Mild to severe depression might be better treated with alternatives to antidepressant drugs, which do not help patients much more than an inactive placebo, researchers said Tuesday.

Combining data from six studies that examined the effectiveness of two commonly prescribed antidepressants — paroxetine and imipramine — found the drugs produced benefits only slightly greater than a placebo in patients with mild to severe depression.

“They would have done just as well or just about as well with a placebo,” said Robert DeRubeis, a psychologist at the University of Pennsylvania, Philadelphia, who with colleagues performed the meta-analysis.

Paroxetine is one of a popular class of drugs, selective serotonin reuptake inhibitors, and is sold under the brand name Paxil by GlaxoSmithKline. Imipramine is an older tricyclic antidepressant drug developed in the 1950s.

The so-called placebo effect is powerful in treating depression, where people believe they are helped even though they are taking an inactive sugar pill, DeRubeis said.

CONSIDER ALTERNATIVES?

In the report published in the Journal of the American Medical Association involving nearly 800 patients, the drugs’ impact was noticeably stronger than a placebo in people diagnosed with very severe cases of depression.

Using a scoring system for depression where a diagnosis of 24 or above indicates a very severe case, the researchers said patients treated with drugs saw their scores drop by 13 points, compared to a drop of 9 points for those given a placebo.

But for those with initial depression scores of 23 or below the drop averaged 8 points for those given antidepressants and 7 points for those given a placebo. Roughly half of those prescribed antidepressants fit into the mild to severe categories.

“Our data should give some pause” to doctors and patients weighing antidepressants, DeRubeis said in a telephone interview. “They should give some consideration to other alternatives.”

Exercise has been shown to be helpful to stem depression, as does psychotherapy, and even “self-treatment” with the aid of the plethora of self-help literature, he said.

A spokeswoman for GlaxoSmithKline said the report “contributes to the extensive research” into antidepressants, noting that Paxil received U.S. government approval in 1992 and has helped “millions of people battling mental illness.

“The studies used for the analysis in the JAMA paper differ methodologically from studies used to support the approval of paroxetine for major depressive disorder, so it is difficult to make direct comparisons between the results,” spokeswoman Sarah Alspach said.

At least 27 million Americans take antidepressants, nearly double the number that did in the mid-1990s, according to a study by Columbia University and University of Pennsylvania researchers reported in the Archives of General Psychiatry.

More than 164 million prescriptions for antidepressants were written in 2008, totaling nearly $10 billion in U.S. sales, according to IMS Health. Global sales were twice that.

Teenagers when

Of 15,500 12 to 18-year-olds studied, those who went to bed after midnight were 24% more likely to have depression than those who went before 2200.

And those who slept fewer than five hours a night had a 71% higher risk of depression than those who slept eight hours, the journal Sleep reports.

It is estimated 80,000 UK children and young people have depression.

The researchers from Columbia University Medical Center in New York looked at data from 15,500 teenagers collected in the 1990s.

One in 15 of those studied were found to have depression.

As well as the higher risk of depression, those who were set a bedtime by their parents of after midnight were 20% more likely to think about suicide than those whose bedtime was 2200 or earlier.

Those who had less than five hours sleep a night were thought to have a 48% higher risk of suicidal thoughts compared with those who had eight hours of sleep.

Teenagers who reported they “usually get enough sleep” were 65% less likely to be depressed.

Depression and suicidal thoughts were also more likely in girls, older teenagers and in those who had a lower self-perception of how much parents care about them.

Most of the parents of the adolescents in the study set a bedtime of 2200 or earlier.

A quarter set a bedtime of 2400 or later.

On average the teenagers were having seven hours and 53 minutes sleep a night – less than the nine hours recommended at that age.

Study leader Dr James Gangwisch said although it it was possible that youngsters with depression struggle to sleep, the fact that parental set bedtimes were linked with depression suggests that a lack of sleep is somehow underpinning the development of the condition.

He said a lack of sleep could affect emotional brain responses and lead to moodiness that hindered the ability to cope with daily stresses.

This moodiness could affect judgment, concentration and impulse control.

Regular exercise

“Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression,” he added.

Sarah Brennan, chief executive at the mental health charity YoungMinds, said: “Enough sleep, good food and regular exercise are all essential to stay emotionally healthy.

“Nearly 80,000 children and young people suffer with depression, yet we are still failing to provide our young people with the help and support to cope with it and prevent it.

“Providing parents with information about how to look after your body, for example by getting enough sleep, and how to get help if they are worried about their teenager, will ensure problems are tackled early and prevent serious mental health conditions such as depression.”

Elderly people who drink several cups of green tea a day were less likely to suffer from depression, probably due to a “feel good” chemical found in this type of tea, Japanese researchers said.

Several studies have linked drinking green tea to lessening psychological problems and Dr Kaijun Niu, of Tohoku University Graduate School, and colleagues found men and women aged 70 and older who drank four or more cups of green tea daily were 44 per cent less likely to have symptoms of depression.

Green tea is widely consumed in many Asian countries, including China and Japan.

Dr Niu and the team investigated 1058 relatively healthy elderly men and women.

About 34 per cent of the men and 39 per cent of the women had symptoms of depression, according to the study that was published in the December issue of the American Journal of Clinical Nutrition.

A total of 488 participants said they drank four or more cups of green tea a day, 284 said they downed two to three cups daily and the rest reported having one or fewer cups daily.

According to the researchers, the apparent effect of drinking more green tea on alleviating symptoms of depression did not fade after they factored in social and economic status, gender, diet, history of medical problems and use of antidepressants.

By contrast, there was no association between consumption of black or oolong tea, or coffee, and lower symptoms of depression.

A green tea component, the amino acid theanine, which is thought to have a tranquillising effect on the brain, may explain the “potentially beneficial effect” shown in the current study, Dr Niu noted.

However, further studies were needed to confirm whether greater green tea intake actually had antidepressant effects, the researchers said.

New research is suggesting that there is a link between depression and a loss of bone mass, which could lead to bone breakage and osteoporosis.

Osteoporosis is more common among women than men, and is a condition that causes bones to weaken and possibly fracture, which is why some nutritionists recommend taking nutritional supplements such as vitamin D and calcium to keep bones strong.

According to a study found in the journal Biological Psychiatry, it was found that after testing thousands of individuals, there was substantially less bone density in depressed individuals than the mentally healthy.

The results showed that after testing 2,327 depressed and 21,141 non-depressed patients, depressed individuals were at a higher risk of osteoporosis.

“All individuals psychiatrically diagnosed with major depression are at risk for developing osteoporosis, with depressed young women showing the highest risk,” wrote the researchers.

Because of these findings, the researchers feel that it’s a good idea for depressed patients to get checkups to try and prevent the development of osteoporosis.

A new study suggests that people who suffer from depression are also at risk for low bone mineral density.

The study published in the journal Biological Psychiatry pooled data from both depressed and non-depressed individuals compiled over the past 14 years.

It finds that those who suffer from depression had less dense bones and increased levels of bone resorption markers than those who did not suffer from the condition.

“We propose that all individuals psychiatrically diagnosed with major depression are at risk for developing osteoporosis, with depressed women—particularly those who are premenopausa—showing a higher risk than men,” the study’s authors Drs. Raz Yirmiya and Itai Bab say.

Previous studies have found higher cortisol levels, often found in depressed patients, can contribute to bone loss because the hormone destroys bone-building cells.

Exercise is a natural health resource proven to aid in both warding off depression and bone loss.

In addition, studies have found that green tea, calcium, magnesium, vitamin D and boron can all aid in maintaining bone density. For those worried their diet may be lacking in these, nutritional health supplements are a viable option.

Meanwhile, omega-3 fatty acids, folic acid and herbal supplements containing St. John’s Wort and Sam-e have been linked to reducing depression.

A study done from researchers in the UK found that an overall healthy diet comprising a high proportion of fruits, fish and vegetables, protected middle aged people against depression compared to a processed food diet containing a high proportion of high fat dairy food, processed meat, fried food, refined grains and sugar-laden desserts.

The study was the work of researchers based at the Department of Epidemiology and Public Health, University College London (UCL), UK and the Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier, France, and is published in the November issue of the The British Journal of Psychiatry which is available online.

In their background information the authors explained that much research on diet and depression tends to focus on individual nutrients so they thought they would look at links between overall dietary patterns and depression.

For the study they looked at data covering 3,486 participants of average age 57 years (nearly three quarters were men) who were part of the Whitehall II study.

The Whitehall II study was set up by co-author and UCL Professor Sir Michael Marmot to investigate links between disease and social class, psychosocial factors and life style. It began by looking at the health of working people, and is now also looking to answer questions about how previous and current circumstances affect health and quality of life in an ageing group of participants.

The data allowed the researchers to identify two dietary patters: a whole food diet and a processed food diet. The whole food diet comprised mainly fresh fruits and vegetables and fish, while the processed diet comprised mainly sweetened desserts, fried foods, high fat dairy foods, processed meat and refined grains.

To assess depression, the researchers used self-reported data that had been gathered five years after the dietary data using the CES-D scale.

CES-D, short for Center for Epidemiologic Studies – Depression scale, is a commonly used self-report questionnaire for assessing depression. It asks a series of multiple choice questions about how the participant has been feeling over the past week, covering topics such as concentration, loss of appetite, worry, how well they have been able to shake off depressive moods, quality of sleep, feelings of loneliness, self-worth, energy levels, and so on.

When they analysed the results and ruled out potential confounders such as age, gender, education, smoking, exercise, and chronic diseases, the researchers found that:

• Participants in the top 33 per cent (top tertile) of the whole food diet pattern, ie whose diet most closely matched the whole food diet, had a 26 per cent lower risk of receiving a CES-D depression assessment five years later (odds ratio 0.74, with 95 per cent probability of this being in the range 0.56 to 0.99) compared to the bottom 33 per cent (bottom tertile), ie whose diet least closely matched the whole food diet.
• In contrast, participants whose diet was high in processed foods had a 58 per cent higher risk of receiving a CES-D depression rating five years later.

The researchers concluded that:

“In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective.”

According to BBC News, co-author Dr Archana Singh-Manoux, who works at UCL and INSERM, suggested there was a possibility that the finding could be explained by a lifestyle factor they had not accounted for.

In other words the study does not prove that a processed food diet causes depression: it could be that people destined to become depressed become inclined to eat more processed foods, that there is a yet undiscovered factor behind both.

However, when results as strong as these emerge, and a consistent pattern linking diet and depression is found by several studies, it would tend to suggest that a healthy diet does protect against mental ill health.

The Chief Executive of the UK-based Mental Health Foundation, Dr Andrew McCulloch told the BBC that:

“This study adds to an existing body of solid research that shows the strong links between what we eat and our mental health.”

He said major studies like this were crucial in helping us understand more about how diet contributes to mental illness. He said people in the UK were increasingly adopting unhealthy diets, and eating less nutritious and fresh food and more saturated fats and sugars.

In a paper, published in the printed edition of British Medical Journal (BMJ) tomorrow, scientists found that despite a drop in the number of new patients diagnosed with depression over 11 years, the number of prescriptions doubled.

“We estimate that more than 2 million people are now taking antidepressants long-term over several years, in particular women aged between 18 and 30,” comments Tony Kendrick, a professor in Primary Medical Care of the University’s School of Medicine, who led the study.

The number of prescriptions issued per patient rose from 2.8 in 1993 to 5.6 in 2004.

Prescription Pricing Authority data shows that more than 30 million prescriptions for SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat, are now issued per year, twice as many as the early 1990s. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

Professor Kendrick adds: “Our previous research found that although these drugs are said not to be addictive, many patients found it difficult to come off them, due to withdrawal symptoms including anxiety. Many wanted more help from their GP to come off the drugs. We don’t know how many really need them and whether long-term use is harmful. This has similarities to the situation with Valium in the past.”

The research team analysed all new cases of depression between 1993 and 2005 from anonymous computerised general practice records covering 170 GP surgeries and 1.7 million registered patients.

According to Reuters, researchers at the University of Helsinki found no association between coffee consumption and declining cognition or dementia scores in either men or women.

They assessed the coffee drinking habits as well as other social, demographic and health data, of a large population of twin pairs who were 50 years old on average. The majority of subjects – 75 percent of men and 83 percent of women – reported drinking more than three cups of coffee a day.
Participants were screened on a yearly basis starting at age 74 to measure cognitive function and dementia. Regardless of gender and coffee consumption, researchers found as subjects aged they exhibited declines in thinking ability.

In addition, the study, appearing in The American Journal of Clinical Nutrition, found coffee consumption wasn’t protective in preserving brain function in middle-age.

Heart disease, diabetes and depression are associated with lower cognitive function, according to the report.

Nutritional supplements that can boost brain function and memory include vitamins B,C and E and beta carotene as well as omega-3 fatty acids and gingko biloba.

The Mediterranean diet, already thought to protect against heart disease and cancer, may also help to prevent depression, Spanish researchers say.

They found depression was more than 30% less likely to develop in people who followed a diet high in vegetables, fruit and cereals, and low in red meat.

They studied 10,094 healthy adults over four years, the Journal of the American Medical Association reports.

However, the team stressed additional, larger-scale studies were required.

Researchers at the Universities of Las Palmas and Navarra recruited university graduates to take part.

Dietary patterns

They completed questionnaires and the researchers calculated their adherence to the Mediterranean dietary pattern (MDP) for an average of four-and-a-half years.

Participants who had a strong adherence to the MDP tended to be male, ex-smokers, married and older individuals.

They were more active physically and showed a higher total energy intake.

The researchers identified 480 new cases of depression during the follow-up period – 156 in men and 324 in women.

They found that those with the highest adherence to the MDP were more than 30% less likely to develop depression.

They took into account marital status, the number of children and factors associated with a healthy lifestyle and found the relationship did not change.

Even taking account of personality traits, such as competitiveness and anxiety, had no effect on the results.

‘More research needed’

Professor Miguel Martinez-Gonzalez, of the University of Navarra, said the results would have to be confirmed in longer trials with more participants but they had found a strong inverse association between the Mediterranean diet and depression.

“Thirty per cent is a large reduction in the risk and this could be very important considering the large burden of disease represented by depression.

“We know how important the Mediterranean diet is in reducing cardiovascular risk factors and the same inflammatory proteins are also raised in patients with depression.”

He said it was likely that the overall dietary pattern was more important than the effect of single components and “may exert a fair degree of protection against depression”.

Dr Cecilia D’Felice, a clinical psychologist, said there was mounting evidence for the importance of diet in treating depression.

She said: “What we do know is that a diet high in olive oil will enhance the amount of serotonin or brain transmitter available to you.

“Most anti-depression drugs work to keep more serotonin available in the brain.”

Depression can damage a cancer patient’s chances of survival, a review of research suggests.

The University of British Columbia team said the finding emphasised the need to screen cancer patients carefully for signs of psychological distress.

The study, a review of 26 separate studies including 9,417 patients, features in the journal Cancer.

It found death rates were up to 25% higher in patients showing symptoms of depression.

“Cancer patients need not panic if they are experiencing depressive symptoms, but it is certainly reasonable to talk to their physicians about their mental health.” Jillian Satin University of British Columbia Cancer: The facts – in-depth UK statistics for major forms of cancer

In patients actually diagnosed with major or minor depression, death rates were up to 39% higher.

The increased risks remained even after other clinical characteristics that might affect survival were taken into consideration.

However, the researchers said more research was needed before any definitive conclusions could be drawn, as it was difficult to rule out the impact of other factors.

They also stressed that, overall, the increased risk of dying from cancer due to depression was small – so patients should not feel they had to maintain a positive attitude to beat their disease.

The studies looked at by the British Columbia team focused on a range of survival times, from one year to 10 years.

The researchers could find no firm evidence to show that depression impacted on the progression of disease – although the number of studies which specifically looked at this was very limited.

Stress impact

Research on animals has suggested that stress can have an effect on tumour growth and the spread of cancer to other parts of the body.

It is possible that depression could have an impact on hormones or the immune system, or that depressed people tend to engage in behaviour which might affect how long they live.

For instance, depressed people may be less likely to comply with treatment regimes.

However, at this stage there is no firm proof that depression actually causes cancer patients to die earlier than they otherwise would.

Previous research has suggested that depression has a much bigger impact on mortality from heart disease.

Lead researcher Jillian Satin said: “It is quite remarkable that the presence of depressive symptoms or a diagnosis of a depressive disorder can predict mortality in cancer patients.

“But it should be kept in mind that the increased risk is quite small.

“Cancer patients need not panic if they are experiencing depressive symptoms, but it is certainly reasonable to talk to their physicians about their mental health.”

Dr Julie Sharp, of the charity Cancer Research UK, said: “This research adds weight to the importance of identifying depression early in people with cancer and offering them appropriate support and care.”

But she added: “There are still many unanswered questions as the effects observed in this study are quite small and may be due to other factors.

“More research will be needed to explain whether these observations are true and if so why.”