APA 2011

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Deployment of a parent in Afghanistan or Iraq increases the risk of a child’s hospitalization for mental health problems by about 10%, compared with other children in military families, according to a study from the Uniformed Services University of the Health Sciences in Bethesda, Md.

"The longer you are deployed, the more chance of a hospitalization for [your] child," said Dr. Jeffrey Millegan, a disaster and preventive psychiatry fellow at the university and a lieutenant commander in the Navy.

Children with past psychiatric problems are at greatest risk, followed by those with civilian mothers who have their own psychiatric issues. "If the civilian mother has more psychiatric problems during the deployment, that leads to worse outcomes in the child," he said at the annual meeting of the American Psychiatric Association.

Pediatricians and primary care providers should keep the findings in mind when dealing with children from military families.

"Be aware of the fact that these kids may be more vulnerable while [a] parent is deployed," Dr. Millegan said. Ask questions during routine visits about how things are going at home and how kids are dealing with having a parent away, he recommends If problems are identified during routine visits, take the kids to outpatient psychiatric care before they turn into issues that require hospitalization, he added.

To arrive at the findings, he and his colleagues linked the medical records of 377,565 children aged 9-17 years to their parents’ service records from fiscal years 2007-2009. In all, 32% of children and adolescents had a parent who deployed to Afghanistan or Iraq. Psychiatric hospitalizations were identified by ICD-9 codes.

The patients’ mean age was 12.5 years; half were boys, and most had married parents. The mean age of the deployed parent was 38 years; more than 90% were fathers away for a median of 11 months.

The adjusted odds ratio for hospitalization of a child with a deployed parent was 1.10, and 1.12 for deployments longer than 6 months, both findings statistically significant. Hospitalizations lasted about a month on average.

Typically, families do poorly at the start of a deployment, get into a groove toward the middle, and face another tough readjustment as the deployment comes to an end, Dr. Millegan said.

It can be especially hard on adolescents already struggling with boundary and transition issues. "Eleven months is a very significant length of time during a period when a lot of big developmental things are going on," he said.

In addition to paying extra attention to children’s psychological states, it’s also important to keep a close eye on family dynamics during deployment. "Be in tune with the mother and other people in the family," he said. "Everybody affects everybody else. They are all intertwined."

Dr. Millegan said he has no disclosures. The study received no outside funding.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Low-normal serum folate, at a level between 2 and 7ng/mL, is associated with an increased risk of depression in diabetes patients, a finding that suggests that, as with other depressed patients, folate supplementation might boost responses to antidepressants.

Among 58 patients with diabetes and low-normal serum folate levels, the age-adjusted prevalence of depression in the study was 6.3%; it was 4.9% in 488 patients with serum folate at or above 7ng/mL. Low-normal folate was associated with a twofold increase in the odds of depression in patients with diabetes (odds ratio, 2.29; confidence interval, 1.01-5.18).

Although folate levels have been previously correlated with depression, the study seems to be the first to find the connection in people with diabetes. Supplementation "has the potential to reduce the dosage of antidepressants necessary for these patients and potentially minimize metabolic side effects," something to which people with diabetes are particularly prone. However, those with diabetes might need more than the typical daily dose of about 400 mcg to overcome the disease’s metabolic derangements, Dr. Kurt Peters reported at the annual meeting of the American Psychiatric Association.

Also, "this study indicates the need to include diabetic patients in future research regarding folic acid supplementation in depression," he and his colleagues concluded.

Dr. Peters, a psychiatrist in private practice in Colorado Springs, said that he routinely supplements his depressed patients with folic acid. "It’s fairly innocuous, and so I think many of us go ahead and treat people with folate. It’s hard to identify who’s going to respond," perhaps 20% in a month or two."

In addition, he said, he has found women to be more responsive to this approach than men, a finding that is consistent with the literature.

The study was based on National Health and Nutrition Examination Survey data collected in 1999-2006. Depression was assessed by either the World Health Organization Composite International Diagnostic Interview or the Patient Health Questionnaire, both of which match the DSM-IV criteria for major depression.

The researchers excluded diabetes patients who had frank folate deficiency (levels below 2 ng/mL). They also adjusted for depression risk factors, including age, sex, race, marital status, and smoking.

In a separate talk, Dr. Srijan Sen, a psychiatrist at the depression center of the University of Michigan, Ann Arbor, agreed that there’s a role for folic acid supplementation in treatment-resistant depression.

"Omega-3 fatty acids and SAM-e [S-adenosyl methionine] have also been shown [to help] in randomized trials. The number needed to treat and the absolute increase in remission rates [are] relatively small, but they seem to have very mild to no side effects, so they are worth considering and using," he said.

Psychiatrist John Greden, the depression center’s executive director, noted, however, that "methyl folate seems to be an inducer of hepatic enzymes that lower the level of mood stabilizers. If people are adding methyl folate, and these people are on mood stabilizers, you may need to adjust doses of mood stabilizers."

Dr. Peters said he has no relevant disclosures. The study was funded by the Philadelphia College of Osteopathic Medicine’s D’Alonzo Memorial Scholarship.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers – to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It’s 3% of the general population, 6% of outpatients, and 12% of medical inpatients – 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness.

"All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies–Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CES-D scale at baseline and at three assessment points during the year (J. Clin. Oncol. 2011;29:413-20).

Only improvement in depression ratings, not treatment vs. no treatment, was associated with longer survival in this secondary analysis of the original study (Cancer 2007;110:1130-8).

Depression was an independent, long-term predictor of mortality. The researchers controlled for all the usual prognostic variables, including estrogen receptor and progesterone receptor status, disease-free interval, and age at diagnosis.

There is other evidence that psychotherapy can significantly reduce depressive symptoms in patients with advanced cancer, said Dr. Spiegel. For example, a Cochrane database analysis showed such a benefit in patients with incurable cancer who received supportive psychotherapy, cognitive-behavioral therapy, or problem-solving psychotherapy (Cochrane Database Syst. Rev. 2008;CD005537).

Dr. Spiegel said the psychotherapy in his study reduced patients’ tendency to suppress emotion. "So this outcome is not about distress; it’s about their management of distress. This, it turned out, mediated the reduction in depression and anxiety.

"We encourage people to face their fears of dying and death. We call it ‘detoxifying dying,’ " Dr. Spiegel said. Patients learn to face death, to reorder priorities, and to communicate better with families and physicians.

More support for an association between less depression and better outcomes for cancer patients emerged from a study of 107 patients with metastatic non–small cell lung cancer (N. Engl. J. Med. 2010:363:733-42). Fewer patients who received early palliative therapy reported depressive symptoms, 16%, vs. 38% of patients assigned to standard care. In addition, the early palliative care group had a longer median survival (11.6 months vs. 8.9 months). Both differences were statistically significant.

However, there is still no consensus in the literature about psychosocial intervention and cancer survival. Seven randomized trials now show a survival benefit, and six show no difference, Dr. Spiegel said. "The results are not random; I’m glad to say that no studies show that psychotherapy kills patients."

Although further research is warranted, Dr. Spiegel said, "it is now reasonable to raise the possibility that treating depression and other psychiatric aspects of cancer may not only help people live better, but may help them live longer."

The study was sponsored by the National Institute of Mental Health, the National Cancer Institute, and the National Institute on Aging. Dr. Spiegel is an editorial advisory board member to this news organization. He reported no other relevant financial disclosures.

HONOLULU – Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers – to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It’s 3% of the general population, 6% of outpatients, and 12% of medical inpatients – 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness.

"All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies–Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CES-D scale at baseline and at three assessment points during the year (J. Clin. Oncol. 2011;29:413-20).

Only improvement in depression ratings, not treatment vs. no treatment, was associated with longer survival in this secondary analysis of the original study (Cancer 2007;110:1130-8).

Depression was an independent, long-term predictor of mortality. The researchers controlled for all the usual prognostic variables, including estrogen receptor and progesterone receptor status, disease-free interval, and age at diagnosis.

There is other evidence that psychotherapy can significantly reduce depressive symptoms in patients with advanced cancer, said Dr. Spiegel. For example, a Cochrane database analysis showed such a benefit in patients with incurable cancer who received supportive psychotherapy, cognitive-behavioral therapy, or problem-solving psychotherapy (Cochrane Database Syst. Rev. 2008;CD005537).

Dr. Spiegel said the psychotherapy in his study reduced patients’ tendency to suppress emotion. "So this outcome is not about distress; it’s about their management of distress. This, it turned out, mediated the reduction in depression and anxiety.

"We encourage people to face their fears of dying and death. We call it ‘detoxifying dying,’ " Dr. Spiegel said. Patients learn to face death, to reorder priorities, and to communicate better with families and physicians.

More support for an association between less depression and better outcomes for cancer patients emerged from a study of 107 patients with metastatic non–small cell lung cancer (N. Engl. J. Med. 2010:363:733-42). Fewer patients who received early palliative therapy reported depressive symptoms, 16%, vs. 38% of patients assigned to standard care. In addition, the early palliative care group had a longer median survival (11.6 months vs. 8.9 months). Both differences were statistically significant.

However, there is still no consensus in the literature about psychosocial intervention and cancer survival. Seven randomized trials now show a survival benefit, and six show no difference, Dr. Spiegel said. "The results are not random; I’m glad to say that no studies show that psychotherapy kills patients."

Although further research is warranted, Dr. Spiegel said, "it is now reasonable to raise the possibility that treating depression and other psychiatric aspects of cancer may not only help people live better, but may help them live longer."

The study was sponsored by the National Institute of Mental Health, the National Cancer Institute, and the National Institute on Aging. Dr. Spiegel is an editorial advisory board member to this news organization. He reported no other relevant financial disclosures.

HONOLULU – Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers – to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It’s 3% of the general population, 6% of outpatients, and 12% of medical inpatients – 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness.

"All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies–Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CES-D scale at baseline and at three assessment points during the year (J. Clin. Oncol. 2011;29:413-20).

Only improvement in depression ratings, not treatment vs. no treatment, was associated with longer survival in this secondary analysis of the original study (Cancer 2007;110:1130-8).

Depression was an independent, long-term predictor of mortality. The researchers controlled for all the usual prognostic variables, including estrogen receptor and progesterone receptor status, disease-free interval, and age at diagnosis.

There is other evidence that psychotherapy can significantly reduce depressive symptoms in patients with advanced cancer, said Dr. Spiegel. For example, a Cochrane database analysis showed such a benefit in patients with incurable cancer who received supportive psychotherapy, cognitive-behavioral therapy, or problem-solving psychotherapy (Cochrane Database Syst. Rev. 2008;CD005537).

Dr. Spiegel said the psychotherapy in his study reduced patients’ tendency to suppress emotion. "So this outcome is not about distress; it’s about their management of distress. This, it turned out, mediated the reduction in depression and anxiety.

"We encourage people to face their fears of dying and death. We call it ‘detoxifying dying,’ " Dr. Spiegel said. Patients learn to face death, to reorder priorities, and to communicate better with families and physicians.

More support for an association between less depression and better outcomes for cancer patients emerged from a study of 107 patients with metastatic non–small cell lung cancer (N. Engl. J. Med. 2010:363:733-42). Fewer patients who received early palliative therapy reported depressive symptoms, 16%, vs. 38% of patients assigned to standard care. In addition, the early palliative care group had a longer median survival (11.6 months vs. 8.9 months). Both differences were statistically significant.

However, there is still no consensus in the literature about psychosocial intervention and cancer survival. Seven randomized trials now show a survival benefit, and six show no difference, Dr. Spiegel said. "The results are not random; I’m glad to say that no studies show that psychotherapy kills patients."

Although further research is warranted, Dr. Spiegel said, "it is now reasonable to raise the possibility that treating depression and other psychiatric aspects of cancer may not only help people live better, but may help them live longer."

The study was sponsored by the National Institute of Mental Health, the National Cancer Institute, and the National Institute on Aging. Dr. Spiegel is an editorial advisory board member to this news organization. He reported no other relevant financial disclosures.

HONOLULU – Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers – to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It’s 3% of the general population, 6% of outpatients, and 12% of medical inpatients – 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness.

"All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies–Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CES-D scale at baseline and at three assessment points during the year (J. Clin. Oncol. 2011;29:413-20).

Only improvement in depression ratings, not treatment vs. no treatment, was associated with longer survival in this secondary analysis of the original study (Cancer 2007;110:1130-8).

Depression was an independent, long-term predictor of mortality. The researchers controlled for all the usual prognostic variables, including estrogen receptor and progesterone receptor status, disease-free interval, and age at diagnosis.

There is other evidence that psychotherapy can significantly reduce depressive symptoms in patients with advanced cancer, said Dr. Spiegel. For example, a Cochrane database analysis showed such a benefit in patients with incurable cancer who received supportive psychotherapy, cognitive-behavioral therapy, or problem-solving psychotherapy (Cochrane Database Syst. Rev. 2008;CD005537).

Dr. Spiegel said the psychotherapy in his study reduced patients’ tendency to suppress emotion. "So this outcome is not about distress; it’s about their management of distress. This, it turned out, mediated the reduction in depression and anxiety.

"We encourage people to face their fears of dying and death. We call it ‘detoxifying dying,’ " Dr. Spiegel said. Patients learn to face death, to reorder priorities, and to communicate better with families and physicians.

More support for an association between less depression and better outcomes for cancer patients emerged from a study of 107 patients with metastatic non–small cell lung cancer (N. Engl. J. Med. 2010:363:733-42). Fewer patients who received early palliative therapy reported depressive symptoms, 16%, vs. 38% of patients assigned to standard care. In addition, the early palliative care group had a longer median survival (11.6 months vs. 8.9 months). Both differences were statistically significant.

However, there is still no consensus in the literature about psychosocial intervention and cancer survival. Seven randomized trials now show a survival benefit, and six show no difference, Dr. Spiegel said. "The results are not random; I’m glad to say that no studies show that psychotherapy kills patients."

Although further research is warranted, Dr. Spiegel said, "it is now reasonable to raise the possibility that treating depression and other psychiatric aspects of cancer may not only help people live better, but may help them live longer."

The study was sponsored by the National Institute of Mental Health, the National Cancer Institute, and the National Institute on Aging. Dr. Spiegel is an editorial advisory board member to this news organization. He reported no other relevant financial disclosures.

HONOLULU – Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers – to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It’s 3% of the general population, 6% of outpatients, and 12% of medical inpatients – 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness.

"All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies–Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CES-D scale at baseline and at three assessment points during the year (J. Clin. Oncol. 2011;29:413-20).

Only improvement in depression ratings, not treatment vs. no treatment, was associated with longer survival in this secondary analysis of the original study (Cancer 2007;110:1130-8).

Depression was an independent, long-term predictor of mortality. The researchers controlled for all the usual prognostic variables, including estrogen receptor and progesterone receptor status, disease-free interval, and age at diagnosis.

There is other evidence that psychotherapy can significantly reduce depressive symptoms in patients with advanced cancer, said Dr. Spiegel. For example, a Cochrane database analysis showed such a benefit in patients with incurable cancer who received supportive psychotherapy, cognitive-behavioral therapy, or problem-solving psychotherapy (Cochrane Database Syst. Rev. 2008;CD005537).

Dr. Spiegel said the psychotherapy in his study reduced patients’ tendency to suppress emotion. "So this outcome is not about distress; it’s about their management of distress. This, it turned out, mediated the reduction in depression and anxiety.

"We encourage people to face their fears of dying and death. We call it ‘detoxifying dying,’ " Dr. Spiegel said. Patients learn to face death, to reorder priorities, and to communicate better with families and physicians.

More support for an association between less depression and better outcomes for cancer patients emerged from a study of 107 patients with metastatic non–small cell lung cancer (N. Engl. J. Med. 2010:363:733-42). Fewer patients who received early palliative therapy reported depressive symptoms, 16%, vs. 38% of patients assigned to standard care. In addition, the early palliative care group had a longer median survival (11.6 months vs. 8.9 months). Both differences were statistically significant.

However, there is still no consensus in the literature about psychosocial intervention and cancer survival. Seven randomized trials now show a survival benefit, and six show no difference, Dr. Spiegel said. "The results are not random; I’m glad to say that no studies show that psychotherapy kills patients."

Although further research is warranted, Dr. Spiegel said, "it is now reasonable to raise the possibility that treating depression and other psychiatric aspects of cancer may not only help people live better, but may help them live longer."

The study was sponsored by the National Institute of Mental Health, the National Cancer Institute, and the National Institute on Aging. Dr. Spiegel is an editorial advisory board member to this news organization. He reported no other relevant financial disclosures.

HONOLULU – Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers – to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It’s 3% of the general population, 6% of outpatients, and 12% of medical inpatients – 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness.

"All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies–Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CES-D scale at baseline and at three assessment points during the year (J. Clin. Oncol. 2011;29:413-20).

Only improvement in depression ratings, not treatment vs. no treatment, was associated with longer survival in this secondary analysis of the original study (Cancer 2007;110:1130-8).

Depression was an independent, long-term predictor of mortality. The researchers controlled for all the usual prognostic variables, including estrogen receptor and progesterone receptor status, disease-free interval, and age at diagnosis.

There is other evidence that psychotherapy can significantly reduce depressive symptoms in patients with advanced cancer, said Dr. Spiegel. For example, a Cochrane database analysis showed such a benefit in patients with incurable cancer who received supportive psychotherapy, cognitive-behavioral therapy, or problem-solving psychotherapy (Cochrane Database Syst. Rev. 2008;CD005537).

Dr. Spiegel said the psychotherapy in his study reduced patients’ tendency to suppress emotion. "So this outcome is not about distress; it’s about their management of distress. This, it turned out, mediated the reduction in depression and anxiety.

"We encourage people to face their fears of dying and death. We call it ‘detoxifying dying,’ " Dr. Spiegel said. Patients learn to face death, to reorder priorities, and to communicate better with families and physicians.

More support for an association between less depression and better outcomes for cancer patients emerged from a study of 107 patients with metastatic non–small cell lung cancer (N. Engl. J. Med. 2010:363:733-42). Fewer patients who received early palliative therapy reported depressive symptoms, 16%, vs. 38% of patients assigned to standard care. In addition, the early palliative care group had a longer median survival (11.6 months vs. 8.9 months). Both differences were statistically significant.

However, there is still no consensus in the literature about psychosocial intervention and cancer survival. Seven randomized trials now show a survival benefit, and six show no difference, Dr. Spiegel said. "The results are not random; I’m glad to say that no studies show that psychotherapy kills patients."

Although further research is warranted, Dr. Spiegel said, "it is now reasonable to raise the possibility that treating depression and other psychiatric aspects of cancer may not only help people live better, but may help them live longer."

The study was sponsored by the National Institute of Mental Health, the National Cancer Institute, and the National Institute on Aging. Dr. Spiegel is an editorial advisory board member to this news organization. He reported no other relevant financial disclosures.