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IN THIS ISSUE:
November 2009

And a One, and a Two… Exercise for Depression
As an adjunct to medication and psychotherapy or by itself, exercise can be an effective treatment for depression.

Milnacipran (Savella)
Milnacipran (Savella) is the third compound to be approved in the United States for the treatment of fibromyalgia syndrome.

Preventing Depression in Adolescents
Current depression in parents negates the positive effects of a group cognitive behavioral prevention program in preventing depression in adolescents.

Anticholinergic Medicines and Cognitive Decline in the Elderly
Anticholinergic medications can impair cognition and memory, especially in elderly patients.

In Brief
Predictors of Mortality in Depressed Patients following Cardiac Events; Disruption of Dopamine Neurotransmission in ADHD

Raising the SSRI Dose: Does It Help?
Selective serotonin reuptake inhibitors (SSRIs) do not appear to have an obvious relationship of dose to likelihood of benefit.

Generic Antidepressants: Bioequivalent?
Generic formulations of antidepressants may not have the same pharmacokinetics and clinical effects as the original brand-name versions.

Lamotrigine in Borderline Personality Disorder
Preliminary research found lamotrigine (Lamictal) superior to placebo in improving symptoms of affective instability and impulsivity in patients with borderline personality disorder.

Preventing Depression in Adolescents

November 2009

Modern psychiatry struggles to optimize treatments for disorders within our province, but we have relatively little to offer for disease prevention. Still, researchers are taking preliminary steps in this direction. We recently reviewed strategies to prevent or attenuate psychosis in ultra-high-risk patients (BTP 2009;32:10–12). Now comes a study focused on adolescents at risk for depression.1

Garber and colleagues begin their paper by noting that adolescent-onset depression often leads to chronic and recurrent depression in adulthood, which, in turn, causes morbidity and mortality. Only about 25% of depressed youth receive treatment. One of the strongest predictors of depression developing in children and adolescents is depression in their parents. Offspring of depressed parents are two to three times more likely to develop depression than other young people.

Building on previous research with a group cognitive behavioral prevention program, the authors set out to assess whether this approach could help to prevent depression in 316 adolescents, aged 13 to 17 years, whose parents were currently depressed or had suffered a previous episode of depression. Participants were assigned at random to receive "usual care" or the cognitive behavioral prevention program, which consisted of eight weekly 90-minute group sessions followed by six monthly continuation sessions. The study was conducted at four sites and funded by the National Institute of Mental Health.

Subjects in the prevention program had an 11% lower risk of developing depression and significantly (P = .03) more improvement in self-reported depressive symptoms compared with the treatment-as-usual group.

Whether the subjects' parents were currently depressed had a profound impact on the efficacy of the cognitive behavioral program. Of adolescents whose parents were not currently depressed, only 11.7% who received the prevention strategy developed depression versus 40.5% of those receiving usual care. Of adolescents whose parents were currently depressed, however, the rates were 31.2% versus 24.3%, respectively, not a statistically significant difference.

The results of this study are similar to those of other preliminary research, in which Higgins and Hecker showed that workshops were helpful in preventing generalized anxiety disorder in college students who were "high worriers."2 Cognitive behavioral therapy is an effective treatment for many psychiatric conditions, including depression, anxiety, and insomnia, among others. Group strategies may provide a cost-effective means to reduce and attenuate depression in at-risk youth. It is noteworthy that the particular prevention approach employed by Dr Garber's group was ineffective in children whose parents were currently depressed. This underscores the importance of bringing more depressed people to clinical attention and assuring that they receive optimal care. When the patient is a parent, the impact goes well beyond the individual sufferer. Good treatment can enhance the health and well-being of the whole family.

1Garber J, Clarke GN, Weersing VR, Beardslee WR, Brent DA, Gladstone TRG, DeBar LL, Lynch FL, D'Angelo E, Hollon SD, Shamseddeen W, Iyengar S: Prevention of depression in at-risk adolescents: A randomized controlled trial. JAMA 2009;301:2215–2224.

2Higgins DM, Hecker JE: A randomized trial of brief cognitive-behavioral therapy for prevention of generalized anxiety disorder. J Clin Psychiatry 2008;69:1336.