Somatic Disorders

SALT LAKE CITY – Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, findings from the Nurses' Health Study suggest.

Data from more than 68,000 women who participated in the study show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night.

The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel reported at the annual meeting of the Associated Professional Sleep Societies.

Furthermore, the relative risk for obesity (BMI over 30 kg/m

Study participants first responded to a questionnaire about sleep habits in 1986 and were followed for 16 years, with additional information about weight and important covariates obtained biannually.

Additional research is needed to elucidate the mechanisms for weight gain as it relates to sleep duration, Dr. Patel said.

SALT LAKE CITY – Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, findings from the Nurses' Health Study suggest.

Data from more than 68,000 women who participated in the study show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night.

The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel reported at the annual meeting of the Associated Professional Sleep Societies.

Furthermore, the relative risk for obesity (BMI over 30 kg/m

Study participants first responded to a questionnaire about sleep habits in 1986 and were followed for 16 years, with additional information about weight and important covariates obtained biannually.

Additional research is needed to elucidate the mechanisms for weight gain as it relates to sleep duration, Dr. Patel said.

SALT LAKE CITY – Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, findings from the Nurses' Health Study suggest.

Data from more than 68,000 women who participated in the study show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night.

The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel reported at the annual meeting of the Associated Professional Sleep Societies.

Furthermore, the relative risk for obesity (BMI over 30 kg/m

Study participants first responded to a questionnaire about sleep habits in 1986 and were followed for 16 years, with additional information about weight and important covariates obtained biannually.

Additional research is needed to elucidate the mechanisms for weight gain as it relates to sleep duration, Dr. Patel said.

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University in St. Louis.

Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. Depression not only impairs their function and quality of life but also increases their risk of death, largely by accelerating coronary heart disease, and their risk of diabetes complications, Dr. Lustman and his associates said (Arch. Gen. Psychiatry 2006;63:521–9).

Pharmacotherapy and psychotherapy improve both mood and glycemic control in depressed diabetic patients, but the benefits appear to be short-lived, with up to 60% of such patients developing a recurrence in the year following successful treatment. Maintenance therapy is known to reduce recurrences in 15%–30% of nondiabetic depressed patients but had not been assessed in diabetic patients until this study was done.

The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression.

The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred.

Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Both the Beck Depression Inventory and the Hamilton Depression Rating scale were used to measure depression symptoms.

Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote.

The interval until one-third of the subjects developed a recurrence was 226 days in those taking sertraline, compared with 57 days in those taking placebo. The median time to recurrence exceeded 365 days, the maximum duration of follow-up, for subjects taking sertraline, compared with 251 days for those taking placebo.

Nearly 77% of recurrences developed early, within 4 months of randomization.

Sertraline did not interfere with glycemic control. In fact, glycemic control improved as depression improved with initial therapy, and it was maintained at that improved level throughout the depression-free interval.

“Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression,” Dr. Lustman and his associates said.

This study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Improvements in glycemic control were maintained throughout the depression-free interval. DR. LUSTMAN

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University in St. Louis.

Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. Depression not only impairs their function and quality of life but also increases their risk of death, largely by accelerating coronary heart disease, and their risk of diabetes complications, Dr. Lustman and his associates said (Arch. Gen. Psychiatry 2006;63:521–9).

Pharmacotherapy and psychotherapy improve both mood and glycemic control in depressed diabetic patients, but the benefits appear to be short-lived, with up to 60% of such patients developing a recurrence in the year following successful treatment. Maintenance therapy is known to reduce recurrences in 15%–30% of nondiabetic depressed patients but had not been assessed in diabetic patients until this study was done.

The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression.

The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred.

Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Both the Beck Depression Inventory and the Hamilton Depression Rating scale were used to measure depression symptoms.

Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote.

The interval until one-third of the subjects developed a recurrence was 226 days in those taking sertraline, compared with 57 days in those taking placebo. The median time to recurrence exceeded 365 days, the maximum duration of follow-up, for subjects taking sertraline, compared with 251 days for those taking placebo.

Nearly 77% of recurrences developed early, within 4 months of randomization.

Sertraline did not interfere with glycemic control. In fact, glycemic control improved as depression improved with initial therapy, and it was maintained at that improved level throughout the depression-free interval.

“Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression,” Dr. Lustman and his associates said.

This study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Improvements in glycemic control were maintained throughout the depression-free interval. DR. LUSTMAN

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University in St. Louis.

Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. Depression not only impairs their function and quality of life but also increases their risk of death, largely by accelerating coronary heart disease, and their risk of diabetes complications, Dr. Lustman and his associates said (Arch. Gen. Psychiatry 2006;63:521–9).

Pharmacotherapy and psychotherapy improve both mood and glycemic control in depressed diabetic patients, but the benefits appear to be short-lived, with up to 60% of such patients developing a recurrence in the year following successful treatment. Maintenance therapy is known to reduce recurrences in 15%–30% of nondiabetic depressed patients but had not been assessed in diabetic patients until this study was done.

The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression.

The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred.

Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Both the Beck Depression Inventory and the Hamilton Depression Rating scale were used to measure depression symptoms.

Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote.

The interval until one-third of the subjects developed a recurrence was 226 days in those taking sertraline, compared with 57 days in those taking placebo. The median time to recurrence exceeded 365 days, the maximum duration of follow-up, for subjects taking sertraline, compared with 251 days for those taking placebo.

Nearly 77% of recurrences developed early, within 4 months of randomization.

Sertraline did not interfere with glycemic control. In fact, glycemic control improved as depression improved with initial therapy, and it was maintained at that improved level throughout the depression-free interval.

“Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression,” Dr. Lustman and his associates said.

This study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Improvements in glycemic control were maintained throughout the depression-free interval. DR. LUSTMAN

LOS ANGELES – Adherence to a self-care action plan helped primary care patients exceed national goals for reducing their depression, reported Dr. Doriane C. Miller, associate division chief of general internal medicine at Stroger Hospital of Cook County in Chicago.

The study of 403 depressed adults in rural South Carolina has implications for improving outcomes for patients with diabetes, whose depression undermines their ability to manage a complex disease, she said at the annual meeting of the American Association of Diabetes Educators.

Patients at CareSouth, a series of federally qualified health centers serving mostly minority, low-income residents, were screened using the Patient Health Questionnaire-9 (PHQ-9), an instrument made available by Pfizer (www.pfizer.com/pfizer/phq-9/index.jsp

Those patients whose scores indicated they had clinically significant depression were enrolled in a collaborative self-management program that included the Depression Self-Care Action Plan (www.collaborativeselfmanagement.org/uploads/ManagingDepression.pdf

Focusing on “simple goals and small steps,” the plan helps patients establish concrete ways to stay physically active, engage in pleasurable activities, spend time with supportive people, incorporate relaxation into their daily lives, and identify life stresses and ways to deal with them.

It's a “living process document,” reviewed at appointments and adapted to the reality of patients' often troubled lives, Dr. Miller said.

After 1 year, 56% of patients had reduced their depression scores by more than 50%, compared with a national goal of 40%. Fully 85% of patients had documented their self-management of depression, compared with a national goal of 70%. About one-fourth of patients participating in the depression collaborative, sponsored by the Health Resources and Services Administration's Bureau of Primary Health Care, had diabetes as a comorbidity.

Perhaps most dramatically, 53% of patients no longer met the PHQ-9 threshold for depression, compared with a national goal of 40%.

“We find this kind of self-care action plan can be a very useful tool for people who have depression and, particularly, people with diabetes [who have depression],” said Dr. Miller, who also serves as national program director of Quality Allies, an effort aimed at improving ambulatory care that is sponsored by the Robert Wood Johnson Foundation and the California HealthCare Foundation.

As many as one in four patients with diabetes have depression, but it can be missed in quick office visits or disguised as hostility, apathetic noncompliance, or a seeming inability to concentrate and follow directions.

People with diabetes are especially burdened by a sense of hopelessness and helplessness about downstream consequences of their disease, such as amputation, blindness, myocardial infarction, or stroke, Dr. Miller said.

“It can have a strong influence on their thinking,” she said. “[They start thinking] 'if it happened to my brother, my grandfather, my mother, it's going to happen to me. It's just a hopeless situation and something I need to bear.'”

Dr. Miller said primary care physicians often don't even want to ask about depression, since they feel unable to deal with it in the 15-minute time slots allotted to appointments for chronic conditions.

But diabetes care can be severely impacted by depression, on many levels. “Patients oftentimes will self-medicate their depression by eating more. They won't check their blood sugar [levels],” she said.

When concentration is hampered by depression, patients will return to the office failing to recall even a simple care plan they agreed to on a previous visit.

“If you're not able to address some of the underlying causes for medication nonadherence, you're not going to get anywhere in terms of clinical treatment,” she said.

Dr. Miller currently screens all of her patients with diabetes using the PHQ-9 at least once a year. When patients screen positive, she sees them more often than usual–at least three times in 90 days if they are receiving an antidepressant–and rescreens them with the PHQ-9 every 4–6 weeks.

She has seen clear benefits of this approach in her own practice, she said.

She described a patient in her late 50s whose diabetes control was falling apart even as she coped with the loss of a job and ensuing financial difficulties and weight gain. By identifying her depression and helping her to implement a self-care plan, Dr. Miller was able to watch as her patient became more physically active and lost weight, began an earnest job search, and returned to HbA_1c levels in the range of 7%–8%, down from a level of 10%.

Dr. Miller has no financial ties to Pfizer, sponsor of the PHQ-9.

Addressing some of the underlying causes for medication nonadherence is critical. DR. MILLER

LOS ANGELES – Adherence to a self-care action plan helped primary care patients exceed national goals for reducing their depression, reported Dr. Doriane C. Miller, associate division chief of general internal medicine at Stroger Hospital of Cook County in Chicago.

The study of 403 depressed adults in rural South Carolina has implications for improving outcomes for patients with diabetes, whose depression undermines their ability to manage a complex disease, she said at the annual meeting of the American Association of Diabetes Educators.

Patients at CareSouth, a series of federally qualified health centers serving mostly minority, low-income residents, were screened using the Patient Health Questionnaire-9 (PHQ-9), an instrument made available by Pfizer (www.pfizer.com/pfizer/phq-9/index.jsp

Those patients whose scores indicated they had clinically significant depression were enrolled in a collaborative self-management program that included the Depression Self-Care Action Plan (www.collaborativeselfmanagement.org/uploads/ManagingDepression.pdf

Focusing on “simple goals and small steps,” the plan helps patients establish concrete ways to stay physically active, engage in pleasurable activities, spend time with supportive people, incorporate relaxation into their daily lives, and identify life stresses and ways to deal with them.

It's a “living process document,” reviewed at appointments and adapted to the reality of patients' often troubled lives, Dr. Miller said.

After 1 year, 56% of patients had reduced their depression scores by more than 50%, compared with a national goal of 40%. Fully 85% of patients had documented their self-management of depression, compared with a national goal of 70%. About one-fourth of patients participating in the depression collaborative, sponsored by the Health Resources and Services Administration's Bureau of Primary Health Care, had diabetes as a comorbidity.

Perhaps most dramatically, 53% of patients no longer met the PHQ-9 threshold for depression, compared with a national goal of 40%.

“We find this kind of self-care action plan can be a very useful tool for people who have depression and, particularly, people with diabetes [who have depression],” said Dr. Miller, who also serves as national program director of Quality Allies, an effort aimed at improving ambulatory care that is sponsored by the Robert Wood Johnson Foundation and the California HealthCare Foundation.

As many as one in four patients with diabetes have depression, but it can be missed in quick office visits or disguised as hostility, apathetic noncompliance, or a seeming inability to concentrate and follow directions.

People with diabetes are especially burdened by a sense of hopelessness and helplessness about downstream consequences of their disease, such as amputation, blindness, myocardial infarction, or stroke, Dr. Miller said.

“It can have a strong influence on their thinking,” she said. “[They start thinking] 'if it happened to my brother, my grandfather, my mother, it's going to happen to me. It's just a hopeless situation and something I need to bear.'”

Dr. Miller said primary care physicians often don't even want to ask about depression, since they feel unable to deal with it in the 15-minute time slots allotted to appointments for chronic conditions.

But diabetes care can be severely impacted by depression, on many levels. “Patients oftentimes will self-medicate their depression by eating more. They won't check their blood sugar [levels],” she said.

When concentration is hampered by depression, patients will return to the office failing to recall even a simple care plan they agreed to on a previous visit.

“If you're not able to address some of the underlying causes for medication nonadherence, you're not going to get anywhere in terms of clinical treatment,” she said.

Dr. Miller currently screens all of her patients with diabetes using the PHQ-9 at least once a year. When patients screen positive, she sees them more often than usual–at least three times in 90 days if they are receiving an antidepressant–and rescreens them with the PHQ-9 every 4–6 weeks.

She has seen clear benefits of this approach in her own practice, she said.

She described a patient in her late 50s whose diabetes control was falling apart even as she coped with the loss of a job and ensuing financial difficulties and weight gain. By identifying her depression and helping her to implement a self-care plan, Dr. Miller was able to watch as her patient became more physically active and lost weight, began an earnest job search, and returned to HbA_1c levels in the range of 7%–8%, down from a level of 10%.

Dr. Miller has no financial ties to Pfizer, sponsor of the PHQ-9.

Addressing some of the underlying causes for medication nonadherence is critical. DR. MILLER

LOS ANGELES – Adherence to a self-care action plan helped primary care patients exceed national goals for reducing their depression, reported Dr. Doriane C. Miller, associate division chief of general internal medicine at Stroger Hospital of Cook County in Chicago.

The study of 403 depressed adults in rural South Carolina has implications for improving outcomes for patients with diabetes, whose depression undermines their ability to manage a complex disease, she said at the annual meeting of the American Association of Diabetes Educators.

Patients at CareSouth, a series of federally qualified health centers serving mostly minority, low-income residents, were screened using the Patient Health Questionnaire-9 (PHQ-9), an instrument made available by Pfizer (www.pfizer.com/pfizer/phq-9/index.jsp

Those patients whose scores indicated they had clinically significant depression were enrolled in a collaborative self-management program that included the Depression Self-Care Action Plan (www.collaborativeselfmanagement.org/uploads/ManagingDepression.pdf

Focusing on “simple goals and small steps,” the plan helps patients establish concrete ways to stay physically active, engage in pleasurable activities, spend time with supportive people, incorporate relaxation into their daily lives, and identify life stresses and ways to deal with them.

It's a “living process document,” reviewed at appointments and adapted to the reality of patients' often troubled lives, Dr. Miller said.

After 1 year, 56% of patients had reduced their depression scores by more than 50%, compared with a national goal of 40%. Fully 85% of patients had documented their self-management of depression, compared with a national goal of 70%. About one-fourth of patients participating in the depression collaborative, sponsored by the Health Resources and Services Administration's Bureau of Primary Health Care, had diabetes as a comorbidity.

Perhaps most dramatically, 53% of patients no longer met the PHQ-9 threshold for depression, compared with a national goal of 40%.

“We find this kind of self-care action plan can be a very useful tool for people who have depression and, particularly, people with diabetes [who have depression],” said Dr. Miller, who also serves as national program director of Quality Allies, an effort aimed at improving ambulatory care that is sponsored by the Robert Wood Johnson Foundation and the California HealthCare Foundation.

As many as one in four patients with diabetes have depression, but it can be missed in quick office visits or disguised as hostility, apathetic noncompliance, or a seeming inability to concentrate and follow directions.

People with diabetes are especially burdened by a sense of hopelessness and helplessness about downstream consequences of their disease, such as amputation, blindness, myocardial infarction, or stroke, Dr. Miller said.

“It can have a strong influence on their thinking,” she said. “[They start thinking] 'if it happened to my brother, my grandfather, my mother, it's going to happen to me. It's just a hopeless situation and something I need to bear.'”

Dr. Miller said primary care physicians often don't even want to ask about depression, since they feel unable to deal with it in the 15-minute time slots allotted to appointments for chronic conditions.

But diabetes care can be severely impacted by depression, on many levels. “Patients oftentimes will self-medicate their depression by eating more. They won't check their blood sugar [levels],” she said.

When concentration is hampered by depression, patients will return to the office failing to recall even a simple care plan they agreed to on a previous visit.

“If you're not able to address some of the underlying causes for medication nonadherence, you're not going to get anywhere in terms of clinical treatment,” she said.

Dr. Miller currently screens all of her patients with diabetes using the PHQ-9 at least once a year. When patients screen positive, she sees them more often than usual–at least three times in 90 days if they are receiving an antidepressant–and rescreens them with the PHQ-9 every 4–6 weeks.

She has seen clear benefits of this approach in her own practice, she said.

She described a patient in her late 50s whose diabetes control was falling apart even as she coped with the loss of a job and ensuing financial difficulties and weight gain. By identifying her depression and helping her to implement a self-care plan, Dr. Miller was able to watch as her patient became more physically active and lost weight, began an earnest job search, and returned to HbA_1c levels in the range of 7%–8%, down from a level of 10%.

Dr. Miller has no financial ties to Pfizer, sponsor of the PHQ-9.

Addressing some of the underlying causes for medication nonadherence is critical. DR. MILLER

Women younger than age 60 have “a remarkably higher rate of depression at the time of acute myocardial infarction, compared with the other demographic groups,” reported Dr. Susmita Mallik of Emory University, Atlanta, and her associates.

The researchers found that 40% of women aged 60 or younger had moderate or worse clinical depression in the multicenter PREMIER study, which enrolled nearly 2,500 MI patients.

“Even after adjusting for various demographic, behavioral, medical history, and clinical factors,” their odds of depression were significantly higher than for other groups and remained over three times higher than those for the reference group, which was men older than 60 years.

It seems likely that this high rate of depression may explain, at least in part, the higher rate of adverse outcomes after MI that has been noted in women, compared with men. Depression predicts higher mortality in MI, with a clear dose-response relationship between severity of depressive symptoms and mortality risk. Depression also is linked to longer hospitalization and worse symptomatic, psychological, and social outcomes.

To date, no study has evaluated the potential role that depression may play in this MI gender gap, Dr. Mallik and her associates noted (Arch. Intern. Med. 2006;166:876–83).

The PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study recruited 2,498 MI patients treated at 19 U.S. medical centers during 2003–2004. Participants were interviewed at admission for MI on sociodemographic, behavioral, and psychosocial factors as well as clinical factors.

Depressive symptoms at presentation were assessed using the nine-question Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire. Possible scores range from 0 to 27, and a score of 10 or higher indicates major depression of a moderate or worse degree.

Major depression was common, with an overall rate of 22%. Younger age, African American race, unmarried status, low levels of social support, and unfavorable socioeconomic indicators all positively correlated with depression.

Women under 60 years had the highest prevalence of depression, 40%, and the highest depression scores, indicating that they experienced more depressive symptoms as well as more severe symptoms than did men and older patients. After the data were adjusted for numerous potentially confounding factors, the odds of depression for women under 60 remained 3.1 times higher than those for the reference group of men over 60.

The cause remains unknown because the study was not designed to examine possible causes. Similarly, the researchers could not determine whether the depressive symptoms were secondary to MI or began shortly before its onset.

Nevertheless, “clinicians should be aware that younger women have a high susceptibility for being depressed after acute MI. Although screening for depression is warranted in all acute MI patients, screening should be particularly aggressive in younger female patients with acute MI,” the researchers stressed.

“Depression was largely unrecognized and untreated in our study,” Dr. Mallik and her associates noted.

Of the depressed patients, 73% had no history of depression when they presented with MI, which suggests the disorder was either unrecognized or that it developed for the first time in association with MI.

Notably, only 18% of the depressed patients were discharged with prescriptions for antidepressants. Clinicians should be reminded that “depression in patients with MI remains a serious condition and deserves treatment,” the researchers said.

“In addition to being an important illness in its own right, depression during hospitalization with acute MI confers 3–5 times higher adjusted odds of death” within 6 months, they added.

Women younger than age 60 have “a remarkably higher rate of depression at the time of acute myocardial infarction, compared with the other demographic groups,” reported Dr. Susmita Mallik of Emory University, Atlanta, and her associates.

The researchers found that 40% of women aged 60 or younger had moderate or worse clinical depression in the multicenter PREMIER study, which enrolled nearly 2,500 MI patients.

“Even after adjusting for various demographic, behavioral, medical history, and clinical factors,” their odds of depression were significantly higher than for other groups and remained over three times higher than those for the reference group, which was men older than 60 years.

It seems likely that this high rate of depression may explain, at least in part, the higher rate of adverse outcomes after MI that has been noted in women, compared with men. Depression predicts higher mortality in MI, with a clear dose-response relationship between severity of depressive symptoms and mortality risk. Depression also is linked to longer hospitalization and worse symptomatic, psychological, and social outcomes.

To date, no study has evaluated the potential role that depression may play in this MI gender gap, Dr. Mallik and her associates noted (Arch. Intern. Med. 2006;166:876–83).

The PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study recruited 2,498 MI patients treated at 19 U.S. medical centers during 2003–2004. Participants were interviewed at admission for MI on sociodemographic, behavioral, and psychosocial factors as well as clinical factors.

Depressive symptoms at presentation were assessed using the nine-question Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire. Possible scores range from 0 to 27, and a score of 10 or higher indicates major depression of a moderate or worse degree.

Major depression was common, with an overall rate of 22%. Younger age, African American race, unmarried status, low levels of social support, and unfavorable socioeconomic indicators all positively correlated with depression.

Women under 60 years had the highest prevalence of depression, 40%, and the highest depression scores, indicating that they experienced more depressive symptoms as well as more severe symptoms than did men and older patients. After the data were adjusted for numerous potentially confounding factors, the odds of depression for women under 60 remained 3.1 times higher than those for the reference group of men over 60.

The cause remains unknown because the study was not designed to examine possible causes. Similarly, the researchers could not determine whether the depressive symptoms were secondary to MI or began shortly before its onset.

Nevertheless, “clinicians should be aware that younger women have a high susceptibility for being depressed after acute MI. Although screening for depression is warranted in all acute MI patients, screening should be particularly aggressive in younger female patients with acute MI,” the researchers stressed.

“Depression was largely unrecognized and untreated in our study,” Dr. Mallik and her associates noted.

Of the depressed patients, 73% had no history of depression when they presented with MI, which suggests the disorder was either unrecognized or that it developed for the first time in association with MI.

Notably, only 18% of the depressed patients were discharged with prescriptions for antidepressants. Clinicians should be reminded that “depression in patients with MI remains a serious condition and deserves treatment,” the researchers said.

“In addition to being an important illness in its own right, depression during hospitalization with acute MI confers 3–5 times higher adjusted odds of death” within 6 months, they added.

Women younger than age 60 have “a remarkably higher rate of depression at the time of acute myocardial infarction, compared with the other demographic groups,” reported Dr. Susmita Mallik of Emory University, Atlanta, and her associates.

The researchers found that 40% of women aged 60 or younger had moderate or worse clinical depression in the multicenter PREMIER study, which enrolled nearly 2,500 MI patients.

“Even after adjusting for various demographic, behavioral, medical history, and clinical factors,” their odds of depression were significantly higher than for other groups and remained over three times higher than those for the reference group, which was men older than 60 years.

It seems likely that this high rate of depression may explain, at least in part, the higher rate of adverse outcomes after MI that has been noted in women, compared with men. Depression predicts higher mortality in MI, with a clear dose-response relationship between severity of depressive symptoms and mortality risk. Depression also is linked to longer hospitalization and worse symptomatic, psychological, and social outcomes.

To date, no study has evaluated the potential role that depression may play in this MI gender gap, Dr. Mallik and her associates noted (Arch. Intern. Med. 2006;166:876–83).

The PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study recruited 2,498 MI patients treated at 19 U.S. medical centers during 2003–2004. Participants were interviewed at admission for MI on sociodemographic, behavioral, and psychosocial factors as well as clinical factors.

Depressive symptoms at presentation were assessed using the nine-question Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire. Possible scores range from 0 to 27, and a score of 10 or higher indicates major depression of a moderate or worse degree.

Major depression was common, with an overall rate of 22%. Younger age, African American race, unmarried status, low levels of social support, and unfavorable socioeconomic indicators all positively correlated with depression.

Women under 60 years had the highest prevalence of depression, 40%, and the highest depression scores, indicating that they experienced more depressive symptoms as well as more severe symptoms than did men and older patients. After the data were adjusted for numerous potentially confounding factors, the odds of depression for women under 60 remained 3.1 times higher than those for the reference group of men over 60.

The cause remains unknown because the study was not designed to examine possible causes. Similarly, the researchers could not determine whether the depressive symptoms were secondary to MI or began shortly before its onset.

Nevertheless, “clinicians should be aware that younger women have a high susceptibility for being depressed after acute MI. Although screening for depression is warranted in all acute MI patients, screening should be particularly aggressive in younger female patients with acute MI,” the researchers stressed.

“Depression was largely unrecognized and untreated in our study,” Dr. Mallik and her associates noted.

Of the depressed patients, 73% had no history of depression when they presented with MI, which suggests the disorder was either unrecognized or that it developed for the first time in association with MI.

Notably, only 18% of the depressed patients were discharged with prescriptions for antidepressants. Clinicians should be reminded that “depression in patients with MI remains a serious condition and deserves treatment,” the researchers said.

“In addition to being an important illness in its own right, depression during hospitalization with acute MI confers 3–5 times higher adjusted odds of death” within 6 months, they added.

Comorbid depression in type 2 diabetic males is significantly associated with a range of adverse heart events, a study has shown. Treatment with antidepressant medications, however, appears to substantially moderate this link, according to Dr. Thomas S. Higgins Jr. of the University of Louisville (Ky.) and colleagues.

Previous studies have shown an increased prevalence of depression among type 2 diabetics. Because diabetes is a known risk factor for heart disease and because depressive symptoms have been associated with an increased prevalence of comorbid myocardial infraction, hypertension, and angina in certain diabetic populations, Dr. Higgins and colleagues sought to determine whether comorbid depression and diabetes together produce greater cardiac health risk than either condition alone.

The investigators reviewed data for 8,185 males over age 40 collected from the electronic medical record system of a Midwestern Veterans Affairs Medical Center (VAMC). All of the subjects had a history of type 2 diabetes and had visited the VAMC within the previous 6 years (Diabetes Res. Clin. Pract. 2006, Jul. 31 [Epub ahead of print]).

Of the 8,815 subjects, 691 had been diagnosed with depression. These individuals tended to be younger and unmarried relative to their nondepressed counterparts, and they were more likely to have a history of smoking and non-heart-related chronic diseases. More than half (57.2%) had been prescribed antidepressant medication.

A total of 2,358 subjects had been diagnosed with heart disease, such as coronary artery disease or myocardial infarction, or had undergone a heart disease-related procedure, such as angioplasty or coronary artery bypass graft (CABG). Subjects in this “adverse heart event” category were more likely to have diagnoses of depression, chronic obstructive pulmonary disease, stroke, hypertension, prostate cancer, and hyperlipidemia than subjects without prior heart events. They were also more likely to be white and to have been prescribed antidepressants.

The investigators used odds ratios to examine the link between depression status and the occurrence of each adverse heart event, and they used logistic regression to control for potential confounding variables. They performed an additional logistic regression analysis in which antidepressant medication status was included as a confounding variable, to evaluate antidepressant prescription status as a moderating variable and the interaction between depression and antidepressant status.

After adjustment for all significant confounders, the analysis demonstrated significant positive associations between depression and any adverse heart event and with each individual heart event except CABG. There was also a significant interaction between depression and antidepressant prescription status for any adverse heart event, coronary artery disease, and angioplasty. After adjustment for this interaction, the associations between depression and adverse cardiac events were no longer significant among the subjects who had been prescribed antidepressant medications; however, they remained significant for those not given antidepressants, the authors wrote.

Although the findings suggest that depressed diabetics are at increased risk for heart disease and that treating depression in diabetics may reduce this increased risk, the study has several limitations, the authors noted. Its cross-sectional design precludes determining which condition presented first and thus cannot be used to suggest a causal relationship. Also, there may be inconsistencies in data quality across the study population, the study may have missed patients who died at the time of their first adverse cardiac event or who received treatment at another hospital, and there is no information on level and duration of antidepressant use. Finally, the inclusion of only older male patients from one center limits the generalizability of the data, they said.

Comorbid depression in type 2 diabetic males is significantly associated with a range of adverse heart events, a study has shown. Treatment with antidepressant medications, however, appears to substantially moderate this link, according to Dr. Thomas S. Higgins Jr. of the University of Louisville (Ky.) and colleagues.

Previous studies have shown an increased prevalence of depression among type 2 diabetics. Because diabetes is a known risk factor for heart disease and because depressive symptoms have been associated with an increased prevalence of comorbid myocardial infraction, hypertension, and angina in certain diabetic populations, Dr. Higgins and colleagues sought to determine whether comorbid depression and diabetes together produce greater cardiac health risk than either condition alone.

The investigators reviewed data for 8,185 males over age 40 collected from the electronic medical record system of a Midwestern Veterans Affairs Medical Center (VAMC). All of the subjects had a history of type 2 diabetes and had visited the VAMC within the previous 6 years (Diabetes Res. Clin. Pract. 2006, Jul. 31 [Epub ahead of print]).

Of the 8,815 subjects, 691 had been diagnosed with depression. These individuals tended to be younger and unmarried relative to their nondepressed counterparts, and they were more likely to have a history of smoking and non-heart-related chronic diseases. More than half (57.2%) had been prescribed antidepressant medication.

A total of 2,358 subjects had been diagnosed with heart disease, such as coronary artery disease or myocardial infarction, or had undergone a heart disease-related procedure, such as angioplasty or coronary artery bypass graft (CABG). Subjects in this “adverse heart event” category were more likely to have diagnoses of depression, chronic obstructive pulmonary disease, stroke, hypertension, prostate cancer, and hyperlipidemia than subjects without prior heart events. They were also more likely to be white and to have been prescribed antidepressants.

The investigators used odds ratios to examine the link between depression status and the occurrence of each adverse heart event, and they used logistic regression to control for potential confounding variables. They performed an additional logistic regression analysis in which antidepressant medication status was included as a confounding variable, to evaluate antidepressant prescription status as a moderating variable and the interaction between depression and antidepressant status.

After adjustment for all significant confounders, the analysis demonstrated significant positive associations between depression and any adverse heart event and with each individual heart event except CABG. There was also a significant interaction between depression and antidepressant prescription status for any adverse heart event, coronary artery disease, and angioplasty. After adjustment for this interaction, the associations between depression and adverse cardiac events were no longer significant among the subjects who had been prescribed antidepressant medications; however, they remained significant for those not given antidepressants, the authors wrote.

Although the findings suggest that depressed diabetics are at increased risk for heart disease and that treating depression in diabetics may reduce this increased risk, the study has several limitations, the authors noted. Its cross-sectional design precludes determining which condition presented first and thus cannot be used to suggest a causal relationship. Also, there may be inconsistencies in data quality across the study population, the study may have missed patients who died at the time of their first adverse cardiac event or who received treatment at another hospital, and there is no information on level and duration of antidepressant use. Finally, the inclusion of only older male patients from one center limits the generalizability of the data, they said.

Comorbid depression in type 2 diabetic males is significantly associated with a range of adverse heart events, a study has shown. Treatment with antidepressant medications, however, appears to substantially moderate this link, according to Dr. Thomas S. Higgins Jr. of the University of Louisville (Ky.) and colleagues.

Previous studies have shown an increased prevalence of depression among type 2 diabetics. Because diabetes is a known risk factor for heart disease and because depressive symptoms have been associated with an increased prevalence of comorbid myocardial infraction, hypertension, and angina in certain diabetic populations, Dr. Higgins and colleagues sought to determine whether comorbid depression and diabetes together produce greater cardiac health risk than either condition alone.

The investigators reviewed data for 8,185 males over age 40 collected from the electronic medical record system of a Midwestern Veterans Affairs Medical Center (VAMC). All of the subjects had a history of type 2 diabetes and had visited the VAMC within the previous 6 years (Diabetes Res. Clin. Pract. 2006, Jul. 31 [Epub ahead of print]).

Of the 8,815 subjects, 691 had been diagnosed with depression. These individuals tended to be younger and unmarried relative to their nondepressed counterparts, and they were more likely to have a history of smoking and non-heart-related chronic diseases. More than half (57.2%) had been prescribed antidepressant medication.

A total of 2,358 subjects had been diagnosed with heart disease, such as coronary artery disease or myocardial infarction, or had undergone a heart disease-related procedure, such as angioplasty or coronary artery bypass graft (CABG). Subjects in this “adverse heart event” category were more likely to have diagnoses of depression, chronic obstructive pulmonary disease, stroke, hypertension, prostate cancer, and hyperlipidemia than subjects without prior heart events. They were also more likely to be white and to have been prescribed antidepressants.

The investigators used odds ratios to examine the link between depression status and the occurrence of each adverse heart event, and they used logistic regression to control for potential confounding variables. They performed an additional logistic regression analysis in which antidepressant medication status was included as a confounding variable, to evaluate antidepressant prescription status as a moderating variable and the interaction between depression and antidepressant status.

After adjustment for all significant confounders, the analysis demonstrated significant positive associations between depression and any adverse heart event and with each individual heart event except CABG. There was also a significant interaction between depression and antidepressant prescription status for any adverse heart event, coronary artery disease, and angioplasty. After adjustment for this interaction, the associations between depression and adverse cardiac events were no longer significant among the subjects who had been prescribed antidepressant medications; however, they remained significant for those not given antidepressants, the authors wrote.

Although the findings suggest that depressed diabetics are at increased risk for heart disease and that treating depression in diabetics may reduce this increased risk, the study has several limitations, the authors noted. Its cross-sectional design precludes determining which condition presented first and thus cannot be used to suggest a causal relationship. Also, there may be inconsistencies in data quality across the study population, the study may have missed patients who died at the time of their first adverse cardiac event or who received treatment at another hospital, and there is no information on level and duration of antidepressant use. Finally, the inclusion of only older male patients from one center limits the generalizability of the data, they said.

SAN FRANCISCO – Preteens and adolescents with asthma who were also depressed or anxious had asthma symptoms on significantly more days and were more prone to individual symptoms, according to a study presented at the annual meeting of the Pediatric Academic Societies.

Based on these findings, the investigators urged physicians to screen for anxiety and depressive disorders when young people have asthma symptoms that do not respond to medication.

“We conclude that youth with asthma and depressive disorders do have a higher symptom burden, and providers should consider screening for depression in youth with high symptom burden if they are not responding to medication or treatment as expected,” Dr. Laura Richardson said in a poster presentation.

The researchers surveyed by telephone 767 young people, 11–17 years of age, who had asthma and were enrolled in a staff-model health maintenance organization to assess the number of days of asthma symptoms each participant had experienced in the 2 weeks prior to a call and the incidence of individual symptoms.

A total of 125 respondents (16%) were found to have anxiety or depressive disorders, while 642 did not (84%). Nearly two-thirds of the depressed youth but fewer than half of the other respondents were female. Both groups were 14 years old on average, reported Dr. Richardson, a pediatrician specializing in adolescent medicine at the University of Washington in Seattle.

Similar proportions of both groups met Health Plan Employer Data Information Set (HEDIS) asthma severity criteria: 69% of the depressed group and 70% of those who were not depressed. The depressed patients had higher Chronic Disease Scores, however (795 vs. 581).

“After controlling for asthma severity and other covariates, [we found that] youth with anxiety or depressive disorders had an average of 5.4 symptom days in the prior 2 weeks, compared to 3.5 days in those without anxiety or depressive disorders,” Dr. Richardson said.

The respondents with anxiety or depressive disorders also were significantly more likely than the other respondents to report each of six asthma-specific symptoms (wheezing with a cold, cold that won't go away, cough, wheezing without a cold, tightness in chest, and shortness of breath) and five less-specific symptoms (difficulty sleeping, stuffy nose/congestion, itchy eyes, skin rash, and headache).

In addition, the investigators charted a linear relationship between the number of symptoms of anxiety and depression and the number of asthma symptoms that the patients reported. “The more anxiety and depression you have, the more asthma you have,” Dr. Richardson said in an interview before her presentation at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.

'Providersshould consider screening for depression' if kids are not responding to treatment. DR. RICHARDSON

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO – Preteens and adolescents with asthma who were also depressed or anxious had asthma symptoms on significantly more days and were more prone to individual symptoms, according to a study presented at the annual meeting of the Pediatric Academic Societies.

Based on these findings, the investigators urged physicians to screen for anxiety and depressive disorders when young people have asthma symptoms that do not respond to medication.

“We conclude that youth with asthma and depressive disorders do have a higher symptom burden, and providers should consider screening for depression in youth with high symptom burden if they are not responding to medication or treatment as expected,” Dr. Laura Richardson said in a poster presentation.

The researchers surveyed by telephone 767 young people, 11–17 years of age, who had asthma and were enrolled in a staff-model health maintenance organization to assess the number of days of asthma symptoms each participant had experienced in the 2 weeks prior to a call and the incidence of individual symptoms.

A total of 125 respondents (16%) were found to have anxiety or depressive disorders, while 642 did not (84%). Nearly two-thirds of the depressed youth but fewer than half of the other respondents were female. Both groups were 14 years old on average, reported Dr. Richardson, a pediatrician specializing in adolescent medicine at the University of Washington in Seattle.

Similar proportions of both groups met Health Plan Employer Data Information Set (HEDIS) asthma severity criteria: 69% of the depressed group and 70% of those who were not depressed. The depressed patients had higher Chronic Disease Scores, however (795 vs. 581).

“After controlling for asthma severity and other covariates, [we found that] youth with anxiety or depressive disorders had an average of 5.4 symptom days in the prior 2 weeks, compared to 3.5 days in those without anxiety or depressive disorders,” Dr. Richardson said.

The respondents with anxiety or depressive disorders also were significantly more likely than the other respondents to report each of six asthma-specific symptoms (wheezing with a cold, cold that won't go away, cough, wheezing without a cold, tightness in chest, and shortness of breath) and five less-specific symptoms (difficulty sleeping, stuffy nose/congestion, itchy eyes, skin rash, and headache).

In addition, the investigators charted a linear relationship between the number of symptoms of anxiety and depression and the number of asthma symptoms that the patients reported. “The more anxiety and depression you have, the more asthma you have,” Dr. Richardson said in an interview before her presentation at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.

'Providersshould consider screening for depression' if kids are not responding to treatment. DR. RICHARDSON

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO – Preteens and adolescents with asthma who were also depressed or anxious had asthma symptoms on significantly more days and were more prone to individual symptoms, according to a study presented at the annual meeting of the Pediatric Academic Societies.

Based on these findings, the investigators urged physicians to screen for anxiety and depressive disorders when young people have asthma symptoms that do not respond to medication.

“We conclude that youth with asthma and depressive disorders do have a higher symptom burden, and providers should consider screening for depression in youth with high symptom burden if they are not responding to medication or treatment as expected,” Dr. Laura Richardson said in a poster presentation.

The researchers surveyed by telephone 767 young people, 11–17 years of age, who had asthma and were enrolled in a staff-model health maintenance organization to assess the number of days of asthma symptoms each participant had experienced in the 2 weeks prior to a call and the incidence of individual symptoms.

A total of 125 respondents (16%) were found to have anxiety or depressive disorders, while 642 did not (84%). Nearly two-thirds of the depressed youth but fewer than half of the other respondents were female. Both groups were 14 years old on average, reported Dr. Richardson, a pediatrician specializing in adolescent medicine at the University of Washington in Seattle.

Similar proportions of both groups met Health Plan Employer Data Information Set (HEDIS) asthma severity criteria: 69% of the depressed group and 70% of those who were not depressed. The depressed patients had higher Chronic Disease Scores, however (795 vs. 581).

“After controlling for asthma severity and other covariates, [we found that] youth with anxiety or depressive disorders had an average of 5.4 symptom days in the prior 2 weeks, compared to 3.5 days in those without anxiety or depressive disorders,” Dr. Richardson said.

The respondents with anxiety or depressive disorders also were significantly more likely than the other respondents to report each of six asthma-specific symptoms (wheezing with a cold, cold that won't go away, cough, wheezing without a cold, tightness in chest, and shortness of breath) and five less-specific symptoms (difficulty sleeping, stuffy nose/congestion, itchy eyes, skin rash, and headache).

In addition, the investigators charted a linear relationship between the number of symptoms of anxiety and depression and the number of asthma symptoms that the patients reported. “The more anxiety and depression you have, the more asthma you have,” Dr. Richardson said in an interview before her presentation at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.

'Providersshould consider screening for depression' if kids are not responding to treatment. DR. RICHARDSON

ELSEVIER GLOBAL MEDICAL NEWS

MIAMI – Athletic patients with significant musculoskeletal pain should be screened for comorbid depression and panic disorder, according to study findings presented at the annual meeting of the American Medical Society for Sports Medicine.

In a study of 148 consecutively-treated athletic patients who presented to a sports medicine clinic with musculoskeletal complaints, the overall prevalence of a major depressive disorder was 6%; 7% had another form of depression.

Dr. William W. Dexter and his associates at the Maine Medical Center sports medicine program in Portland surveyed participants using the Primary Care Evaluation of Mental Disorders (PRIME-MD) patient questionnaire.

Although these overall prevalence rates are similar to those in a general primary care practice, the prevalence of mood disorders was even higher among those patients who presented with pain severity scores of 6 or higher on a scale of 0–10, Dr. Dexter noted in an interview.

Overall, the prevalence of panic disorder was 17%.

Although the association between mood disorders and musculoskeletal pain has been documented in the literature, there are no data on the prevalence of mental health disorders in a primary care sports medicine population. “In our clinic, we felt we were seeing a lot of musculoskeletal complaints in patients who had an undiagnosed or underdiagnosed mood disorder,” Dr. Dexter said.

If patients' comorbid depression and/or panic disorder are not addressed, significant improvements in musculoskeletal pain are unlikely, he added.

“Many of the subjects in the study did not have a prior diagnosis of mood disorder,” Dr. Dexter said. They were identified through screening with the PRIME-MD tool

MIAMI – Athletic patients with significant musculoskeletal pain should be screened for comorbid depression and panic disorder, according to study findings presented at the annual meeting of the American Medical Society for Sports Medicine.

In a study of 148 consecutively-treated athletic patients who presented to a sports medicine clinic with musculoskeletal complaints, the overall prevalence of a major depressive disorder was 6%; 7% had another form of depression.

Dr. William W. Dexter and his associates at the Maine Medical Center sports medicine program in Portland surveyed participants using the Primary Care Evaluation of Mental Disorders (PRIME-MD) patient questionnaire.

Although these overall prevalence rates are similar to those in a general primary care practice, the prevalence of mood disorders was even higher among those patients who presented with pain severity scores of 6 or higher on a scale of 0–10, Dr. Dexter noted in an interview.

Overall, the prevalence of panic disorder was 17%.

Although the association between mood disorders and musculoskeletal pain has been documented in the literature, there are no data on the prevalence of mental health disorders in a primary care sports medicine population. “In our clinic, we felt we were seeing a lot of musculoskeletal complaints in patients who had an undiagnosed or underdiagnosed mood disorder,” Dr. Dexter said.

If patients' comorbid depression and/or panic disorder are not addressed, significant improvements in musculoskeletal pain are unlikely, he added.

“Many of the subjects in the study did not have a prior diagnosis of mood disorder,” Dr. Dexter said. They were identified through screening with the PRIME-MD tool

MIAMI – Athletic patients with significant musculoskeletal pain should be screened for comorbid depression and panic disorder, according to study findings presented at the annual meeting of the American Medical Society for Sports Medicine.

In a study of 148 consecutively-treated athletic patients who presented to a sports medicine clinic with musculoskeletal complaints, the overall prevalence of a major depressive disorder was 6%; 7% had another form of depression.

Dr. William W. Dexter and his associates at the Maine Medical Center sports medicine program in Portland surveyed participants using the Primary Care Evaluation of Mental Disorders (PRIME-MD) patient questionnaire.

Although these overall prevalence rates are similar to those in a general primary care practice, the prevalence of mood disorders was even higher among those patients who presented with pain severity scores of 6 or higher on a scale of 0–10, Dr. Dexter noted in an interview.

Overall, the prevalence of panic disorder was 17%.

Although the association between mood disorders and musculoskeletal pain has been documented in the literature, there are no data on the prevalence of mental health disorders in a primary care sports medicine population. “In our clinic, we felt we were seeing a lot of musculoskeletal complaints in patients who had an undiagnosed or underdiagnosed mood disorder,” Dr. Dexter said.

If patients' comorbid depression and/or panic disorder are not addressed, significant improvements in musculoskeletal pain are unlikely, he added.

“Many of the subjects in the study did not have a prior diagnosis of mood disorder,” Dr. Dexter said. They were identified through screening with the PRIME-MD tool

The “changing hormonal milieu” of menopause is strongly associated with new-onset major depression as well as depressive symptoms in women with no history of mood disturbance, reported Ellen W. Freeman, Ph.D., of the departments of ob.gyn. and psychiatry at the University of Pennsylvania, Philadelphia, and her associates in the Penn Ovarian Aging Study.

Women are significantly more likely to develop a depressive disorder when their levels of estradiol fluctuate, levels of FSH and LH increase, and levels of inhibin B decrease, as happens during the transition to menopause. It appears that the hormonal changes characteristic of ovarian aging produce “destabilizing effects” that contribute to depression, the investigators said (Arch. Gen. Psychiatry 2006;63:375–82).

This finding should make a substantial contribution to what has been only “limited evidence” in the literature about mood symptoms in the perimenopausal years. “Whether mood symptoms increase in the perimenopausal years and whether the occurrence of depressed mood is independently associated with ovarian changes or is secondary to vasomotor or other bothersome symptoms” has been controversial, they noted.

Dr. Freeman and her associates examined the issue by assessing fluctuations in reproductive hormone levels in 231 premenopausal women aged 35–47 years at baseline who were followed for 8 years. During that interval, 43% of the women entered the transition to menopause.

Hormone assays were conducted in 10 assessment periods, the first 6 at 8-month intervals. Blood samples were collected at the start of menstrual cycles. Depressive symptoms were assessed using the CES-D (Center for Epidemiological Studies-Depression) scale; either the PRIME-MD (Primary Care Evaluation of Mental Disorders) or the PHQ (Patient Health Questionnaire) was used to detect major depressive disorder.

A total of 116 women (50%) were found to have depressive symptoms on the CES-D during follow-up. Of these, 16 women had depressive symptoms on two consecutive assessments and 35 had them on three or more consecutive assessments.

Of the 231 women, 59 (26%) were found to have depressive disorders on the PRIME-MD or PHQ; 26 had major depressive disorder and 33 had other depressive disorders. Nine of the women had depressive disorders on two consecutive assessments and four had them on three or more consecutive assessments.

A total of 108 women (47%) showed no depressive symptoms on either measure, Dr. Freeman and her associates said.

Changes in individual women's levels of FSH, LH, and inhibin B were significantly associated with depressive symptoms and with major depression. Similarly, variability in a woman's mean levels of estradiol, FSH, and LH also were linked to depression and depressive symptoms. “On average, the women were 4.58 times more likely to have higher FSH levels … 3 times more likely to have higher LH levels … and 63% more likely to have lower inhibin B levels … at the time of high [depression] scores,” compared with the time before high scores, the investigators said.

After the data were adjusted for several other depression risk factors, including change in employment status or marital status, the researchers found that a woman was, on average, more than five times “more likely to be in menopausal transition at the time of reporting high [depression] scores than she was before the onset of depressive symptoms.”

The “strongest risk factor for the new onset of diagnosed depressive disorders was the increased variability of estradiol (around the woman's own mean levels) at the time of the diagnosed disorder,” Dr. Freeman and her associates said.

However, other health and demographic factors also significantly affected depression risk, “confirming … the multifactorial nature of depressive symptoms.” These factors included hot flashes, body mass index, smoking status, and the presence or absence of PMS.

The 'strongestrisk factor forthe new onset of [depression] was the increased variability of estradiol.' DR. FREEMAN

The “changing hormonal milieu” of menopause is strongly associated with new-onset major depression as well as depressive symptoms in women with no history of mood disturbance, reported Ellen W. Freeman, Ph.D., of the departments of ob.gyn. and psychiatry at the University of Pennsylvania, Philadelphia, and her associates in the Penn Ovarian Aging Study.

Women are significantly more likely to develop a depressive disorder when their levels of estradiol fluctuate, levels of FSH and LH increase, and levels of inhibin B decrease, as happens during the transition to menopause. It appears that the hormonal changes characteristic of ovarian aging produce “destabilizing effects” that contribute to depression, the investigators said (Arch. Gen. Psychiatry 2006;63:375–82).

This finding should make a substantial contribution to what has been only “limited evidence” in the literature about mood symptoms in the perimenopausal years. “Whether mood symptoms increase in the perimenopausal years and whether the occurrence of depressed mood is independently associated with ovarian changes or is secondary to vasomotor or other bothersome symptoms” has been controversial, they noted.

Dr. Freeman and her associates examined the issue by assessing fluctuations in reproductive hormone levels in 231 premenopausal women aged 35–47 years at baseline who were followed for 8 years. During that interval, 43% of the women entered the transition to menopause.

Hormone assays were conducted in 10 assessment periods, the first 6 at 8-month intervals. Blood samples were collected at the start of menstrual cycles. Depressive symptoms were assessed using the CES-D (Center for Epidemiological Studies-Depression) scale; either the PRIME-MD (Primary Care Evaluation of Mental Disorders) or the PHQ (Patient Health Questionnaire) was used to detect major depressive disorder.

A total of 116 women (50%) were found to have depressive symptoms on the CES-D during follow-up. Of these, 16 women had depressive symptoms on two consecutive assessments and 35 had them on three or more consecutive assessments.

Of the 231 women, 59 (26%) were found to have depressive disorders on the PRIME-MD or PHQ; 26 had major depressive disorder and 33 had other depressive disorders. Nine of the women had depressive disorders on two consecutive assessments and four had them on three or more consecutive assessments.

A total of 108 women (47%) showed no depressive symptoms on either measure, Dr. Freeman and her associates said.

Changes in individual women's levels of FSH, LH, and inhibin B were significantly associated with depressive symptoms and with major depression. Similarly, variability in a woman's mean levels of estradiol, FSH, and LH also were linked to depression and depressive symptoms. “On average, the women were 4.58 times more likely to have higher FSH levels … 3 times more likely to have higher LH levels … and 63% more likely to have lower inhibin B levels … at the time of high [depression] scores,” compared with the time before high scores, the investigators said.

After the data were adjusted for several other depression risk factors, including change in employment status or marital status, the researchers found that a woman was, on average, more than five times “more likely to be in menopausal transition at the time of reporting high [depression] scores than she was before the onset of depressive symptoms.”

The “strongest risk factor for the new onset of diagnosed depressive disorders was the increased variability of estradiol (around the woman's own mean levels) at the time of the diagnosed disorder,” Dr. Freeman and her associates said.

However, other health and demographic factors also significantly affected depression risk, “confirming … the multifactorial nature of depressive symptoms.” These factors included hot flashes, body mass index, smoking status, and the presence or absence of PMS.

The 'strongestrisk factor forthe new onset of [depression] was the increased variability of estradiol.' DR. FREEMAN

The “changing hormonal milieu” of menopause is strongly associated with new-onset major depression as well as depressive symptoms in women with no history of mood disturbance, reported Ellen W. Freeman, Ph.D., of the departments of ob.gyn. and psychiatry at the University of Pennsylvania, Philadelphia, and her associates in the Penn Ovarian Aging Study.

Women are significantly more likely to develop a depressive disorder when their levels of estradiol fluctuate, levels of FSH and LH increase, and levels of inhibin B decrease, as happens during the transition to menopause. It appears that the hormonal changes characteristic of ovarian aging produce “destabilizing effects” that contribute to depression, the investigators said (Arch. Gen. Psychiatry 2006;63:375–82).

This finding should make a substantial contribution to what has been only “limited evidence” in the literature about mood symptoms in the perimenopausal years. “Whether mood symptoms increase in the perimenopausal years and whether the occurrence of depressed mood is independently associated with ovarian changes or is secondary to vasomotor or other bothersome symptoms” has been controversial, they noted.

Dr. Freeman and her associates examined the issue by assessing fluctuations in reproductive hormone levels in 231 premenopausal women aged 35–47 years at baseline who were followed for 8 years. During that interval, 43% of the women entered the transition to menopause.

Hormone assays were conducted in 10 assessment periods, the first 6 at 8-month intervals. Blood samples were collected at the start of menstrual cycles. Depressive symptoms were assessed using the CES-D (Center for Epidemiological Studies-Depression) scale; either the PRIME-MD (Primary Care Evaluation of Mental Disorders) or the PHQ (Patient Health Questionnaire) was used to detect major depressive disorder.

A total of 116 women (50%) were found to have depressive symptoms on the CES-D during follow-up. Of these, 16 women had depressive symptoms on two consecutive assessments and 35 had them on three or more consecutive assessments.

Of the 231 women, 59 (26%) were found to have depressive disorders on the PRIME-MD or PHQ; 26 had major depressive disorder and 33 had other depressive disorders. Nine of the women had depressive disorders on two consecutive assessments and four had them on three or more consecutive assessments.

A total of 108 women (47%) showed no depressive symptoms on either measure, Dr. Freeman and her associates said.

Changes in individual women's levels of FSH, LH, and inhibin B were significantly associated with depressive symptoms and with major depression. Similarly, variability in a woman's mean levels of estradiol, FSH, and LH also were linked to depression and depressive symptoms. “On average, the women were 4.58 times more likely to have higher FSH levels … 3 times more likely to have higher LH levels … and 63% more likely to have lower inhibin B levels … at the time of high [depression] scores,” compared with the time before high scores, the investigators said.

After the data were adjusted for several other depression risk factors, including change in employment status or marital status, the researchers found that a woman was, on average, more than five times “more likely to be in menopausal transition at the time of reporting high [depression] scores than she was before the onset of depressive symptoms.”

The “strongest risk factor for the new onset of diagnosed depressive disorders was the increased variability of estradiol (around the woman's own mean levels) at the time of the diagnosed disorder,” Dr. Freeman and her associates said.

However, other health and demographic factors also significantly affected depression risk, “confirming … the multifactorial nature of depressive symptoms.” These factors included hot flashes, body mass index, smoking status, and the presence or absence of PMS.

The 'strongestrisk factor forthe new onset of [depression] was the increased variability of estradiol.' DR. FREEMAN

SALT LAKE CITY – Patients with sleep-related eating disorder may benefit from topiramate treatment, a small study suggests.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 discontinued treatment due to lack of efficacy and 2 others stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients remained on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes. Ten of these 11 patients lost a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested that it is helpful for controlling SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; and the other 8 received topiramate as first-line therapy, noted Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. Those patients had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

SALT LAKE CITY – Patients with sleep-related eating disorder may benefit from topiramate treatment, a small study suggests.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 discontinued treatment due to lack of efficacy and 2 others stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients remained on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes. Ten of these 11 patients lost a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested that it is helpful for controlling SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; and the other 8 received topiramate as first-line therapy, noted Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. Those patients had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

SALT LAKE CITY – Patients with sleep-related eating disorder may benefit from topiramate treatment, a small study suggests.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 discontinued treatment due to lack of efficacy and 2 others stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients remained on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes. Ten of these 11 patients lost a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested that it is helpful for controlling SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; and the other 8 received topiramate as first-line therapy, noted Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. Those patients had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

WASHINGTON – A significant number of patients with diabetes say they need help coping with the disease, but too few have such psychological needs addressed during initial diabetes education sessions, Mark Peyrot, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

“Most of patients' basic care needs are addressed” in diabetes self-management training, said Dr. Peyrot of the department of medicine at Johns Hopkins University, Baltimore. “But very little of their psychosocial needs are being addressed.”

Dr. Peyrot reported that 44% percent of 178 patients in this study, which was based at the University of Pittsburgh Medical Center, chose “healthy coping” as one of the areas in which they wanted help.

Patients were asked to review the American Association of Diabetes Educators' seven “self-care behaviors”–which it uses in its patient assessment instrument and in its system for evaluating outcomes in diabetes education–and choose areas in which they wanted to set goals and learn skills. Patients could choose as many behaviors as they wished.

The interest in “healthy coping” was unexpectedly similar to the interest in “reducing risks” (49%), “being active” (46%), and “problem-solving” (41%).

Dr. Peyrot said that he expected interest in coping would be more modest. On the other hand, some areas–such as “monitoring” (chosen by 39%) and “taking medications” (chosen by 34%)–were rated “lower than what we'd expect,” he said.

Diabetes educators' responses to patients' needs varied widely. In 94% of initial visits, educators addressed monitoring issues, for instance, and in 88% and 87% of initial visits they addressed exercise and eating, respectively. Medications were addressed in 75% of visits, problem-solving in 44%, and risk reduction in 56%, said Dr. Peyrot, who is also director of the center for social and community research at Loyola College, Baltimore.

Although almost half of patients expressed psychological needs, coping was addressed in only 18% of patients' initial visits, he said.

“To a large extent, there was a standardized package being delivered to patients,” he noted.

They were seen at four of the University of Pittsburgh Medical Center's diabetes self-management training programs, each of which uses the AADE's National Diabetes Education Outcomes System to track and assess diabetes education.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – A significant number of patients with diabetes say they need help coping with the disease, but too few have such psychological needs addressed during initial diabetes education sessions, Mark Peyrot, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

“Most of patients' basic care needs are addressed” in diabetes self-management training, said Dr. Peyrot of the department of medicine at Johns Hopkins University, Baltimore. “But very little of their psychosocial needs are being addressed.”

Dr. Peyrot reported that 44% percent of 178 patients in this study, which was based at the University of Pittsburgh Medical Center, chose “healthy coping” as one of the areas in which they wanted help.

Patients were asked to review the American Association of Diabetes Educators' seven “self-care behaviors”–which it uses in its patient assessment instrument and in its system for evaluating outcomes in diabetes education–and choose areas in which they wanted to set goals and learn skills. Patients could choose as many behaviors as they wished.

The interest in “healthy coping” was unexpectedly similar to the interest in “reducing risks” (49%), “being active” (46%), and “problem-solving” (41%).

Dr. Peyrot said that he expected interest in coping would be more modest. On the other hand, some areas–such as “monitoring” (chosen by 39%) and “taking medications” (chosen by 34%)–were rated “lower than what we'd expect,” he said.

Diabetes educators' responses to patients' needs varied widely. In 94% of initial visits, educators addressed monitoring issues, for instance, and in 88% and 87% of initial visits they addressed exercise and eating, respectively. Medications were addressed in 75% of visits, problem-solving in 44%, and risk reduction in 56%, said Dr. Peyrot, who is also director of the center for social and community research at Loyola College, Baltimore.

Although almost half of patients expressed psychological needs, coping was addressed in only 18% of patients' initial visits, he said.

“To a large extent, there was a standardized package being delivered to patients,” he noted.

They were seen at four of the University of Pittsburgh Medical Center's diabetes self-management training programs, each of which uses the AADE's National Diabetes Education Outcomes System to track and assess diabetes education.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – A significant number of patients with diabetes say they need help coping with the disease, but too few have such psychological needs addressed during initial diabetes education sessions, Mark Peyrot, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

“Most of patients' basic care needs are addressed” in diabetes self-management training, said Dr. Peyrot of the department of medicine at Johns Hopkins University, Baltimore. “But very little of their psychosocial needs are being addressed.”

Dr. Peyrot reported that 44% percent of 178 patients in this study, which was based at the University of Pittsburgh Medical Center, chose “healthy coping” as one of the areas in which they wanted help.

Patients were asked to review the American Association of Diabetes Educators' seven “self-care behaviors”–which it uses in its patient assessment instrument and in its system for evaluating outcomes in diabetes education–and choose areas in which they wanted to set goals and learn skills. Patients could choose as many behaviors as they wished.

The interest in “healthy coping” was unexpectedly similar to the interest in “reducing risks” (49%), “being active” (46%), and “problem-solving” (41%).

Dr. Peyrot said that he expected interest in coping would be more modest. On the other hand, some areas–such as “monitoring” (chosen by 39%) and “taking medications” (chosen by 34%)–were rated “lower than what we'd expect,” he said.

Diabetes educators' responses to patients' needs varied widely. In 94% of initial visits, educators addressed monitoring issues, for instance, and in 88% and 87% of initial visits they addressed exercise and eating, respectively. Medications were addressed in 75% of visits, problem-solving in 44%, and risk reduction in 56%, said Dr. Peyrot, who is also director of the center for social and community research at Loyola College, Baltimore.

Although almost half of patients expressed psychological needs, coping was addressed in only 18% of patients' initial visits, he said.

“To a large extent, there was a standardized package being delivered to patients,” he noted.

They were seen at four of the University of Pittsburgh Medical Center's diabetes self-management training programs, each of which uses the AADE's National Diabetes Education Outcomes System to track and assess diabetes education.

ELSEVIER GLOBAL MEDICAL NEWS