Wednesday, December 15, 2010

Black Heart Patients Undertreated For Depression

Blacks and whites with heart disease are both likely to experience symptoms of depression, but blacks are only half as likely to receive treatment for the disorder, according to a new study from Duke University Medical Center.
"This is an important finding because we know that depression is associated with a 2- to 4-fold increase in the risk of complications and death from heart disease," says James Blumenthal, PhD, a psychologist at Duke and a co-author of the study appearing early online in the American Heart Journal. "Undertreatment of depression is a serious clinical issue."
Coronary heart disease is the leading cause of death in the United States, and previous studies show that it takes a disproportionate toll among blacks
Through support from a grant from the National Institutes of Health, Duke researchers studied 864 patients (727 whites and 137 blacks) who received care at the Diagnostic Cardiac Catheterization Laboratory at the Duke Heart Center between April 1999 and June 2002. Researchers reviewed the patients' records, noting use of medications and any cardiovascular risk factors. They also asked participants to complete the Beck Depression Inventory (BDI) to assess symptoms of depression.
The scientists found that depression was common in this group: Thirty-five percent of the black patients and 27 percent of the white patients had elevated measures of symptoms of depression. But while 21 percent of the whites were taking antidepressants to treat the disorder, only 11.7 percent of the blacks were receiving treatment.
There also appeared to be important gender differences. Among those with the most severe symptoms of depression, 43 percent of white men, but only 22 percent of black men were on antidepressants. In comparison, 64 percent of white women and 67 percent of black women were taking such medications.
"These findings suggest that depression in heart disease is undertreated, and it appears that black men are suffering the most," says Silvina Waldman, MD, a cardiologist at the Duke Heart Center and lead author of the study. "It is sobering to realize that large numbers of patients are missing out on important and readily available therapeutic options."
Blumenthal says available data do not provide a clear explanation for the disparity in treatment rates, but he believes it is probably due to several factors. Studies show that depression in conjunction with medical illness tends to be under diagnosed. Blumenthal says that some physicians may not be adept at recognizing depression in minority patients and that some patients may feel that a diagnosis of depression is stigmatizing and may not feel comfortable talking about their symptoms with their doctor. Blumenthal says insurance coverage and patients' ability to pay out-of-pocket expenses may also play a role. Some patients may indeed have been prescribed antidepressants, but can't afford to have prescriptions filled - a dilemma that could affect treatment rates.
"We clearly need to do a better job of recognizing and treating depression, especially in heart patients," Blumenthal said. "We need treatments that work, treatments that are acceptable to patients, and treatments that are actually incorporated into medical practice."
Blumenthal believes that medications may not be the only way, however, to treat depression in heart disease. He is currently conducting a clinical trial (called UPBEAT) comparing aerobic exercise to antidepressants as a means of relieving symptoms of depression.

Friday, December 10, 2010

Every 12 Adolescents Experienced Major Depression

About 2.1 million teens aged 12 to 17 experienced a major depressive episode in the past year, according to a new nationwide report by the Substance Abuse and Mental Health Services Administration. For almost half of the teens, depression drastically reduced their abilities to deal with aspects of their daily lives, the report said.
Overall, 8.5 percent of adolescents, the equivalent of one in every 12, experienced a major depressive episode, but there were striking differences by gender, with 12.7 percent of females and 4.6 percent of males reporting the conditions.
“Fortunately, depression responds very well to early intervention and treatment,” said SAMHSA Administrator Terry Cline, Ph.D. “Parents concerned about their child’s mental health should seek help with the same urgency as with any other medical condition. Appropriate mental health care can help their child recover and thrive.”
The report defines a major depressive episode as a period of two weeks or longer of depressed mood or loss of interest or pleasure, and at least four other symptoms reflecting a change in functioning (for example, problems with sleep, energy, concentration and self-image). This is the definition established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association.
Major Depressive Episode among Youths Aged 12 to 17 in the United States of America: 2006 also reveals the often devastating effect these major depressive episodes can have on adolescents. Nearly half of adolescents experiencing major depression (48.3 percent) report that it severely impaired their ability to function in at least one of four major areas of their everyday lives (home life, school/work, family relationships, and social life). Adolescents reporting the most severe impairment reported that they were unable to carry out normal activities on an average of 58.4 days in the past year.
The report is based on combined data from the 2004 to 2006 National Surveys on Drug Use and Health (NSDUH) involving responses from 67,706 people aged 12 to 17 throughout the United States. The survey is based on a scientific random sample of households throughout the United States, and professional field representatives personally visit each household to conduct the survey.

Sunday, December 5, 2010

Depression symptoms may come from modern living

According to one researcher, experiencing depression symptoms might simply be the result of modern living. Stephen Ilardi, associate professor of clinical psychology at the University of Kansas believes living in an industrialized society may be a root cause of why we experience symptoms of depression, especially given the increased incidence of depressive disorders, despite pharmaceutical therapies.
"A century ago, according to the best epidemiological evidence we have, the lifetime rate of depressive illness in the U.S. was about 1 percent," said Ilardi. "The rate now stands at 23 percent. So we've had roughly a 20-fold increase over the course of a century. Since World War II there's been roughly a 10-fold increase. And a recent study found the rate of depression has more than doubled in just the past decade." Experiencing symptoms of depression takes a toll on overall health and has been associated with a variety of chronic illnesses, including heart disease.
Ilardi contends that reclaiming a more primitive type of lifestyle could be the answer to treating depression. His book The Depression Cure (Da Capo Lifelong Books), published June 1, is based on research from the Therapeutic Lifestyle Change project, lead by Kansas University Researchers.
"As a species, humans were never designed for the pace of modern life," said Ilardi. "We're designed for a different time — a time when people were physically active, when they were outside in the sun for most of the day, when they had extensive social connections and enjoyed continual face time with their friends and loved ones, when they experienced very little social isolation, when they had a much different diet, when they got considerably more sleep and when they had much less in the way of a relentless, demanding, stress-filled existence." The result of living more simply was fewer symptoms of depression.
To prove that assuming a less modern role might cure symptoms of depression, study participants were asked to adopt six habits from the past that are basic to good health - consuming more omega-3 fatty acids; remaining actively engaged to combat eating; getting regular sunlight exposure; increasing physical exercise; connecting more with others socially; and getting increased , quality sleep.
Ilardi’s own studies, in addition to the ongoing Therapeutic Lifestyle Change project, show that modern day existence fosters unhappiness, leading to symptoms of depression. He says individuals whose lifestyles are more closely related to our ancestors experience less depression.
Ilardi cites the Amish culture whose rates of depression are low, as well as observations from anthropologist Edward Schieffelin who observed that the Kaluli people of the New Guinea highlands do not experience depression. They spend their days foraging and gardening, just as our ancestors did.
Modern life may indeed contribute to symptoms of depression, which has been increasing steadily since World War II. Less time spent in the sun, lack of sleep, fast food diets, social isolation, and physical inactivity are the direct result of the way we live. Of depression, Ilardi says, “Virtually everyone knows someone with this affliction.”
Ilardi is convinced that modern living is at the root of why people experience symptoms of depression, which include lack of sleep, difficulty enjoying activities, fatigue, irritability, increased pain, feelings of hopelessness, crying, lack of sexual desire, and even thoughts of suicide. According to the National Institute of Mental Health, “Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.” If you suffer from symptoms of depression, speak with your health care provider. You may also want to consider a more simple existence.

Wednesday, December 1, 2010

Bill Would Encourage Postpartum Depression Research

The House on Monday voted 382-3 to pass a bill (HR 20)that would authorize $3 million in grants in fiscal year 2008 to studythe causes and treatments of postpartum depression and postpartumpsychosis, CQ Today reports (Armstrong, CQ Today, 10/15).
The bill, sponsored by Rep. Bobby Rush (D-Ill.), also would provide grants through HHSfor the %26quot;establishment, operation and coordination of effective andcost-efficient systems for the delivery of essential services%26quot; forwomen with the conditions and their families. The measure initiallywould have directed NIHto conduct research on postpartum depression and postpartum psychosis,but a House subcommittee in July approved an amendment that changed thelanguage from %26quot;directed%26quot; to %26quot;encouraged.%26quot; The bill would authorize%26quot;such sums as necessary%26quot; to continue the research for FY 2009 and FY2010 (Kaiser Daily Women’s Health Policy Report, 9/28). According to the Congressional Budget Office, the measure could cost $15 million over five years if grants and other programs in the bill are funded (CQ Today, 10/15).
The bill also encourages the National Institute of Mental Health, NIH and the HHS secretary to carry out a national campaign to increaseawareness and knowledge of postpartum depression and postpartumpsychosis, the AP/Google.comreports. The measure also includes language that calls for a study intomental health issues related to abortion and miscarriages. Rep. JosephPitts (R-Pa.), who opposes abortion rights, said that althoughpostpartum depression is a serious disease, it is "just as important toknow the effects of adoption, miscarriage and abortion in order toproperly help women" (Abrams, AP/, 10/15).
According to a CDC study, about 18% of women experience depression after giving birth. The Senate has introduced a companion bill (S 1375)that does not contain abortion-related language. According to a Rushaide, Rush’s staff will speak with Sen. Robert Menendez (D-N.J.),sponsor of the Senate legislation, about making his measure moresimilar to the House bill. Rush said, "No longer will postpartumdepression be dismissed as mere ‘baby blues’" (CQ Today, 10/15).
Reprinted with permission from You can view theentire Kaiser DailyWomen’s Health Policy Report, search the archives, and sign up for emaildelivery at The Kaiser Daily Women’s Health Policy Report is published for, afree service of The Henry J. Kaiser Family Foundation. 2007 Advisory BoardCompany and Kaiser Family Foundation. All rights reserved.