A total of 105 patients received Aventyl, 51 were given Prozac, and 85 received Zoloft. The investigators monitored patient compliance with the assigned therapy by measuring plasma concentrations of the prescribed drugs at four weeks.


They also genotyped patients for s/l polymorphisms in the 5-HTT promoter region, 5-HTT intron 2 s/l variation, and the norepinephrine transport (NET) G1287A variation of exon 9.


The main study outcome was response to SSRIs and the NRI, defined as a 50% or greater decrease in Hamilton Rating Scale for Depression score at six weeks.


They found that patients who responded to Aventyl were nearly eight times more likely to carry the NET G1287A polymorphism (odds ratio, 7.54, 95% confidence interval, 2.53-22.49, P<0.001). An even stronger association was seen between an SSRI response and the presence of the 5-HTT intron 2 s/l variation (odds ratio 20.11, 95% CI, 4.27- 94.74, P<0.001).


A less robust, but still significant association between a polymorphism and an SSRI response was seen with s/l variants in the 5-HTT promoter region (odds ratio, 3.34, 95% CI, 1.41-7.91, P=0.006).


They found that in this population of unrelated patients of Korean origin, the favorable allele for SSRI response was S 5-HTTLPR, which contrasts with findings of the influence of polymorphisms on antidepressant responses in white patients, the authors noted.


They also found that the S 5-HTTLPR was associated also with a response to Aventyl (odds ratio, 3.73, 95% CI, 1.32-10.53; P=0.01).


The NET polymorphism was not associated with an SSRI response in their study. They also determined that the NET G1287A GG genotype, which occurs in 56% of the population in Korea, was associated with better response to Aventyl than to either Prozac or Zoloft. (83.3% to 58.7%, odds ratio 3.52, 95% CI, 1.39-8.95; P=0.006).


The presence of some of the genotype combinations was predictive of a high rate of antidepressant responses, while other combinations were predictive of low response rates, the authors noted.


Several limitations were pointed out by the authors. "Our patients were mostly elderly (77% age more than 50), and most (60%) had late-onset illnesses with few previous depressive episodes." In addition, the absence of a placebo-treated group prevented determination of the rate of nonspecific or non-drug attributable response,


"The results of this study need to be confirmed in other populations, using selective NRIs other than nortriptyline," they wrote. "Additional studies in younger populations with depression are also needed. Confirmation of these preliminary findings would permit refined pharmacogenetic selection of antidepressant treatment."

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« Reply #13 on: October 12, 2006, 01:25:21 pm »

Lupus and Depression
 
Introduction
Depression can be an extremely difficult battle to fight, especially when compounded with a lupus diagnosis. It can be particularly hard at times to know whether depression is related to lupus-related mood swings, the side effects of medicines, the emotional impact of coping with a potentially severe and unpredictable illness, or to a separate, unrelated, clinical depression.

Types of depression
Clinical depression is often described as being "chemical" or "reactive". Chemical depression involves chemical changes or neurological factors in the brain that trigger depressive symptoms. Reactive depression, on the other hand, stems from an emotional response to something that occurred in one's life, e.g., personal loss, death, or a variety of stressors that can trigger a sense of sadness that does not go away for weeks or months.

Is it depression or is it the "blues"?
There is a big difference between clinical depression and what is often referred to as the "blues". The "blues" can merely cause someone to feel "down in the dumps" as a result of a variety of life stressors, including job difficulties, money problems, or relationship issues. The "blues" typically last for several days, and a person can feel sad one day and happy the next. Most people experience the "blues" at some point in their lives. The holiday season, for example, or anniversaries of sad events, can frequently evoke the "blues".

In the case of depression, however, the symptoms are more fixated or permanent and not transient, unlike the "blues". When someone is depressed, it might seem that nothing excites or "tickles" them anymore.

Some Symptoms of Clinical Depression

Depressed mood (usually lasting all day)
Feeling of emptiness
Lack of motivation
Loss of interest in hobbies or activities that brought pleasure before
Weight gain or weight loss related to loss or gain of appetite (not from medicines)
Trouble sleeping or sleeping too much
Lack of concentration
Loss of sexual interest
Low energy or fatigue
Low self-esteem
Feeling helpless or hopeless
What can be confusing for those with lupus is that a number of these symptoms can alternatively be explained by the symptoms of their condition, e.g., fatigue or lack of concentration. It can be challenging to differentiate between the emotional and physical factors that may be contributing to feelings of depression. This underscores the need to talk to a physician about these symptoms.

Some of these symptoms can occur when someone is experiencing the "blues." However, if any or all of these symptoms persist for more than two weeks in a row, professional help should be considered. In any case, if these symptoms of depression get in the way of the ability to function normally, they should be brought to a physician's attention.

Some Additional Facts
Depression is a very common problem, whether there is a chronic illness involved or not. 20% of women have experienced clinical depression at some time in their lives.

Studies have reflected rates of depression varying from 15-60% in people with chronic illnesses. In lupus patients, depression may sometimes be experienced during or after a flare. This may be related to the lupus itself or to the emotional feelings that are triggered by having to cope with an active illness episode.

It is important to note the dangers of alcohol while depressed, because alcohol - as a natural depressant - can markedly increase the severity of depression and its symptoms.

Treatment/Medication
There are several treatment options for depression. Both psychotherapy and antidepressant medications can be quite effective. Those suffering from the symptoms of depression should ask their physician, social worker, or nurse, or contact their local professional association, medical society, or Lupus/Arthritis Foundation for the name of a licensed mental health professional experienced in treating people with chronic illnesses such as lupus. Working with a mental health professional can be useful in identifying additional ways to cope with the stress of chronic illness. Joining support groups such as those offered by Hospital for Special Surgery, the Lupus Foundation, or the Arthritis Foundation may be additionally helpful. It is important to keep communication open between the primary care physician, the rheumatologist, and the patient about feelings of depression so they can all work together early and effectively.

Some of the newer antidepressant medications can be very effective partners in the treatment process. Serotonin reuptake inhibitors (SSRIs) tend to have fewer side-effects than older medications. Patients can take SSRIs for 2-12 weeks to be fully effective, and sometimes different medicines and dosages need to be tried to find what works best. Generally, these medicines will be used for at least six months after the patient begins to feel better.

Things for patients to do to help themselves
Changes in behavior may be helpful in combating a serious depressive onset as well as fighting the "blues".

Exercise regularly
Take medication consistently
Pace yourself and get enough rest
Assertiveness - ask for help when needed
Find effective ways to communicate with family members
Join a support group or program
Eat healthily
Although depression is often a normal reaction and sometimes sadness may even help the healing process, one must be careful and vigilant about these kinds of feelings and trust their instincts when it is clear that something is wrong.

The Ultimate Goal
It is normal for someone to grieve the loss of their old self. It's important to learn to come to terms with a disease -- to try to befriend it and not to deny it. It's important to give oneself permission to be depressed for short periods of time and to develop a sense of humor along with a positive attitude. And most importantly, to get on with living.

 

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« Reply #14 on: October 27, 2006, 06:30:44 am »

SAN DIEGO, Calif., Oct. 26 -- Although antidepressants may have an effect on fetuses in utero, so may the lack of the drug during pregnancy.

Babies born to women with untreated major depressive disorder had significant changes in neurobehavioral function, were born at an earlier gestational age, and had elevated stress hormones, according to a small study reported at the American Academy of Child and Adolescent Psychiatry meeting here.


"The question is, does bathing an infant in an intrauterine environment where the mother's stress hormones are high affect the baby?" said Sheila M. Marcus, M.D., of the University of Michigan in Ann Arbor.


While some evidence has suggested that the medications used to treat depression, such as selective serotonin reuptake inhibitors (SSRIs), may have a negative prenatal impact, the issue is still unclear and little study has been done on the effect of untreated depression during pregnancy, Dr. Marcus and and colleagues said.


The investigators reported the preliminary findings from 53 infant-mother pairs of 135 pregnant women enrolled in the study. Maternal plasma cortisol and other stress hormones were measured throughout pregnancy. Infant cord blood was examined for adrenocorticotrophic hormone and cortisol while salivary cortisol was measured for the first seven months after birth.


The study by Dr. Marcus and colleagues found that infants born to women with depression were born significantly earlier. Mean gestational ages were:


35.6 weeks for infants born to women with major depressive disorder.
38.6 weeks for those of women with high risk of depression (past history of depression or Edinburgh Postnatal Depression Scale likelihood ratio greater than 10).
39.4 weeks for those born to women at low risk of depression (no past history of depression and Edinburgh Postnatal Depression Scale likelihood ratio less than 10).

Motor maturity tended to be lower and cortisol levels higher in the infants with depressed mothers, but the differences were not significant.


Regarding the limbic-hypothalamic-pituitary-adrenal axis (LHPA), women who developed major depressive disorder had significantly higher cortisol and adrenocorticotropic hormone levels compared to low risk women (P=0.05). Cord blood of babies born to depressed mothers tended to have more cortisol, but the trend did not reach significance in the relatively small group analyzed.


No significant differences were seen when the babies were scored at age two weeks on a neurobehavioral scale that describes developmental and behavioral maturation, central nervous system integrity and stress responses.


The findings for infants of high risk women were:


Poorer quality of movement (-0.36 versus -0.26 low risk, P=0.07),
More hypotonia (0.49 versus -0.22 low risk, P>0.01), and
Higher stress scores (0.56 versus 0.13 low risk, P>0.003).

"These findings may indicate altered neurological development," Dr. Marcus and colleagues said.


The researchers cautioned that the findings are preliminary but said the study "may improve our understanding of the early genesis of mood disorders."

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« Reply #15 on: November 13, 2006, 08:15:38 am »

Targacept Announces Positive Results of Phase II Clinical Trial in Major Depression


Top Line Data Suggest Potential of TRIDMAC in Non-Responsive Patients

WINSTON-SALEM, N.C., November 09, 2006 Targacept, Inc. today reported positive results from a double blind, placebo controlled Phase II clinical trial of mecamylamine hydrochloride as an augmentation treatment for major depression. The trial (n=184) evaluated the effects of mecamylamine taken with citalopram hydrobromide, a treatment combination known as TRIDMAC, in patients who did not respond adequately to citalopram alone. Citalopram hydrobromide is a commonly prescribed treatment for depression marketed as Celexa(R) in the United States.


On one of two primary endpoints in the trial, patients receiving TRIDMAC showed greater improvement on symptoms of depression, as measured by group mean change from baseline on the Hamilton Depression Rating Scale (HAM-D), than patients receiving placebo with continued citalopram therapy. This result was statistically significant on an intent to treat basis (p=0.041) and showed a strong trend on a per protocol basis (p=0.059). HAM-D is a commonly used 17-item scale that evaluates depressed mood and other symptoms of depression and anxiety. The result on the trial's other primary endpoint, achievement of remission, favored the TRIDMAC group over the placebo group, although this result did not reach statistical significance. In addition, the trial included five other rating scales as secondary measures. The results on all five rating scales favored the TRIDMAC group over the placebo group with statistical significance (p<0.05) on a per protocol basis. On an intent to treat basis, the results on three of the five rating scales were statistically significant.

"The TRIDMAC study indicates the potential for a new treatment option for the millions of patients suffering from major depression for whom current treatment modalities are inadequate. The large-scale STAR*D trial funded by The National Institute of Mental Health has clearly demonstrated both this significant societal need and the value of combining treatments," commented Ranga Krishnan M.D., Chairman of Department of Psychiatry, Duke University Medical Center.

"We are very pleased with the outcome of our TRIDMAC trial. These results add to the large body of clinical and scientific evidence supporting the promise of NNRs as therapeutic targets for treating depression and other mood disorders. They also reflect the breadth of our pipeline of NNR Therapeutics(TM), with TRIDMAC representing a potential late-stage opportunity as a treatment for depression in addition to our clinical candidates in development for cognitive disorders and pain," commented J. Donald deBethizy, Ph.D., President and Chief Executive Officer of Targacept. "Our near-term objectives include defining plans for further development in our depression program following dialogue with the Food and Drug Administration," deBethizy added.

TRIDMAC was generally well tolerated in the trial. There was one serious adverse event reported in each of the TRIDMAC and placebo groups. In the TRIDMAC group, a patient experienced an upper respiratory tract infection and irregular heartbeat and discontinued participation in the trial.

Targacept intends to present the full data from the trial at an appropriate scientific forum.

About the TRIDMAC Trial

The TRIDMAC trial included two phases and was conducted at one site in the U.S. and nine sites in India under an Investigational New Drug Application and the analogous Indian regulatory process. In the first phase, patients with a diagnosis of Major Depressive Disorder (n=450) were given open label citalopram hydrobromide over six weeks and evaluated based on their improvement on two scales -- HAM-D and the Clinical Global Impression subscale for severity of illness (CGI-SI) -- to determine the extent of any response. Partial and non-responders based on scores on the two scales at the end of the six-week dosing period (HAM-D greater than or equal to 14 and CGI-SI greater than or equal to 4) were enrolled in the second phase (n=184), which was double blind and placebo-controlled. In the second phase, patients received either mecamylamine or placebo, together with continued citalopram therapy, for an additional eight weeks. Patients in the mecamylamine dose group initially received 5mg daily, titrating up to 10mg over the dosing period at the clinician's discretion based on tolerability and therapeutic response. The primary endpoints of the trial were group mean change from baseline and achievement of remission, in each case as measured by HAM-D and compared to continued citalopram therapy plus placebo. The secondary outcome measures for the trial included rating scales to assess symptoms of depression and anxiety, disability, irritability, global improvement or severity of illness. Data from the trial were evaluated on both an intent to treat and per protocol basis. The intent to treat data set (n=160) includes all patients who received at least one dose of blinded study medication and were assessed using HAM-D at least once post baseline. The per protocol data set (n=151) includes patients who were at least 80% compliant with the dosing regimen called for by the protocol and were assessed using HAM-D at the end of the dosing period.

About Depression

Major depression is a severe psychiatric mood disorder. It is characterized by a wide range of symptoms that cause significant impairment in the ability to work, study, sleep, eat, and enjoy once pleasurable activities. These symptoms include persistent despondence, loss of interest in normal activities, changes in appetite, difficulty in sleeping, agitation, apathy or feelings of guilt.

    According to the National Institute of Mental Health:

    * Each year, 9.5 percent of the population, or about 20.9 million American
      adults, will struggle with depressive illness.

    * Major depression is a recurring and chronic illness, frequently
      returning for two or more episodes, with episodes that often last two
      years or more.

    * Depression is currently the fourth most disabling illness worldwide,
      and, according to the World Health Organization, it will be the second
      leading cause of disability by the year 2020.

    * About 10 percent of men and up to 25 percent of women will experience
      depression in their lifetime.

    * Depression is responsible for up to 70 percent of psychiatric
      hospitalizations and about 40 percent of suicides.

    * The cost of depression in the United States in the year 2000 was
      estimated to be $83 billion, including both $26 billion in costs of
      treatment and $57 billion in losses such as absenteeism, reduced
      productivity at work, and the value of lifetime earnings lost due to
      suicide-related deaths.

    About STAR*D

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study funded by the National Institute of Mental Health was a nationwide public health clinical trial, the purpose of which was to determine the effectiveness of different treatments for patients with major depression who do not respond to initial treatment with an antidepressant. Over a seven-year period, STAR*D enrolled more than 4,000 outpatients, aged 18-75 years. In the first phase of STAR*D, patients were dosed with citalopram. Only about 33% of these patients achieved remission and only 10-15% more responded at all, leaving more than half of the patients without symptomatic relief. Subsequent phases of STAR*D evaluated the effect in non-responsive patients of switching treatments or augmenting existing treatments with additional treatments. For more information on STAR*D, see http://www.nimh.nih.gov/healthinformation/stard.cfm.

About Targacept

Targacept is a clinical-stage biopharmaceutical company that discovers and develops NNR Therapeutics, a new class of drugs for the treatment of central nervous system diseases and disorders. Targacept's product candidates selectively modulate neuronal nicotinic receptors that serve as key regulators of the nervous system activity to promote therapeutic effects and limit adverse side effects. Targacept has product candidates in development for Alzheimer's disease and cognitive deficits in schizophrenia, pain and depression, and multiple preclinical programs. Targacept is located in Winston-Salem, North Carolina.

Forward-Looking Statements

Any statements in this press release about expectations, plans and prospects for Targacept, Inc., including, without limitation, statements regarding the development plans and objectives for TRIDMAC, the projected prevalence of depression and market for depression therapies and all other statements that are not purely historical in nature, constitute "forward- looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. Without limiting the foregoing, the words "may," "will," "could," "would," "should," "expect," "intend," "plan," "anticipate," "believe," "estimate," "predict," "project," "potential," "promise," "continue," "ongoing," "near-term" and similar expressions are intended to identify forward-looking statements. Actual results may differ materially from those expressed or implied by forward-looking statements as a result of various important factors, including risks and uncertainties relating to: the receptivity of applicable regulatory authorities to a treatment combination that includes mecamylamine, which is a racemic compound, as opposed to one of its constituent enantiomers such as TC-5214; and AstraZeneca's right to terminate our collaboration agreement based on the results of its safety and product characterization studies and all other available information with respect to TC-1734 (AZD3480). Other risks and uncertainties that we face are described under the heading "Risk Factors" in our most recent Quarterly Report on Form 10-Q and in other filings that we make with the Securities and Exchange Commission. As a result of the risks and uncertainties, the results or events indicated by the forward-looking statements may not occur. We caution you not to place undue reliance on any forward-looking statement.

In addition, any forward-looking statements in this release represent our views only as of the date of this release and should not be relied upon as representing our views as of any subsequent date. We anticipate that subsequent events and developments may cause our views to change. Although we may elect to update these forward-looking statements publicly at some point in the future, whether as a result of new information, future events or otherwise, we specifically disclaim any obligation to do so, except as required by applicable law.

TRIDMAC(TM) and NNR Therapeutics(TM) are trademarks of Targacept. Celexa(R) is a trademark of Forest Pharmaceuticals, Inc.

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« Reply #16 on: November 16, 2006, 08:28:38 am »

Bipolar Disorder: Family Holiday Tips


If you have a loved one with bipolar disorder, the holidays come with a lot of anxiety. You never quite know what to expect. But by being open and planning ahead, there are many ways to help your loved one -- and that can make the holidays happier for everyone.

Be direct. This is by far the most important suggestion when helping a loved with bipolar disorder. Don't just guess at how you can help; sit down and talk with your loved one. Ask what you can do. Ask how you can check in on them without being intrusive. Preferably, do it early -- aim for late October, says Ellen Frank, PhD, director of the depression and manic depression prevention program at the University of Pittsburgh's Western Psychiatric Institute and Clinic.

Think about what's worked in the past and what hasn't. Try to recreate the aspects of past holidays that have worked and avoid those that haven't, says Raymond L. Crowel, PsyD, of the National Mental Health Association. For instance, if you see an unpleasant pattern -- like a happy holiday party that usually devolves into a nasty fight in the late evening -- reschedule things. Plan your dinner for earlier in the day and end the party before things typically go awry.

Offer to help. If your loved one with bipolar disorder is hosting a family dinner, pitch in early. He or she may really need assistance in planning it from the start. Once you get close to the actual date, arrive early to help with final preparations.

Pare down the guest list. A huge family gathering may be overwhelming for a person with bipolar disorder. If you're hosting, think about planning something more modest this year, especially if there are specific family members who tend to trigger mood swings in your loved one. In order to make it up to the people you didn't invite, get together with them after your loved one with bipolar disorder has left.

Change the venue. If holidays have been difficult for your loved one in the past, try mixing things up. Plan a holiday dinner out or a day at the movies. A change in routine could help keep everyone from falling into familiar patterns.

Think about limiting alcohol. If your loved one with bipolar disorder has problems with alcohol, find ways to de-emphasize it. "Some families decide that if a person has been having trouble with alcohol, they will have an alcohol-free holiday that year," says Michael E. Thase, MD, professor of psychiatry at the University of Pittsburgh Medical Center.

Offer a place to go during a party. If you're hosting a get-together, offer your loved one a place to retreat to during the party if things get too intense. Having a place to unwind for a few minutes by lying down, reading, or watching television may make him or her much more relaxed.

Don't forget about your own needs. If you sacrifice everything for your loved one with bipolar disorder, you may just wind up unhappy and resentful. So try to strike a balance between what your loved one wants and what you want.

Accept your limitations too. No matter what you do, you can't single-handedly keep another person safe and happy -- whether they're coping with bipolar disorder or any other condition. Make sure to get help from other family members. You may benefit from seeing a therapist to help you tackle some of these difficult issues.

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« Reply #17 on: November 16, 2006, 08:37:14 am »

Depression Basics


 
Sometimes physical problems can cause depression. But other times, symptoms of depression are part of a more complex psychiatric problem. There are several different types of depression, including:


Major depressive disorder
Dysthymia
Seasonal affective disorder
Psychotic depression
Bipolar depression
Major Depression
An individual with major depression, or major depressive disorder, feels a profound and constant sense of hopelessness and despair.

Major depression is marked by a combination of symptoms that interfere with the person's ability to work, study, sleep, eat, and enjoy once pleasurable activities. Major depression may occur only once but more commonly occurs several times in a lifetime.
 
 
What are the symptoms of major depression?
 
 
Symptoms of depression include:


Sadness
Anxiety
Irritability
Loss of interest in activities once enjoyed
Withdrawal from social activities
Inability to concentrate
Psychotic Depression
Roughly 25% of people who are admitted to the hospital for depression suffer from what is called psychotic depression. In addition to the symptoms of depression, psychotic depression includes some features of psychosis, such as hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears).
 
 
How is psychotic depression different than other mental disorders?
 
 
While people with other mental disorders, like schizophrenia, also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren't true. They may be ashamed or embarrassed and try to hide them, which can make diagnosing this condition difficult.
 
 
What are the symptoms of psychotic depression?
 
 
Anxiety (fear and nervousness)
Agitation
Paranoia
Insomnia (difficulty falling and staying asleep)
Physical immobility
Constipation (difficulty having a bowel movement)
Intellectual impairment
Psychosis
Dysthymia
Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression but the depression symptoms linger for a long period of time, perhaps years. Those who suffer from dysthymia are usually able to function normally, but seem consistently unhappy.

It is common for a person with dysthymia to also experience major depression at the same time - swinging into a major depressive episode and then back to a more mild state of dysthymia. This is called double depression.


Symptoms of dysthymia include:
Difficulty sleeping
Loss of interest or the ability to enjoy oneself
Excessive feelings of guilt or worthlessness
Loss of energy or fatigue
Difficulty concentrating, thinking or making decisions
Changes in appetite
Observable mental and physical sluggishness
Thoughts of death or suicide
Seasonal Affective Disorder
Seasonal depression, called seasonal affective disorder (SAD), is a depression that occurs each year at the same time, usually starting in fall or winter and ending in spring or early summer. It is more than just "the winter blues" or "cabin fever." A rare form of SAD known as "summer depression," begins in late spring or early summer and ends in fall.
 
 
What are the symptoms of seasonal affective disorder?
 
 
People who suffer from SAD have many of the common signs of depression: Sadness, anxiety, irritability, loss of interest in their usual activities, withdrawal from social activities, and inability to concentrate. But symptoms of winter SAD differ from symptoms of summer SAD.


Symptoms of winter SAD include the seasonal occurrence of:
Fatigue
Increased need for sleep
Decreased levels of energy
Weight gain
Increase in appetite
Difficulty concentrating
Increased desire to be alone
Symptoms of summer SAD include the seasonal occurrence of:
Weight loss
Trouble sleeping
Decreased appetite
 
 
 
What causes depression?
 
 
There is not just one cause of depression. It is a complex disease that can occur as a result of a multitude of different factors, including biology, emotional and environmental influences. For some, depression occurs due to a loss of a loved one, a change in one's life, or after being diagnosed with a serious medical disease. For others, depression just happened, possibly due to a family history of the disorder.

There is absolute proof that people suffering from depression have changes in their brains compared to people who do not suffer from depression. The hippocampus, a small part of the brain that is vital to the storage of memories, is 9%-13% smaller in women with a history of depression than in those who've never been depressed. A smaller hippocampus has fewer serotonin receptors. Serotonin is a neurotransmitter -- a chemical messenger that allows communication between nerves in the brain and the body.

What scientists don't yet know is why the hippocampus is smaller. Investigators have found that cortisol (a stress hormone that is important to the normal function of the hippocampus) is produced in excess in depressed people. They believe that cortisol has a toxic or poisonous effect on the hippocampus. It's also possible that depressed people are simply born with a smaller hippocampus and are therefore inclined to suffer from depression.
 
 
How is depression diagnosed?
 
 
The diagnosis of depression begins with a physical exam by a doctor. Although there are no laboratory tests to specifically diagnose depression, the doctor may use various tests to look for physical illness as the cause of the symptoms. If a physical cause for the depression is ruled out, your doctor will likely refer you to a psychiatrist or psychologist for evaluation.

The doctor bases his or her diagnosis of depression on the patient's report of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the patient's symptoms and degree of dysfunction point to depression.
 
 
How is depression treated?
 
 
The most common treatment for depression includes the combination of antidepressant medicine, including selective-serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, and psychotherapy (called "therapy" for short, or "counseling"). Electroconvulsive therapy, also called ECT, may be used as a last resort when severe depression is unresponsive to other forms of therapy.

In October 2004, The FDA has determined that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.
 
 
What is the outlook for people with depression?
 
 
The outlook for depressed people who seek treatment is very promising. By working with a qualified and experienced mental health care professional, you can regain control of your life.

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« Reply #18 on: November 26, 2006, 10:56:53 am »

new folder for Lupus & MCTD patients that suffer with Depression
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« Reply #19 on: December 07, 2006, 09:07:18 am »


There Is Accounting for Taste in Treatment of Depression
 

December 06, 2006
   
   
 

Explain to patients who ask that depression, anxiety, and other mental and physical disorders can alter taste perception. This study suggests that the neurotransmitters serotonin and norepinephrine, levels of which are targeted by newer antidepressants, may be involved in taste alteration.
   
  Dec. 6 -- For newly diagnosed depression patients, there may be a tell-tale taste test for selecting the right antidepressant.

On the basis of their finding that serotonin and norepinephrine can alter taste thresholds, investigators here think they may have found a tasteful way to choosing the antidepressant that fits the patient.


In a study of 20 healthy adult volunteers, those who were exposed to the selective serotonin reuptake inhibitor Paxil (paroxetine) had significantly lower thresholds for sweet and bitter tastes than they normally did, wrote Lucy F. Donaldson, Ph.D., of the University of Bristol, and colleagues, in the Dec. 6 issue of Journal of Neuroscience.


Similarly, volunteers given the norepinephrine reuptake inhibitor Edronax (reboxetine) were able to detect much smaller concentrations of bitter and sour tastes than they normally could, although neither drug appeared to affect taste thresholds for salt, the investigators found.


"Because we have found that different tastes change in response to changes in the two different neurotransmitters, we hope that using a taste test in depressed people will tell us which neurotransmitter is affected in their illness," said Dr. Donaldson.


"This is very exciting," agreed co-author Jan Melichar, M.D. "Until now we have had no easy way of deciding which is the best medication for depression. As a result, we get it right about 60% to 80% of the time. It then takes up to four weeks to see whether the drug is working, or if we need to change it. However, with a taste test, we may be able to get it right first time."


Alteration of taste has been documented in patients with depression, anxiety, and panic disorder. One theory about the etiology of depression holds that the disorder is caused by either lower levels of circulating monoamine neurotransmitters (such as serotonin, norepinephrine, and dopamine) or a reduction in the sensitivity of monoamine receptors, or both, the authors noted.


"Many antidepressants modulate monoamine function, and their use is associated with dysgeusia," they wrote. "This modulation of monoamine function may have an impact on taste perception, and this may be the basis for altered taste in affective disorders."


To see whether they could detect a link between mood, taste, and levels of the neurotransmitters, the investigators enrolled 20 healthy volunteers (12 men and 8 women) from the ages of 19 to 47. One of the volunteers completed only part of the study.

The volunteers were tested for depression with the Beck Depression Inventory and for anxiety with the Spielberger State and Trait Inventory at each of three visits, and were then tested for taste recognition thresholds -- that is, their ability to sense sweet, salty, sour, and bitter tastes in various dilutions.


They were then given either 20 mg of Paxil, 4 mg of Edronax, or a placebo, and were tested again two hours after taking the drug. The volunteers were told what taste they would be given, but not the concentration or whether they would be expected to recognize the taste.


The authors found that boosting serotonin levels via the use of Paxil resulted in a 27% reduction in the taste threshold for sucrose, and a 53% reduction in the taste threshold for quinine (bitter).


In contrast, elevated norepinephrine levels, courtesy of Edronax, resulted in a 39% reduction in the taste threshold for quinine, and a 22% reduction in the recognition threshold for sour.


There were no effects on taste from the placebo.


To determine whether mood and taste sensitivity might be related, the authors looked at baseline thresholds and scores on the anxiety and depression scales.


Although depression scores were low in the group and anxiety scores were within the clinically normal range, they did detect an association between Spielberger Trait scores (general anxiety levels) and both bitter and salt taste thresholds among participants with high-normal anxiety.


Among the participants with the highest levels of anxiety, the taste thresholds were higher, meaning that their sensitivity for bitter and salt (but not sweet or sour) tastes was blunted, the authors wrote.


"Our findings show that taste, previously thought to be principally genetically determined with little day-to-day variability, can be extremely plastic and is profoundly affected by modulation of the 5-HT [serotonin] and/or noradrenergic systems in normal healthy individuals," Dr. Donaldson and colleagues wrote.


"Our results reinforce previously reported findings of taste disturbances in patients with affective disorders, in that taste threshold is directly related to anxiety level, again in a normal healthy population where response bias is likely to be less of a problem than in an ill population," they continued. "These results support an important and basic role for 5-HT and NA in taste function and may explain why anxious and depressed individuals exhibit diminished appetite."

 

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« Reply #20 on: December 21, 2006, 03:13:27 pm »

http://www.yourtimeforchange.com/

Free DVD & Information from Wyeth Pharmaceuticals Inc.
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« Reply #21 on: March 03, 2007, 08:45:38 pm »

March 03, 2007

Appearance related to illness tied to depression



 Appearance and physical disability are risk factors for depression in people afflicted with rheumatoid arthritis, researchers report. With systemic lupus erythematosus, commonly known as just lupus, only appearance seems to predict depression.

Physical deformities, particularly of the hands and feet, can develop with rheumatoid arthritis, whereas skin rashes and other lesions can occur with lupus, Dr. Louise Sharpe, from the University of Sydney in Australia, and colleagues note in the medical journal Arthritis & Rheumatism.

Although few studies have looked at body image concerns, there is evidence that women with these disorders have a poorer body image than unaffected women, the team notes.
The focus of their study was to evaluate the link between physical appearance concerns and psychological distress in patients with lupus and rheumatoid arthritis.

The study involved 60 patients with lupus, 44 with chronic rheumatoid arthritis, and 53 with recent-onset rheumatoid arthritis. They completed a variety of questionnaires regarding their physical and mental health.
Increased psychological distress was noted in all three groups. Moreover, 53 percent of lupus patients reported feeling unattractive because of their disease compared with just 30 percent and 34 percent of patients with chronic and new-onset rheumatoid arthritis.

As noted, appearance concerns raised the risk of depression in both lupus and arthritis patients, whereas physical disability only had an effect in the latter group. These factors did not influence the occurrence of anxiety in either group.

"What this study highlights is that appearance concerns and depression are closely interrelated," the authors conclude, "and that it is important that they be considered together in the psychological functioning of patients with rheumatic disease."


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« Reply #22 on: January 10, 2011, 10:23:45 am »


CeNeRx Initiates Phase II Trial of TriRima as Monotherapy in Treatment Resistant Depression


-- Follows Successful Safety Studies of New and Improved Formulation of this Novel Antidepressant -



Jan. 6, 2011

CeNeRx BioPharma, Inc., today reported that it has initiated a Phase II trial of its new formulation of TriRima™, the company's novel antidepressant in development as monotherapy for treatment resistant depression. CeNeRx also announced that it will be presenting at Biotech Showcase™ 2011 on Tuesday, January 11, 2011 at 11:00 AM PST.

TriRima is a member of a novel class of drugs known as RIMAs, or reversible and selective inhibitors of monoamine oxidase A (MAO-A). MAO inhibitors achieve superior "triple-action" antidepressant efficacy by elevating the levels of all three of the key neurotransmitters that positively affect mood. However, older MAO inhibitors have been limited by their potential to cause serious cardiovascular side effects when foods containing the naturally occurring substance tyramine are consumed.

TriRima is designed to achieve the efficacy of the MAO inhibitor class while reducing or eliminating the risk of these food-associated effects. In a recently reported "tyramine challenge" study, subjects receiving the new formulation of TriRima showed no signs of any negative effects, even after being exposed to large amounts of tyramine. These positive results further confirmed the good safety profile demonstrated by TriRima in Phase I studies.

The Phase II trial is a double blind, placebo-controlled study designed to assess the efficacy of TriRima administered twice daily as monotherapy in patients with treatment resistant depression. Secondary objectives include evaluating TriRima's safety and tolerability and assessing its pharmacokinetic profile. CeNeRx expects to enroll 360 patients in the study, which is being conducted at multiple centers in the U.S.

"We are eager to test the efficacy of our promising new formulation of TriRima in treatment resistant depression, and we are delighted that our Phase II trial is now enrolling patients," said Daniel Burch, MD, Chief Medical Officer of CeNeRx. "The new formulation of TriRima has demonstrated excellent safety in multiple studies to date, and we believe that it has the potential to become the first agent to achieve the triple action efficacy of MAO inhibitor drugs without their limiting side effects."

The modified release formulation of TriRima has major advantages over the version used in earlier studies. In addition to displaying excellent pharmacokinetic properties, the dosing frequency has been reduced to one tablet administered once or twice daily.

"TriRima addresses a large unmet medical need -- currently a substantial proportion of patients with major depression do not receive adequate relief from their therapy," noted Barry Brand, Chief Executive Officer of CeNeRx. "TriRima has the potential to be the first option that provides these patients superior efficacy and a good safety profile as monotherapy, and we look forward to advancing the Phase II trial in the coming year."

CeNeRx will be presenting at the Biotech Showcase 2011 meeting at 11:00 AM PST on January 11. The conference is being held January 10-12, 2011 at the Parc 55 Wyndham, San Francisco. More information on the meeting can be found at www.ebdgroup.com/bts/index.php.

.

About CeNeRx BioPharma

CeNeRx is a privately held clinical-stage biopharmaceutical company developing and commercializing innovative treatments for diseases of the central nervous system. CeNeRx's most advanced compound, a reversible inhibitor of monoamine oxidase, or RIMA, is in Phase II development for treatment resistant depression. RIMAs may have efficacy advantages over current agents for depression and are expected to have a good safety profile. The company's CNS pipeline also includes clinical-stage hypothalamic-pituitary adrenal (HPA) axis modulators for the treatment of a variety of CNS disorders including anxiety and depression; a small molecule, orally active agent for the prevention and treatment of neuropathies and neurodegenerative disorders; and a series of selective cannabinoid compounds that have recently completed successful preclinical proof-of-concept studies for the treatment of pain, glaucoma and spasticity. The company's investors include Perseus Soros Biopharmaceutical Fund, L Capital Partners and Pappas Ventures. For more information, visit www.cenerx.com.[/b]

Contact:

GendeLLindheim BioCom Partners

Barbara Lindheim

212 918 4650
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