Too little exercise, too much TV tied to depression

Peposted at http://darkestcloset.blogspot.com/   Posted at http://www.reuters.com/article/2011/11/14/us-depression-exercise-idUSTRE7AD04I20111114

Sun Nov 13, 2011 9:26pm EST

(Reuters) - Older women who got more exercise and less television time were the least likely to be diagnosed with depression, according to a U.S. study of thousands of women -- with physical activity having the biggest impact.

According to findings published in the American Journal of Epidemiology, researchers found that women who reported exercising the most in recent years were about 20 percent less likely to get depression than those who rarely exercised.

On the other hand, the more hours they spent watching TV each week, the more their risk of depression crept up.

"Higher levels of physical activity were associated with lower depression risk," wrote study author Michel Lucas, from the Harvard School of Public Health in Boston.

More time spent being active might boost self-esteem and women's sense of control, as well as the endorphins in their blood, although the study could not prove directly that watching too much television and avoiding exercise caused depression, she added.

The report included close to 50,000 women who filled out surveys every couple of years as part of the U.S. Nurses' Health Study, and covered the years 1992 to 2006.

Participants recorded the amount of time they spent watching TV each week in 1992, and also answered questions about how often they walked, biked, ran and swam between 1992 and 2000.

On the same questionnaires, women reported any new diagnosis of clinical depression or medication taken to treat depression.

The analysis only included women who did not have depression in 1996. Over the next decade, there were 6,500 new cases of depression.

After the researchers accounted for aspects of health and lifestyle linked to depression, including weight, smoking and a range of diseases, exercising the most -- 90 minutes or more each day -- meant women were 20 percent less likely to be diagnosed with depression than those who exercised 10 minutes or less a day.

Women who watched three hours or more of television a day were 13 percent more likely to be diagnosed with depression than those who hardly ever tuned in, but Lucas said at least part of that link might be due to women replacing time they could be exercising with TV watching.

One alternative explanation the researchers brought up is that women might have been experiencing some symptoms of depression before they were diagnosed, leading them to exercise less. A formal diagnosis could have come later.

"Previous studies have suggested that physical activity is associated with a lower risk of depressive symptoms," said Gillian Mead, who studies geriatric medicine at Edinburgh's Royal Infirmary but was not involved in the study.

"(The finding) adds to the growing body of evidence that physical activity is important to maintain brain health," she added in an email to Reuters Health. SOURCE: bit.ly/sQbWMU

(Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies and Ron Popeski)

http://www.reuters.com/article/2011/11/14/us-depression-exercise-idUSTRE7AD04I20111114

Psychiatry manual revisions spark row

US psychiatrists divided by claims of secrecy and scientific overreach.

Posted at http://www.nature.com/news/2009/090722/full/460445a.html

Reposted at http://wwwdarkestcloset.blogspot.com/

The question of how best to revise the 'bible' of American psychiatry once again has tempers flaring. The manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is significant because it is used to determine clinical diagnoses, insurance reimbursements and research agendas throughout the United States, and is often used as a reference in other countries.

Planning for the upcoming fifth edition of the manual (DSM-V) began in 1999, but as work has picked up during the past year, critics have alleged that the process has been too secretive, and that working groups have been pushed to meet an unrealistic 2012 publication date. Some, including the architects behind the last two editions of the DSM, also complain that project leaders are pushing for the premature inclusion of changes meant to incorporate recent genetic and neurobiological advances, before they are ready for the clinic.

Supporters, meanwhile, say that the changes will not be too drastic, and are meant to make the manual more flexible for future revisions.

Even light tweaking of definitions in the DSM can bring about radical changes in psychiatric practice, as Allen Frances, professor emeritus of psychiatry at Duke University in Durham, North Carolina, wrote in a recent commentary in Psychiatric Times. Frances, chairman of the committee that produced the fourth edition of the manual in 1994, acknowledged that changes in the definitions of autistic disorder and attention-deficit/hyperactivity disorder made then may have contributed to the recent surge in diagnoses of these conditions.

In addition, the manual sometimes has an outsized influence on research directions, says Steven Hyman, provost of Harvard University and a member of the DSM-V task force that is overseeing the revision. Hyman became interested in reforming the DSM when he was director of the National Institute of Mental Health in Bethesda, Maryland, and witnessed the control that it exerted over grant review panels. "I was spending taxpayer money on grants that were being forced into categories that might or might not conform to nature," he says.

“There just hasn't been time to do this in an organized way.”

The latest revisions come as financial ties between prominent psychiatrists and pharmaceutical companies are being closely scrutinized. A 2006 analysis of potential conflicts of interest among those who participated in the last revision showed that 56% of panel members had financial links to the pharmaceutical industry (L. Cosgrove et al. Psychother. Psychosom. 75, 154–160; 2006). For the DSM-V, the American Psychiatric Association, which publishes the manual, vetted potential members of working groups under a new conflict-of-interest policy. But the process introduced delays, and working groups were not finalized until 2008.

Then word broke last July that working group members had signed non-disclosure agreements, agreeing to refrain from distributing pre-publication materials or divulging the content of group discussions pertaining to the rewrite. The agreements were intended to prevent members from publishing material to be used in the DSM-V, says Darrel Regier, vice-chair of the DSM-V task force and director of the American Psychiatric Association's research division. But Robert Spitzer, a professor of psychiatry at Columbia University in New York who oversaw the DSM-III, says that his request to look at minutes of a DSM-V meeting was denied because of these confidentiality agreements.

Since then, DSM-V working groups have begun posting regular summaries of their activities online. "All of us have been encouraged to be as public as we can be," says William Carpenter of the Baltimore-based University of Maryland School of Medicine and chair of the working group on psychotic disorders. "But just to have [the confidentiality agreements] — that never would have been considered in the previous revisions," says Spitzer.

From the start, Hyman and DSM-V chairman David Kupfer have also planned to change how the DSM-V evaluates mental disorders. Rather than relying strictly on categorical diagnoses — one either has depression or does not, for example — they have pushed to add 'dimensional' criteria to ascertain to what extent a person is depressed. Such criteria could also address similarities among different disorders, reflecting, for example, neuroimaging studies that suggest multiple anxiety disorders can affect the same region of the brain.

 

For this reason, Carpenter and others have said the DSM-V will represent a "paradigm shift" — an expression that alarmed critics, who say the science behind such dimensional assessments is not yet ready to be incorporated into clinical assessments. In March, Duke University psychologist and epidemiologist Jane Costello resigned from the working group on child and adolescent disorders after receiving a memo from Kupfer and Regier about including the dimensional approach. Adding these assessments would require a great deal of extra research, she says, at a time when working groups were already behind schedule for their 2012 publication deadline. "There just hasn't been time to do this in an organized way," she says. "This is a huge job."

Hyman says that the changes will not necessarily be so drastic, and could take the form of a few additional, and optional, diagnostic criteria without replacing the old methods. 

Mental-health guide accused of overreach

Dispute grows over revisions to diagnostic handbook.

Psychologist David Elkins had modest ambitions for his petition. He and his colleagues were worried that proposed changes to an influential handbook of mental disorders could classify normal behaviours as psychological conditions, potentially leading to inappropriate treatments. So they laid out their concerns in an open letter, co-sponsored by five divisions of the American Psychological Association in Washington DC. “I thought, 'Well, maybe we'll get a couple or maybe 30 signatures',” says Elkins, an emeritus professor at Pepperdine University in Malibu, California.

But the letter, posted online on 22 October (http://go.nature.com/uhmvqq), touched a nerve. Within 10 days more than 2,800 people had signed it, many identifying themselves as mental-health professionals.
The petition targets proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a tome used by psychiatrists, psychologists, counsellors and others worldwide to diagnose mental maladies and set research agendas. The American Psychiatric Association, based in Arlington, Virginia, plans to publish a new edition of the manual, DSM-5, in 2013. The association has declined to comment on Elkins's petition.

Psychiatrist Allen Frances, who was the chief architect of DSM-IV and is an outspoken critic of its successor, has dubbed the open letter a “buyer's revolt”. “I think the petition is the last best hope to influence the DSM-5 from the outside,” says Frances, an emeritus professor at Duke University School of Medicine in Durham, North Carolina.

Elkins's petition is not the first to raise concerns that the DSM-5 proposals could overreach. In June, the British Psychological Society, based in Leicester, issued a critique that highlighted, for example, the proposed addition of 'attenuated psychosis syndrome'. The society argued that this could be used “to stigmatize eccentric people”.

“There should be a black box warning about how child bipolar disorder is being overdiagnosed.”

Elkins and his colleagues have complained about other proposals, such as the elimination of a 'bereavement exclusion' in the diagnosis of major depression. The previous edition of the manual recommended that the condition not be diagnosed in people grieving the death of a loved one within the previous two months. The revisions shorten this to two weeks, a change that troubles psychiatrist Ramin Mojtabai of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Categorizing these patients as having depression could boost the use of medications when psychotherapy may be the better treatment, he says.

Efforts to tighten loose definitions of attention deficit and hyperactivity disorder (ADHD) and bipolar disorder in children have also proved controversial. In response to worries that inexact criteria may have contributed to a surge in diagnoses of these conditions since the 1990s, the DSM-5 task force has proposed a syndrome called 'disruptive mood dysregulation disorder', which would provide an alternative to labelling a child as bipolar or having ADHD. But Frances says that is not enough. “There should be a black box warning about how child bipolar disorder is being overdiagnosed,” he says. “Instead, they've created a new disorder.”

Field trials of the proposed DSM-5 criteria have been completed and investigators plan to publish the results. Helena Kraemer, a statistician and emeritus professor at Stanford University School of Medicine in Palo Alto, California, who is on the DSM-5 committee, says that results from trials of some criteria will indicate whether they generate more frequent diagnoses.

But Mojtabai cautions that trial results may not reflect what will happen when DSM-5 is published. “Any trial is artificial,” he says. “The clinicians in these trials have intensive training, but people who will use this manual in clinical practice will not receive that level of instruction.”

Nature Volume: 479, Pages: 14 (03 November 2011)

Corrected online:

This story originally stated that the DSM-5 petition was co-sponsored by the American Psychological Association. In fact, it was co-sponsored by five divisions of the association, not the association as a whole. The text has been changed to reflect this.

Posted at http://www.nature.com/news/mental-health-guide-accused-of-overreach-1.9291

FDA: Smoking Cessation Drug Does Not Cause More Psychiatric Hospitalizations Than Nicotine Patches

By Join Together Staff | October 25, 2011 |

The Food and Drug Administration (FDA) has determined the smoking cessation drug Chantix (varenicline) is no more likely than nicotine patches to cause psychiatric events that require hospitalization.

The FDA drew its conclusions after reviewing two studies comparing Chantix to nicotine replacement therapy, including nicotine patches. The agency acknowledged the studies had limitations and will keep the “black box” warning labels on Chantix to advise about possible psychiatric side effects, including changes in behavior, hostility, agitation, depressed mood and suicidal thoughts or actions, Reuters reports.

“Overall, FDA has determined that the current warnings in the Chantix drug label, based on postmarketing surveillance reports, remain appropriate,” the FDA said in a statement.

One study conducted by the Department of Veterans Affairs compared 14,131 veterans using Chantix with an equal number of veterans who used nicotine patches. A second study conducted by the Department of Defense compared almost 20,000 people using Chantix with about 16,000 people who used nicotine patches for a month after they began treatment to quit smoking.

The manufacturer of Chantix, Pfizer, is conducting a large safety clinical trial of the drug to assess psychiatric side effects. Results are expected in 2017.

In June, the FDA said Chantix may be associated with a small, increased risk of certain heart problems in patients with heart disease.

http://www.drugfree.org/join-together/research/fda-smoking-cessation-drug-does-not-cause-more-psychiatric-hospitalizations-than-nicotine-patches?utm_source=Join+Together+Daily&utm_campaign=42a2475b68-JT+Daily+News%3A+Take-Back+Programs...&utm_medium=email

Reposted at darkestcloset@blogspot.com

Health Reform to Increase Number Receiving Medicaid Mental Health Services

The number of Medicaid beneficiaries using mental health and addiction treatment services is expected to increase from 2.1 million in 2006 to 4.4 million in 2019—the date when all health reform provisions are implemented to expand Medicaid coverage to low-income childless adults between the ages of 18 and 64. The number of 18-to-64-year-old adult behavioral health service users overall (counting those covered by Medicare, Medicaid, private insurance, and the uninsured) is expected to increase from 25.4 million in 2006 to 26.6 million by 2019.. The projected increase in behavioral health service utilization was based on research on non-elderly adults’ mental health status and insurance status by income level reported in the 2004–2006 Medical Expenditure Panel Surveys. (Open Minds, 10/10/11)

Happy World Mental Health Day!

World Mental Health Day—October 10, 2011

World Mental Health Day raises public awareness about mental health issues. The day promotes open discussion of mental health and investments in prevention, promotion, and treatment services.

This year, the theme is "Investing in Mental Health." Significant behavioral health disparities persist in diverse communities across the globe. To reach these communities, we need to increase investment for mental health and to shift available resources toward more effective forms of services delivered through primary health care and community settings.

"Off-label" Use of Antipsychotic Drugs for Some Conditions Not Supported by Evidence