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Magnetic Therapy for
Depression and Other Disorders? Karen Wright reports in the November, 2001 issue of Discover magazine (pages 28-29 that transcranial magnetic stimulation (TMS) has shown promise for the treatment of depression, obsessive-compulsive disorder, and even schizophrenia in some clinical trials. TMS consists of strong magnetic stimulation that induces electrical currents in the brain. In one study of depression the results were comparable to those of electroconvulsive shock, the most effective alternative treatment available. TMS involves little pain for most patients, and few if any side effects. However, the favorable results of TMS have been difficult to replicate, and little is known about whom they might help or what the best treatment parameters (strength, length, frequency, and placement of magnets) would be. Given all these problems, TMS will probably not be used regularly for several years, if ever, but it does show promise of a "kinder, gentler" treatment in the future. Fluoxetine
hydrochloride in the form of Prozac Weekly has been approved by the
Food and Drug Administration for the treatment of long-term
depression. It is the only drug that can be administered weekly for
the continuation treatment phase of long-term depression. Many
depressive people whose symptoms are in remission require continuing
medication to prevent relapse. Relapse frequently occurs within 2
months of discontinuing medication. The weekly dosage is made
possible because fluoxetine normally has a long half-life, which is
extended by encapsulating it in an enteric coating that delays its
release. Guidelines issued by the Agency for Healthcare Research and
Quality recommend that medical treatment should be continued for 9
months or more after symptoms have remitted. Fluoxetine, like most
medications, can have adverse side effects, with nausea, headache,
and insomnia the most common. It also interacts with other
medications and never should be administered except under the care
of a physician who is aware of any other medications the patient is
taking or has taken in the past few weeks; also, no monoamine
oxidase inhibitor should be taken for at least five weeks after
the administration of fluoxetine. Fluoxetine
and other antidepressants, the selective serotonin reuptake
inhibitors (SSRIs) and serotonin and norepinephrine reuptake
inhibitors (SNRIs) among them, can lead to sexual dysfunction as a
side effect. Dr. Anita Clayton of the University of Virginia
compared rates of dysfunction related to treatment with several
antidepressants in a sample of 6,297 patients. Bupropion HCl
produced lower rates of dysfunction than the other antidepressants
tested. Dr. Clayton's study also showed that patient reports of
dysfunction were about two times higher than physicians thought they
would be. Communication between patients and physicians is clearly a
problem in the case of sexual dysfunction, which neither party may
feel comfortable in discussing--but they should! Most of the
patients (91%) said they would like the option to switch medications
if they suffered from sexual dysfunction. A very substantial
minority, 42%, of patients said that their physician had not
discussed sexual functioning with them prior to the study. A related
study by the National Depressive and Manic-Depressive Association
indicated that 69% of physicians claimed that they usually mention
sexual problems as a possible side effect of antidepressant
medication, but only 16% of patients recalled any such discussion!
This communication gap is important not only because it can affect
the sex life of patients, but also because patients may stop taking
medication, and hence suffer relapse, because it interferes with
their sexual functioning. A
study by Dr. Michael Thane and collaborators at the University of
Pittsburgh found that venlafaxine produced higher rates of remission
than selective serotonin reuptake inhibitors (45% vs 35%, with 25%
remission on placebos). The investigators estimate that a dose of
more than 150 mg of venlafaxine daily may be necessary to maximize
the chances of remission. However, one should keep in mind that
people vary in their sensitivity to many drugs, and that different
drugs may be best for different people. Thus it may be necessary for
physicians to try different drugs and different dosages--perhaps
even different combinations of drugs--to find what works best for a
given individual. Whether
an antidepressant is working or not, aerobic exercise may help
depressed people. An article in the British Journal of Sports
Medicine reports that 6 of 12 patients were significantly less
depressed after only 10 days of 30-minute-per-day exercise on a
treadmill. Two were slightly less depressed, and only four remained
the same. Considering that antidepressants usually take 2 to 4 weeks
to work, the results of this small study are encouraging. Finally,
an Australian report by Dr. Michael Sawyer of Adelaide University
indicates that communication about depression between parents and
adolescents isn't any better than that about sexual dysfunction
between patients and physicans. Caretakers estimated that 4.8% of
adolescents suffered from depression; 12.1% of the adolescents
themselves said they were depressed. Furthermore, parents failed to
identify 88% of those who said they were depressed, and 74% of those
the parents thought were depressed said they weren't. It appears
that it would be a good idea for parents to ask their children
whether they're depressed, and get them into treatment if they are.
In most cases depression can be successfully treated, and treatments
are improving steadily, but there can't be any treatment until the
problem is recognized! An article in the August 2003 Journal of the American Medical Association is one of the few that report benefits of a medication for depressed children. Zoloft was superior to placebo, 69% to 59% significant improvement. Children tend to show more improvement than adults when given placebos, consistent with the 59% who improved in this study, so the difference, although it is only 10%, is encouraging. If You're Depressed, Connect with Your Doctor! A
survey of 1001 depressed patients and 900 doctors, reported in
February, 2001, indicated that the two didn't understand each other
very well. The doctors thought that they warned the patients
adequately about side effects, but most patients disagreed. The
doctors thought the patients wouldn't want to change medications,
but patients should tell their doctors if their old medication isn't
working. Most doctors thought their patients were being adequately
treated, but only 25% of patients thought their depression was
controlled adequately. The lesson seems to be that patients and
physicians are very willing to work with each other, but aren't
communicating that willingness very well. There also seems to be an
over-reliance on medication, particularly on the part of physicians.
Cognitive therapy reduces relapses in
major depression. A study by Dr. Robin Jarrett and her colleagues, published in the April, 2001, Archives of General Psychiatry shows that continuing cognitive therapy for 8 months reduced relapses from 31% to 10%. For younger patients, the results over 24 months were even more dramatic; relapse was reduced from 67% in control patients to 16% in the group that received the continuation therapy. Previous research had shown that relapse can be as high as 80% in patients who stop taking medication when their depression goes into remission. These findings, together with the results of previous studies showing that cognitive therapy is as effective as medication in treating patients who are in the acute phase of depression, make long-term cognitive therapy look like a good choice.
Last updated 12/19/03 |
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