Increased Depression, Burden, Reported in Family Caregivers of ALS Patients

Family caregivers of people with ALS, most often spouses, are likely to become depressed and feel burdened, but that's not the case for the people they are caring for, according to a study published in the March 20, 2007, issue of Neurology , the scientific journal of the American Academy of Neurology.
"Since there's evidence a caregiver's mental status greatly influences ALS patients, these findings show a family caregiver's physical and psychological condition should not be overlooked when planning ALS care," said study author Adriano Chio, MD, with the University of Torino in Torino, Italy, and a member of the American Academy of Neurology.
Researchers interviewed 31 ALS patient-caregiver couples at the beginning and end of a nine-month study. Couples were tested for depression and quality of life. Researchers also examined a caregiver's feeling of burden, along with a patient's self-perceived burden.
The study found a significant increase of burden and depression among caregivers over the nine months, while depression, quality of life, and self-perceived burden remained virtually unchanged among people with ALS.
Mild to moderate depression among caregivers jumped from 9.7 percent to 19.3 percent. Feeling burdened increased 11 percent among caregivers, with the most common complaint being not enough time for oneself. Quality of life scores dropped slightly among caregivers.
Chio says several factors may have contributed to the steadiness among quality of life and depression in people with ALS, including a patient's acceptance of the deadly disease, or possibly cognitive impairment.
The study also found while quality of life was higher in caregivers than in patients at the beginning of the study, quality of life was higher in patients by the end. "ALS is considered a family disease, meaning that it involves every member of the patient's entourage. Interventions specifically designed to enhance effective communication between patients and caregivers might improve the psychological well-being of both parties, helping patients to be more aware of their caregivers' needs, and caregivers to accept their straining, but invaluable role," said Chio.
The study was supported by the Ricerca Sanitaria Finalizzata (an Italian health research program) by the Piemonte Region, Italy.

Girls complaining about their problems at greater risk of developing anxiety, depression

Symptoms of Depression and Anxiety in Girls

A researcher at the University of Missouri-Columbia has found that girls who talk very extensively about their problems with friends are likely to become more anxious and depressed.
The research was conducted by Amanda Rose, associate professor of psychological sciences in the College of Arts and Science. The six-month study, which included boys and girls, examined the effects of co-rumination - excessively talking with friends about problems and concerns. Rose discovered that girls co-ruminate more than boys, especially in adolescence, and that girls who co-ruminated the most in the fall of the school year were most likely to be more depressed and anxious by the spring.
"When girls co-ruminate, they are spending such a high percentage of their time dwelling on problems and concerns that it probably makes them feel sad and more hopeless about the problems because those problems are in the forefront of their minds. Those are symptoms of depression," Rose said. "In terms of anxiety, co-ruminating likely makes them feel more worried about the problems, including about their consequences. Co-rumination also may lead to depression and anxiety because it takes so much time - time that could be used to engage in other, more positive activities that could help distract youth from their problems. This is especially true for problems that girls can't control, such as whether a particular boy likes them, or whether they get invited to a party that all of the popular kids are attending."
The study involved 813 third, fifth, seventh and ninth grade students. The participants answered questionnaires that assessed co-rumination, depression, anxiety and the quality of their best friendship in the fall and spring of the school year.
Ironically, although co-rumination was related to increased depression and anxiety, Rose also found that co-rumination was associated with positive friendship quality, including feelings of closeness between friends. Boys who co-ruminated also developed closer friendships across the school year but did not develop greater depressive and anxiety symptoms over time.
"For years, we have encouraged kids to find friends who they can talk to about their problems, and with whom they can give and receive social support," Rose said. "In general, talking about problems and getting social support is linked with being healthy. What's intriguing about theses findings is that co-rumination likely represents too much of a good thing. Some kids, especially girls, are taking talking about problems to an extreme. When that happens, the balance tips, and talking about problems with friends can become emotionally unhealthy."
Rose said adolescents should be encouraged to talk about their problems, but only in moderation and without co-ruminating.
"They also should engage in other activities, like sports, which can help them take their minds off their problems, especially problems that they can't control," she said.

Relapse from antidepressant medication may be lack of response to medication

Study suggests that loss of depression treatment response is likely due to loss of placebo response.
A new study by Rhode Island Hospital researchers indicates that a relapse during antidepressant continuation treatment may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.). The study was published in the August issue of the Journal of Clinical Psychiatry.
Historically, the treatment of depression is divided into three phases " initial/acute, continuation and maintenance. During the initial phase, the goal is to reduce symptoms and psychosocial impairment. During the continuation phase, usually six months to one year after initial treatment response, the goal is to maintain the gains and prevent a relapse. In the maintenance phase, which occurs after a sustained period of improvement, the goal is to further maintain the gains and prevent recurrence of the disorder.
Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at the Warren Alpert School of Medicine at Brown University, is the paper's lead author. Zimmerman, along with his colleague Tavi Thongy, MD, also of Rhode Island Hospital and Brown University, conducted a meta-analysis of continuation studies of new generation antidepressants that began as placebo-controlled acute phase studies. Treatment studies of depression have found that approximately 50 to 65 percent of patients respond to medication and that approximately 25 to 35 percent respond to placebo.
Past studies have indicated that a number of patients who respond to treatment in the initial phase experience a relapse or recurrence despite ongoing pharmacotherapy during the two latter phases of treatment. This return of symptoms is often interpreted as a loss of efficacy of antidepressant activity, and is referred to as tachyphylaxis or the "poop-out" effect.
Zimmerman says, "When a patient improves after being prescribed an antidepressant medication you do not know if they got better because of the medication or because they had a placebo response."
The researchers used formulas developed by Quitkin and colleagues more than a decade ago to calculate the relapse rate attributable to relapse in presumptive placebo responders. "Our study suggests that the return of symptoms despite ongoing treatment during the continuation and maintenance phases of treatment may not represent a loss of drug effect because the patient may not have experienced a true drug response in the first place."
Zimmerman also notes, "While our conclusion is limited to the continuation phase of treatment, our results suggest that these findings probably also apply to the maintenance phase of treatment."
The researchers note that these findings are not inconsistent with conclusions that continuation and maintenance studies of antidepressants have clearly established the benefit of ongoing treatment beyond the acute phase.

Pumpkin Eases Stress

As you enjoy your second piece of pumpkin pie this Thanksgiving, consider this: A Toronto physician has found that an amino acid found in pumpkin seeds helped research subjects feel less nervous in stressful situations.
In the most recent issue of the Canadian Journal of Physiology and Pharmacology (September 2007; 85(9):928-932), Craig Hudson, M.D., reports that subjects who consumed pumpkin seeds reported feeling calmer — and recorded slower heart rates — as they performed a task while being videotaped.
Organic pumpkin seed flour, pressed to remove the oil, contains a high amount (22 mg per gram) of the amino acid tryptophan, a precursor to both melatonin and serotonin. Combined with carbohydrates to cross the blood-brain barrier more effectively, the tryptophan reacts to light to ease stress during the daytime and promote sleep after dark.
In another double-blind, placebo-controlled study (Nutritional Neuroscience, April 2005, 8(2):121-127), research subjects reported not only that they fell asleep more easily and stayed asleep longer when taking the food-based tryptophan, but that they felt less stressed and more relaxed during the day, lost weight and even enjoyed sex more.
Dr. Hudson, a Toronto psychiatrist, studies how the brain responds to dietary changes. In his book Feel Great Day and Night, Dr. Hudson suggests a simple behavior modification plan to trade bad sleep habits for restful nights and more pleasant days.

Transcranial Magnetic Stimulation Effective Treatment For Depression

For the first time in a large-scale study, transcranial magnetic stimulation has been shown to be an effective, non-drug treatment for major depression. Current antidepressant therapies are not beneficial for at least a third of depressed individuals, leaving many with a lack of adequate treatment options. This study will be published in the December 1st issue of Biological Psychiatry.
Co-author Dr. Philip Janicak, professor of Psychiatry at Rush University Medical Center, says the treatment may be an option for patients with major depression who have not responded to conventional antidepressant medications.
Transcranial magnetic stimulation (TMS), a non-invasive technique that excites neurons in the brain by magnetic pulses introduced through the scalp, has previously been identified as a potential new treatment for depression but prior, smaller studies have shown conflicting results.
The authors present the results from the first large scale, multi-center, double-blind, sham-controlled study of TMS as a treatment for people with depression who had not responded to prior antidepressants and who were not taking antidepressant medications during the study. After four to six weeks of active or sham TMS, response and remission rates with active TMS were approximately twice those of sham.
This study was also associated with a low dropout rate, due to generally mild side effects, indicating that the treatment was well-tolerated by patients.
Dr. John P. O'Reardon, the corresponding author on this project and associate professor of Psychiatry at the University of Pennsylvania, explains, "These results indicate that TMS provides a novel and attractive treatment option for patients with major depression who have not responded to conventional antidepressant medications."
Dr. John H. Krystal, editor of Biological Psychiatry, highlights the significance of this article's findings. "This study provides new support for the efficacy of TMS as a 'stand alone' treatment for depression. This finding could be particularly important for patients who do not tolerate antidepressant medications, for whom they are not safe, or who have not benefited from other alternative treatments."
O'Reardon adds, "As indicated by recent large scale, government-sponsored, studies of existing treatment options for major depression conducted by the National Institute of Health (the STAR-D reports), there is a great need to develop new effective treatments for patients, especially those not benefiting from first line interventions. The results of this study indicate that TMS offers new hope to patients in this regard."