Depression and Bipolar info explaining the latest research in everyday English

12Oct/11Off

Bipolar disorder from the clinician’s perspective

I recently came across this great video by Dr. Jeffrey Applebaum, a Family Medicine physician at UC Davis in the USA. He provides a cool, calm look at Bipolar Disorder and seems to 'get it'. Well worth the watch.


Depression from the clinician\'s perspective

1Sep/10Off

A review of findings from the world’s largest study of Bipolar Disorder

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) ran from 1998 to 2005, with over 4,000 sufferers of Bipolar Disorder (BD) taking part in various trials and assessments over a two-year period.

Researchers were looking at how BD progresses through a person's life, how related it is to other psychiatric disorders, and how related it is to suicidality.

It found that few treatments alone were successful in treating BD, however psycho-social interventions (such as Cognitive Behaviour Therapy) and psycho-education interventions combined with mood stabilizers showed the most positive results.

BD was also shown to be strongly related to substance abuse and smoking, both of which affected the success or otherwise of chemical and psychological treatments.

Interestingly, paroxetine or bupropion were shown to be no more effective than a placebo in achieving sustained recovery (in this instance, determined as eight weeks of 'stable' behavior). So, too, were lamotrigine, risperidone, and inositol found to deliver minimal positive effects.

To the vexed, 'hidden', taboo subject of suicide -- the 'S' word not spoken of by the media (although thankfully that is slowly changing, at least in Australia). Suicidality persists with BD, even when treatment outcomes are good. The biggest predictor of suicidality being previous attempts.

The authors' conclusions
The authors of this review paper note seven contributions of the STEP-BD program:

1. Antidepressants remain poorly effective in treating BD;

2. BD is particularly disabling (tell me about it), and frequently doesn't respond to medications;

3. BD does respond modestly to intensive psycho-social interventions;

4. Other psychiatric disorders are common and destabilizing, yet anxiety disorders and smoking are able to be treated and when treated positively impact on BD;

5. An early age on onset of BD usually results in a more severe course of the illness, but rapid-cycling usually diminishes;

6. The sub-syndrome of Depression may be so strong as to mask the manic pole of BD, therefore careful symptom appraisal by psychiatrists is essential;

7. Suicidal thoughts persist in BD sufferers, and a previous attempt is a good indicator of a future event. However, by reducing feelings of 'hopelessness' in particular, there is the possibility of reducing the risk of suicide.

 

Source: Parikh, S.V., LeBlanc, S.R., & Ovanessian, M.M. 2010. Advancing Bipolar Disorder: Key Lessons From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The Canadian Journal of Psychiatry, Vol. 55, No 3, p.p. 136-143.

 


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28Mar/10Off

Options for mild or moderate depression

The Harvard Mental Health Letter (HMHL) is reporting on the implications of a meta-analysis study into the efficacy of medication for mild, moderate and severe major depression.

[That sounds/reads bizarre, doesn’t it? Surely ‘major’ means that it’s flown past being a ‘mild’ or ‘moderate’ depression… but I digress.]

The study by Fournier et al reduced 2,164 studies to just six worth analysis (by their standards) and found that medication only helps those with severe depression.

There are, of course, limitations with the study – the low number of studies in their meta-analysis being just one, but it does allow the HMHL an opportunity to remind us that exercise, psychotherapy and relaxation are powerful aids in the fight against the black dog for those suffering mild to moderate depression.

----------

Source:

Fournier JC, et al. “Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis,” Journal of the American Medical Association (Jan. 6, 2010): Vol. 303,
No. 1, pp. 47–53.

Harvard Mental Health Letter, April 2010 – www.health.harvard.edu


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16Aug/09Off

More on caffeine and depression

Further to the research into caffeine and adolescent anxiety, I have noticed that my own health has been impacted by caffeine.

In the last few weeks I have been drinking a lot of fresh coffee (I can't stand the instant stuff) and I've found that my medication hasn't been as effective as normal.

Normally, I could take my medication in the morning and it would last 24 hours; over the last few weeks and coinciding with my increased coffee intake my meds only seem to last until early evening. Certainly my night-time dreaming has been wacko-weird as a result of the medication not 'protecting' me as long as it normally does; and whilst the dreams are certainly entertaining and vivid, the headaches that I am suffering before and after sleep are equally as vivid and definitely not welcome.

So last week I reduced my caffeine intake. Result: 24 hour cover and a lot less headaches. The dreaming is no longer vividly technicolour, alas, but that is a price I am prepared to pay. Perhaps when I come to write the 'Great Australian Novel' I may revisit that decision... [smile]



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4Aug/09Off

Do SSRIs erode your bones?

There's a growing body of evidence that SSRIs are eroding bones, resulting in increased risks of osteoporosis and fractures.

The Harvard Mental Health Letter for August 2009 reports on a ten-year history of research that noticed a disturbing correlation (a seeming relationship between two sets of data): depressed patients had lower bone strength and a greater risk of fractures.

Although the earlier studies left the door open to a pharmaceutical reason for increased risk of fracture (as in, the medications used may have caused dizziness, resulting in falls and fractured bones), later studies have been better-designed and seem to implicate SSRIs are causing bone erosion.

Two recent significant studies appear to conflict. One finds that inhibiting 5-HTT, which SSRIs do better than any other antidepressants, slows bone formation and accelerates bone resorption (which is when calcium and other minerals are released into the bloodstream, leaving trenches behind in the bones); the other finds that inhibiting 5-HTT actually increases bone mass.

5-HTT is the transporter mechanism for 5-HT, which you might know as serotonin; SSRIs enhance serotonin activity.

Despite the conflict between the two aforementioned studies, the Canadian Multicentre Osteoporosis Study Research Group followed 5,008 men and women who were aged 50 and over for five years, finding that the patients who were taking SSRIs everyday had lowered bone mineral density measurements, particularly in the hip. They were also twice as likely as non-SSRI-taking patients to suffer a bone fracture.

Ways to overcome any risk of bone erosion include increasing the intake of calcium, increasing the intake of vitamin D, reducing the amount of caffeine and alcohol taken, and exercising in a way that bears weight on bones (such as walking, weight lifting, stair climbing). It also seems that some medications help slow bone resorption: alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva) are mentioned positively.

Of equal significance is that no one has yet taken a look at how SSRIs might affect the bones of children or teenagers.

Source: Harvard Mental Health Letter, August 2009 - www.health.harvard.edu.


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3Aug/09Off

Comparing mood stabilizers for bipolar disorder

Comparing mood-stablising medication for sufferers of bipolar disorder.

As those who suffer from it know, bipolar disorder is characterised by cyclical swings between happy mania and unhappy depression, with periods of mental peace and tranquility in between. It apparently affects around 2% of Americans and is associated with significant treatment costs, particularly around the medications used to control its effects on sufferers.

Sometimes just one medication isn't enough; often a treating physician will test various pharmaceuticals in combination with each other to create a 'cocktail' that seems to work best for the sufferer. This is true not just for bipolar disorder, but increasingly for other medical conditions as well, including depression.

Of course, whether using one medication or a cocktail, the cost of administration of the medication can be steep: not only the cost of the medication itself but also the cost of monitoring its performance, monitoring the dosing frequency, monitoring its effectiveness, monitoring its tolerability and side effects, and so on.

Brandon Suehs and Tawny Bettinger, two pharmacologists from Austin, Texas, saw a gap in the decision-making process of which mood-stabilizing medication to use with a patient and so sought to develop a model to help their colleagues.

Working with 116 psychiatric pharmacist specialists -- pharmacists with specialist training and practice in clinical psychopharmacology -- Suehs and Bettinger sought to determine the optimum medications based on five descending criteria: Effectiveness, Safety & Tolerability, Dosing Frequency, Monitoring Burden, and Cost.

Effectiveness was a composite score based on a medication's effectiveness in 1) treating acute mania, 2) treating acute bipolar depression and 3) effectiveness in maintenance treatment.

Suehs and Bettinger found that lithium is the most effectiveness across both acute mania and maintenance treatment factors, as well as overall effectiveness; lamotrigine is the medication with the most effectiveness in treating acute bipolar depression. Aripiprazole scored moderately well as the antipsychotic of choice for safety, tolerability and maintenance factors.

Of additional interest was the finding that gabapentin and topiramate scored poorly across all three factors (acute mania, acute bipolar depression and maintenance treatment).

Source: Suehs, B.T., & Bettinger, T.L. 2009. A Multiattribute Decision Model for Bipolar Disorder: Identification of Preferred Mood-Stabilizing Medications. American Journal of Managed Care; 15(7); e42-e52

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