Older Diabetics With Depression Face Higher Death Rate

In a group of Medicare beneficiaries who have diabetes, being depressed was associated with a higher death rate, according to a new study. Read more

Health Tip: When Seniors Have Trouble Sleeping

(HealthDay News) -- Sleep disturbances -- including trouble getting to sleep or waking frequently throughout the night -- are common in elderly people.

The U.S. National Library of Medicine offers this list of common reasons for sleep problems in older people:

• Increased need to urinate.
• Pain, particularly from arthritis.
• Depression.
• Neurological problems.
• Alzheimer's disease.
• Side effects of taking certain medications.
• Alcohol use.
• Not getting enough exercise.
• Consuming too much caffeine.

NeuroStar Depression Therapy Cleared

(HealthDay News) -- The NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy system has been approved by the U.S. Food and Drug Administration for people with major depressive disorder who haven't seen satisfactory improvement from at least one prior antidepressant medication, device maker Neuronetics said in a news release.

TMS is a non-invasive therapy that involves stimulation of nerve cells in the brain that have been linked to depression. This is done by delivering MRI-strength magnetic pulses during a 40-minute outpatient procedure, in which patients do not require anesthesia or sedation, the company said. The daily treatment typically is given for four-to-six weeks.

In clinical studies involving 164 people with major depressive disorder, significant improvement was recorded for symptoms of core depression, anxiety, and other forms of psychological distress, Neuronetics said.

The most common side effect was mild-to-moderate scalp pain or discomfort at the treatment area, which declined "markedly after the first week," the company said. Fewer than 5 percent of patients stopped treatment due to adverse effects.

Initially, the therapy will only be available at a limited number of treatment centers across the United States, Neuronetics said.

More information
To learn more about depression, visit the U.S. National Institute of Mental Health.

Drinking Problems Greater Among Returning Combat Veterans

(HealthDay News) -- A host of new studies confirm that the effects of war linger long after the conflict ends.

The Aug. 13 issue of the Journal of the American Medical Association is a special themed issue on violence and human rights, and three studies published in that issue found that various mental health issues, such as alcohol misuse and post-traumatic stress disorder (PTSD), were more common after exposure to violent conflicts. The one bright spot was a study that found suicide rates weren't higher for returning combat veterans.

The first study found that veterans coming home from combat were 63 percent more likely to report new-onset heavy drinking than were military personnel that hadn't been deployed to combat zones.

"Our study found that combat deployment in support of the wars in Iraq and Afghanistan was significantly associated with new-onset heavy weekly drinking, binge drinking, and other alcohol-related problems among Reserve/Guard and younger personnel after return from deployment," wrote the study's authors, who represent various branches of the U.S. military, including the Naval Health Research Center in San Diego.

"Because alcohol use may serve as a coping mechanism after traumatic events, it is plausible that deployment is associated with increased rates of alcohol consumption or problem drinking," the researchers suggested.

Their study included nearly 50,000 military personnel: 26,613 were active duty and 21,868 were Reserve or National Guard. Most -- 37,310 -- were not deployed, while 5,661 were deployed, but in non-combat areas. Just over 5,500 were deployed into combat zones.

New-onset rates of heavy weekly drinking were 8.8 percent after combat deployment, according to the study. Rates of new-onset binge drinking were 25.6 percent for combat veterans returning home, and new-onset alcohol-related problems were 7.1 percent.

Young soldiers had the highest risk for developing alcohol-related outcomes, and Reserve and National Guard members returning from combat had higher rates of new-onset heavy drinking than soldiers from other military branches, according to the study.

"I think this study is probably very accurate. As part of the re-entry process, people will turn to coping mechanisms that are easily accessible, and alcohol is easily available, socially acceptable and quite effective for short-term stress relief," said Jeffrey T. Parsons, chair of the department of psychology at Hunter College and the Graduate Center of the City University of New York, in New York City. Parsons added that long-term use of alcohol as a coping mechanism can lead to numerous negative outcomes.

He recommended that returning soldiers try to immediately rebuild their support networks. If a deployment has lasted awhile, Parsons pointed out that friends and family members may have moved or just drifted away. "Surround yourself with people you can talk to and establish a support system that isn't tied to a bar," he advised.

Parsons added that being a soldier doesn't mean that you have to be devoid of emotions, and that asking for help isn't a sign of weakness. And, he added, this study may trigger awareness campaigns for military personnel that could "have a huge effect, and it could lead people to treatment on their own." He added that if the military were to develop some kind of routine psychological screening for returning veterans, it "would be a real and clear indication that they valued and respected the contribution of these people."

Another study, this one published as a letter in the same issue of the journal, offers some good news about the mental health of returning combat veterans. This study found there were no statistically significant differences in the rates of suicide between U.S. veterans returning from Iraq or Afghanistan compared to the U.S. population as a whole.

Two other studies in the same issue looked at former child soldiers in Nepal and in people who fought in the Liberian civil wars who experienced sexual violence. In both groups, researchers found higher rates of PTSD symptoms and depression. Thoughts of suicide were also higher in Liberians who had been exposed to sexual violence.

More information
To learn more about alcohol abuse, visit the National Institute of Alcohol Abuse and Alcoholism.

Health Tip: Can't Sleep?

(HealthDay News) -- If you have trouble falling or staying asleep, it's important to understand the reasons for your insomnia.

Here's a list of possible reasons for your sleepless nights, courtesy of the U.S. National Library of Medicine:

• Discomfort or illness.
• Depression.
• Stress or anxiety.
• Drinking caffeine or alcohol, smoking, or taking certain medications or illicit drugs.
• An inappropriate sleep environment, including one that's too bright or too noisy.
• Related activities that affect your sleep, such as taking naps or going to bed too early.

The 9 Best Natural Medicines for Depression

These 9 best natural Medicines are helping people with depression using naturopathic medicine. Alternative medicines, herbal medicine, nutritional therapies, diet, and lifestyle are wonderful complementary approaches to addressing depression over the long haul. read moredigg story

We Try Harder

By Walter Armstrong

I originally thought of this blog entry as “Where, Oh Where, Did My Orgasm Go?” I had in mind a comic riff on that most notorious downside of antidepressants: sexual dysfunction (SD). I was going to regale you with anecdotes of my many frustrating, fumbling, ultimately heroic efforts to achieve sexual satisfaction against the seemingly insurmountable odds posed by the little green-and-yellow pill. I’m single and often solitary, by the way, so for this blog I’m going to talk about solitary sex.
Like the time I lay in bed for over an hour, sweating, swearing, starting, and stopping but refusing to yield in my bull-headed determination to reach orgasm. I was Sisyphus pushing the boulder of arousal up the hill—and not getting anywhere near the peak.
Read More

Hallucinogen Gives Lasting Spiritual Boost

(HealthDay News) -- The spiritual effects of a substance in "sacred mushrooms" can last more than a year, Johns Hopkins researchers claim.

The scientists said their investigations may lead to new ways to help people with conditions such as cancer, depression and drug dependence..

In a previous study, the researchers gave psilocybin to 36 healthy, well-educated volunteers with active spiritual lives. After taking the substance under controlled conditions, 60 percent of the participants reported have a "full mystical experience."

When the researchers checked with the volunteers 14 months later, the same percentage said taking psilocybin increased their sense of well-being or life satisfaction.

"Most of the volunteers looked back on their experience up to 14 months later and rated it as the most, or one of the five most, personally meaningful and spiritually significant of their lives," lead investigator Roland Griffiths, a professor in the departments of psychiatry and behavioral sciences and neuroscience, said in a prepared statement.

The study was published in the current issue of the Journal of Psychopharmacology.

"This is truly remarkable finding, "Griffiths said. "Rarely in psychological research do we see such persistently positive reports from a single event in the laboratory. This gives credence to claims that the mystical-type experiences some people have during hallucinogen sessions may help patients suffering from cancer-related anxiety or depression, and may serve as a potential treatment for drug dependence. We're eager to move ahead with that research."

He noted that while some of the volunteers "reported strong fear or anxiety for a portion of their day-long psilocybin sessions, none reported any lingering harmful effects, and we didn't observe any clinical evidence of harm."

However, if hallucinogens are used in poorly supervised settings, the possible fear or anxiety responses could lead to harmful behaviors, Griffiths warned.

More information
The National Institute on Drug Abuse has more about hallucinogens.

Diabetes: The 2-for-1 Special

By Sean Kelley

In the past few weeks, there have been news stories linking type 2 diabetes to a host of other conditions. We’ve known for a long time that type 2 diabetes was a risk factor for heart disease and stroke, that it’s associated with obesity, and that diabetics can also have depression, erectile dysfunction, and a host of other complications.
What has been less clear (but is becoming more so by the day) is that other diseases can often be a gateway to diabetes. On June 17, researchers at Johns Hopkins University released a study showing that patients with depression have a higher risk of diabetes. A week before that, the International Diabetes Federation issued a statement recommending that patients with obstructive sleep apnea be screened for metabolic disease and type 2 diabetes. Read More

Deep Brain Stimulation Helps Severely Depressed

(HealthDay News) -- For those with the most severe depression, a novel therapy may offer new hope.

The treatment is deep brain stimulation (DBS), which is used for some people with Parkinson's disease, and researchers found that it cut depression symptoms by 50 percent for about half of those treated.

"This is a new therapy for patients with severe, intractable depression. There's a lot of promise for this approach," said study author Dr. Ali Rezai, director of the Center for Neurological Restoration at the Cleveland Clinic in Ohio.

Deep brain stimulation requires minimally invasive surgery to place electrodes into specific parts of the brain that are believed to be malfunctioning. Once in place, the electrodes emit tiny, adjustable, electrical pulses that block dysfunctional activity in the brain. It's been used for about 20 years in the treatment of Parkinson's disease. Rezai added that the current group working on DBS and depression, which includes researchers from Brown University and Massachusetts General Hospital as well, has also had success using DBS to treat obsessive-compulsive disorder.

Severe depression occurs in about 10 percent to 20 percent of depression cases, according to Rezai. Antidepressants, and even electroconvulsive (ECT) therapy, often fail to bring about improvement in depressive symptoms for those with this severe form, leaving them at an increased risk of suicide. The suicide rate in people with major depression may be as high as 15 percent, according to the researchers.

In the current study, 15 people suffering from severe depression for at least five years who weren't helped by other forms of treatment received DBS implants. Six months later, 47.1 percent had at least a 50 percent reduction in their depressive symptoms, based on a commonly used depression scale. At one year, that number was 50 percent.

Even patients who didn't meet the 50 percent reduction criteria used as an endpoint in this study still experienced some symptom reduction, according to Rezai, who added that all of the participants said they would undergo DBS again.

The procedure was well-tolerated, and just one patient had a brief seizure in this study.

"This is not for everyday depression, but for those who have failed everything else, hope is on the way," said Dr. Kathryn Holloway, a professor of neurosurgery at the Virginia Commonwealth University Medical Center in Richmond. "There are new treatments being developed that are having success where no medication has," she noted. Other treatments that have shown promise include vagal nerve stimulation and transcranial magnetic stimulation. The problem, she said, is that many insurers won't cover these procedures for depression.

Rezai was expected to present the findings April 29 at the American Association of Neurological Surgeons annual meeting, in Chicago. He said that his DBS group is now conducting a larger, controlled study.

Another depression study being presented Monday at the meeting found that people on medications for clinical depression who underwent surgery for a malignant brain tumor, called an astrocytoma, had an increased risk of death after the surgery.

Depression prior to surgery upped the odds of death after surgery by about 40 percent, according to the Johns Hopkins School of Medicine study. At 12 months after surgery, just 15 percent of those who were depressed before their operation were alive, compared to 41 percent of those who weren't depressed. At 20 months, none of the depressed patients were still alive, yet 21 percent of the non-depressed were still alive. The authors concluded that effectively treating depression before surgery might help improve outcomes.

More information

Talk Therapy Proves Effective for Terminal Cancer Patients

(HealthDay News) -- Talk therapy can help treat depression symptoms in patients with terminal cancer, according to Japanese researchers who reviewed the results of six studies that included a total of 517 patients with incurable cancer and depression.

The primary type of depression treatment for these patients was supportive expressive group therapy, in which they were encouraged to discuss their deepest fears and feelings and to help each other cope with them.

The review authors found that the benefits of this kind of treatment were only slightly less than those found in clinical trials of antidepressant drugs in general patient populations.

"Psychotherapy can be a promising treatment for ameliorating depressive states in advanced cancer patients if they prefer to receive it," said review lead author Tatsuo Akechi, an associate professor of psychiatry and cognitive-behavioral medicine at the Nagoya City University Graduate School of Medical Sciences.

However, Akechi and his colleagues found that psychotherapy did not significantly improve patient anxiety. This may be because there were too few patients to give enough statistical power to demonstrate an effect, Akechi suggested.

The researchers didn't examine whether psychotherapy could improve survival or response to cancer treatment. The review appears in the current issue of the journal The Cochrane Library.

"The key finding is that psychotherapy for depression for gravely ill cancer patients works," David Spiegel, associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine and an expert on therapy in cancer patients, said in a prepared statement. He wasn't involved in the review but was one of the lead investigators on one of the studies included in the review.

Spiegel said that many doctors don't look for depression in patients with advanced cancer, or they consider it a normal and untreatable response among dying patients. Spiegel noted that only about 25 percent of patients with terminal cancer suffer depression due to their situation, which is different than the grief, sadness and anger associated with the thought of dying.

"Depression and existential dread or sadness is not the same thing. Patients with depression feel hopeless, helpless and worthless. They feel like a burden to others," Spiegel said.

More information
The U.S. National Cancer Institute has more about depression.

Music as Medicine

(HealthDay News) -- Almost everyone has used music at one time or another to relax or perhaps to get energized. But the discipline of music therapy takes the use of music much further, from battling depression to combating cancer.

"Music therapy is an evidence-based practice that can affect changes in physical, psychological, social and cognitive domains through music experiences and the relationship that develops between the client and the therapist," said Cheryl Dileo, a professor of music therapy and director of the Arts and Quality of Life Research Center at Temple University in Philadelphia.

Just turning up the radio to your favorite tune to erase a blue mood doesn't qualify as music therapy, Dileo explained. "Self-help through music is not music therapy, although many people do use music for themselves, for example for relaxation to improve their moods, or to accompany exercise."

Music therapy, on the other hand, "involves an interpersonal process through which a trained therapist uses his or her knowledge and skills to address the client's assessed needs and issues," she said. "Although many people understand intuitively how to use music for themselves, when it is used within a music-therapy process by a trained therapist, it can be a powerful means to achieving positive physical, psychological, cognitive and social outcomes."

The uses of music therapy are myriad, according to Dileo. Music therapy can be used to reduce the anxiety of hospital patients undergoing difficult medical procedures. It can help lessen pain and improve mood, she said. Music therapy can also help depressed patients express their feelings.

Music therapy has been used to keep Alzheimer's patients calm and help them improve their memories at the Institute for Music and Neurologic Function at the Beth Abraham Family of Health Services in New York City.

At Children's Memorial Hospital in Chicago, board-certified music therapist Elizabeth Pociask uses music therapy to help new parents calm their infants.

"Music is a natural source of distraction. When a child is visibly upset, the introduction of a novel stimulus (turning on some music) will at least temporarily divert their attention away from what is upsetting them," she explained. "The parent's singing voice accomplishes the same thing and adds the element of familiarity -- the most comforting sound for an infant will nearly always be a parent's voice. When used regularly, music and/or singing can become a calming ritual, and the infant then learns to associate the music with relaxation or sleep."

Dileo said that music therapists should be board-certified, which means they've attended at least a four-year college program, as well as completed a supervised internship and have passed a national exam.

However, less formal music programs can be helpful as well. Katherine Puckett, national director of mind-body medicine at the Cancer Treatment Centers of America, said that while they don't have board-certified music therapists on staff, the centers do use music as a means to help their patients.

"Music can activate the relaxation response, which helps promote deep breathing, lower heart rate, lower blood pressure, ease muscle tension and create less stress. That can help cancer patients sleep better, and difficulty sleeping is a common problem for cancer patients," Puckett said.

"Relaxing the body can also help relieve physical pain, and people may need less pain medication," she added.

The Cancer Treatment Centers of America keep a library of music available for patients to use, and they have special events, such as drumming circles, that help provide an emotional release for their patients, Puckett said. "Some people can release their emotions through talking, but sometimes people need a non-verbal release. We've had people moved to tears in our special events," she said.

"People respond to music -- you don't have to be sick to respond to music. It's relaxing, comforting and soothing," Puckett added.

More information
To learn more about music therapy, visit the American Music Therapy Association.

Scientists Spot Biochemical Sign of Depression

(HealthDay News) -- Researchers say they've discovered a biomarker for depression that could lead to a quick lab test to determine whether a particular antidepressant is making headway against the disease.

"This may be a very simple biochemical indicator for depression," said study co-author Mark Rasenick, director of the Interdisciplinary Neuroscience Program at the University of Illinois at Chicago. The test "wouldn't tell you which [medication] to start, but it would tell you if the one you're taking is working."

It may even be possible to use the test to determine whether rounds of psychotherapy are reaping any benefit, he said.

For now, however, such a test is a hypothetical, pending further exploration of the finding reported in the March edition of The Journal of Neuroscience.

At issue is whether the brain itself shows physical or chemical signs of depression.

The researchers looked at the interaction of neurotransmitters and a protein called Gs alpha. In brain cells, the protein acts like a kind of butler, passing messages from neurotransmitters on the outside and amplifying their messages, Rasenick explained.

When the protein is working properly, it's like a butler whose "hands are just flying, cooking and cleaning at the same time," he said. But when the brain is depressed, "it just sits there in the corner."

In this post-mortem study, the researchers looked at the protein in the brains of 18 depressed people who committed suicide and compared them to the brains of non-depressed people. They found the protein would have worked less effectively in the brain cells of the suicide victims.

The findings raise the prospect of a blood test that would measure within days whether antidepressants are effectively treating depression, Rasenick said.

Now, it can take several weeks for patients and psychiatrists to figure out if an antidepressant is working properly. According to Rasenick, only about 30 percent of depression patients will respond to a specific drug.

"Unfortunately, we have a very poor ability to predict which antidepressant might be more effective for any individual," said Dr. Gregory Simon, a psychiatrist and mental health researcher with Group Health Cooperative in Seattle. "There's a long history of research using patterns of symptoms or biological measures -- chemicals measured in blood or spinal fluid -- to predict response to a particular antidepressant. None of those hoped-for predictors have significant value."

Genetic tests may provide some clues, he said, and the new study suggests there might be another approach. "It would not eliminate trial-and-error, but it would reduce the waiting time with each trial. But it's a long way from a study like this one to a test that's useful to patients and doctors."

Rasenick is hopeful, however, and he said the proposed test could do more than gauge whether drugs are working. It could conceivably measure the effectiveness of talking to a therapist, study co-author Rasenick said, since psychiatrists think psychotherapy has a physical effect on the brain.

Rasenick said more research and money are needed. The study was funded by the U.S. Public Health Service and the American Foundation for Suicide Prevention.

"The next step is to partner with people who are doing large-scale studies on individuals with depression and begin to look at this," he said. "We can begin to get hundreds of people and see if we can confirm that we're right."

More information
Learn more about depression from the National Institute of Mental Health.

Depression After a Heart Attack Dangerous for Years

(HealthDay News) -- The increased risk of death associated with depression after a heart attack persists for at least five years, a study finds.

"We've known for a number of years that depression increases the risk of mortality as well as morbidity [illness] after a heart attack for at least three to six months," said study author Robert M. Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis. "We assumed that we would find a decline in risk, but that was not what we found. The risk remained worse after five years."

Carney and his colleagues followed more than 750 people after their heart attacks, according to their report in the current online issue of the Journal of Affective Disorders. Using diagnostic interviews rather than the self-reporting common in most such studies, the researchers determined that 163 had major depression, and 195 had minor depression. Over the five-year study, the death rate was 87 percent higher for those with major depression and 76 percent higher for those with any form of depression.

In real numbers, 62 people diagnosed with depression died during the study, while 44 non-depressed heart attack patients died.

Why depression should increase the risk of dying is a mystery, Carney said. "We think that because depression is a chronic and recurrent problem, the factors causing that risk recur over time," he said. "But we don't know the mechanism."

The researchers have started a trial to determine whether the omega-3 fatty acids that are found in fish oil can reduce that risk. Heart patients are being given an antidepressant drug and a special formulation of omega-3 fatty acids, comparing them with a similar group that gets only an antidepressant.

"A number of studies over the years have found an inverse relationship between the amount of fish people eat and depression," Carney said. "The advantage of giving them in heart disease is that they have an effect on the cardiovascular system as well."

The major finding of the study and the use of omega-3 fatty acids are already in the mainstream of research on depression and heart disease, said Dr. Alexander H. Glassman, a professor of psychiatry at Columbia University Medical Center in New York City.

"There is a torrent of information that depression in relation to vascular disease worsens the outcome," Glassman said. "If you look at post-stroke patients, you find the same data. If you look at heart failure, depression has a similar effect on mortality."

The value of the study is that it had the longest follow-up of any trial using diagnostic interviews, which are regarded as more accurate than self-reporting, Glassman said. "It makes the evidence firmer and extends the evidence," he explained.

The use of omega-3 fatty acids is "a hot issue," being tried in cardiac and non-cardiac cases, Glassman said. "It is a logical thing to do," he added.

The study and the omega-3 trial will still leave some major issues about depression and heart disease open, Glassman said.

"The two key questions that remain are: Does treating depression make the outcome better? And what is it about depression that is causing the problem in the first place?" he said.

More information
Advice on depression after a heart attack is offered by the American Academy of Family Physicians.

Weight-Loss Drug Fights Alcoholic Fatty Liver Disease

(HealthDay News) -- Mice given the weight-loss drug rimonabant became resistant to alcohol's fat-building effects in the liver, which suggests the medication may help fight alcoholic fatty liver in humans, says a U.S. study.

Alcoholism is the leading cause of liver disease in Western societies, according to background information in the study.

Rimonabant, which blocks cannabinoid receptors, is approved for weight loss in several European countries but has not been approved in the United States. Last June, a U.S. Food and Drug Administration panel recommended that rimonabant should not be given the FDA's blessing because of continuing concerns about increased risks for suicidal thoughts among some users.

In this latest study, the researchers found that mice fed a low-fat diet and ethanol showed an increase in the gene encoding the CB1 cannabinoid receptor and in liver levels of an endocannabinoid called 2-arachidonoylglycerol (2-AG). These mice developed fatty livers.

Another group of mice that received the same diet plus rimonabant did not differ from mice fed a control diet. And mice lacking CB1 receptors, either throughout the body or only in the liver, were protected from alcoholic fatty liver.

"What makes these findings particularly interesting from our perspective is that they may have practical implications," said study author George Kunos, of the U.S. National Institute on Alcohol Abuse and Alcoholism. "Treatment of animals with a [cannabinoid receptor] antagonist largely prevented alcohol's effect. It suggests that the development of fatty liver in those who use alcohol could be interfered with, or perhaps reversed, with such treatment."

The findings were published in the March issue of Cell Metabolism.

"Although alcoholic fatty liver is reversible in the early stages by cessation of drinking, this is often not feasible," the study authors wrote. "The present findings suggest that treatment with a CB1 antagonist may slow the development of fatty liver and thus prevent its progression to more severe and irreversible forms of liver disease."

Drugs that selectively act on CB1 receptors found outside of the brain might help fight fatty liver with less risk of side effects such as anxiety and depression, they said.

"Rimonabant has recently been introduced in Europe for the treatment of visceral obesity and the metabolic syndrome, which themselves are known risk factors for [liver disease]. Clinical trials testing the effectiveness of CB1 receptor blockers in the treatment of both alcoholic and nonalcoholic fatty liver and their more severe sequelae may be warranted," the researchers concluded.

More information
The American Liver Foundation has more about fatty liver.