Long-Term Antidepressant Treatment Contributes To Significant Increases In Weight Gain And Obesity

On January 18, 2011, in Depression, Medication, by Christopher Fisher, PhD


This study demonstrates that patients using antidepressant medication continuously, mostly serotonin-selective reuptake inhibitors (SSRIs), show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of antidepressant medication used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures (i.e., measurement of of human physical variations).

In a study published in the last 2010 issue of Psychotherapy and Psychosomatics, a group of researchers of the University of Amsterdam presents new findings on the relationship between weight and recurrent depression.

The literature on the relation between obesity and the recurrent type of major depressive disorder (MDD-R; having had at least 2 major depressive episodes) is limited and equivocal. Most studies on depression and obesity did not distinguish between single and recurrent episodes. However, this distinction may be important because depression is increasingly considered a chronic recurrent disorder with various levels of interepisodic functioning, and evidence is growing that the recurrent type is a distinct one.

Most studies on the relation between depression and obesity did not control for antidepressant (AD) medication use, although a substantial part (20 – 60%) of the recurrently depressed patients use ADs for lengthy periods of time. This study elaborates on their findings by focusing on the relation between obesity and MDD-R and the association between long-term use of ADs and obesity.

To be eligible for this study, patients had to meet the following criteria: (a) at least 2 major depressive episodes in the past 5 years (DSM IV), (b) current remission status, according to DSM-IV criteria, for longer than 10 weeks and no longer than 2 years before, and (c) Hamilton Rating Scale for Depression of <10.

At 2 years, follow-up assessment anthropomorphic parameters were collected of 134 subjects.

To assess relapse/recurrence, the Structured Clinical Interview for DSM-IV (SCID-I) was used. Regarding the use of ADs, two groups were distinguished: those who used Ads throughout the entire 2-year study period (n = 46) and those who did not use ADs continuously, but intermittently (n = 49) or not at all (n = 39). Differences between these groups in BMI, waist circumference, and waist-to-hip ratio were tested stratified by gender.

Overweight and obesity occurred more often in patients with recurrent depression than in the reference group, although statistical significance was reached in women only (74% of this sample). Within the MDD-R patient group, serotonin-selective reuptake inhibitors (SSRIs) were the most commonly used type of AD among the continuous AD users. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures.

The mean AD equivalent correlated positively with both waist circumference (p = 0.006) and waist-to-hip ratio (p = 0.004), but not with BMI. In addition, mean waist circumference and waist-to-hip ratio scores were consistently higher amongst the continuous AD users compared to intermittent and no AD users. Patients using ADs continuously, mostly SSRIs, show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures. The authors did find, however, a small association between AD equivalent dosage and waist circumference and waist-to-hip ratio.

In general, a better understanding of the relationship between obesity and depression that includes understanding the beneficial and adverse effect of psychotropics on appetite, eating behaviour, body weight, and metabolism should improve our ability to prevent and treat both obesity and depression. Thereby, ideally persontailored interventions can be developed, including effective nonpharmaceutical preventive strategies for recurrent depression and extra physical activities with – as added benefit – protection against AD-induced weight gain.

Material adapted from Journal of Psychotherapy and Psychosomatics.

Reference
Lok, A.; Visscher, T.L.S.; Koeter, M.W.J.; Assies, J.; Bockting, C.L.H. ; Verschuren, W.M.M. ; Gill, A. ; Schene, A.H. The ‘Weight’ of Recurrent Depression: A Comparison between Individuals with Recurrent Depression and the General Population and the Influence of Antidepressants. Psychother Psychosom 2010;79:386-388.

Web Source: http://www.bmedreport.com/archives/22150?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+TheBehavioralMedicineReport+(The+Behavioral+Medicine+Report)

UNC Researchers Investigate Estrogen Replacement Therapy To Prevent Depression And Cardiovascular Disease

Article Date: 13 Jan 2011 – 2:00 PST


Researchers at the University of North Carolina at Chapel Hill have launched a new clinical trial to determine if estrogen replacement therapy may help prevent depression and cardiovascular illness in women between the ages of 45 and 55.

It’s a move that may raise eyebrows in some quarters, given that a Women’s Health Initiative (WHI) study was halted in 2004 due to findings that estrogen therapy resulted in an increased risk of stroke and blood clots.

But there’s an important difference between the UNC study and the WHI estrogen study, said David Rubinow, MD, UNC’s chair of psychiatry and one of two principal investigators of the new 5-year study, which is funded by a $4.5 million grant from the National Institutes of Health. The other principal investigator is Susan Girdler, PhD, professor of psychiatry.

“The Women’s Health Initiative study led to the mistaken belief that estrogen replacement therapy is bad for all women. And as a result, it has served to deprive some women of a treatment that might greatly and favorably impact their lives. Much of the negative impact of estrogen that they found was related to the fact that most of the women in the Women’s Health Initiative study were far past the menopause and up to 79 years old,” Dr. Rubinow said.

“There are now a large number of studies that demonstrate what has been called the timing hypothesis. That is, giving estrogen within a year or two of menopause has beneficial effects, but giving estrogen in women more than five years beyond the menopause can actually be harmful.

“When the women who were close to menopause were looked at separately, the adverse effects on the heart were not seen and in fact some suggestion of beneficial effects was seen. Perimenopausal women in the Women’s Health Initiative who received estrogen had significantly lower coronary artery calcification compared to the women who didn’t take estrogen.

“That raises the question: Is estrogen potentially beneficial for women in the perimenopause – the years surrounding the menopause? It’s really an unanswered question at this point. Our study is an effort to find out what puts an individual woman at risk for heart disease and depression and what predicts beneficial effects of estrogen replacement during the perimenopause on affective well-being and cardiovascular well-being.”

The study, which began in August 2010 and will be conducted entirely at UNC, seeks to enroll a total of 320 women ages 45 to 55 who are in the menopause transition. All will be randomized to receive treatment with estradiol (estrogen replacement) skin patches or placebo.

Women in the study will be tested three times: before treatment and then again after 6 months and 12 months of treatment. These laboratory tests will measure their cardiovascular and inflammatory responses to mental stress, indicators of cardiovascular health and metabolic markers such as a glucose tolerance test, waist/hip ratio and lipid profiles. In addition, assessments of their moods, vital signs, side effects and compliance with the treatment regimen will be conducted on each participant

“Given the mortality and morbidity associated with depression and heart disease, and the tremendous increase in risk of these disorders during the perimenopause, it is critical that we identify those women who will be helped by estradiol,” Dr. Rubinow said.

The research study is currently enrolling participants. Eligible women will receive free study related medical evaluations and up to $1,200 in monetary compensation for completing all study visits.

Source:
University of North Carolina at Chapel Hill School of Medicine

View drug information on Estradiol Transdermal System.

Research May Yield New Drug Targets for Memory, Anxiety Disorders

By TRACI PEDERSEN Associate News Editor
Reviewed by John M. Grohol, Psy.D. on January 10, 2011


A new drug target for anxiety disorders — and particularly post-traumatic stress disorder (PTSD) — is now possible due to a recent unexpected discovery by UCLA scientists.  Their research has honed in on neuronal gap junctions — channels in which electrical communication occurs between inhibitory neurons. 

The discovery also holds promise for Alzheimer’s disease and other memory-related disorders.

“The brain has many processes we have not yet explored,” said UCLA Professor of Psychology Dr. Michael Fanselow. ”Understanding them and how they normally work can open up new approaches that may help in very prevalent and debilitating diseases, such as anxiety disorders and memory disorders.”

Gap junctions form where inhibitory neurons touch one another. They are an opening between nerve cells that allow electrical activity to pass from one neuron to another.

When an individual has a terrifying experience, there is often a lingering fear of the place where it happened. This occurs because the nerve cells in certain brain regions increase their ability to excite or stimulate one another, said Fanselow, leader of the study and member of UCLA’s Brain Research Institute.

So far, most studies have emphasized that this experience happens because of the communication among neurotransmitters moving across synapses (spaces between neurons). However, there is also direct electrical contact among other small, inhibitory neurons in these areas as well, and these connect through gap junctions, Fanselow said.

“I was completely surprised by this discovery,” he added. “I really thought we were taking a long shot and was surprised that gap junctions were not only playing a role but that their importance was so great.”

Interestingly, these gap junctions are very common in invertebrates but rare in mammals, where they can only be found on certain inhibitory interneurons.

“Because of this, no one has looked at the importance of these gap junctions for learning, memory and emotion,” Fanselow said. “We hypothesized that these gap junctions may be very important. Because the gap junctions cause the inhibitory neurons to fire together, they may cause these inhibitory neurons to act as a pacemaker for the excitatory neurons, making them fire at the same time so they are better able to make fear memories.”

The study included the use of several drugs that block gap junctions in rats, and it was discovered that because the medications disrupted vital rhythms in the dorsal hippocampus (a brain region most associated with cognition), they were able to keep any “fear of place” memories from forming.

The drug injections worked when given right after a frightening experience, revealing that they could be particularly useful for PTSD.  Also, the drugs were just as effective when regularly injected into a cavity near the abdomen as when put directly into the brain.

“Because we don’t know when a person will experience trauma, treatments that can work after the experience hold more promise,” Fanselow said.

“Our research shows a way that neurons can coordinate their activity, and this coordination is critical for memory formation,” Fanselow said. “Perhaps if we had a way of enhancing gap junction function, we may improve memory formation by facilitating gap junctions when memory is impaired by diseases such as Alzheimer’s. However, we have not shown this yet.”

Fanselow noted that the formation of fear memories is what drives anxiety disorders, which are quite common and can be very debilitating. “Gap junctions appear to be key in coordinating the activity of the network of neurons that produce fear memories, specifically, and probably other memories, generally, as well,” he said.

Source:  University of California

Source Site: http://psychcentral.com/news/2011/01/10/research-may-yield-new-drug-targets-for-memory-anxiety-disorders/22437.html

The Year of Living Anxiously

by Henry Emmons, M.D.

The Anxiety Resolutions


There are sure-fire ways to make yourself anxious, if you wanted to do so. No one would do this on purpose, yet without knowing it that is exactly what many of us do every day. How do we do it? Here’s my list of some of the most common mistakes that aggravate the condition we call anxiety. But first I’d like to comment on stress.

In my opinion, stress has gotten a bad rap. Life is stressful, and always has been. Yet when we feel like ourselves, we are naturally resilient. We adapt to stresses remarkably well, often finding ourselves stronger or more skilled by having confronted life’s unavoidable challenges.

Stress alone is not the problem. Instead, we become our own enemy. The common mistakes that follow will reliably turn everyday stress into overwhelming anxiety:

1.) Keep thinking about what is wrong.
Neuroscience has confirmed what we already know: when we replay worrying thoughts again and again, we strengthen the neural pathways for those thoughts, so that they become ingrained in our mind like bad habits. It is as if we are rehearsing worry and anxiety. As with anything, we get better and better at it with practice.

2.) Keep talking about what is wrong.
Pop psychology has given us the notion that it is good to express our feelings. That can be true, but many of us take that to mean that we should “vent”. If someone is willing to listen, we often share our stories of woe. Repeated unloading keeps our anxious feelings alive and may even strengthen them.


3.) Over-stimulate yourself.
Caffeine, tobacco, loud noise, driving fast, working without breaks, skipping meals-there are so many ways to keep the body and brain on overdrive and keep the anxiety levels high.

4.) Don’t allow for time to refresh and renew.
After a stressful experience, it is normal and healthy to take time to rest and recover. That lets the body’s stress response system calm down, reset and get prepared for the next challenge. Our ancestors ran and then they rested; we stay on the treadmill. Not allowing for downtime differentiates our response to stress from every other time in human history.

5.) Stay constantly busy.
This is a variation on the last point. It is not only during the stressful times in life that we overdo. Most of us do too much every single day. You may have heard the phrase: “We are human beings, not human doings.” We are simply not designed to be on the go 24/7.

6.) Give in to your cravings.
Most of us reach reflexively, without thinking, without deciding, for something to soothe ourselves when we feel stressed or anxious. We often eat comfort food like sweets or other food laden with carbs and fats. Whatever we crave, we crave it because it makes us feel better-for much too short a time. Unfortunately, the comfort is brief and we almost always end up feeling worse in the long run.

7.) Short-change your sleep.


If there were a single sure-fire way to break a person down, it would have to be too little sleep. Lack of sleep is an accelerator toward most mental illness, and anxiety is no exception. Getting an average of 7-8 hours per night is not only helpful, it is essential.

8.) Stay sedentary.
Think about what happens in nature: the “fight or flight” reaction means that stress hormones flood the body, priming it for some kind of physical action. Sitting most of the day means the stress hormones have nothing to do but re-circulate. Moving your body helps to discharge the effects of all of those stress hormones and reset yourself back to a normal resting state.

9.) Isolate yourself.
It is a wonder that so many have become isolated and alone when we are clearly wired to connect. As the Dalai Lama has said, “We can live without religion and meditation, but we cannot survive without human affection.” Meaningful connection doesn’t solve everything, but it goes a very long way toward helping us endure the difficult side of life.

10.) Believe that you’re in it on your own.
The spiritual traditions give us a consistently reassuring message: “All will be well.” But when our brains get locked into anxious patterns, we can’t believe that. We see our small, individual selves as being solely responsible for our lives without any support. It is an illusion. If we can see through it, we can tap into a deep well of reassurance and hope.

11.) Watch the news daily.
You’ve heard that we are what we eat. We may also be what we take in through our eyes and ears. A study in Scandinavia showed that watching the evening news, filled with stories of tragedy, violence or other bad news, had a strong effect on rates of anxiety and depression. Does that mean that we should keep our head in the sand? No, but it may be wise to pay attention to what we are feeding ourselves through our minds, especially when we are going through personally hard times.

12.) Play video games.
It should come as no surprise that a game that simulates trauma and violence would put the brain into a state that is similar to the real thing. Researchers have found that common video games do just that. They may even create lasting brain changes so that things don’t go right back to normal when the game is done. The news is not all bad for video games, though. Soldiers in Iraq who played an absorbing game like Tetrus shortly after witnessing a trauma were able to protect themselves from developing post-traumatic stress symptoms.

13.) Become addicted to stress.
Some people appear to thrive on stress. They choose to remain overly committed, or constantly create high drama in their lives, and they seem to do fine. But if the stress stops, things begin to crumble. It is as if they have become addicted to stress and the high level of stress hormones that flood their body. Take the stress away, and they go into a form of withdrawal. Since no one can remain stressed forever without consequences, they should heed the warning signs and get a handle on their stress level.

We would do well to avoid what we can of the above pitfalls, but we won’t do it perfectly any more than we can keep all of our resolutions to do the right things. If we are in the game of life, stress cannot be avoided. That is all the more reason to become better at dealing with it.

Depression Thwarts Attempts to Quit Smoking

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on January 3, 2011


New research suggests diagnosed or undiagnosed depression can hinder an individual’s efforts to stop smoking.

In the study, published in the January 2011 edition of the American Journal of Preventive Medicine. scientists determined approximately 24 percent of surveyed callers to the California Smokers’ Helpline currently suffered from major depression and 17 percent of callers had mild depression.

Over half the surveyed callers, depressed or not, made at least one attempt to quit after calling the helpline.

At the two-month mark, however, the success rate of those with major depression was much lower than that of mildly depressed or non-depressed callers. Nearly one in five callers with major depression reported success, but of others, nearly one in three was able to remain smoke-free.

Most quit-lines do not assess smokers for depression, even though mild depression already is known to reduce the success of quitting. This study suggests that major depression reduces the success rate even farther.

That is important because the California quit-line receives a high number of calls from heavy smokers and smokers on Medicaid – two circumstances associated with depression. Since more than 400,000 smokers call U.S. quit-lines every year, the authors believe that up to 100,000 depressed smokers nationally are not getting the targeted treatment they need.

“Assessing for depression can predict if a smoker will quit successfully, but the assessment would be more valuable if it were linked to services,” said lead study author Kiandra Hebert, Ph.D., of the University of California at San Diego.

Hebert said an integrated health care model is a potential solution. Depressed smokers could have better quitting success if they receive services that address both issues. Quit-lines, which are extremely popular, are in a good position to offer such services to a large number of depressed smokers and to pass on the services they develop to quit-lines across the country.

Treatment programs, including quit-lines, report that a growing number of callers have other disorders, such as depression, said Wendy Bjornson, co-director of the Oregon Health & Science University Smoking Cessation Center, who was not involved in the study.

“The results of this study are important. They show the scope of the problem and point to the need for protocols that can lead to better outcomes.”

Source: Health Behavior News Service