Depressed Teenager

ScienceDaily (May 25, 2010) ? More than one-third of teenagers with treatment-resistant depression — many of whom had been depressed for more than two years — became symptom-free six months after switching their medication or combining a medicine switch with cognitive behavioral therapy during a multicenter study led by UT Southwestern Medical Center researchers.

See Also:Health & MedicineMental Health ResearchTeen HealthDiabetesMind & BrainDepressionMental HealthPsychiatryReferenceAntidepressantSeasonal affective disorderNarcolepsyNeurosis

The study findings, available online and in a future edition of the American Journal of Psychiatry, found that teenagers who showed an improvement of symptoms after just three months into their new regimen were much more likely to show lasting beneficial effects.

“This study provides hope for parents and teenagers that persistence in seeking treatment will lead to recovery in some patients, especially if early treatment is aggressive,” said Dr. Graham Emslie, professor of psychiatry and pediatrics at UT Southwestern and a principal investigator of the study. “Even after six months of treatment, however, about two-third of teenagers were still suffering from at least some symptoms of depression.”

The 334 study participants ranged from 12 to 18 years of age. They exhibited traits of moderate to severe major depressive disorder, including thoughts of suicide. Historically, these types of patients have the worst treatment outcomes.

In February 2008, Dr. Emslie and colleagues first published work about these teenagers, who had failed to respond to a class of antidepressant medications known as SSRIs, or selective serotonin reuptake inhibitors. SSRIs, are the most common drug treatment for depression, although about 40 percent of teenagers on the drugs don’t respond to the first treatment.

After three months, nearly 55 percent of the teens in Dr. Emslie’s study improved when they both switched to a different antidepressant and participated in cognitive behavioral therapy, which examines thinking patterns to modify behavior. That study also found that after three months, about 41 percent of participants showed improvement after just switching to either a different SSRI or to venlafaxine, a non-SSRI type of depression medication.

Dr. Emslie and colleagues have now examined the six-month data from that study, and found that nearly 39 percent of participants who completed six months of treatment no longer had symptoms of depression. Those participants were more likely to have had lower levels of depression, hopelessness and anxiety at the beginning of the study.

Those who responded to the new regimen during the first three months were more likely to achieve remission, meaning minimal symptoms of depression or no symptoms at all. Many of those participants, who came from six sites across the country, responded during the first six weeks of treatment.

Current treatment guidelines suggest staying with a treatment for at least two to three months before trying another treatment.

“In light of our new findings, those guidelines may need to be revisited because these latest results suggest more aggressive treatment early on may improve outcomes,” said Dr. Emslie, who also serves as chief of child and adolescent psychiatry at Children’s Medical Center Dallas.

Dr. Emslie and his colleagues are continuing their studies on teenage depression and will use the new data to refine treatment guidelines.

Other UT Southwestern researchers participating in this study were Dr. Betsy Kennard, professor of psychiatry, and Taryn Mayes, faculty associate in psychiatry. Researchers at The University of Pittsburgh; the National Institute of Mental Health; Kaiser Permanente Center for Health Research in Portland, Ore.; UT Medical Branch in Galveston; the University of California, Los Angeles; and Brown University also participated in the research.

The study was funded by the National Institute of Mental Health and the Advanced Center for Interventions & Services Research for Early-Onset Mood & Anxiety Disorders at the Western Psychiatric Institute in Pittsburgh.

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Obtaining therapy via teleconference is just as effective as face-to-face sessions, according to a new research by Stéphane Guay, a psychiatry professor at the Université de Montréal.

“Previous studies have shown that phobia therapy via teleconferencing was just as efficient as face to face contact,” says Dr. Guay, who is also director of the Trauma Studies Centre at the Louis-H. Lafontaine Hospital’s Fernand-Seguin Research Centre. “We wanted to see if the process could also be used for post-traumatic stress treatment.”

Until recently, telemedicine was limited to doctors using the technology to communicate with peers who would weigh-in on x-rays results or supervise a surgery. With teletherapy, patients could theoretically consult experts from the other side of the globe.

As part of this study, 17 post-traumatic stress victims from the Outaouais region underwent 16 to 25 sessions via teleconference with Montreal therapists. A control group consisted of patients receiving face-to-face therapy.

The teletherapy participants, however, still needed to visit a hospital equipped with the necessary equipment and supervised by medical personnel. “It would be ethically indefensible for them to stay home,” says Dr. Guay. “Post-traumatic stress therapies require that a patient relive certain traumatic events and should they become uncomfortable it is mandatory that someone be there to intervene.”

The teletherapy group and the control group equally benefited from their therapy. “The same number of patients in both groups saw a significant decrease in their post-traumatic stress, depression and anxiety symptoms,” says Dr. Guay. “In fact, 75 to 80 percent overcame their chronic post-traumatic stress.”

Patients were later evaluated and none were affected by distance to their therapist and none expressed discomfort about the technological aspects of the procedure. “In fact, comments were more in favor of tele-therapy,” says Dr. Guay. “It seems patients appreciate a certain distance from their therapist.”

Teletherapy could be increasingly used to provide access to treatments requiring specialists who are unavailable in remote regions. While Dr. Guay says teletherapy can’t be used for all types of rehabilitation, it would lend itself well to the treatment of depression, phobias and eating disorders.

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— Acupuncture can calm highly anxious dental patients and ensure that they can be given the treatment they need, suggests a small study published in Acupuncture in Medicine.

See Also:Health & MedicineAlternative MedicineDentistryPain ControlMind & BrainAnxietyPsychiatryDisorders and SyndromesReferencePhantom limbTension headacheAcupressureDetox

A visit to the dentist provokes extreme fear and anxiety in an estimated one in 20 people, and can put them off going altogether, a condition termed odontophobia. And up to a third of patients report moderate anxiety at the prospect of dental treatment, studies show.

The authors base their findings on 16 women and four men from eight dental practice lists.

Each of the patients was moderately or extremely anxious about going to the dentist for treatment, as assessed by a validated questionnaire — the Back Anxiety Inventory (BAI).

All were in their 40s and had been trying to deal with this problem for between two and 30 years.

The BAI score was assessed before and after five minutes of acupuncture treatment, targeting two specific acupuncture points (GV20 and EX6) on the top of the head.

The acupuncture was carried out by the dentists themselves, all of whom are members of the British Dental Acupuncture Society.

The average BAI score of 26.5 fell to 11.5, and all 20 patients were able to undergo their planned treatment, whereas before this had only been possible in six — and then only partially and after a great deal of effort on the part of both dentist and patient.

The authors point out that several attempts have been made to conquer this type of anxiety, including sedatives, relaxation techniques, behavioural therapies, biofeedback and hypnosis. The research indicates that these do help, but they are time consuming and require considerable levels of psychotherapeutic skills, if applied properly, say the authors.

They caution that further larger studies are needed to confirm the value of acupuncture in these sorts of cases, but suggest that acupuncture “may offer a simple and inexpensive method of treatment.”

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