Monday, December 6, 2010

Family Reaction: Barrier To Teen Depression Treatment

Although teen depression poses a widespread problem for which proven treatments exist, few depressed teens receive any care.
Why don’t they undergo treatment? The answer depends whether you ask parents or the adolescents themselves, according to a study in the June issue of the journal Medical Care.
“With teenagers, treatment decisions greatly involve other parties, especially parents. For instance, teenagers often rely on adults for transportation. Doctors need a sense not just of what the teen thinks or what the parent thinks, but what both think,” said Lisa Meredith, Ph.D., lead author of the new study.
The ability of their physicians to address all the perceived barriers “affects the teenager’s own ability to acknowledge their depression and do something about it,” said Meredith, a reseacher at RAND.
Teens with untreated depression more often have social and academic problems, become parents prematurely, abuse drugs and alcohol and suffer adult depression and suicide.
For the study, researchers recruited 368 adolescent patients of diverse backgrounds receiving care in seven public or private primary care practices. Of these, half had a diagnosis of depression. One parent or guardian of each enrolled teenager also participated.
Teens and parents rated the effects of seven possible barriers: 1) cost of care, 2) what others might think, 3) problems finding or making appointments with a doctor or therapist, 4) time constraints and other responsibilities, 5) not wanting family to know about the depression (this was asked of teens only), 6) good care being unavailable and 7) just not wanting care.
Parents were significantly less likely to report barriers than teens.
For teens, concerns about stigma and relatives’ reactions were among the significant issues, and those who perceived barriers were less likely to undergo therapy or take medications. Depressed teens were significantly more likely to perceive barriers to care than their non-depressed peers were.
“Adolescents do tend to go undiagnosed and untreated. They don’t want to seem abnormal. They want to fit in. Yet when they deny problems, they often act out adaptively, drinking a lot and pursuing other high-risk behaviors,” said Deborah Amdur, a psychiatrist with the Advanced Psychiatric Group in Orlando, Fla.
“This study has the potential to be significant if the findings reach the primary care physicians and help them understand their task in ensuring that adolescents have access to care,” Amdur said. “It’s not a simple one step of speaking with the teenager. They also have to coordinate care with the parent.”
“Once primary care doctors understand the perceived barriers that exist on both sides, they are better able to work with a family to get care that feels right for a particular teenager,” Meredith said.

Thursday, December 2, 2010

Depression treatment enhanced program appears to reduce symptoms

Depression treatment and work productivity
Employees seeking treatment for depression who participated in a program that included a telephone outreach intervention had fewer symptoms, worked more hours and had greater job retention than participants receiving usual care, according to a study in the September 26 issue of JAMA.
Depression has enormous societal burdens, with annual U.S. economic costs of tens of billions of dollars due largely to productivity losses. Comparative cost-of-illness studies show that depression is among the most costly of all health problems to employers, according to background information in the article. Despite evidence that there are effective treatments, many depressed workers are untreated or inadequately treated. Employer-purchasers (those who purchase corporate health benefits) often do not invest in enhanced depression screening-treatment programs because of the uncertainty of the return-on-investment of such programs.
Philip S. Wang, M.D., Dr.P.H., of the National Institute of Mental Health, Rockville, Md., and colleagues examined the impact of a depression outreach-treatment program on the outcomes of depression symptom relief, job retention, sickness absence, and increased work productivity. The randomized controlled trial included 604 employees covered by a managed behavioral health plan who were identified in a 2-stage screening process as having significant depression. The telephonic outreach and care management program encouraged workers (n = 304) to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to clinicians. Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy. Three hundred participants received usual care.
The researchers found that measurements of depression severity were significantly lower in the intervention than in the usual care group by 6 months and at 12 months, and that patients in the intervention group were more likely to experience recovery (26.2 percent vs. 17.7 percent). Scores on the hours worked measure were significantly higher in the intervention than usual care group at 6 and 12 months. The data indicated that workers in the intervention group worked an average of two more hours per week than workers in the usual care group, which is equivalent to an annualized effect of more than two weeks of work. This overall effect was due to a higher rate of job retention (92.6 percent vs. 88.0 percent) and significantly more hours worked among employed respondents.
"The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes," the authors write. "The financial value of the latter to employers in terms of recovered hiring, training, and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers."
In an accompanying editorial, Kenneth B. Wells, M.D., M.P.H., and Jeanne Miranda, Ph.D., of the University of California, Los Angeles, comment on the challenge of depression treatment.
"Exactly how programs to improve depression care are implemented may affect the distribution of benefits – an important issue given evidence of disparities in quality of depression care and the potential for practice-based programs to overcome disparities in depression outcomes. Developers of interventions and policies should consider implications of their design for inclusion of underserved groups who may not seek behavioral health care. Despite the extensive efforts by Wang et al to reach general employees, the majority of persons had already inquired about outpatient care. Learning how to optimize personal and societal gains by improving access to quality depression care across diverse communities through employer, practice, and community-based programs and policy changes is a next agenda for evidence-based action. As a community participant in the Witness for Wellness program recently stated: ‘Depression is everybody’s business.’"

Friday, November 26, 2010

Depression increases cancer deaths

New research shows that depression can increase risk of dying among cancer patients. The findings highlight the importance of physician screening for depression among patients undergoing cancer treatment.
Maintaining a positive mental attitude has repeatedly been shown to also have a positive impact on health. The new study published in the November 15, 2009 issue of Cancer, reviewed research related to the effects of depression and survival among cancer patients.
Graduate student Jillian Satin, MA, of the University of British Columbia in Vancouver, Canada, and colleagues uncovered 26 studies with a total of 9417 patients to find that depression can increase risk of dying in cancer patients.
"We found an increased risk of death in patients who report more depressive symptoms than others and also in patients who have been diagnosed with a depressive disorder compared to patients who have not," said Satin. The risk of dying from cancer was twenty five and thirty nine percent for depressive symptoms, and minor or major depression respectively.
The researchers took into account other clinical characteristics that could account for cancer deaths in their analysis, still finding that depression plays a role in the risk of dying from cancer. The study emphasizes the importance of screening and treating patients with cancer for depression that can increase the chances of dying.

Monday, November 22, 2010

7 Depression Tips To Get Through Tthe Most Depressing Day of the Year

The most depressing day of the year is January 19. Here are some depression busting tips to get through the most depressing day of the year and manage depression.
Just how much can a person take these days? Worst unemployment since World War II, global economy is collapsing and now you tell me it’s “The Most Depressing Day of the Year?” You have to be kidding me!
Why This Day? January 19th is Blue Monday. Dr. Cliff Arnall, a researcher at University of Cardiff’s Center for Lifelong Learning, devises a formula that uses a variety of emotional and stress factors, to proclaim January 19 the most depressing day of the year in 2009. To make things worse, studies show that there are more heart attacks on Mondays than any other day of the week.
• Light: Low light levels and bad weather combine to create Seasonal Affective Disorder
• Bills Due: Holiday bills are hitting the mailbox and debt becomes more apparent
• Resolutions: Many New Year’s resolutions are already broken
• No Hope: People have low motivational levels and a feeling of need to take action
“People, don’t take this lying down,” said Dr. Kathleen Hall, internationally recognized lifestyle expert in stress and work-life balance, and founder and C.E.O. of The Stress Institute. “Put together a simple, Fun Plan to get through this darkest, most depressing day of the year.”
Dr. Hall suggests 7 Depression Busting tips to get through most of the Most Depressing Day of the Year and the rest of the winter blues.
1. Plan a “Mental Health” day – or better, play hooky. Spend the day with a good friend or your spouse or partner doing something fun like visiting the zoo or a museum. Science tells us that fun increases immune cells that combat depression.
2. Begin your day with a walk, walk at lunch. . . or walk with family after dinner. You’ll get the endorphin boost for both your mind and body that will improve your mood.
3. Shower yourself in Optimism. Shower using your favorite bath products like peppermint or lavender, and wake up your senses as you revitalize yourself. Slip away at lunch for a pedicure to revive your soles and soul.
4. Treat Yourself to a Healthy Breakfast. It sets your metabolism and regulates your mood for the day. Your biggest mood boost comes from combining lean protein and complex carbs.
5. Plan a Lunch Bunch. Just hanging out with a group of friends is a mood booster. Brown-bag it and meet at a park, or get friends together at your favorite hip hang out. Be sure to eat fish and B6’s, with a combination of protein and complex carbs for sustained energy.
6. Listen to music and turn off the news. During your commute or while at work, your favorite music can improve your mood instantly.
7. End your day with a fun dinner that includes family or friends. Rent a funny movie or go to a comedy club for some laughs – laughter releases the “happiness” hormones serotonin and endorphins.

Thursday, November 18, 2010

FDA Approves Generic Effexor for Depression Treatment

The US Food and Drug Administration (FDA) has approved the first generic version of Effexor XR extended release capsules (venlafaxine hydrochloride). The antidepressant, used for depression treatment, will be manufactured by Teva Pharmaceuticals, based in North Wales, PA.
Effexor XR is used for the treatment of major depressive disorder. Symptoms include feelings of sadness, loss of interest in pleasurable activities, and hopelessness. It is also indicated for the treatment of generalized anxiety, social anxiety and panic disorders.
“The approval of this widely used antidepressant is another example of the FDA’s efforts to increase access to safe and effective generic drugs,” said Keith Webber, Ph.D., deputy director of the Office of Pharmaceutical Science in the FDA’s Center for Drug Evaluation and Research.
“Access to treatments for depression is important because depression can interfere with a person’s daily life and routine, which can significantly affect relationships with family and friends.”
Venlafaxine hydrochloride extended-release capsules will be available as 37.5 milligram, 75 milligram, and 150 milligram capsules.
Prescribing information for the generic version of Effexor XR may differ from that of the brand name because of patents held by Wyeth Pharmaceuticals, the FDA said. But the same safety warnings will apply.
Generic Effexor XR's label will include a warning that antidepressants may raise the risk of suicidal thoughts or tendencies among some children, teens and young adults within the first few months of treatment, the agency said. The warning will also note that depression and other serious mental illnesses are the most important causes of suicidal thoughts or actions.
The shipments of the generic Effexor XR are expected to start on July 1st as per the terms of a 2006 agreement with Wyeth.