Nearly 15 million U.S. adults suffer from clinical depression. Treating them is currently a process of trial and error.

“It’s always been a combination of physician preference, patient preference and… who you actually choose to see for your depression,” Dr. Helen Mayberg, a neurologist at Emory University School of Medicine, said. “If you choose to go see a psychologist, psychologists do therapy. If you go to your family doctor… the likelihood is that you’ll be prescribed a medication.”

With fewer than 40 percent of patients achieving success with their initial treatment for depression, the majority have to wait to see if additional therapies are effective.

“It’s a serious illness,” Mayberg said. “There are consequences to going another six weeks, another eight weeks, another 12 weeks on a treatment that is unlikely to work.”

Now, Mayberg and a team of researchers may have discovered a way to reduce the guesswork involved with treating clinical depression. Their study, published online in JAMA Psychiatry, suggests the solution is locked in a portion of the brain called the anterior insula.

PET scans revealed that patients who benefitted from escitalopram (an antidepressant also known by the brand name Lexapro) had different activity levels in the anterior insula than patients who responded well to “talk therapy.”

“The patients who did the best on escitalopram have high insula activity (compared to other parts of the brain),” Callie McGrath, an Emory graduate student and lead author of the study, said. “And the patients who do the best on cognitive behavioral therapy have low insula activity.”

The researchers believe they’ve found the first reliable indicator to guide doctors in their selection of initial treatments for clinical depression. This has the potential to spare many patients from the prolonged suffering and uncertainty associated with current trial and error methods.

“It’s a very discouraging process,” said Edi Guyton, who leads local support programs with the National Alliance on Mental Illness (NAMI). “It’s long. You begin to feel hopeless.”

Guyton said she struggled with treatment-resistant depression for most of her life until she was able to bring it under control through deep brain stimulation (DBS), an experimental therapy developed by Dr. Mayberg. Guyton said she hopes Mayberg’s separate study on the relationship between brain activity and treatment outcomes will lead to more research that takes the hit and miss factor out of helping people with depression.

“That would be wonderful, just knowing what medicine,” Guyton said. “If you were pretty sure, even 80 percent sure, that this is gonna work for me, I think it would make all the difference in the world.”

Read more: http://www.foxnews.com/health/2013/06/13/depression-treatments-brain-scans-may-suggest-best-course/#ixzz2WUhEmiWA

Heightened telomerase activity in patients with untreated major depression may represent the body’s attempt to fight back against the progression of disease, according to a new study.

Researchers led by Owen Wolkowitz, professor of psychiatry at University of California San Francisco, in an ongoing study found that within cells of the immune system, activity of an enzyme called telomerase is greater, on average, in untreated individuals with major depression.

Telomerase is an enzyme that lengthens protective end caps on the chromosomes’ DNA, called telomeres. Shortened telomeres have been associated with earlier death and with chronic diseases in population studies.

The heightened telomerase activity in untreated major depression might represent the body’s attempt to fight back against the progression of disease, in order to prevent biological damage in long-depressed individuals, Wolkowitz said.

The researchers made another discovery that may suggest a protective role for telomerase. Using magnetic resonance imaging (MRI), they found that, in untreated, depressed study participants, the size of the hippocampus, a brain structure that is critical for learning and memory, was associated with the amount of telomerase activity measured in the white blood cells.

Such an association at a single point in time cannot be used to conclude that there is a cause-and-effect relationship with telomerase helping to protect the hippocampus, but it is plausible, Wolkowitz said.

The researchers also found that the enzyme’s activity went up when some patients began taking an antidepressant. In fact, depressed participants with lower telomerase activity at baseline – as well as those in whom enzyme activity increased the most with treatment – were the most likely to become less depressed with treatment.

The researchers also measured telomere length in the same immune cells. Only very chronically depressed individuals showed telomere shortening, Wolkowitz said.

The 20 depressed participants enrolled in the study had been untreated for at least six weeks and had an average lifetime duration of depression of about 13 years.

After baseline evaluation and laboratory measures, 16 of the depressed participants were treated with sertraline, a member of the most popular class of antidepressants, the serotonin-selective-reuptake-inhibitors (SSRIs), and then evaluated again after eight weeks. There were 20 healthy participants who served as controls.

The preliminary findings from the study were presented at the annual meeting of the American Psychiatric Association in San Francisco.

Article from Firstpost.

Mark Worsdale decided it was time to retire from his 30-year career in business when he was diagnosed with early-stage Parkinson’s disease three years ago.

“I wanted to dedicate more time to my well-being,” said Worsdale, 59. “It is important.”

Worsdale joined ParkOptimist, a group of about 100 members who meet a few times a week at St. Matthew Episcopal Church near South Miami for fitness classes like yoga, tai chi, and dance. ParkOptimist, whose umbrella organization is the National Parkinson Foundation’s South Florida chapter, also conducts a support group for Parkinson’s patients and hosts voice and music therapy classes.

Worsdale said the activities, and the friends he’s made, have made living with the disease easier.

“My only regret is not finding the group earlier, when I was diagnosed,” said Worsdale, who dedicates four to five hours a week to go to group activities, and also exercises at home. “I am doing very well, and I think it is the result of how active I keep myself.”

To date, there is no cure for Parkinson’s disease. But research has shown that diet and fitness play a big part in maintaining a healthy lifestyle, particularly curbing depression, a byproduct of the disease.

Parkinson’s disease is a neurological disorder that progresses slowly in most people, usually after age 50, although some patients can be in their 20s and 30s. It occurs when the cells in the brain that produce dopamine — a chemical that helps the brain send signals to control muscle movement — are slowly destroyed.

About one million Americans are diagnosed with the condition; Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s.

The disease causes stiffness, trouble with balance, slowness of movement and tremors, said Dr. Carlos Singer, chief of the Movement Disorders Division at the University of Miami Miller School Of Medicine. Other symptoms are lack of sleep, urinary and gastrointestinal problems and fatigue. People with the disease also can contend with depression and anxiety.

“It can be confusing at the beginning for many patients,” Singer said. “It affects their daily lives.”

A bedside examination by a neurologist remains the first and most important diagnosis tool for patients suspected of having Parkinson’s disease, according to the National Parkinson Foundation.

A neurologist will base the diagnosis on a detailed medical history of the patient, an examination of the patient’s ability to perform a number of tasks, and the patient’s response to medication that helps produce dopamine. Singer said that patients often get diagnosed when they start noticing a tendency to drag a leg and tremor of the arms either while resting or while holding an object.

“It starts taking them longer to shave,” he said. “Or it becomes difficult to get dressed, sit at the table to eat, or take a walk.”

Last fall, the National Parkinson Foundation (NPF) released a study showing that depression is one of the biggest factors influencing the health of Parkinson’s patients. Several places in South Florida offer extensive health and fitness programs for people with Parkinson’s.

In addition to the programs at St. Matthew, which cost $25 per year per membership with the National Parkinson Foundation, St. Catherine’s Rehabilitation Hospital, of Catholic Health Service, offers Parkinson’s focus groups in North Miami and Hialeah Gardens.

The Michael Ann Russell Jewish Community Center in North Miami Beach and the David Posnack JCC Fitness Center in Davie also run extensive programs for people with Parkinson’s.

“I encourage Parkinson’s patients at any stage to participate in these kinds of activities,” Worsdale said. “I am not saying it can cure the disease but you are going to look and feel better.”

For those seeking medical intervention, deep brain stimulation, or DBS, may be an option.

But this surgical technique does not slow or retard the progression of Parkinson’s disease, said Dr. Bruno Gallo, who has been the director of DBS Therapy at UM Health System for a decade.

Deep brain stimulation consists of electric wires implanted in the patient’s brain and connected to a brain pacemaker in the chest. The pacemaker sends electrical impulses to certain parts of the brain to stimulate activity in targeted areas affected by the disease.

“I like to set realistic goals of what the treatment can and cannot accomplish,” said Gallo, who explained that some patients seek the surgical procedure hoping the disease goes away. “It does improve patients’ quality of life significantly, much more than maximal medical management can in patients who qualify for therapy.’’
Read more here.

Being depressed is known to increase the risk for stroke. Now a new study suggests that the association is even stronger in younger women.

Australian researchers studied 10,457 women, average age 52, without a history of stroke, surveying them every three years for 12 years. Using a well-validated depression scale, they found that about 24 percent were depressed at each survey. The study, published online this month in the journal Stroke, found 177 strokes over the study period.

Being depressed nearly doubled the risk for stroke, even after the researchers accounted for other risk factors like age, education, high blood pressure, diabetes, heart disease, smoking, alcohol intake, physical activity and body mass index.

A study published in 2011 on the same subject found an increased risk of only 30 percent, but the average age in the study was 14 years older, and at least one analysis found no increased risk at all in people over 65.

“The study adds to the evidence around depression and increased risk of stroke. And it’s possibly even stronger in younger women,” said the lead author, Caroline A. Jackson, an epidemiologist at the University of Queensland. “But it’s important to remember that this is a relatively small study, and it needs to be explored in a much larger population.”

Article from NY Times Blog.