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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.

In Brief

November 2009

Patients who develop major depressive disorder (MDD) following an acute myocardial infarction are at greater risk of dying. We previously reported on two studies which suggested that serious adverse cardiac events decreased when patients were treated with a selective serotonin reuptake inhibitor (SSRI) antidepressant following a coronary event (BTP 2007;30:18, 2006;29:6–7, 2003;26:21–22). In a 7-year follow-up of patients in one of those studies—the Sertraline Antidepressant Heart Attack Randomized Trial (SADHART)—investigators assessed whether the following variables were associated with long-term mortality: baseline depression severity, previous MDD episodes, onset of MDD before or after the acute coronary syndrome (ACS), 6 months of treatment with sertraline (Zoloft and others), and mood improvement independent of treatment (Glassman AH, et al. Arch Gen Psychiatry 2009;66:1022–1029). Seventy-five (20.9%) of the 369 patients who were enrolled in the double-blind, placebo-controlled, randomized trial died during the study. Long-term mortality was not associated with previous episodes of MDD, onset before or after the index ACS, or 6 months of sertraline treatment. Severity of MDD measured within a few weeks of hospitalization for ACS and failure of MDD to improve substantially during treatment with either sertraline or placebo in the 6 months following ACS were strongly and independently associated with long-term mortality, predicting more than a doubling of mortality over the median 6.7 years of follow-up. Patients who experienced marked improvement in depressive symptoms adhered better to study medication. The authors urge physicians to treat depression aggressively and to diligently promote adherence to guideline cardiovascular drug therapy.

Attention-deficit/hyperactivity disorder (ADHD) affects 3% to 5% of adults in the United States. Several studies have suggested that disrupted dopamine neurotransmission may underscore the symptoms of inattention and impulsivity that are central to this illness. Volkow and colleagues used positron emission tomography to assess whether there are abnormalities in the meso-accumbens dopamine pathway, which projects from the ventral tegmental area in the midbrain to the nucleus accumbens, in patients with ADHD (JAMA 2009;302:1084–1091). Dopamine synaptic markers—dopamine transporters (DAT) and D2/D3 receptors—were measured in 53 nonmedicated adults with ADHD and 44 healthy controls. Specific binding was lower in ADHD patients than in controls in the midbrain and the nucleus accumbens. ADHD participants also had lower than normal D2/D3 receptor availability in the hypothalamus, providing preliminary evidence of the involvement of this region in ADHD as well.

Heather S. Hopkins