Yet a new University of Michigan poll shows only one in 100 parents of teens 13 to 17 years old believes that their teen has used a study drug.

Study drugs often include stimulant medications prescribed for the treatment of attention deficit hyperactivity disorder (ADHD). Common drugs abused for this purpose include Adderall, Concerta, Ritalin, and Vyvanse.

Researchers discovered that among parents of teens who have not been prescribed a stimulant medication for ADHD, only 1 percent believes their teen has used a study drug to help study or improve grades.

The finding stems from the latest University of Michigan Mott Children’s Hospital National Poll on Children’s Health.

However, recent national data from the Monitoring the Future survey indicates that 10 percent of high school sophomores and 12 percent of high school seniors say they have used an amphetamine or other stimulant medication not prescribed by their doctor.

Experts say that students without ADHD will take someone else’s medication, to try to stay awake and alert and try to improve their scores on exams or assignments.

However, taking study drugs has not been proven to improve students’ grades, and it can be very dangerous to their health, says Matthew M. Davis, M.D., M.A.P.P., director of the Children’s Hospital National Poll on Children’s Health.

“Taking these medications when they are not prescribed for you can lead to acute exhaustion, abnormal heart rhythms and even confusion and psychosis if the teens get addicted and go into withdrawal,” said Davis.

“What we found in this poll is a clear mismatch between what parents believe and what their kids are reporting. But even though parents may not be recognizing these behaviors in their own kids, this poll also showed that one-half of the parents say they are very concerned about this abuse in their communities,” he said.

White parents were most likely to say they are “very concerned” (54 percent), compared with black (38 percent) and Hispanic/Latino (37 percent) parents.

Despite this concern, only 27 percent of parents polled said they have talked to their teens about using study drugs. Black parents were more likely to have discussed this issue with their teens (41 percent), compared with white (27 percent) or Hispanic (17 percent) parents.

“If we are going to make a dent in this problem, and truly reduce the abuse of these drugs, we need parents, educators, health care professionals and all who interact with teens to be more proactive about discussing the issue,” Davis said.

More than three-quarters of parents polled said they support school policies aimed at stopping abuse of study drugs in middle schools and high schools. Overall, 76 percent of parents said they believe schools should be required to discuss the dangers of ADHD medication abuse.

Moreover, 79 percent of parents support a policy to require students with a prescription for ADHD medications to keep their pills in a secure location such as the school nurse’s office.

This requirement could prohibit students from carrying such drugs which could potentially be shared with, or sold to, other students.

“We know teens may be sharing drugs or spreading the word that these medications can give their grades a boost,” Davis said.

“But the bottom line is that these prescription medications are drugs, and teens who use them without a prescription are taking a serious risk with their health.”

Sourc: University of Michigan

Teenager holding pills in his hand photo by shutterstock.

This is the main conclusion of a new University of Gothenburg study recently published in the British Journal of Sports Medicine.

The study included almost 700 former Swedish wrestlers, weightlifters, powerlifters and throwers who competed at the elite level sometime between 1960 and 1979.

Twenty per cent of them admitted using steroids during their active careers. The purpose of the study was to look for links between AAS use and mental problems.

“We found a clear link. AAS users were more likely to have been treated for depression, concentration problems and aggressive behavior,” said researcher and psychologist Dr. Claudia Fahlke.

Investigators also found that AAS users were more likely to have abused other illicit drugs and alcohol.

Still, it remains unclear whether the steroid use actually caused the mental health problems or the mental health problems rather caused the steroid use.

‘What we were able to show, though, is that psychiatric symptoms and use of steroids and other drugs tend to reinforce each other in a vicious cycle,” Fahlke said.

“This suggests that the anti-doping efforts remain very important, both in and outside of sports.”

Source: University of Gothenburg

Hand holding a syringe photo by shutterstock.

According to researchers from the Icahn School of Medicine at Mount Sinai Hospital in New York City, the antidepressant benefits of ketamine, normally used as an anesthetic, were seen within 24 hours. Traditional antidepressants can take days or even weeks to demonstrate a reduction in depression, researchers noted.

Led by psychiatrists Drs. Dan Iosifescu, of Mount Sinai, Sanjay Mathew of Houston’s Baylor College of Medicine; and James Murrough, at Mount Sinai, the research team evaluated 72 people with treatment-resistant depression, which means their depression failed to respond to two or more medications.

These patients were administered a single intravenous infusion of ketamine for 40 minutes or an active placebo of midazolam, another type of anesthetic without antidepressant properties.

Patients were interviewed after 24 hours and again after seven days.

According to the researchers, after 24 hours, the response rate was 63.8 percent in the ketamine group compared to 28 percent in the placebo group.

The response to ketamine, however, did not last for most, with only 45.7 percent reporting benefits seven days after treatment. Only 18 percent of people in the placebo group reported such benefit after a week.

“Using midazolam as an active placebo allowed us to independently assess the antidepressant benefit of ketamine, excluding any anesthetic effects,” said Murrough, who is first author on the new study. “Ketamine continues to show significant promise as a new treatment option for patients with severe and refractory forms of depression.”

Major depression is caused by a breakdown in communication between nerve cells in the brain, a process involving chemicals called neurotransmitters, the researchers explained. Traditional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), influence the activity of the neurotransmitters serotonin and noreprenephrine to reduce depression, though the exact mechanism is not known.

But these medications can take a long time to make a difference — and up to 60 percent of people do not respond to treatment, according to the U.S Department of Health and Human Services.

Ketamine works differently than traditional antidepressants in that it influences the activity of the glutamine neurotransmitter to help restore the dysfunctional communication between nerve cells in the depressed brain, the researchers said. It also works much more quickly than traditional antidepressants.

Further studies are needed to investigate the longer term safety and efficacy of ketamine in depression, according to Murrough.

He recently published a preliminary report in the journal Biological Psychiatry on the safety and efficacy of ketamine given three times weekly for two weeks in patients with treatment-resistant depression.

Because ketamine is a short-acting drug, it must be injected multiple times a week in order for a person to continue to receive its antidepressant effects. Longitudinal studies on its long-term use over the course of months or even years have not yet been done, so its long-term effects on a person’s health remain unknown.

“We found that ketamine was safe and well-tolerated and that patients who demonstrated a rapid antidepressant effect after starting ketamine were able to maintain the response throughout the course of the study,” he said. “Larger placebo-controlled studies will be required to more fully determine the safety and efficacy profile of ketamine in depression.”

“Major depression is one of the most prevalent and costly illnesses in the world, and yet currently available treatments fall far short of alleviating this burden,” said Dr. Dennis Charney, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai. Charney was among the researchers who discovered the potential of ketamine for treating depression.

“There is an urgent need for new, fast-acting therapies, and ketamine shows important potential in filling that void,” he said.

Source: The Mount Sinai Hospital/Mount Sinai School of Medicine

Model of Ketamin photo by shutterstock.

Lead researcher Dr. Jerome Sarris, from the Department of Psychiatry at the University of Melbourne, said that GAD is a complex condition that significantly affects people’s day-to-day lives. Current medications have a modest clinical effect and new effective options are needed.

“Based on previous work, we have recognized that plant-based medicines may be a viable treatment for patients with chronic anxiety,” Sarris said.

“In this study we’ve been able to show that kava offers a potential natural alternative for the treatment of chronic clinical anxiety. Unlike some other options it has less risk of dependency and less potential for side effects.”

The roots of the kava plant have long been used to make a drink that has sedative and anesthetic effects. It is consumed throughout the Pacific Ocean cultures of Polynesia, including Hawaii, Vanuatu, Melanesia and some parts of Micronesia.

The study, published in the Journal of Clinical Psychopharmacology, also found that genetic differences in neurobiological mechanisms called GABA transporters may affect response to kava.

“If this finding is replicated, it may pave the way for simple genetic tests to determine which people may be likely to have a beneficial anxiety-reducing effect from taking kava,” Sarris said.

The eight-week study involved 75 patients who had been clinically diagnosed with generalized anxiety disorder.  The participants were given either kava or placebo, and anxiety levels were regularly assessed.

Those in the kava group were given tablets twice per day consisting of water-soluble extracted kava (peeled rootstock) for a total dose of 120mg of kavalactones for the first three-week controlled phase. In cases of non-response, this was increased to a double-dose twice per day for the second three-week controlled phase.

Participants in the placebo group took matching dummy tablets in the same manner.

At the end of the study, the kava group showed a significant reduction in anxiety compared to the placebo group.  For those diagnosed with moderate to severe GAD, kava had an even greater effect in reducing anxiety.

In the end, 26 percent of the kava group were in remission from their symptoms compared to six percent of the placebo group.

Kava was also well-tolerated. The findings showed no significant difference among the two groups for liver function, which had previously been a concern for kava’s medicinal use.

Furthermore, there were no significant adverse reactions that could be attributed to kava and no difference in withdrawal or addiction between the groups.

Another novel finding of the study, recently published in Phytotherapy Research, was that kava increased women’s sex drive compared to those in the placebo group.  This is thought to be a result of the reduction in anxiety, rather than an aphrodisiac effect.

Source: Journal of Clinical Psychopharmacology

Kava plant photo by shutterstock.

To combat the pain, some individuals resort to taking prescription painkillers on a regular basis. The medications are often opioids, and, in a new research study, these are found to be associated with a higher risk of erectile dysfunction (ED) in men.

In a study published online in the journal Spine, researchers reviewed the health records of more than 11,000 men with back pain to find out if men taking prescription painkillers were more likely to also receive prescriptions for testosterone replacement or ED medications.

More than 19 percent of men who took high-dose opioids for at least four months also received ED prescriptions, while fewer than 7 percent of men who did not take opioids received ED prescriptions.

In the study, men over 60 were much more likely to receive ED prescriptions, but even after researchers adjusted for age and other factors, men taking high-dose opioids were still 50 percent more likely to receive ED prescriptions than men who did not take prescription painkillers.

“Men who take opioid pain medications for an extended period of time have the highest risk of ED,” said lead author Richard A. Deyo, M.D., M.P.H., investigator with the Kaiser Permanente Center for Health Research.

“This doesn’t mean that these medications cause ED, but the association is something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain.” Deyo added.

Opioid use is growing in the United States as the Centers for Disease Control reports prescription opioid sales quadrupled between 1999 and 2010.

Another recent survey, published in the journal Pain, estimates 4.3 million adults in the U.S. use these opioid medications on a regular basis. The most commonly used prescription opioids are hydrocodone, oxycodone, and morphine.

“There is no question that for some patients opioid use is appropriate, but there is also increasing evidence that long-term use can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, reduced hormone production, and now erectile dysfunction,” said Deyo, who has spent more than 30 years studying treatments for back pain.

For this study, Deyo and colleagues identified 11,327 men in Oregon and Washington enrolled in the Kaiser Permanente health plan who visited their doctors for back pain during 2004. The researchers examined the men’s pharmacy records for six months before and after the back pain visit to find out if they had filled prescriptions for opioids and for ED or testosterone replacement.

Opioid use was categorized as “none” for men who did not receive a prescription for opioids; “acute” for men who took opioids for three months or less; “episodic” for men who took opioids for more than three months, but less than four months and with fewer than 10 refills; and “long-term” for men who took opioids (a) for at least four months or (b) for more than three months with 10 or more refills. Anything more than 120 mg of morphine equivalent was categorized as high-dose use.

More than 19 percent of the men who took high-dose opioids for at least four months also received ED medications or testosterone replacement. More than 12 percent of men who took low-dose opioids (under 120 mg) for at least four months also received ED medications or testosterone replacement. Fewer than 7 percent of men who didn’t take opioids received ED medications or testosterone replacement.

Researchers found that age was the factor most significantly associated with receiving ED prescriptions. Men 60 to 69 were 14 times more likely to receive prescriptions for ED medication than men 18 to 29.

Depression, other health conditions (besides back pain), and use of sedative hypnotics like benzodiazepines also increased the likelihood that men would receive ED prescriptions.

But even after researchers adjusted for these factors, long-term opioid use increased the likelihood of also receiving prescriptions for ED medication by 50 percent.

Source: Kaiser Permanente

Cure worse than the problem pill bottle photo by shutterstock.

If the mother contracts the flu, the child has a nearly four-fold increased chance of developing bipolar disorder in adulthood, say researchers.

The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

“Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University.

“In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.”

Brown and colleagues reported their findings online in the journal JAMA Psychiatry.

Although researchers have suspected a linkage between maternal influenza and bipolar disorder, the new study is the first to prospectively follow families using physician-based diagnoses and structured standardized psychiatric measures.

The research was made possible by use of comprehensive electronic medical records by Kaiser-Permanente, in association with county and Child Health and Development Study databases.

This shared health care data repository allowed the evaluation of more cases with detailed maternal flu exposure information than in previous studies.

Among nearly a third of all children born in a northern California county during 1959-1966, researchers followed, 92 who developed bipolar disorder, comparing rates of maternal flu diagnoses during pregnancy with 722 matched controls.

The nearly fourfold increased risk implicated influenza infection at any time during pregnancy, but there was evidence suggesting slightly higher risk if the flu occurred during the second or third trimesters.

Moreover, the researchers linked flu exposure to a nearly six-fold increase in a subtype of bipolar disorder with psychotic features.

Prior research suggested a threefold increased risk for schizophrenia associated with maternal influenza during the first half of pregnancy.

Autism has similarly been linked to first trimester maternal viral infections and to possibly related increases in inflammatory molecules.

“Future research might investigate whether this same environmental risk factor might give rise to different disorders, depending on how the timing of the prenatal insult affects the developing fetal brain,” suggested Brown.

Bipolar disorder shares with schizophrenia a number of other suspected causes and illness features, the researchers note.

For example, both share onset of symptoms in early adulthood, susceptibility genes, run in the same families, affect nearly one percent of the population, show psychotic behaviors and respond to antipsychotic medications.

Source: NIH/National Institute of Mental Health

Georgetown University Medical Center researchers discovered the drug prevented the accumulation of toxic proteins linked to Parkinson’s disease in the brains of mice. Researchers will now develop a clinical trial to study the effects of the drug on humans.

Investigators say their study, published online in Human Molecular Genetics, is a new strategy to treat neurodegenerative diseases that feature abnormal buildup of proteins.

Common diseases that develop in association with the abnormal buildup of proteins include Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), frontotemporal dementia, Huntington disease and Lewy body dementia, among others.

“This drug, in very low doses, turns on the garbage disposal machinery inside neurons to clear toxic proteins from the cell,” said the study’s senior investigator, neuroscientist Charbel E-H Moussa, M.B., Ph.D.

“By clearing intracellular proteins, the drug prevents their accumulation in pathological inclusions called Lewy bodies and/or tangles, and also prevents amyloid secretion into the extracellular space between neurons, so proteins do not form toxic clumps or plaques in the brain,” he said.

When the drug, nilotinib, is used to treat chronic myelogenous leukemia (CML), it forces cancer cells into autophagy — a biological process that leads to death of tumor cells in cancer.

“The doses used to treat CML are high enough that the drug pushes cells to chew up their own internal organelles, causing self-cannibalization and cell death,” Moussa said.

“We reasoned that small doses — for these mice, an equivalent to one percent of the dose used in humans — would turn on just enough autophagy in neurons that the cells would clear malfunctioning proteins, and nothing else.”

Moussa hypothesized that the cancer drugs could help to clean up diseased brains. “No one has tried anything like this before,” he said.

However, a unique characteristic of the brain is a membrane that separates circulating blood from the brain’s extracellular fluid (BECF) in the central nervous system (CNS).

This blood-brain barrier protects the brain from many common bacterial infections but also has historically limited the administration of medical and therapeutic agents.

To this end, Moussa and his team searched for cancer drugs that can cross the blood-brain barrier.

They discovered two candidates — nilotinib and bosutinib, which is also approved to treat CML. This study discusses experiments with nilotinib, but Moussa says that use of bosutinib is also beneficial.

The mice used in this study were genetically engineered to have the Lewy bodies that are found in Parkinson’s disease and dementia patients, and in many other neurodegenerative diseases.

The animals were given one milligram of nilotinib every two days. (By contrast, the FDA approved use of up to 1,000 milligrams of nilotinib once a day for CML patients.)

“We successfully tested this for several diseases models that have an accumulation of intracellular protein,” Moussa says. “It gets rid of alpha synuclein and tau in a number of movement disorders, such as Parkinson’s disease as well as Lewy body dementia.”

The team also showed that movement and functionality in the treated mice was greatly improved, compared with untreated mice.

In order for such a therapy to be as successful as possible in patients, the agent would need to be used early in neurodegenerative diseases, Moussa said. Later use might retard further extracellular plaque formation and accumulation of intracellular proteins in inclusions such as Lewy bodies.

Moussa is planning a phase II clinical trial in participants who have been diagnosed with disorders that feature build-up of alpha Synuclein, including Lewy body dementia, Parkinson’s disease, progressive supranuclear palsy (PSP) and multiple system atrophy (MSA).

Source: Georgetown University Medical Center

Abstract of the brain photo by shutterstock.

“Despite the substantial evidence supporting the use of exercise in the treatment of MDD, previous studies have not provided a clear indication of the proper dose of exercise needed to elicit an antidepressant effect,” said Chad Rethorst, PhD, and Madhukar Trivedi, MD, of the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas.

To fill this gap, the researchers looked at available data taken from randomized controlled trials, with the goal of developing detailed recommendations for clinicians on how to prescribe exercise for their patients with clinical depression.

Based on research, aerobic exercise is the preferred form of exercise for patients with major depression. There is also some research support for resistance training, said Rethorst and Trivedi.

Researchers suggest that patients participate in three to five exercise sessions per week, for 45 to 60 minutes per session. In terms of intensity, for aerobic exercise, they recommend achieving a heart rate that is 50 to 85 percent of the individual’s maximum heart rate.

For resistance training, they recommend a variety of upper and lower body exercises — three sets of eight repetitions at 80 percent of the maximum weight that the person can lift one time.

The findings suggest that patients may experience a relief in depression in as little as four weeks after starting exercise. However, Rethorst and Trivedi emphasize that the exercise regimen should be continued for at least 10 to 12 weeks to achieve the greatest antidepressant effect.

Although some people question whether patients with MDD would actually participate in an exercise program, the studies reveal that only about 15 percent of patients dropped out of the exercise programs — comparable to dropout rates in studies of medications and psychotherapy.

The researchers suggest strategies that may help improve adherence to exercise programs, such as consulting patients about their favorite type of exercise and giving out individualized educational materials and feedback.

“Taken as a whole, these findings suggest that exercise doses below the current recommendations may still be beneficial for patients with MDD,” said Rethorst and Trivedi.

“Therefore, clinicians should encourage patients to engage in at least some exercise, even if they do not exercise enough to meet current public health recommendations.”

Source: Wolters Kluwer Health

Woman on a exercising machine photo by shutterstock.

Sodium nitroprusside is used to treat severe hypertension. But there is also evidence that it also regulates the activity of N-methyl-D-aspartate (NMDA) glutamate receptors, said the researchers.

Since blocking those receptors in animals leads to psychosis-like behavior, the researchers wondered if the drug could benefit humans with schizophrenia.

In a small randomized trial, many patients experienced a diminishing of their symptoms within four hours, while those who got a matching placebo did not, according to Serdar Dursun, M.D., Ph.D., of the University of Alberta in Edmonton, and colleagues. 

The improvements lasted up to four weeks without any noticeable adverse effects.

Although the results should be considered preliminary because of the size of the study — only 20 patients — the authors said that the findings “are exciting in terms of effectiveness of the drug.”

The study involved 20 patients, in an acute phase of schizophrenia, all of whom required inpatient care. The participants were between the ages of 19 and 40 and were in the first five years since diagnosis. All were on stable antipsychotics at the time of the infusion.

Ten patients received sodium nitroprusside at 0.5 micrograms per kilogram of body weight per minute for four hours – the lowest recommended dose for humans. The remaining 10 patients got 5 percent glucose, also infused for four hours.

During the infusions and for four weeks afterward, psychiatrists monitored schizophrenia symptoms using the 18-item Brief Psychiatric Rating Scale and the negative subscale of the Positive and Negative Syndrome Scale. They also measured safety and tolerability of the drug, both physiologically and psychologically.

During the infusion, they found a positive effect on the brief rating scale that was apparent by the second hour. The effect was seen in all patients getting the drug, but not in any placebo patient.

A similar rapid effect was observed on the positive-negative symptom scale.  On both scales, the improvement continued for at least four weeks, the researchers reported.

The findings offer further support that NMDA receptors are underperforming in schizophrenia, commented Joseph Coyle, M.D., of Harvard Medical School.

Coyle noted that the results are consistent with other studies that involve those receptors. But, he said, the current study remains too small to justify changes in clinical practice.

“Caution must be exercised until sufficiently powered clinical trials of nitroprusside are performed in patients with schizophrenia,” said Coyle.

The researchers note that participants were fairly early in their disease course. Future research, they said, should test the drug in patients with long-term illness.

They also noted that the study allowed for changes to supplemental medications (such as benzodiazepines and analgesics) 48 hours after the infusion and to antipsychotics after seven days. Because of this, there is “uncertainty to the antipsychotic effects of sodium nitroprusside alone at later time points.”

Source: JAMA Psychiatry

schizophrenia word collage photo by shutterstock.

Researchers at the University of Michigan Health System also found that older people who were widowed and those who lived alone were more likely to develop C. difficile, a bacterium that is responsible for more than 7,000 deaths a year in the U.S.

According to researchers, there are more than 300,000 such infections in hospitals alone every year. Symptoms range from diarrhea to life-threatening colon inflammation.

“We have long known that depression is associated with changes in the gastrointestinal system.

“In our research, we have shown that adults with depression are more likely to develop Clostridium difficile infection — a potentially fatal infection,” said lead author Mary Rogers, Ph.D., M.S., a research assistant professor at the University of Michigan Medical School and research director of the Patient Safety Enhancement Program at the U-M Health System and the VA Ann Arbor Healthcare System.

In a representative sample of older Americans, Rogers and her colleagues found that individuals with major depression were 36 percent more likely to develop C. difficile infection than those without depression.

Adults who were widowed had a 54 percent greater risk than those who were married.

People who lived with others had a 25 percent decreased risk compared to those who lived alone, according to the researcher.

“We know that older people who live alone are more likely to experience depression so it’s possible that the link between C. difficile infection and widowhood reflects the relationship between depression and this type of infection,” said Rogers.

The researchers also found that patients who received the common antidepressants Remeron (mirtazapine) and Prozac (fluoxetine) were twice as likely to test positive for C. difficile.

Both drugs have previously been linked to gastrointestinal side effects, the researchers noted, adding most types of antidepressants did not affect infection risk.

It is unclear whether the increase in risk of infection is due to microbial changes in the gut during depression or to the medications associated with depression, the researcher said.

“This relationship between specific anti-depressants and C. difficile is new and needs to be studied further,” Rogers said. “People with these prescriptions should not stop taking them unless otherwise advised by their physician.”

The study was published in BioMed Central’s open access journal BMC Medicine.

Source: University of Michigan Health System

Depressed person in the hospital photo by shutterstock.

Researchers at Washington University School of Medicine in St. Louis are beginning to discover how implanting these electronic stimulators lessens depression.

Their findings, published in the journal Brain Stimulation, reveal that vagus nerve stimulation causes changes in brain metabolism weeks or even months before patients feel relief from symptoms.

“Previous studies involving large numbers of people have demonstrated that many with treatment-resistant depression improve with vagus nerve stimulation,” said first author Charles R. Conway, M.D., associate professor of psychiatry.

“But little is known about how this stimulation works to relieve depression. We focused on specific brain regions known to be connected to depression.”

The study involved 13 people with treatment-resistant depression. Their symptoms had not improved after several months of treatment with as many as five different antidepressant medications. Most had been depressed for at least two years, but some had been clinically depressed for more than 20 years.

All of the patients underwent surgery to have a device inserted that would electronically stimulate the left vagus nerve, which runs down the side of the body from the brainstem to the abdomen. Once activated, the device delivers a 30-second electronic stimulus to the vagus nerve every five minutes.

The researchers used positron emission tomography (PET) brain imaging on the patients before their first stimulation, and again three and 12 months after stimulation had begun.

Over time, nine of the 13 participants experienced improvements in depression with the treatment.

However, in most cases it took several months for improvement to occur.

In those who reported improvement, the scans showed significant changes in brain metabolism following three months of stimulation. 

This typically preceded improvements in symptoms of depression by several months.

“We saw very large changes in brain metabolism occurring far in advance of any improvement in mood,” Conway says. “It’s almost as if there’s an adaptive process that occurs. First, the brain begins to function differently. Then, the patient’s mood begins to improve.”

Many of those who responded to the device eventually were able to stop taking medication, said Conway.

“Sometimes the antidepressant drugs work in concert with the stimulator, but it appears to us that when people get better, it is the vagus nerve stimulator that is doing the heavy lifting,” Conway explains. “Stimulation seems to be responsible for most of the improvement we see.”

Furthermore, the PET scans showed that structures deeper in the brain also begin to change several months after nerve stimulation begins. Many of those structures have high concentrations of brain cells that release dopamine.

There is growing evidence that problems in dopamine pathways may be especially important in treatment-resistant depression, said Conway.

The finding that vagus nerve stimulators influence those pathways may explain why the therapy can help and why, when it does work, its effects are long-lasting. Patients who respond to vagus nerve stimulation tend to get better and to stay better.

“We hypothesized that something significant had to be occurring in the brain, and our research seems to back that up,” he said.

Source:  Washington University in St. Louis

For example, some doctors started preschoolers on medication too soon before trying any non-drug treatment, such as counseling parents on how to deal with their child’s behavior.

The results are concerning because doctors should recommend behavioral treatments first, the researchers said.

“At a time when there are public and professional concerns about overmedication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children,” said study researcher Dr. Jaeah Chung, of Cohen Children’s Medical Center in New York.

For the study, researchers surveyed 560 doctors who specialize in diagnosing and managing children ages 4 to 6 with ADHD.

The findings revealed that only 8 percent of doctors followed all guidelines from the American Academy of Pediatrics.

The rest prescribed medications too soon, prescribed medications without first checking to see if behaviora; therapy was working, or did not use the drug methylphenidate as the first drug treatment.

One in five doctors said they often prescribe medications to preschoolers with ADHD as their first line of treatment. The AAP said in 2011 that doctors should attempt to treat ADHD in preschoolers with behavioral therapies before prescribing medications.

Furthermore, about 40 percent of doctors said that when they did prescribe drugs, they initially used a medication other than the ADHD drug methylphenidate (Ritalin).

According to the AAP, methylphenidate should be used first in preschoolers because it has been more rigorously studied in young children than other medications such as amphetamines.

Approximately 20 percent of doctors said they expected the number of children they treated with medications would increase in the future.

Study researcher Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s, noted that the AAP guidelines are written for general pediatricians, and it’s possible that specialists see children with more severe ADHD (who are more likely to need medications).

However, “Doctors collectively should recommend their patients pursue behavior therapies first,” Adesman said.

Adesman noted that there may be obstacles to behavioral therapy: The treatment is not always covered by insurance, and families may live in an area without a behavior therapy specialist.  In this case, the AAP recommends that doctors weigh the risks of starting drugs at an early age against the risks of delaying treatment.

Source: North Shore-Long Island Jewish (LIJ) Health System

Doctor holding out pills in his hand photo by shutterstock.

Twitter allows experts and policymakers the opportunity to track the use of Adderall, in much the same way an outbreak of influenza can be followed as it works its way across the nation.

In the new study, BYU health science and computer science researchers report the findings of their six-month investigation in the Journal of Medical Internet Research.

Researchers say the study produced two major revelations about Adderall:

• It is mentioned most heavily among students in the northeast and south regions of the U.S.;
• Tweets about Adderall peak sharply during final exam periods.

“Adderall is the most commonly abused prescription stimulant among college students,” said lead researcher Carl Hanson, Ph.D., a professor of health science at BYU.

“Our concern is that the more it becomes a social norm in online conversation, the higher risk there is of more people abusing it.”

For the study, researchers monitored all public-facing Twitter mentions of “Adderall” between November 2011 and May 2012, but removed tweets from users whose screen-names indicated they were promoting Adderall.

The results showed 213,633 tweets from 132,099 unique users mentioned the drug during the study, with an average of 930 per day.

Though the analysis didn’t sort out “legal” vs. “illegal,” use, Adderall tweets spiked sharply during traditional finals periods, with peaks on Dec. 13 (2,813) and April 30 (2,207).

Researchers also found that Adderall tweets peaked during the middle of the week and declined by the weekend. Both findings are consistent with previous research that shows college students who abuse ADHD stimulants do so primarily during times of academic stress.

“It’s not like they’re using it as a party drug on the weekend,” Hanson said. “This data suggests that they’re using it as a study aid. Many of the tweets even made a study reference.”

Researchers found that the rate of Adderall tweets was highest among college and university clusters in the northeast and south regions of the United States.

A possible link to the high activity could be a well-established Greek system of fraternities and sororities, especially in the northeast.

Vermont had the highest per capita Adderall tweet rate, followed by Massachusetts and Alabama, while Southeast Texas had the lowest, followed by Central Illinois and Northern California.

The Northern Utah college cluster was one of the lowest Adderall-tweeting areas, as were a number of western areas such as Phoenix, Los Angeles and Reno.

The Twitter analysis also revealed that 9 percent of Adderall tweets mentioned another substance, with the most common two being alcohol (4.8 percent) and stimulants like coffee or Red Bull (4.7 percent). Other substances included cocaine, marijuana, methamphetamines and anti-anxiety medications such as Xanax.

“Tweets hinting at co-ingestion are particularly troubling because morbidity and mortality risk increases when substances are combined,” said study co-author Michael Barnes, Ph.D.

Researchers hope the study renews interest in promoting the safe and legal use of Adderall and other substances on college campuses. Study authors also hope that as the general public learns about the dangerous use of substances to improve academic performance, improved promotion of student well-being and study habits will surface.

Researchers say additional resources are needed to better to help students better manage the academic demands and pressures of college.

Source: Brigham Young University

Researchers examined adults with depression identified by a doctor or other medical professional, and individuals who experienced major depressive episodes within a 12-month period.

Investigators found that when these individuals were assessed for major depressive episodes using a structured interview, only 38.4 percent of adults with clinician-identified depression met the 12-month criteria for depression — despite the fact that a majority of participants were prescribed and were using psychiatric medications.

The results are featured in the journal Psychotherapy and Psychosomatics.

“Depression overdiagnosis and overtreatment is common in the U.S., and frankly the numbers are staggering,” said Ramin J. Mojtabai, Ph.D., author of the study and an associate professor with the Bloomberg School’s Department of Mental Health.

“Among study participants who were 65 years old or older with clinician-identified depression, 6 out of every 7 did not meet the 12-month major-depressive-episodes criteria. While participants who did not meet the criteria used significantly fewer services and treatment contacts, the majority of both groups used prescription psychiatric medication.”

From a sample of 5,639 participants from the 2009-2010 United States National Survey of Drug Use and Health, Mojtabai assessed clinician-identified depression based on questions about conditions that the participants were told they had by a doctor or other medical professional in the past 12 months.

The study indicates that even among participants without a lifetime history of major or minor depression, a majority reported having taken prescription psychiatric medications.

“A number of factors likely contribute to the high false-positive rate of depression diagnosis in community settings, including the relatively low prevalence of depression in these settings, clinicians’ uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes,” said Mojtabai.

Researchers lament that prior research suggested an underdiagnosis and undertreatment of major depression in community settings. Now, experts believe that both undertreatment and overtreatment of depression are occurring.

“The new data suggest that the underdiagnosis and undertreatment of many who are in need of treatment occurs in conjunction with the overdiagnosis and overtreatment of others who do not need such treatment,” Mojtabai said.

Source: Johns Hopkins University Bloomberg School of Public Health

Elderly woman being comforted by nurse photo by shutterstock.

The scientists from University of California San Francisco and Baystate Medical Center in Springfield, Mass. looked at the medical records of more than 530,000 patients who underwent surgery at 375 U.S. hospitals between 2006 and 2008.

“There have been small studies that suggested there was a problem, but it has never been well-proven,” said lead author Andrew D. Auerbach, M.D., M.P.H., a UCSF professor of medicine.

Selective serotonin reuptake inhibitors (SSRIs) are the most popularly prescribed class of antidepressants. They are prescribed for a wide variety of conditions, ranging from chronic pain to clinical depression. Most SSRI prescriptions are written by primary care or family physicians.

“With this huge data set, we feel confident in saying that SSRIs are associated with about a 10 percent increased risk for these adverse outcomes.” Adverse outcomes the study identified include an increased risk of bleeding, transfusion, hospital readmission and death when SSRIs are taken around the time of surgery.

The study authors noted that patients on SSRIs are more likely to have conditions that in themselves increase surgical risk, such as obesity, chronic pulmonary disease and depression.

To address the question of whether these factors might have accounted for the differences in outcomes, they retrospectively matched patients who had taken SSRIs with patients who were not taking the drugs.

After matching and controlling for variables such as age, gender, medical condition and depression, they found that patients on SSRIs still were at increased risk.

The scientists also looked at whether the increased risk could be accounted for by patients receiving SSRIs for the first time before surgery. “This was not the case,” said Auerbach. “These drugs are almost never used acutely. They are prescribed for chronic conditions such as depression, almost always for long-term use.”

The study was not designed to look at possible causes for the increased risk.

However, noted Auerbach, SSRIs are known to interfere with the functioning of platelets — blood cells that play a crucial role in blood clotting. In turn, platelet dysfunction can lead to excess bleeding.

Auerbach cautioned that since the study was retrospective, “a prospective observational study, in which patients are randomly assigned to take SSRIs around the time of surgery, is still needed.”

He said that while it would be premature to advise patients not to take SSRIs before surgery, “it’s definitely worth discussing with your surgeon or primary care physician.”

Their results are published today in the journal, JAMA Internal Medicine.

Source: JAMA Internal Medicine

Woman in the hospital photo by shutterstock.