Even Light Exercise Prevents Future Depressions

December 22, 2017 · Posted in Risk Factors · Comment 

walking

A 2017 article in The American Journal of Psychiatry suggests that regular leisure-time exercise of any intensity can protect against future depressions.

The study by Samuel B. Harvey and colleagues followed a group of 33,908 healthy adults for 11 years. The researchers found a link between regular leisure-time exercise and reduced incidence of future depression (but not anxiety). This link occurred regardless of the intensity of the exercise, and most of the effect occurred at low levels of exercise. Analysis suggested that 12% of future cases of depression could be prevented if all participants fit one hour of physical activity into their week.

A small part of the benefit came from the social and physical health benefits of exercise.
Harvey and colleagues suggested that from a public health perspective, increasing population levels of exercise modestly could lead to a substantial decrease in depressions.

Editor’s Note: Alongside maintenance treatment, in the form of antidepressants for unipolar depression or mood stabilizers and atypical antipsychotics for bipolar disorder, exercise could provide some benefits in preventing future depressions.

Simvastatin Looks Promising in Treatment of Negative Symptoms of Schizophrenia

December 20, 2017 · Posted in Potential Treatments · Comment 

simvastatin

The statin drug simvastatin (Zocor) enhances the effects of risperidone on negative symptoms of schizophrenia, according to a 2017 article by Soode Tajik-Esmaeeli and colleagues in the journal International Clinical Psychopharmacology.

In the 8-week study, 40 mg/day of simvastatin enhanced the effects of 4–6 mg/day of the antipsychotic risperidone on negative symptoms of schizophrenia, such as apathy and withdrawal, but not positive symptoms such as hallucinations or delusions.

Other statins, lovastatin and pravastatin, have not had a similar effect, possibly because they do not cross the blood-brain barrier as easily as simvastatin does.

Simvastatin has other benefits as well. Like all statins it decreases lipid levels, reducing cardiovascular disease. People with schizophrenia and bipolar disorder are at especially high risk for cardiovascular disease.

Simvastatin also decreases inflammation (lowering IL-1 alpha and TNF-beta levels) and may be neuroprotective, as it increases brain-derived neurotrophic factor (BDNF), a protein that protects neurons and is important for learning and memory. Inflammation is increasingly implicated in schizophrenia and bipolar disorder.

There is also some evidence that statins can prevent depressions over long-term follow-up. Studies in women without depression and men who had recently had heart attacks both showed that those taking statins had a lower rate of future depression than those not taking statins.

Editor’s Note: These findings suggest a potential 5-fold benefit to simvastatin: 1) It reduces negative symptoms in schizophrenia. 2) It reduces inflammation. 3) It increases BDNF. 4) It decreases cardiovascular disease risk by lowering lipid levels. 5) It may prevent future depressions.

Other approaches to augmenting schizophrenia treatment include nutritional supplements vitamin D3 and folate. Patients with psychosis often have vitamin D deficits. Folate supplements can reduce homocysteine, which has been linked to cognitive deficits in schizophrenia.

Liraglutide Decreased Body Weight, Improved Glucose Tolerance and Cardio Health in Schizophrenia

December 18, 2017 · Posted in Potential Treatments · Comment 

weightA 2017 article by Julie R. Larsen and colleagues in the journal Archives of General Psychiatry reported that the drug liraglutide, a treatment for type 2 diabetes, improved certain health measures in people with schizophrenia who were overweight and prediabetic and being treated with the atypical antipsychotics olanzepine or clozapine.

In the 16-week trial, patients received a daily 2 mg injection of liraglutide under the skin or placebo. Liraglutide decreased body weight, improved glucose tolerance, and improved cardio-metabolic measures. Weight decreased by more than 10 pounds on average compared to placebo.

Liraglutide is derived from a human metabolic hormone. It binds to the same receptors as does the metabolic hormone GLP-1, which stimulates insulin secretion.

FDA Approves New Higher Dose of Valbenazine for Tardive Dyskinesia

December 15, 2017 · Posted in Current Treatments · Comment 

tardive dyskinesia

The US Food and Drug Administration has approved an 80 mg capsule dose of valbenazine (Ingrezza) for tardive dyskinesia (jerky, involuntary movements of the face, especially the mouth and tongue, fingers and body that can be a side effect of antipsychotic medication). Valbenazine, a selective vesicular monoamine transporter 2 inhibitor, was the first drug FDA-approved for tardive dyskinesia. The FDA initially approved a dosage of 40 mg/day in April 2017. The 80 mg/day dose was approved in October 2017.

The new approval was based on a 6-week clinical trial in which 80 mg of valbenazine improved tardive dyskinesia significantly compared to placebo. Improvement continued over 48 weeks of treatment.

Augmentation Strategies for Negative Symptoms of Schizophrenia

December 13, 2017 · Posted in Potential Treatments · Comment 

 teen

In a 2017 article in the journal JAMA Psychiatry, Christoph U. Correll and colleagues reviewed 42 secondary strategies to treat schizophrenia when the primary antipsychotic treatment has an incomplete effect. Many people with schizophrenia show only a limited response to antipsychotic drugs, so additional treatments are often necessary, but currently there are no US Food and Drug Administration guidelines for combination treatment.

Correll and colleagues compiled data from 29 meta-analyses covering 381 individual trials. They found that while the meta-analyses were well done, the quality of the data in the original studies was lacking.

Focusing on Negative Symptoms

However, since the negative symptoms of the illness such as apathy, withdrawal, and blunted emotional response are the hardest to treat, any amount of improvement in this area could be particularly helpful. Read more

Probiotics May Improve Depression As Well As IBS

December 11, 2017 · Posted in Potential Treatments · Comment 

vitamin DA pilot study of people with irritable bowel syndrome (IBS) suggests that taking a probiotic nutritional supplement can improve depression as well as gastrointestinal upset.
In the 2017 study published in the journal Gastroenterology, researcher Maria Pinto Sanchez and colleagues at the Farncombe Family Digestive Health Research Institute found that when those with IBS took a probiotic, their co-occurring depression improved more than it did in people with IBS who took a placebo.

Senior author Premysl Bercik suggested the study confirms that the microbiota environment in the gut affects what goes on in the brain, opening new avenues for the treatment of psychiatric diseases.

The study included 44 adults with IBS who also had mild to moderate anxiety and depression. For 10 weeks, half received a daily dose of the probiotic Bifidobacterium longum NCC3001, while the others received placebo.

After 6 weeks, 64% of the probiotic group saw improvement in their depression, compared to 32% of the placebo group. Functional magnetic resonance imaging (fMRI) showed brain changes associated with the improvement in mood.

The researchers are planning larger trials of probiotics.

TDCS Better Than Placebo But Not as Good as Escitalopram at Improving Unipolar Depression

December 8, 2017 · Posted in Potential Treatments · Comment 

An article by André R. Brunoni and colleagues in the New England Journal of Medicine reports that transcranial direct current stimulation (tDCS) can treat unipolar depression more effectively than placebo, but not quite as effectively as the selective serotonin reuptake inhibitor (SSRI) antidepressant escitalopram. TDCS consists of a constant, low direct current applied to the scalp via electrodes.

The study included 245 patients with moderate to severe depressive symptoms, many of whom also had anxiety disorders. To minimize the placebo effect, patients all participated in sessions wearing tDCS gear and received a daily pill. However, one group received real tDCS treatment but placebo pills, a second group received sham tDCS but real escitalopram pills, and the third group received both sham tDCS and placebo pills.

The real tDCS treatment consisted of 30-minute sessions of tDCS every day for 15 consecutive weekdays, then seven once-a-week treatments. The escitalopram dosage was 10 mg/day for three weeks, then 20 mg daily.

Ten weeks into treatment, those who received escitalopram showed the greatest improvement in depression. Those who received tDCS showed slightly less improvement, but still significantly more than those who received neither treatment. Cognitive performance either improved or stayed the same in all the groups.

In terms of side effects, those who received escitalopram were more likely to report sleepiness or severe constipation. Those who received tDCS reported more skin redness/tingling, itching, tinnitus, and nervousness. Two patients in the tDCS group had new-onset mania during treatment. There were no suicides, hospitalizations, or other serious side effects.

Taking SSRI Antidepressants May Increase Stroke Risk

December 6, 2017 · Posted in Current Treatments · Comment 

pill bottleA Taiwanese study published in the Journal of Clinical Psychiatry in 2017 finds that taking selective serotonin reuptake inhibitor (SSRI) antidepressants can increase risk of stroke. The study by Chin-Hong Chan and colleagues analyzed eight years of data from Taiwan’s National Health Insurance Research Database, comparing people who had taken SSRIs for at least two consecutive months to those who had not. First onset strokes were more common among people who had taken SSRIs, and the higher stroke rates in this group persisted for three years after exposure.

Ischemic strokes (which occur when a blood vessel carrying blood to the brain is obstructed) were more common than hemorrhagic strokes (which occur when a weak blood vessel ruptures). Younger adult participants exposed to SSRIs were more likely to have strokes, while people older than 65 saw only a slight increase in stroke risk from taking SSRIs. More strokes occurred during the first three years of SSRI treatment than later in treatment.

Chan and colleagues suggest that these strokes are caused by cerebral microbleeding or by overcorrection of hemostasis, the process by which the body slows or stops bleeding by constricting blood vessels and coagulating blood.

Best Antidepressants for Post-Stroke Depression

December 4, 2017 · Posted in Current Treatments · Comment 

strokeA recent meta-analysis in the journal BMJ Open analyzes the efficacy and tolerability of 10 different antidepressants given to treat depression following a stroke. The meta-analysis incorporated data from 12 trials and a total of 707 participants. Reboxetine was the most effective antidepressant, followed by paroxetine, doxepin, and duloxetine. Sertraline, fluoxetine, and nefiracetam failed to outperform placebo in the treatment of post-stroke depression.

In terms of tolerability, paroxetine had the least side effects and led to significantly fewer discontinuations than doxepin, citalopram, and fluoxetine. After paroxetine, the most tolerable drugs were sertraline and nortriptyline. The least tolerable drug was citalopram.
Researchers led by Yefei Sun suggested that paroxetine might be the best antidepressant to prescribe after a stroke due to its efficacy and good tolerability. Fluoxetine might be the worst due to its poor efficacy and poor side effects profile.

Editor’s Note: Multiple randomized controlled trials suggest that antidepressants can be helpful for anyone who has a stroke, both to decrease depression and to improve neurological and functional outcomes.  

Botox for Depression

December 1, 2017 · Posted in Potential Treatments · Comment 

botox injectionSeveral recent clinical trials have suggested that Botox injections between the eyebrows may improve depression. The theory is that decreasing muscle tension could reduce feelings of depression, instead of depression causing muscle tension. In a phase 2 double blind multicenter trial of 258 women with depression, participants were randomized to receive 30 units of Botox, 50 units of Botox, or placebo. Those who received the 30-unit injections showed significantly greater improvement in depression at three weeks and nine weeks compared to those who received placebo. However, it was not superior to placebo at the primary endpoint of the study, six weeks, and the 50-unit dosage was not superior to placebo. Both doses were well tolerated.

Botox is derived from botulinum toxin, which can relax tense muscles. It is also being explored as a treatment for migraine headaches. The manufacturer, Allergan, expects to move forward with phase 3 trials of Botox for depression.

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