What’s the Most Effective Depression Treatment for Children?

Answer
from Jay L. Hoecker, M.D.

For children, depression treatment may include psychotherapy either alone or in combination with antidepressant medication. Although opinions vary about which depression treatment should be tried first, a growing body of evidence indicates that the best approach for most children is a combination of both. Treatment is most often provided in an outpatient setting. Sometimes hospital care may be needed. The treatment plan must be tailored to the severity of the child’s symptoms and how they affect his or her development.

Many types of psychotherapy are available. For depression treatment, cognitive behavioral therapy may be especially effective. Children who are depressed often have an unhealthy, negative view of themselves and their experiences. With cognitive behavioral therapy, children learn to develop a healthier, more positive outlook — which can help relieve depression. Sometimes it’s helpful for families to be involved in therapy as well.

Antidepressant medication is another option for childhood depression treatment, especially when psychotherapy is unable to effectively treat mood symptoms. Untreated mood disorders in adolescents are associated with an increased risk of suicide. Some research also indicates a link between antidepressants and increased suicidal thoughts and behaviors in children being treated with these drugs, so it’s important for doctors to carefully weigh the risks and benefits before prescribing antidepressants to children. Still, for many kids, the benefits of antidepressants outweigh the risks.

Antidepressants may be particularly helpful for children who:

  • Have severe symptoms that likely won’t respond to therapy alone
  • Don’t have convenient or timely access to therapy
  • Have chronic or recurring depression
  • Have a family history of depression with good response to medication
  • Don’t have active substance abuse issues
  • Don’t have bipolar depression or an active psychotic illness

Even when symptoms of depression go away, continuing psychotherapy or antidepressants for a time reduces the risk that depression will recur.

Remember, depression is as common in children as it is in adults. Early detection and treatment of depression is important at any age — and family support is essential. If you suspect that your child is depressed, contact your child’s doctor or a mental health provider.

Article originally published by the Mayo Clinic at:
http://www.mayoclinic.com/health/depression-treatment/AN00685/rss=1

New Findings Pull Back Curtain on Relationship Between Iron and Alzheimer’s Disease

Massachusetts General Hospital researchers say they have determined how iron contributes to the production of brain-destroying plaques found in Alzheimer’s patients.

The team, whose study results appear in the Journal of Biological Chemistry, report that there is a very close link between elevated levels of iron in the brain and the enhanced production of the amyloid precursor protein, which in Alzheimer’s disease breaks down into a peptide that makes up the destructive plaques.

Dr. Jack T. Rogers, the head of the hospital’s neurochemistry lab who oversaw the team’s work, said the findings “lay the foundation for the development of new therapies that will slow or stop the negative effects of iron buildup” in patients with the progressive neurodegenerative disease, symptoms of which include memory loss, impaired judgment, disorientation and personality changes.

While it had been known that an abundance of iron in brain cells somehow results in an abundance of amyloid precursor protein, or APP, and its destructive peptide offspring, Rogers’ team set out to open up new avenues for therapies by determining what goes on at the molecular level. In 2002, they identified the molecular location where APP and iron interact, a discovery that laid the groundwork for the work being reported now.

Today it is clear that, under healthy conditions, iron and APP keep each other in check: If there’s too much iron in a brain cell, more APP is made, and then APP and a partner molecule escort excess iron out. And, as the team reported last month in a related paper in the journal Cell, if there’s too little iron, fewer APP molecules are made available to help escort iron out. As a result, iron accumulates, and the process begins again in a feedback loop.

Rogers said the team’s work detailed in the two recent papers “seals the loop” in what has been understood about APP and iron and paves the way for the development of drugs that will beef up the ability of APP and its partner to eject iron and restore the iron balance when needed.

The researchers also identified, in the JBC paper, another important player in the system of checks and balances used to regulate iron in brain cells. Known as IRP1, which stands for iron-regulating protein 1, the special molecule attaches to the messenger RNA that holds the recipe for making APP. When there’s less iron in the brain cell, IRP1 is more likely to hook up with the RNA, which prevents the production of APP. When there’s abundant iron present, IRP1 doesn’t hook up with the RNA, and APP production becomes excessive.

The new information solidified the team’s hunch that the particular region where IRP1 binds to the messenger RNA is a potential drug target.

“With other research teams, we are investigating novel therapies that remove excessive iron, and we’re looking at the precise spot on the messenger RNA where IRP1 binds to screen for drugs that specifically prevent APP production,” said Dr. Catherine Cahill, one of the lead authors.

The team’s research was funded by the National Institutes of Health, the Alzheimer’s Association and the Institute for the Study of Aging. The resulting “Paper of the Week” will appear in the JBC’s Oct. 8 issue.

The other team members were Hyun Hee Cho, Charles R. Vanderburg of Harvard NeuroDiscovery Center, Clemens R. Scherzer of Brigham and Women’s Hospital, Bin Wang of Marshall University and Xudong Huang.

Can Vigorous Exercise Curb Drug Abuse?

Can exercise reduce cravings for drugs? UT Southwestern Medical Center investigators are conducting a research study to find out.

A $15.7 million award from the National Institute on Drug Abuse (NIDA) is allowing researchers to see whether consistent exercise will help people abstain from stimulant abuse.

“It’s a scientifically exciting question,” said Dr. Madhukar Trivedi, professor of psychiatry at UT Southwestern and principal investigator of the national study. “Exercise would give people who abuse drugs an alternative ritualistic activity that may help them disengage from their drug-related behaviors while also improving their health and quality of life.”

Exercise helps alleviate conditions as diverse as obesity, anxiety and depression. Evidence from animal studies suggests that exercise leads to improvements in brain function similar to what is seen when a brain recovers from drug abuse, Dr. Trivedi said.

The Stimulant Reduction Intervention using Dosed Exercise, or STRIDE, study will be the largest NIDA-funded trial on the issue to date. More than 300 people from at least 10 clinics throughout the country are expected to participate.

Dr. Trivedi was a principal investigator of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study – the largest ever on the treatment of major depressive disorder and considered a benchmark in the field of depression research. The six-year, $35 million study initially included more than 4,000 patients from clinics across the country.

Dr. Trivedi also has published research on the effects of exercise on depression, with more work on the topic awaiting publication.

The STRIDE trial at UT Southwestern is already under way, but the second wave will begin in November. Each wave will last about 15 months.

Participants are patients in community-based residential treatment facilities, such as the Nexus Recovery Center, for abuse of or dependence on stimulants, such as cocaine, methamphetamines and amphetamines.

Participants have been randomized into two groups. One group is receiving usual care – 21 to 30 days of residential treatment followed by outpatient treatment – plus three supervised sessions of vigorous treadmill exercise per week for three months. Vigorous exercise is the equivalent of walking 4 mph for 30 minutes three times a week for a person weighing about 175 pounds. The other group is receiving usual care plus time spent getting information on health-related matters.

After three months, exercise will continue for six more months on treadmills or on the ground, and subjects will be monitored through heart rate monitors and step counters.

Researchers will use urine tests to monitor drug abstinence and relapse. In addition to improved drug abstinence and relapse rates, researchers hope that the participants who exercised will have decreased their use of other types of drugs and will experience improvement in sleep, weight, cognitive function, mood, and quality and enjoyment of life.

“If exercise is a successful treatment, then it could drastically change addiction interventions,” said Dr. Trivedi. “Exercise is relatively inexpensive and can be done by an individual without a huge therapeutic setting – people could start running on the streets.”

This trial is affiliated with NIDA’s Clinical Trials Network (CTN) at UT Southwestern. The CTN comprises more than 15 academic centers and surrounding treatment programs nationally that conduct multisite trials to improve the quality of drug abuse treatment in the U.S.

Source:
UT Southwestern Medical Center

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New Studies Suggest That Depression And Distress Is Not Detected In The Majority Of Patients Seen By Nurses

New research from the University of Leicester reveals that nursing staff have ‘considerable difficulty’ detecting depression and distress in patients.

Two new research studies led by Dr Alex Mitchell, consultant in psycho-oncology at Leicestershire Partnership Trust and honorary senior lecturer at the University of Leicester, highlight the fact that while nurses are at the front line of caring for people, they receive little training in mental health.

The researchers call for the development of short, simple methods to identify mood problems as a way of providing more targeted and appropriate treatment for patients.

Dr Mitchell, of the Department of Cancer Studies and Molecular Medicine at the University of Leicester, said: “In terms of dealing with distress and depression, nursing staff are probably the most important group of health professionals.

“In the NHS 400,000 nurses provide valuable support to those suffering a range a physical and mental illnesses but struggle to detect depression in the early stages. Nurses are often very capable of forming good therapeutic relationships and provide a great deal of psychological support which is highly valued. However their ability to do this is increasingly under-pressure from high workloads and little funding for professional development.

“Our first analysis found that 7000 nurses and nursing assistants often overlooked depression in clinical settings. Nurses working in hospital settings and nursing homes correctly identified about 4 out of 10 people with depression and practice nurses working in primary care correctly identified only one in four people with depression.”

A second study examined the ability of nurses to detect distressed patients and found half were missed until distress became severe.

Dr Mitchell said the research discovered a number of reasons that accounted for this situation: “Factors that appear to be influential include greater empathy, more confidence with mental health and more time spent with patients. However most nursing staff receive little training in mental health and report low experience in this area. It may be unrealistic to expect nurses to remember complex criteria for detection of depression or to apply lengthy screening tools. In the future we may focus more on who has impaired function and who needs help rather than depression alone.”

Dr Mitchell’s team is working on short, simple methods to identify mood problems and these can be freely accessed here.

Note
Mitchell AJ, Kakkadasam V. Ability of nurses to identify depression in primary care, secondary care and nursing homes – A meta-analysis of routine clinical accuracy. International Journal of Nursing Studies (2010) online first and on ScienceDirect doi:10.1016/j.ijnurstu.2010.05.01

Mitchell, A. J., Hussain, N., Grainger, L. and Symonds, P. , Identification of patient-reported distress by clinical nurse specialists in routine oncology practice: a multicentre UK study. Psycho-Oncology, n/a. doi: 10.1002/pon.1815

Source:
University of Leicester

Warning: Racism Is Bad for Your Health

By Elizabeth Page-Gould

Elizabeth Page-Gould explains that the targets of prejudice aren’t the only ones harmed by it.

When we think about the victims of racism, we typically think of the immediate targets of racial prejudice: Those who have suffered at the hand of discrimination and oppression. But new research has identified another, unlikely group of victims: the racists themselves.

In the urban metropolises of the United States and Canada, it is almost impossible to avoid talking to someone of another race. So imagine the toll it would take if every time you did, your body responded with an acute stress reaction: You experience a surge in stress hormones, and your heart pumps harder while your blood vessels constrict, inhibiting the flow of blood to your limbs and brain.

These types of bodily reactions are helpful in truly dangerous situations, but a number of recent studies have found that racially prejudiced people experience them even during benign social interactions with people of different races. This means that just navigating the supermarket, coffee shop, or modern workplace can be stressful for them. And if the racist person then has to go through this every single day, the repeated stress can become a chronic problem, which places them at heightened risk for disease in later life.

Harboring prejudice, it seems, may be bad for your health.

Challenge vs. threat
The human body is incredibly adaptive to stressful situations. But our nervous system reacts very differently to stressful situations we perceive as challenges than to those we see as threats. It’s a distinction that, in the long run, could mean the difference between life and death for people with racial prejudices.

Challenges incite a sequence of physiological responses that send more blood to our muscles and brains, enhancing our physical and cognitive performance. Threats, on the other hand, set off a physiological response that restricts our blood flow and releases the hormone cortisol, which breaks down muscle tissue and halts digestive processes so that the body can quickly muster the energy it needs to confront the threat. Over time, these responses wear down muscles, including the heart, and damage the immune system.

In other words, facing challenges is good for you; facing threats is not. And whether you perceive interracial interactions as a challenge or a threat may be the key to thriving in a multicultural society.

In one study, Wendy Berry Mendes, Jim Blascovich, and their colleagues invited European-American men into the laboratory to engage in social interactions with African-American men or with men of the same race as themselves. The participants were hooked up to equipment that measured the responses of their autonomic nervous system while they played the game Boggle with their white or black partners.

When interacting with African-American partners, the white men tended to respond as to a physiological threat, marked by diminished blood pumped through the heart and constriction of the circulatory system. However, European Americans who had positive experiences with African Americans in the past responded as though the game posed a challenge—increased blood pumped by the heart and dilation of the circulatory system.

This is not an isolated result. In a study with Rodolfo Mendoza-Denton and Linda Tropp, I randomly paired European-American and Latino participants into same-race and cross-race pairs and had them disclose personal information to each other. At the beginning and end of the social interaction, participants provided saliva samples so we could measure their cortisol responses to the social interactions.

More on Are We Born Racist?
Read more about the book, or order your copy
Read Susan Fiske’s essay on the new science of racism
Read Allison Briscoe-Smith’s essay on teaching tolerance to kids

In other words, prejudiced individuals perceived partners of a different race as a physical threat, even though they were in a safe laboratory setting and engaging in a task that was structured to build closeness between the participant pairs. This was true for both Latino and European-American participants who were prejudiced. Imagine these same individuals trying to negotiate a racially diverse street scene or meeting at work.

In another study, Wendy Berry Mendes and her colleagues invited European Americans to take a survey over the Internet, measuring their levels of automatic prejudice against African Americans. These white participants were then invited to a laboratory where either European Americans or African Americans evaluated participants, as if in a job interview.

Again, as in the study I did with my colleagues, cortisol spiked in the relatively racist participants—and at the same time, their bodies released low levels of DHEA-S, a hormone that helps repair tissue damage caused by the taxing “flight or fight” response. In contrast, the more egalitarian participants—those who scored low in automatic prejudice—responded to the interracial interaction with greater increases in DHEA-S than cortisol, which suggests that they saw the evaluation more as a healthy challenge than as a threat.

A healthy society?
The bottom line is clear: Harboring racist feelings in a multicultural society causes daily stress; this kind of stress can lead to chronic problems like cancer, hypertension, and Type II diabetes. But interracial interactions are not inherently stressful. Low-prejudice people show markedly different physiological responses during interracial interactions. In all three of these studies, people who had positive attitudes about people of other races responded to interracial interactions in ways that were happy, healthy, and adaptive.

These positive attitudes can be learned; prejudiced people are not doomed to be that way forever. In my own study with Latino and European-American participants, we randomly assigned racist participants—those who were measurably stressed out by simple cross-race conversations—to complete a series of friendship-building tasks over several weeks with people of a different race. Over the next several weeks, we watched cortisol levels diminish in prejudiced participants, a trend that lasted throughout the friendship meetings. Furthermore, in the 10 days following their final friendship meeting, prejudiced participants who had made a cross-race friend in the lab sought out more daily interracial interactions afterward.

It’s that simple: Building friendships with people of other races seems to eliminate unhealthy stress responses, so that each new interaction can be greeted as a challenge instead of a threat. In a racially diverse society, those who feel comfortable with people of other races are at an advantage over those who do not.

These results have profound implications for the way we design our neighborhoods and institutions; indeed, they suggest that race-mixing policies like affirmative action might be just as good for white people as for people of color. The future health of racist people is not set in stone. If they’re willing to take the first step and reach out to people of other groups in a friendly way, they may learn to thrive in a society that is increasingly diverse