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New studies show suicide behavior drops as soon as antidepressants started

Suicidal behavior among adults taking antidepressants drops almost as soon as they begin medication, researchers said on Sunday in findings that experts said confirm their effectiveness in older patients.

The decline was especially significant among patients taking newer drugs to treat depression, including selective serotonin reuptake inhibitors, or SSRIs, compared to those taking older medicines.

The findings, published in the January issue of the American Journal of Psychiatry, come as experts grapple with whether such drugs can provoke suicidal tendencies.

In 2004, the Food and Drug Administration concluded there was a higher risk of suicidal behavior among children and teenagers and ordered strong label warnings. In July, it said there may be a link in adults and urged close monitoring.

However, after reviewing more than 65,000 patient records from 1992 to 2003, researchers in Seattle found fewer suicide attempts or deaths after patients began medication.

In the six months after medication, there were 76 attempts severe enough to require a hospital visit compared with 73 attempts in the three months prior.

Adolescents showed more attempts than adults, but there was not enough data for a strong conclusion. About 6 percent of patients were 17 and younger, according to the study funded by the National Institute of Mental Health (NIMH).

Researchers reviewed records from the Group Health Cooperative health plan.

"The conventional wisdom that the first few weeks of treatment are especially risky doesn't seem to be true," said psychiatrist Gregory Simon, a researcher for the cooperative.

AT ODDS WITH THE FDA

His conclusion differs from the FDA's, he said, because his team reviewed behavior in the time before treatment rather than once medication began, as in placebo-controlled trials.

Others questioned such a broad statement, saying the records included patients with previous suicidal behavior who could skew results. They also did not count thoughts or other symptoms not requiring hospitalization.

"If you've selected for people who've had a suicide attempt ... it's not surprising the suicide rate goes down with treatment," said University of Florida psychiatrist Wayne Goodman, an FDA advisor. "I think you have to be careful what conclusion you draw."

Goodman and others said the findings confirm antidepressants help adults. They also welcomed the strikingly higher improvement among patients taking newer medications, such as Eli Lilly & Co's Prozac.

Other antidepressants include GlaxoSmithKline's Paxil, Pfizer's Zoloft and Forest Laboratories's Celexa, among others.

To be sure, Simon said, suicide risk still exists and patients should be monitored closely.

FDA spokeswoman Susan Cruzan said the analysis would not affect current warnings, which offered "good information." She added the FDA was continuing its review for adults.

DRUGS OFFER HALF A CHANCE

Another study, also published in the journal on Sunday, found depression medications help about half who take them.

Researchers at 14 medical institutions found about 33 percent of 3,000 patients taking Celexa fully recovered from their symptoms, which can include a change in sleep patterns, eating habits or concentration.

Another 10 to 15 percent found some relief, while the rest, about 53 percent, had no improvement.

Officials for NIMH, which sponsored the study, said the results will help uncover why only certain patients benefit.

"The real goal ... is how to best help the 70 percent of patients for whom treatment with a representative SSRI is not enough for remission," NIMH Director Dr. Thomas Insel said.

The results come from the first phase of a four-phase study, called STAR-D. Other medicines were offered in later phases of the ongoing study, led by the University of Texas Southwestern Medical Center.

Source: Reuters 1/1/06, "Studies find antidepressants work for some", Susan Heavey

 

Cognitive behavior therapy is at least as good as antidepressant drugs

Chronic, constant worry (generalized anxiety disorder) is most frequently treated with psychotropic drugs (benzodiazepines and antidepressants).

A randomized controlled trial published in Psychotherapy and Psychosomatics by a group of researchers at the University of Berlin suggests the usefulness of psychotherapy.

Generalized anxiety disorders (GAD) are among the most prevalent mental disorders. Recent studies have suggested that cognitive behavior therapy (CBT) is an effective treatment for GAD. A controlled clinical trial was done to evaluate the efficacy of CBT treatment in outpatients with pure GAD who were treated by a therapist working in routine care.

Seventy-two outpatients, fulfilling GAD criteria were included in the study. From this group, 36 patients (CBT-A) were randomly assigned to 25 sessions of CBT and the other 36 formed a contact control group (CCG). After the contact control period (CC period), these patients were also treated with CBT (CBT-B), allowing not only a parallel group comparison but also an A-B comparison. Therapists were licensed full-time psychologists who worked routinely in outpatient care and had a professional training in CBT.

Treatment was done in accordance with a manual, and treatment conformity was controlled by several methods. The reduction in the score on the Hamilton Anxiety Observer Rating Scale was 6.4% (1.5 points) in the CCG, 35.4% (9.5 points) in the CBT-A and 47.3% (10.3 points) in the CBT-B. In the self-rating Spielberger State-Trait Anxiety Inventory, a reduction of 2.7% was seen in CCG, 14.6% in CBT-A, and 11.6% in CBT-B. According to the Clinical Global Impression Rating, 65.6% of patients were still at least moderately ill at the end of the CC period, while this rate was 33.4% at the end of CBT-A, or 15.7% at the end of CBT-B.

All these differences between treatment and control group are statistically highly significant. The clinical improvement remained stable over a follow-up period of 8 months. CBT is an effective method of treatment for GAD. Differences between control and treatment group are comparable to or larger than those reported in studies on antidepressant drugs (Linden M, Zubraegel D, Baer T, et al., Efficacy of cognitive behaviour therapy in generalized anxiety disorders. Psychother Psychosom, 2005;74:36-42).

This article was prepared by Drug Week editors from staff and other reports. Copyright 2005, Drug Week via NewsRx.com & NewsRx.net.

Generalized Anxiety Disorder (GAD)

When persistent and unrealistic worry becomes a part of a person's response to most situations, the person may be suffering from generalized anxiety disorder (GAD). People with GAD are affected by unrealistic and excessive anxiety and worry about most life circumstances. For example, they may have consistent worries about financial matters, even though they have a 'healthy' bank balance and have no major debts. Patients with GAD often feel 'shaky', reporting that they feel 'on edge' and that they sometimes 'go blank' because of the tension they feel.

The psychological symptoms of GAD are chronic, exaggerated worry, restlessness, tension, and irritability, that appear to have no cause, or are more intense than is reasonable in the situation. People with GAD may also have concentration problems and trouble going to sleep or staying asleep. In addition to these psychological symptoms there are often physical signs such as trembling, headaches, dizziness, twitching, muscle tension, aches or soreness, abdominal upsets, and sweating.

Realistic anxiety, such as financial concerns after losing a job, is not a sign of GAD. The essential feature of GAD is persistent worry that is not a reasonable reaction to the situation, and is not related to any other anxiety disorder. Chronic and excessive worry about events that are unlikely to occur is a cause for concern. Furthermore, the anxiety in thosewith GAD is difficult to control, and causes notable complications in daily work and social settings.

Most of those with GAD claim to have felt anxious for their entire lives, and the disorder is often first seen in childhood or adolescence. However, adult onset of the disorder is not uncommon.

Experts believe that GAD is probably caused by a combination of biological factors and life events. Many people who have GAD also have other medical disorders, such as depression and/or panic disorder, that seem to involve changes in brain chemistry, in particular abnormalities in the levels of the neurotransmitter serotonin.

Anxiety is among the most treatable of mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication may also be required in some cases. The most commonly used anti-anxiety drugs, are the benzodiazepines, such as diazepam, alprazolam, and lorazepam. Other drugs, such as buspirone, can be helpful for some individuals.

Original article found at http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=nonprofbackanx011&s=1

Study reports ADHD, TV watching unlinked

WIRE-04/28/2004-Ohio U.: Study reports ADHD, TV watching unlinked 2003 The Post Via U-WIRE

U-WIRE via NewsEdge Corporation : U-WIRE-04/28/2004-Ohio U.: Study reports ADHD, TV watching unlinked (C) 2003 The Post Via U-WIRE

By Danielle Trusso, The Post (Ohio U.)

ATHENS, Ohio -- A recent study linking television exposure with attention problems in young children has not found a connection between TV viewing and Attention Deficit Hyperactivity Disorder.

The American Academy of Pediatrics published the study in April with the conclusion that early television watching is related to attention problems at age 7, and television viewing in children should be limited.

In the study, 1,278 1-year-old children and 1,345 3-year-old children were studied. One-year-olds watched an average of 2.2 hours of television per day, and 3-year-olds watched 3.6 hours per week. Ten percent of the children had attentional problems at age 7.

While the study showed there was a correlation between early television watching and shortened attention spans, there is no clear evidence that links television watching and ADHD.

ADHD, a psychological disorder with a chemical imbalance in the brain, is not likely to be affected by television or other environmental factors, said Eugene Geist, Health and Human Services professor at Ohio University.

According to the study, ADHD, which affects between 4 percent and 12 percent of U.S. children, is the most common behavioral disorder of childhood.

The study's conclusion states there might be a causal relationship with television watching and ADHD, but the researchers did not have conclusive evidence.

"If you read the conclusion carefully, it's not necessarily a causal relationship," said Norma Pecora, associate professor in OU's College of Communication.

This is the kind of study that gains a lot of media attention because people want answers and television is an easy answer, she said.

Six years ago, Geist conducted his own research that focused on TV content, which the current study omitted. Geist's study found that children who watched faster-paced shows had shorter attention spans than those who watched slower-paced shows or no television

The content of television can decrease the amount of time children are willing to wait for information because television, as well as everything else, rewires the brain.

Geist said the TV argument is like the chicken versus the egg argument. TV viewing might increase a child's chance of developing an attention problem, but children with attention problems or short attention spans might be more likely to watch television.

Although it generally is assumed that television rewires the brain in a bad way, it can have positive effects, such as increasing children's verbal skills, and it might be creating a generation of children who are visual and auditory learners, he said.

Pecora said television can be used for both good and ill, and we are quick to accuse it of the ill and overlook its good.

"We, as parents and educators, need to be cautious in our interpretation of (television)," she said.

The OU Child Development Center tries to engage children in activities that stimulate creativity. The center does not have TV access for the 99 children, ages 6 weeks old to 5 years old, at their childcare facility, said Cathy Waller, development center administrator.

Sometimes television leads to inappropriate behavior, she said.

"We try to encourage parents not to use TV as a baby sitter," Waller said.

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((Distributed via M2 Communications Ltd - http://www.m2.com)) .end (paragraph)<>

<< Copyright ©2004 U-Wire >>

Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common health concerns among school-aged children.

ADHD can occur in both genders as well as in all ethnic and racial populations. Although it is diagnosed as much as nine times more often in males than in females, many researchers believe that it occurs equally in girls, but because females display more inattentive symptoms and fewer behavioral symptoms, they may never be diagnosed or may be diagnosed much later than males.

How do I know when to seek help?

There are two basic clusters of symptoms that characterize ADHD: cognitive symptoms are seen in inattention; behavioral symptoms are seen in hyperactivity and impulsivity. If your child displays many of the symptoms below or if your child’s teacher is concerned about similar patterns of behavior being present in the classroom, you should speak to a professional and consider the possibility of having your child evaluated for ADHD.

Signs of inattention. Your child—

does not pay close attention to details or makes careless mistakes in school work
is easily distracted from tasks or play
is often forgetful or does not appear to listen when spoken to
does not follow instructions, or fails to complete school work or chores
has trouble organizing tasks and personal belongings
avoids or dislikes activities requiring concentration, such as schoolwork
Signs of hyperactivity and impulsivity. Your child—

has difficulty sitting still, often fidgets and squirms
often talks out of turn or excessively in the classroom
displays high levels of energy and activity, often engaging in risky behaviors
interrupts frequently or intrudes into conversations or games
acts or speaks impulsively
displays immaturity in a variety of social situations
ADHD can affect families by straining sibling relationships; causing a child to underachieve in school, which may lead to failure and truancy; diminishing parental bonding and family cohesiveness; and creating marital stress, tension, and potential divorce.

Since ADHD causes repercussions in so many aspects of a child’s life and affects the entire family, several professionals may be involved in accurately assessing the disorder and developing an effective treatment plan. A skilled family therapist may be the best professional to coordinate the overall plan and provide ongoing therapy to family members. Additional professionals may include a special education person from the child’s school who would coordinate the school’s accommodation plan for the student; a pediatric specialist or child psychiatrist who would assess the need for medication; an educational specialist who would assist in providing academic and tutorial resources; and a psychometrist who would provide psychoeducational testing to determine the severity of the symptoms and the level of cognitive impairment (and who could also address the presence of learning disabilities, which are common among children with ADHD).

How do I distinguish between normal and problem behaviors?

Reports in the media of greatly increased rates of diagnosis of ADHD and the frequent prescribing of stimulants for children may lead parents to wonder if ADHD is being diagnosed properly. Are these diagnosed children simply exhibiting normal childhood behaviors? Aren’t many children extremely active, impulsive, or inattentive?

Each child’s range of behaviors must be evaluated according to their age and developmental maturity. For example, behaviors which may be normal in a 5-year-old might be viewed as problematic in a 10-year-old. The symptoms that support a diagnosis of ADHD are usually present in early childhood, though the inattentive symptoms may not be recognized until much later in a child’s life. Patterns of forgetfulness, disorganization, and overactive behaviors which would determine a diagnosis of ADHD occur more frequently and persistently, and create more problems in a variety of settings than behavior that is typical in a particular age group. Further information on exactly what ADHD is and how it differs from typical childhood behavior can be found in the resources listed at the end of this flyer.

How do I know that the diagnosis of ADHD for my child is correct?

A diagnosis of ADHD requires several steps and may take two or three visits to a qualified health professional. Information to support the diagnosis is collected from parents, teachers, health care professionals, and an interview with the child. The clinician who is assessing your child will also consider other possible causes of problem behaviors. Select a professional who specializes in working with ADHD and share your concerns. If you still question the diagnosis, get a second opinion from another qualified professional.

Does my child have to be treated with medication?

In treating ADHD, medication may be used to reduce hyperactivity and impulsivity, and to improve a person’s ability to concentrate and focus on activities and tasks. The effectiveness of the medication can help a child perform better in school, as well as in family and social situations. The first-line medications prescribed are the stimulants, which include Ritalin, Dexedrine, and Adderall. These have the most direct effect on moderating the ADHD symptoms and may be effective in up to 75% of ADHD children and adolescents. If these medications cause unacceptable side effects or are found to be ineffective, antidepressants may be prescribed, but often with somewhat less effectiveness. Improvement with the medication may be dramatic. However, medication does not cure the disorder; it controls the symptoms temporarily. Experts advise that medication is most effective when combined with therapy in order to improve self esteem, social skills, family relations, and academic performance. The use of medication without supportive therapy is less effective.

Family therapists are well qualified to suggest the type of assessment and treatment which might be needed to help. Children who are successfully treated for the disorder live happier, more secure lives, and are better able to succeed in their educational and career goals. Adults who are successfully treated for the disorder are able to improve their marital relationships, parenting skills, social interactions, and career direction and success.

Consumer Resources

For Parents

Taking charge of ADHD. By Russell Barkley. NY: Guilford Press (1995).

The attention zone. By Michael Cohen. NY: Brunner/Mazel (1997).

For Children

Putting on the brakes. By Patricia Quinn and Judith Stern. NY: Magination Press (1992).

SHELLEY the hyperactive turtle. By Deborah Moss. Rockville, MD: Woodbine House (1989).

Learning to slow down and pay attention: A book for kids about ADD. By Kathleen G. Nadeau, Ellen Dixon. NY: Magination Press (1997).

For Adolescents

I would if I could: A teenager’s guide to ADHD/hyperactivity. By T. Gordon. NY: GSI Publications (1992).

Adolescents and ADD: Gaining the advantage. By Patricia Quinn. NY: Brunner/Mazel (1995).

For Adults

Driven to distraction. By E. Hallowell and John Ratey. NY: Pantheon (1994).

Organizations

Children and Adults with Attention Deficit Disorders (CHADD)
499 NW 70th Avenue, Suite 101
Plantation, Florida 33317
http://www.chadd.org

Original text found at: aamft.org

The text for this brochure was written by Sandra Volgy Everett, Ph.D., and Craig A. Everett, Ph.D.

Resources and Links

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Therapeutic Services for Individuals, Couples, and Families

Craig A. Rens, MA, LMFT provides confidential and convenient services to individuals, couples, and families of all ages and ethnicities to help them accomplish their unique goals.

Craig's areas of interest include:
• Depression & Anxiety
• Trauma Related Issues
• Self-Injurious Behaviors
• Children & Adolescent behavioral issues
• Sexual and Physical Abuse
• Grief & Loss
• Eating disorders
• Step/Blended-family specific issues
• Workplace stress

Craig’s therapeutic style mixes humor, genuineness, and empathy in a caring way to help hold the client in a trusting, safe environment. His systemic, experiential and instructional approach to therapy brings his client’s strengths to the forefront and enhances their own abilities to problem solve.