Depression and Bipolar info explaining the latest research in everyday English


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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Does depression and lowered self-esteem affect how safe you feel your neighbourhood is?

Depression, lowered self-esteem, perceived neighborhood fear and drug use among young adults.

We all know that some neighbourhoods feel 'riskier' than others -- somewhere not to walk alone at night, somewhere not to engage with groups of local youths -- but is our level of self-esteem and depression a confounding factor? Do we take more drugs if we are depressed and/or suffering low self-esteem, and if so do we then rate our neighbourhood as 'riskier'?

These are the questions that Katherine Theall, Claire Sterk and Kirk Elifson sought to answer with a four-year study in Atlanta, Georgia, USA.

We know from the academic literature that stress, and exposure to stressful situations, is not good for our health, including reduced immune defences and increased risk of depression. Additionally, social stress (such as being scared to walk in your neighbourhood for fear of violence or victimisation) can lead to feelings of helplessness and hopelessness, often (but not always) leading to escapist activities such as drug use, alcoholism, and increased sexual risk-taking behaviour as examples.

Research has shown that depressed individuals (regardless of their environment/neighbourhood) are more likely to initiate drug use, or relapse back to drug use, as well as indulge in greater levels of risk-taking behaviour, sexual and alcohol-associated included.

Theall, Sterk and Elifson sampled 210 inner-city young adults (18-25 years of age) who were recruited from Atlanta between September 2002 and August 2006. Interestingly, according to records from the Atlanta Police Department and the Community Epidemiology Work Group of the National Institute on Drug Abuse for Atlanta showed no major shift in crime or drug trends over the study period. That isn't to say that crime and drug use didn't change, only that the official records didn't capture any significant changes.

They found that the strongest predictors for perceived fear of one's neighbourhood include being unemployed, being a gang member, being physically or sexually abused, suffering low self-esteem and suffering from depressive symptoms.

What they were really looking for they didn't find: while increased fear did result in increased drug use, these behaviours did not appear to be as a result of lowered self-esteem or increased levels of depression.

The implication of the study seems to be that lowered self-esteem or higher levels of depression by themselves have no significant effect on how likely someone is to take drugs in order to 'cope' with their fear of their neighbourhood. It would appear that more inclusive factors -- such as a person's household, community and personal resources -- as well as sociological-level interactions need to be taken into account when considering how to reduce the 'fear factor' a certain neighbourhood might raise in a neighbourhood resident.

Source: Theall, K.P., Sterk, C. E., & Elifson, K.W. 2009. Perceived neighborhood fear and drug use among young adults. American Journal of Health Behavior; 33(4): 353-365

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