By Joene Hendry

NEW YORK (Reuters Health) – Girls who repeatedly focus on the same emotionally charged or negative topics when chatting with friends, may be more likely to develop symptoms of anxiety and depression, especially if the girls are also romantically involved.

In a study that assessed the personal relationships of 83 girls in the seventh and eighth grades, the repeated discussion of problems in a very negative, emotion-focused manner, referred to as “co-rumination,” was associated with “increases in depression among girls with greater levels of romantic experience,” said Lisa Starr, a doctoral candidate at the State University of New York at Stony Brook.

On the other hand, co-rumination “was associated with slight decreases in depressive symptoms among girls with lower levels of romantic involvement,” Starr told Reuters Health.

Over a 1-year period, Starr and co-investigator Joanne Davila, also at SUNY at Stony Brook, collected information on the girls’ personal relationships and psychological symptoms from the girls and their parents.

Their findings, reported in the Journal of Adolescence, generally replicate those of previous studies that linked co-rumination with positive friendship qualities, as well as with more negative psychological aspects, such as symptoms of depression.

However, in this population of girls, Starr and Davila found co-rumination further associated with higher levels of romantic involvement. For example co-rumination was related to having a higher number of male friends, but not to having a greater number of close or female friends.

Co-ruminating about the challenges of teen romance, such as rejection, heartbreak, conflict, or unrequited love might amplify or prolong negative emotions, Starr explained. By contrast, repeated discussion of relatively benign topics may not have the same negative effects.

The investigators call for further research to examine whether emotions related to teen romance alter the relationship between co-rumination and symptoms of depression.

In the meantime, it is important for parents to distinguish between negative, emotion-focused, and repetitive co-rumination and problem-solving, as the latter, Starr said, is a more adaptive form of discussion that can often lead to solutions.

SOURCE: Journal of Adolescence, February 2009.

Reuters Health

HealthDay

By Kevin McKeever

Anti-social behavior among young elementary school girls and increased anxiety in either boys or girls that age tend to predict whether they develop depression in adolescence, a new study shows.

However, showing signs of depression in first or second grade did not mean adolescent depression was imminent, said the report published in The Journal of Early Adolescence.

“When all the risk factors were analyzed, anti-social behavior and anxiety were the most predictive of later depression. It just may be that they are more prevalent in the early elementary school years than depression,” study lead author James Mazza, a University of Washington professor of educational psychology, said in a news release issued by his school.

His research followed more than 800 predominantly white children for seven years, starting when they were in first or second grade. Children, parents and teachers provided information that measured the students’ levels of depression, anxiety, anti-social behavior and social competency. Parents were also asked by family and marital conflict, family stress and parental depression.

“One finding from this study that is a mind-grabber is that young children can identify themselves as being anxious and depressed,” Mazza said. “When they had scores that were elevated, we were a bit surprised, because we thought they would say, ‘My life is fun, and I play a lot.’ Nevertheless, they are able to understand and report feeling depressed or anxious, and tell us so. This suggests giving health surveys in early elementary school is a good idea, and we should talk to kids in the first and second grades because they can give us valuable information.”

While doctors may start assessing children as young as six for depression, middle-school age is usually when the condition is first recognized or diagnosed in children. That is the time when the genders split, with more girls showing signs of depression than boys.

“Boys with early anti-social behavior typically go on to show more anti-social behavior, while girls may turn inward with symptoms, morphing into other mental health problems such as depression eating disorders, anxiety and suicidal behavior during adolescence,” he said.

HealthDay

Alcohol abuse may increase the risk of depression, instead of the other way around, a New Zealand study suggests.

Previous research has identified a link between alcohol abuse or dependence and major depression. But it hasn’t been determined whether one disorder causes the other, or whether a common genetic or environmental factor increases the risk for both conditions.

This new study included 1,055 people born in 1977 who were assessed for alcohol abuse and depression at ages 17 to 18, 20 to 21, and 24 to 25. The number of participants who met criteria for alcohol problems and major depression were: 19.4 percent and 18.2 percent, respectively, at ages 17 to 18; 22.4 percent and 18.2 percent at ages 20 to 21; and 13.6 percent and 13.8 percent at ages 24 to 25.

At all ages, alcohol abuse or dependence was associated with a 1.9 times increased risk of major depression, said David M. Ferguson and colleagues at the Christchurch School of Medicine and Health Sciences.

“This analysis suggested that the best-fitting model was one in which there was a unidirectional association from alcohol abuse or dependence to major depression but no reverse effect from major depression to alcohol abuse or dependence,” they wrote.

“The underlying mechanisms that give rise to such an association are unclear; however, it has been proposed that this link may arise from genetic processes in which the use of alcohol acts to trigger genetic markers that increase the risk of major depression. In addition, further research suggests that alcohol’s depressant characteristics may lead to periods of depressed affect among those with alcohol abuse or dependence.”

In addition, alcohol abuse may cause social, financial and legal problems that cause stress and increase the risk of depression, said the researchers, who added that further research is required to fully understand the connection between alcohol abuse and depression.

The study was published in the March issue of the Archives of General Psychiatry.

HealthDay

Women who use antidepressants appear to be at heightened risk for sudden cardiac death, although the exact nature of the link remains unclear, researchers say.

The finding doesn’t necessarily mean that antidepressant drugs are dangerous, the researchers said.

“We suspect that their use is a marker for people with worse depression,” explained study lead author Dr. William Whang, an assistant professor of clinical medicine at Columbia University Medical Center in New York City. “The elevated risk seems more specific for antidepressant use, but that use may well be a marker of more severe symptoms.”

The link between depression and heart trouble is more likely physical than psychological, Whang added. “We found that women who had worse depressive symptoms had higher rates of risk factors such as hypertension, diabetes and smoking,” he said.

Women with clinical depression were more than twice as likely to experience sudden cardiac death, the report said.

The findings were published in the March 17 issue of the Journal of the American College of Cardiology.

The researchers relied on data on more than 63,000 American women in the Nurses Health Study. And while the research team did find a link between depression and heart risk, the incidence of sudden cardiac death was associated more strongly with the use of antidepressant drugs than with symptoms of depression.

Antidepressant drug use was not associated with a higher risk of heart attacks or overall fatal heart disease, just with sudden cardiac death, the study found.

Previous studies have shown a link between depression and higher mortality for people who already had heart disease, Whang said. “But this was a group of women without heart disease, and that makes it different,” he noted.

The results do not necessarily apply to men because only women were in the study, Whang said. “It’s hard to make more generalized conclusions,” he said.

But for doctors seeing women with depression, there is a clear message, Whang said.

“The biggest clinical implication is that management of coronary heart disease risk factors may be especially important for those with depressive symptoms,” he said. “Taking care of those risk factors can modify the risk for coronary disease.”

Dr. Sanjiv M. Narayan, an associate professor of medicine at the University of California, San Diego, School of Medicine and co-author of an accompanying editorial, said in a statement that the “data indicate the link between depression and serious heart rhythm problems may be more complex than previously thought.”

His editorial called the relationship between antidepressant use and sudden cardiac death “surprising” and added it “merits scrutiny.”

But it is possible that “antidepressant use merely indicates that depression is of sufficient severity to merit treatment,” the editorial said. One recent study of people with heart failure found that depression was associated with increased mortality but that use of antidepressants was not.

Another report in the same issue of the journal said that feelings of anger and hostility are significantly associated with a higher risk of heart disease in healthy people and a poorer outcome in people with heart disease.

Anger and hostility predicted a 19 percent increased risk of such coronary heart disease events as heart attacks among healthy people, and a 24 percent increased risk among those with existing heart disease, said the report by researchers at University College, London.

The British study, which reviewed 42 studies, found the same relationship seen in the study of depression and heart disease: an increase in behavioral risk factors for coronary problems. A subset analysis found that the increased risk could be explained by such factors as smoking, physical activity and obesity, the report said.

HealthDay

The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 to 18 years of age. Clinical depression is an important cause of poor health and lower quality of life among children and adolescents. Depression can cause difficulties in school and disruptions of family and social relationships as well as diminished quality of life.

“Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed,” said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. “It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression.”

There is adequate evidence that treating adolescents with selective serotonin reuptake inhibitors (SSRIs), psychotherapy or combined therapy (SSRIs and psychotherapy) result in decreased clinical depression symptoms. Treating clinically depressed youths with SSRIs is associated with an increased risk of suicidality (suicidal thoughts, preparation and attempts of suicide) and, therefore, should only be considered if careful clinical supervision is possible.

Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24 and the sixth-leading cause of death among those age 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood. Nearly 6 percent of adolescents 13 to 18 years of age are clinically depressed, and it is more common among girls than boys.

The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by the Agency for Healthcare Research and Quality, conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Selvi Williams, M.D., at the Kaiser Permanente Center for Health Research, which is part of AHRQ’s Oregon Evidence-based Practice Center.

HealthDay

By Robert Preidt

Two non-drug treatments — cognitive behavior therapy and supportive stress management — seem to be more effective than usual care for treating depression in patients who’ve had coronary artery bypass graft (CABG) surgery, a new study finds.

About 20 percent of bypass patients suffer major depression and another 20 percent experience milder forms of depression, according to background information in the study by Kenneth E. Freedland, of the Washington University School of Medicine in St. Louis, and colleagues.

The study included 123 patients who had major or minor depression one year after bypass. They were randomly selected to receive either usual care (40 patients) as determined by a physician, 12 weeks of cognitive behavior therapy (41 patients), or 12 weeks of supportive stress management (42 patients).

In cognitive behavioral therapy, a psychologist or social worker helped patients identify problems and develop cognitive techniques for overcoming them. In supportive stress management, patients were counseled about how to improve their ability to cope with stressful life events.

All the patients were assessed at the start of the study and again after three, six and nine months. After three months, remission of depression was seen in 71 percent of patients in the cognitive behavior therapy group, 57 percent of patients in the supportive stress management group, and 33 percent of the usual care group.

After nine months, the rates were 73 percent for the cognitive behavior therapy group, 57 percent for the supportive stress management group and 35 percent for the usual care group.

“Cognitive behavior therapy was also superior to usual care on most secondary psychological outcomes, including anxiety, hopelessness, perceived stress and the mental (but not the physical) component of health-related quality of life. On most of these measures, differences between cognitive behavior therapy and usual care were found at all three follow-up assessments. Supportive stress management was superior to usual care only on some of these measures,” Freedland and colleagues wrote.

“In conclusion, this randomized, controlled trial showed that cognitive behavior therapy was an efficacious treatment for depression in patients with a recent history of coronary bypass surgery,” the researchers said. “Supportive stress management was also superior to usual care for depression in these patients, but it had smaller and less durable effects than cognitive behavior therapy.”

The study appears in the April issue of the Archives of General Psychiatry.
HealthDay

WEDNESDAY, April 8 (HealthDay News) — In a unanimous vote, a U.S. Food and Drug Administration advisory panel determined Wednesday that AstraZeneca’s antipsychotic drug Seroquel has too many safety concerns to make it a first-line treatment against depression or anxiety disorders.

However, in a separate 6-to-3 vote, the panelists recommended that the medication could be used as supplemental treatment for patients with depression who do not get symptom relief from other drugs, the Associated Press reported. The expert panel did not hold a similar vote for anxiety disorders.

Overall, “I saw no clear advantage demonstrated in efficacy,” said Dr. Wayne Goodman, the panel’s chairman and a psychiatric researcher at the U.S. National Institutes of Health. “There were side effects, and I would expect unintended consequences associated with wide-scale use of the drug.”

The FDA is not mandated to follow its advisory panels’ advice, although it usually does. Federal health officials have already approved the use of Seroquel (quetiapine) and drugs like it to treat schizophrenia and bipolar disorder.

Wednesday’s decision, by a panel of psychiatric experts, follows a study released earlier this year that suggested that newer, second-generation antipsychotics such as Seroquel might pose heart risks — specifically, a higher risk of sudden death due to cardiac arrest. The study was published in the Jan. 15 issue of the New England Journal of Medicine.

At the time, experts said that the overall odds of a heart problem for patients taking this class of medications — which also includes clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal) — were probably low, and the drugs remained appropriate for certain patients. Still, doctors, families and patients should be cautious, according to the study’s lead author, Wayne Ray, director of the Vanderbilt University School of Medicine’s Division of Pharmacoepidemiology.

“If they’re being used for schizophrenia, consider a cardiology evaluation. If you’re considering using them for bipolar disorder, think about using another alternative drug first,” Ray told HealthDay in January.

And patients should rarely, if ever, take the drugs to treat other conditions, he said. However, doctors have also prescribed them for so-called “off-label” uses to treat conditions such as anxiety, attention deficit disorder in children and dementia in the elderly.

“For schizophrenics, they work pretty well. They’re pretty much the only alternative,” Ray said. But other drugs offer alternatives for bipolar patients, he noted.

In their study, Ray and his colleagues expanded on earlier research that suggested the newer drugs disrupt the heart’s rhythm. The team found that users of the newer drugs were 2.26 times more likely to suffer from sudden cardiac death than those not on the medications. Those who used the older drugs were 1.99 times more likely to die versus those not taking the medications.

The drugs appear to cause problems by disrupting potassium in the heart, causing its electrical rhythm to fail, Ray said.

In a statement released Wednesday, Dr. Howard Hutchinson, chief medical officer of AstraZeneca, which makes Seroquel, said the company was “pleased” that the panel found Seroquel appropriate as adjunctive therapy for depression.

Acknowledging that the panel “had concerns around the long-term safety profile in these new populations,” Hutchinson said that he and his colleagues “look forward to having further discussions with the FDA” regarding the new drug applications.

In the meantime, AstraZeneca is fending off claims from thousands of former Seroquel users that the U.K.-based drug maker held back data on the drug’s risks, according to the Associated Press. Seroquel’s labeling now alerts users to heightened risks for high blood pressure, diabetes and death.
HealthDay