Depression

Adults with asthma–chronic obstructive pulmonary disease overlap syndrome who took statins had lower rates of anxiety and depression than did those not on statins, based on data from approximately 9,000 patients.

Although asthma–COPD overlap syndrome (ACOS) has been associated with depression, the effects of oral and inhaled corticosteroids on anxiety and depression in these patients have not been well investigated, wrote Jun-Jun Yeh, MD, of Ditmanson Medical Foundation Chia-Yi (Taiwan) Christian Hospital, and colleagues.

In a study published in the Journal of Affective Disorders, the researchers analyzed 9,139 ACOS patients including 1,252 statin users and 7,887 nonstatin users; 62% were male.

The statin users had significantly lower risk of both anxiety and depression than did the nonstatin users (adjusted hazard ratio 0.34 for anxiety and 0.36 for depression) after researchers controlled for factors including age, sex, comorbidities, and medications. Statin users experienced a total of 109 anxiety or depression events over an average of 8 years’ follow-up, while nonstatin users experienced a total of 1,333 anxiety or depression events over an average of 5 years’ follow-up.

The incidence density rate of anxiety was 11/1,000 person-years for statin users and 33/1,000 person-years for nonstatin users. The incidence density rate of depression was 3/1,000 person-years for statin users and 9/1,000 person-years for nonstatin users.

Significantly lower risk of anxiety and depression also were observed in statin users, compared with nonstatin users, in subgroups of men, women, patients younger than 50 years, and patients aged 50 years and older. The risks of anxiety and depression were lower in statin users versus nonstatin users across all subgroups with or without inhaled or oral corticosteroids.

Overall, the statin users were significantly younger, had more comorbidities, and were more likely to use inhaled or oral corticosteroids than were the nonstatin users.

The findings were limited by several factors including the retrospective nature of the study and a lack of information on prescribed daily doses of medication, the researchers noted. However, the results support those from previous studies and suggest that “the anti-inflammatory effect of statins may attenuate anxiety and depression in ACOS patients, even in the late stages of the disease,” although the exact mechanism of action remains unknown and larger, randomized, controlled trials are needed, they said.

The study was supported by grants from a variety of organizations in Taiwan, China, and Japan. The researchers had no financial conflicts to disclose.

SOURCE: Yeh JJ et al. J Affect Disord. 2019 Jun 15; 253:277-84.

Adults with asthma–chronic obstructive pulmonary disease overlap syndrome who took statins had lower rates of anxiety and depression than did those not on statins, based on data from approximately 9,000 patients.

Although asthma–COPD overlap syndrome (ACOS) has been associated with depression, the effects of oral and inhaled corticosteroids on anxiety and depression in these patients have not been well investigated, wrote Jun-Jun Yeh, MD, of Ditmanson Medical Foundation Chia-Yi (Taiwan) Christian Hospital, and colleagues.

In a study published in the Journal of Affective Disorders, the researchers analyzed 9,139 ACOS patients including 1,252 statin users and 7,887 nonstatin users; 62% were male.

The statin users had significantly lower risk of both anxiety and depression than did the nonstatin users (adjusted hazard ratio 0.34 for anxiety and 0.36 for depression) after researchers controlled for factors including age, sex, comorbidities, and medications. Statin users experienced a total of 109 anxiety or depression events over an average of 8 years’ follow-up, while nonstatin users experienced a total of 1,333 anxiety or depression events over an average of 5 years’ follow-up.

The incidence density rate of anxiety was 11/1,000 person-years for statin users and 33/1,000 person-years for nonstatin users. The incidence density rate of depression was 3/1,000 person-years for statin users and 9/1,000 person-years for nonstatin users.

Significantly lower risk of anxiety and depression also were observed in statin users, compared with nonstatin users, in subgroups of men, women, patients younger than 50 years, and patients aged 50 years and older. The risks of anxiety and depression were lower in statin users versus nonstatin users across all subgroups with or without inhaled or oral corticosteroids.

Overall, the statin users were significantly younger, had more comorbidities, and were more likely to use inhaled or oral corticosteroids than were the nonstatin users.

The findings were limited by several factors including the retrospective nature of the study and a lack of information on prescribed daily doses of medication, the researchers noted. However, the results support those from previous studies and suggest that “the anti-inflammatory effect of statins may attenuate anxiety and depression in ACOS patients, even in the late stages of the disease,” although the exact mechanism of action remains unknown and larger, randomized, controlled trials are needed, they said.

The study was supported by grants from a variety of organizations in Taiwan, China, and Japan. The researchers had no financial conflicts to disclose.

SOURCE: Yeh JJ et al. J Affect Disord. 2019 Jun 15; 253:277-84.

Adults with asthma–chronic obstructive pulmonary disease overlap syndrome who took statins had lower rates of anxiety and depression than did those not on statins, based on data from approximately 9,000 patients.

Although asthma–COPD overlap syndrome (ACOS) has been associated with depression, the effects of oral and inhaled corticosteroids on anxiety and depression in these patients have not been well investigated, wrote Jun-Jun Yeh, MD, of Ditmanson Medical Foundation Chia-Yi (Taiwan) Christian Hospital, and colleagues.

In a study published in the Journal of Affective Disorders, the researchers analyzed 9,139 ACOS patients including 1,252 statin users and 7,887 nonstatin users; 62% were male.

The statin users had significantly lower risk of both anxiety and depression than did the nonstatin users (adjusted hazard ratio 0.34 for anxiety and 0.36 for depression) after researchers controlled for factors including age, sex, comorbidities, and medications. Statin users experienced a total of 109 anxiety or depression events over an average of 8 years’ follow-up, while nonstatin users experienced a total of 1,333 anxiety or depression events over an average of 5 years’ follow-up.

The incidence density rate of anxiety was 11/1,000 person-years for statin users and 33/1,000 person-years for nonstatin users. The incidence density rate of depression was 3/1,000 person-years for statin users and 9/1,000 person-years for nonstatin users.

Significantly lower risk of anxiety and depression also were observed in statin users, compared with nonstatin users, in subgroups of men, women, patients younger than 50 years, and patients aged 50 years and older. The risks of anxiety and depression were lower in statin users versus nonstatin users across all subgroups with or without inhaled or oral corticosteroids.

Overall, the statin users were significantly younger, had more comorbidities, and were more likely to use inhaled or oral corticosteroids than were the nonstatin users.

The findings were limited by several factors including the retrospective nature of the study and a lack of information on prescribed daily doses of medication, the researchers noted. However, the results support those from previous studies and suggest that “the anti-inflammatory effect of statins may attenuate anxiety and depression in ACOS patients, even in the late stages of the disease,” although the exact mechanism of action remains unknown and larger, randomized, controlled trials are needed, they said.

The study was supported by grants from a variety of organizations in Taiwan, China, and Japan. The researchers had no financial conflicts to disclose.

SOURCE: Yeh JJ et al. J Affect Disord. 2019 Jun 15; 253:277-84.

Depressive symptoms may be linked to poor-quality diets in middle-aged and older men, according to findings from the Longitudinal Aging Study Amsterdam (LASA).

In a longitudinal study of 1,312 Dutch people aged 55 years or older, 52% of whom were women, depressive symptoms were associated with significantly lower diet quality scores on food quality questionnaires among men, Liset E.M. Elstgeest of the Amsterdam Public Health research institute at Vrije Universiteit Amsterdam and coauthors reported in the Journal of Affective Disorders.

Depressive symptoms were defined as a score of at least 16 on the Center for Epidemiologic Studies Depression scale (CES-D). Study participants were assessed in 2014-2015, and for five cycles of three times per year from 2001-2003 to 2015-2016. Diet quality was assessed in 2014 and 2015 using the Mediterranean Diet Score, Alternative Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH) score.

The majority (84.8%) had no depressive symptoms in both cycles, while 5.4% experienced emerging, 4.6% remitted, and 5.1% chronic/recurrent depressive symptoms. For the history sample, the numbers with depressive symptoms were 69 (10.0%), 67(9.8%), 59 (8.6%), and 60 (8.7%) in the four regular cycles from 2001-2003 to 2011-2013. In total 144 participants (21.0%) ever had a CES-D of at least 16 from 2001-2003 to 2011-2013, of which 20 had an elevated CES-D score only in 2011-2013.

Compared with participants with CES-D scores less than 16, the 120 (9.7%) study participants with CES-D scores of at least 16 in 2011-2013 and the 130 (10.5%) study participants with elevated CES-D scores in 2015-2016 were more likely to have lower Mediterranean Diet Score and Alternative Healthy Eating Index scores. After adjustment for confounders, however, the association remained statistically significant only for men. Current depressive symptoms were also associated with a lower Alternative Healthy Eating Index score in men, but not in women.

More longitudinal studies are needed to confirm results, the investigators added. “Such studies should preferably include repeated diet measurements and investigate gender differences,” they concluded.

No conflicts of interest were reported.

SOURCE: Elstgeest L et al. 2019. J Affec Disord. doi: 10.1016/j.jad.2019.02.004.

Depressive symptoms may be linked to poor-quality diets in middle-aged and older men, according to findings from the Longitudinal Aging Study Amsterdam (LASA).

In a longitudinal study of 1,312 Dutch people aged 55 years or older, 52% of whom were women, depressive symptoms were associated with significantly lower diet quality scores on food quality questionnaires among men, Liset E.M. Elstgeest of the Amsterdam Public Health research institute at Vrije Universiteit Amsterdam and coauthors reported in the Journal of Affective Disorders.

Depressive symptoms were defined as a score of at least 16 on the Center for Epidemiologic Studies Depression scale (CES-D). Study participants were assessed in 2014-2015, and for five cycles of three times per year from 2001-2003 to 2015-2016. Diet quality was assessed in 2014 and 2015 using the Mediterranean Diet Score, Alternative Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH) score.

The majority (84.8%) had no depressive symptoms in both cycles, while 5.4% experienced emerging, 4.6% remitted, and 5.1% chronic/recurrent depressive symptoms. For the history sample, the numbers with depressive symptoms were 69 (10.0%), 67(9.8%), 59 (8.6%), and 60 (8.7%) in the four regular cycles from 2001-2003 to 2011-2013. In total 144 participants (21.0%) ever had a CES-D of at least 16 from 2001-2003 to 2011-2013, of which 20 had an elevated CES-D score only in 2011-2013.

Compared with participants with CES-D scores less than 16, the 120 (9.7%) study participants with CES-D scores of at least 16 in 2011-2013 and the 130 (10.5%) study participants with elevated CES-D scores in 2015-2016 were more likely to have lower Mediterranean Diet Score and Alternative Healthy Eating Index scores. After adjustment for confounders, however, the association remained statistically significant only for men. Current depressive symptoms were also associated with a lower Alternative Healthy Eating Index score in men, but not in women.

More longitudinal studies are needed to confirm results, the investigators added. “Such studies should preferably include repeated diet measurements and investigate gender differences,” they concluded.

No conflicts of interest were reported.

SOURCE: Elstgeest L et al. 2019. J Affec Disord. doi: 10.1016/j.jad.2019.02.004.

Depressive symptoms may be linked to poor-quality diets in middle-aged and older men, according to findings from the Longitudinal Aging Study Amsterdam (LASA).

In a longitudinal study of 1,312 Dutch people aged 55 years or older, 52% of whom were women, depressive symptoms were associated with significantly lower diet quality scores on food quality questionnaires among men, Liset E.M. Elstgeest of the Amsterdam Public Health research institute at Vrije Universiteit Amsterdam and coauthors reported in the Journal of Affective Disorders.

Depressive symptoms were defined as a score of at least 16 on the Center for Epidemiologic Studies Depression scale (CES-D). Study participants were assessed in 2014-2015, and for five cycles of three times per year from 2001-2003 to 2015-2016. Diet quality was assessed in 2014 and 2015 using the Mediterranean Diet Score, Alternative Healthy Eating Index, and Dietary Approaches to Stop Hypertension (DASH) score.

The majority (84.8%) had no depressive symptoms in both cycles, while 5.4% experienced emerging, 4.6% remitted, and 5.1% chronic/recurrent depressive symptoms. For the history sample, the numbers with depressive symptoms were 69 (10.0%), 67(9.8%), 59 (8.6%), and 60 (8.7%) in the four regular cycles from 2001-2003 to 2011-2013. In total 144 participants (21.0%) ever had a CES-D of at least 16 from 2001-2003 to 2011-2013, of which 20 had an elevated CES-D score only in 2011-2013.

Compared with participants with CES-D scores less than 16, the 120 (9.7%) study participants with CES-D scores of at least 16 in 2011-2013 and the 130 (10.5%) study participants with elevated CES-D scores in 2015-2016 were more likely to have lower Mediterranean Diet Score and Alternative Healthy Eating Index scores. After adjustment for confounders, however, the association remained statistically significant only for men. Current depressive symptoms were also associated with a lower Alternative Healthy Eating Index score in men, but not in women.

More longitudinal studies are needed to confirm results, the investigators added. “Such studies should preferably include repeated diet measurements and investigate gender differences,” they concluded.

No conflicts of interest were reported.

SOURCE: Elstgeest L et al. 2019. J Affec Disord. doi: 10.1016/j.jad.2019.02.004.

What would you do if a 17-year-old patient ran out of a therapy group you were leading, went into a bathroom, and superficially cut her wrists?

You might be surprised by child psychiatrist’s Mike Shooter’s response revealed in his book, “Growing Pains: Making Sense of Childhood: A Psychiatrist’s Story”(London: Hodder & Stoughton, 2018). Rather than hospitalizing this patient, as was done many times before, he makes a bold decision to listen to the group members, who help the patient develop a plan that ultimately leads to greater resiliency.

Dr. Shooter shares many stories about the power of therapy to heal, often visiting patients at their homes to better understand the dynamics of their distress. Stories themselves heal: “It is the job of the therapist to encourage them to reveal their story, to listen to it, and to help them find a better outcome.”

From these stories, we learn about Dr. Shooter’s passion and commitment to his relationship with the child – listening, fostering autonomy, recognizing the power of family systems, working with a multidisciplinary team, and using his own experiences with depression to better help his patients.

Dr. Shooter closes the distance between himself and readers by sharing his own story – his difficult relationship with his strict father, his own uncertainty about his future profession, the deep depression that could have derailed his family life and career, and the treatment that got him back on track.

This book is an excellent read for psychiatrists and other mental health professionals, whether they work with children or adults. It is especially valuable to psychiatrists like me who work with college students – transitional-age youth at the border between childhood and adulthood. Dr. Shooter beautifully describes the societal ills that have contributed to a global rise in child and adolescent mental health problems:

“We live in an ever-more competitive world. To the normal pressures of growing up are added the educational demands to pass more and more exams, a gloominess about the future, and a loss of faith in political processes to put it right; private catastrophes at home and global catastrophes beamed in from all over the world; and a media that’s in love with how to be popular, how to look attractive, and how to be a success.”

The general public would also find this book an interesting glimpse into the world of child psychiatry. The public as well as politicians would benefit from knowing the value child psychiatry can provide at a time when services are underfunded in many countries, including the United States.

This book uses the words of children to highlight the challenges young people face – from bereavement to bullying to abuse. He writes about children on the “margins of margins.” As I read the book, Dr. Shooter reminded me of psychiatrist and author Robert Coles, who taught my favorite college class and wrote about children in crisis from the Appalachians to Africa.

Not surprisingly, Dr. Shooter describes spending time with Dr. Coles at a conference on bereavement. He adheres to the advice Dr. Coles offered, which was to “Listen to what the children say, not what the adults say about them. ... Follow what your gut tells you, not your head.”

In addition to listening to the patient and your gut, Dr. Shooter describes offering hope as another essential element to treatment. He describes giving hope to children of parents who die by suicide, as these children often fear they will meet their parents’ fate. “And they need to know, too, that suicide is not inevitable. … Help is ready and available to stop the children and young people ever getting to that state.”

One element of treatment Dr. Shooter minimally addresses is psychopharmacology, and mostly in a negative way. While he acknowledges that some children genuinely do have attention-deficit/hyperactivity disorder or depression, he feels they are overdiagnosed and thus overtreated with medication. I would have liked to hear more about the times he prescribed medication and how it was integrated into comprehensive care that included therapy and lifestyle changes. I would not want parents reading this book to feel badly if they have supported having their child take medication for a mental health disorder.

Dr. Shooter does make the important point that therapy is often left on the sidelines in current medical systems. Therapy can benefit people of all ages as we face our own “growing pains.” He highlights the “opportunity for growth” that challenges provide, and indeed gives us a great sense of hope in our lives and our work as psychiatrists.

Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of “The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students” (Lanham, Md.: Rowman & Littlefield of Lanham, 2018).

What would you do if a 17-year-old patient ran out of a therapy group you were leading, went into a bathroom, and superficially cut her wrists?

You might be surprised by child psychiatrist’s Mike Shooter’s response revealed in his book, “Growing Pains: Making Sense of Childhood: A Psychiatrist’s Story”(London: Hodder & Stoughton, 2018). Rather than hospitalizing this patient, as was done many times before, he makes a bold decision to listen to the group members, who help the patient develop a plan that ultimately leads to greater resiliency.

Dr. Shooter shares many stories about the power of therapy to heal, often visiting patients at their homes to better understand the dynamics of their distress. Stories themselves heal: “It is the job of the therapist to encourage them to reveal their story, to listen to it, and to help them find a better outcome.”

From these stories, we learn about Dr. Shooter’s passion and commitment to his relationship with the child – listening, fostering autonomy, recognizing the power of family systems, working with a multidisciplinary team, and using his own experiences with depression to better help his patients.

Dr. Shooter closes the distance between himself and readers by sharing his own story – his difficult relationship with his strict father, his own uncertainty about his future profession, the deep depression that could have derailed his family life and career, and the treatment that got him back on track.

This book is an excellent read for psychiatrists and other mental health professionals, whether they work with children or adults. It is especially valuable to psychiatrists like me who work with college students – transitional-age youth at the border between childhood and adulthood. Dr. Shooter beautifully describes the societal ills that have contributed to a global rise in child and adolescent mental health problems:

“We live in an ever-more competitive world. To the normal pressures of growing up are added the educational demands to pass more and more exams, a gloominess about the future, and a loss of faith in political processes to put it right; private catastrophes at home and global catastrophes beamed in from all over the world; and a media that’s in love with how to be popular, how to look attractive, and how to be a success.”

The general public would also find this book an interesting glimpse into the world of child psychiatry. The public as well as politicians would benefit from knowing the value child psychiatry can provide at a time when services are underfunded in many countries, including the United States.

This book uses the words of children to highlight the challenges young people face – from bereavement to bullying to abuse. He writes about children on the “margins of margins.” As I read the book, Dr. Shooter reminded me of psychiatrist and author Robert Coles, who taught my favorite college class and wrote about children in crisis from the Appalachians to Africa.

Not surprisingly, Dr. Shooter describes spending time with Dr. Coles at a conference on bereavement. He adheres to the advice Dr. Coles offered, which was to “Listen to what the children say, not what the adults say about them. ... Follow what your gut tells you, not your head.”

In addition to listening to the patient and your gut, Dr. Shooter describes offering hope as another essential element to treatment. He describes giving hope to children of parents who die by suicide, as these children often fear they will meet their parents’ fate. “And they need to know, too, that suicide is not inevitable. … Help is ready and available to stop the children and young people ever getting to that state.”

One element of treatment Dr. Shooter minimally addresses is psychopharmacology, and mostly in a negative way. While he acknowledges that some children genuinely do have attention-deficit/hyperactivity disorder or depression, he feels they are overdiagnosed and thus overtreated with medication. I would have liked to hear more about the times he prescribed medication and how it was integrated into comprehensive care that included therapy and lifestyle changes. I would not want parents reading this book to feel badly if they have supported having their child take medication for a mental health disorder.

Dr. Shooter does make the important point that therapy is often left on the sidelines in current medical systems. Therapy can benefit people of all ages as we face our own “growing pains.” He highlights the “opportunity for growth” that challenges provide, and indeed gives us a great sense of hope in our lives and our work as psychiatrists.

Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of “The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students” (Lanham, Md.: Rowman & Littlefield of Lanham, 2018).

What would you do if a 17-year-old patient ran out of a therapy group you were leading, went into a bathroom, and superficially cut her wrists?

You might be surprised by child psychiatrist’s Mike Shooter’s response revealed in his book, “Growing Pains: Making Sense of Childhood: A Psychiatrist’s Story”(London: Hodder & Stoughton, 2018). Rather than hospitalizing this patient, as was done many times before, he makes a bold decision to listen to the group members, who help the patient develop a plan that ultimately leads to greater resiliency.

Dr. Shooter shares many stories about the power of therapy to heal, often visiting patients at their homes to better understand the dynamics of their distress. Stories themselves heal: “It is the job of the therapist to encourage them to reveal their story, to listen to it, and to help them find a better outcome.”

From these stories, we learn about Dr. Shooter’s passion and commitment to his relationship with the child – listening, fostering autonomy, recognizing the power of family systems, working with a multidisciplinary team, and using his own experiences with depression to better help his patients.

Dr. Shooter closes the distance between himself and readers by sharing his own story – his difficult relationship with his strict father, his own uncertainty about his future profession, the deep depression that could have derailed his family life and career, and the treatment that got him back on track.

This book is an excellent read for psychiatrists and other mental health professionals, whether they work with children or adults. It is especially valuable to psychiatrists like me who work with college students – transitional-age youth at the border between childhood and adulthood. Dr. Shooter beautifully describes the societal ills that have contributed to a global rise in child and adolescent mental health problems:

“We live in an ever-more competitive world. To the normal pressures of growing up are added the educational demands to pass more and more exams, a gloominess about the future, and a loss of faith in political processes to put it right; private catastrophes at home and global catastrophes beamed in from all over the world; and a media that’s in love with how to be popular, how to look attractive, and how to be a success.”

The general public would also find this book an interesting glimpse into the world of child psychiatry. The public as well as politicians would benefit from knowing the value child psychiatry can provide at a time when services are underfunded in many countries, including the United States.

This book uses the words of children to highlight the challenges young people face – from bereavement to bullying to abuse. He writes about children on the “margins of margins.” As I read the book, Dr. Shooter reminded me of psychiatrist and author Robert Coles, who taught my favorite college class and wrote about children in crisis from the Appalachians to Africa.

Not surprisingly, Dr. Shooter describes spending time with Dr. Coles at a conference on bereavement. He adheres to the advice Dr. Coles offered, which was to “Listen to what the children say, not what the adults say about them. ... Follow what your gut tells you, not your head.”

In addition to listening to the patient and your gut, Dr. Shooter describes offering hope as another essential element to treatment. He describes giving hope to children of parents who die by suicide, as these children often fear they will meet their parents’ fate. “And they need to know, too, that suicide is not inevitable. … Help is ready and available to stop the children and young people ever getting to that state.”

One element of treatment Dr. Shooter minimally addresses is psychopharmacology, and mostly in a negative way. While he acknowledges that some children genuinely do have attention-deficit/hyperactivity disorder or depression, he feels they are overdiagnosed and thus overtreated with medication. I would have liked to hear more about the times he prescribed medication and how it was integrated into comprehensive care that included therapy and lifestyle changes. I would not want parents reading this book to feel badly if they have supported having their child take medication for a mental health disorder.

Dr. Shooter does make the important point that therapy is often left on the sidelines in current medical systems. Therapy can benefit people of all ages as we face our own “growing pains.” He highlights the “opportunity for growth” that challenges provide, and indeed gives us a great sense of hope in our lives and our work as psychiatrists.

Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of “The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students” (Lanham, Md.: Rowman & Littlefield of Lanham, 2018).

A new analysis has found that, for African Americans with major depressive disorder (MDD), friendship’s mitigating benefits can vary based on education levels.

“These findings underscore the complexity of social support as a possible intervening process in depression,” wrote Ann W. Nguyen, PhD, of Case Western Reserve University in Cleveland, and her coauthors. The study was published in the Journal of Affective Disorders.

To determine how certain elements of friendship affect MDD, the researchers analyzed 3,434 responses from African Americans to the National Survey of American Life. They assessed variables such as “subjective closeness to friends,” “frequency of contact with friends,” “receipt of support from friends,” and “provision of support to friends” via responses to related questions, along with factoring in the impact of education level on 12-month MDD. Analysis was performed via logistic regression.

Among all respondents, the 12-month prevalence of MDD was 6.7%. Overall, subjective closeness and frequency of contact with friends were negatively associated with 12-month MDD. Those with higher levels of education saw their probability of meeting MDD criteria decrease as frequency of contact increased; those with lower levels of education saw no association between frequency of contact and 12-month MDD. There was a similar association between receipt of support or provision of support and education: The high education group saw their probability of MDD decrease as receipt or provision of support increased.

The authors acknowledged their study’s limitations, including the impossibility of causal inferences because of its cross-sectional design. In addition, the survey only included community-dwelling adults, meaning its findings cannot be extended to institutionalized and homeless individuals. Also, each friendship variable was assessed through a single question. “Future research,” they noted, “should assess these relationship dimensions using multi-item scales, as they tend to be more stable, reliable, and precise.”

No conflicts of interest were reported.

SOURCE: Nguyen AW et al. J Affect Disord. 2019 Jun 15. doi: 10.1016/j.jad.2019.04.013

A new analysis has found that, for African Americans with major depressive disorder (MDD), friendship’s mitigating benefits can vary based on education levels.

“These findings underscore the complexity of social support as a possible intervening process in depression,” wrote Ann W. Nguyen, PhD, of Case Western Reserve University in Cleveland, and her coauthors. The study was published in the Journal of Affective Disorders.

To determine how certain elements of friendship affect MDD, the researchers analyzed 3,434 responses from African Americans to the National Survey of American Life. They assessed variables such as “subjective closeness to friends,” “frequency of contact with friends,” “receipt of support from friends,” and “provision of support to friends” via responses to related questions, along with factoring in the impact of education level on 12-month MDD. Analysis was performed via logistic regression.

Among all respondents, the 12-month prevalence of MDD was 6.7%. Overall, subjective closeness and frequency of contact with friends were negatively associated with 12-month MDD. Those with higher levels of education saw their probability of meeting MDD criteria decrease as frequency of contact increased; those with lower levels of education saw no association between frequency of contact and 12-month MDD. There was a similar association between receipt of support or provision of support and education: The high education group saw their probability of MDD decrease as receipt or provision of support increased.

The authors acknowledged their study’s limitations, including the impossibility of causal inferences because of its cross-sectional design. In addition, the survey only included community-dwelling adults, meaning its findings cannot be extended to institutionalized and homeless individuals. Also, each friendship variable was assessed through a single question. “Future research,” they noted, “should assess these relationship dimensions using multi-item scales, as they tend to be more stable, reliable, and precise.”

No conflicts of interest were reported.

SOURCE: Nguyen AW et al. J Affect Disord. 2019 Jun 15. doi: 10.1016/j.jad.2019.04.013

A new analysis has found that, for African Americans with major depressive disorder (MDD), friendship’s mitigating benefits can vary based on education levels.

“These findings underscore the complexity of social support as a possible intervening process in depression,” wrote Ann W. Nguyen, PhD, of Case Western Reserve University in Cleveland, and her coauthors. The study was published in the Journal of Affective Disorders.

To determine how certain elements of friendship affect MDD, the researchers analyzed 3,434 responses from African Americans to the National Survey of American Life. They assessed variables such as “subjective closeness to friends,” “frequency of contact with friends,” “receipt of support from friends,” and “provision of support to friends” via responses to related questions, along with factoring in the impact of education level on 12-month MDD. Analysis was performed via logistic regression.

Among all respondents, the 12-month prevalence of MDD was 6.7%. Overall, subjective closeness and frequency of contact with friends were negatively associated with 12-month MDD. Those with higher levels of education saw their probability of meeting MDD criteria decrease as frequency of contact increased; those with lower levels of education saw no association between frequency of contact and 12-month MDD. There was a similar association between receipt of support or provision of support and education: The high education group saw their probability of MDD decrease as receipt or provision of support increased.

The authors acknowledged their study’s limitations, including the impossibility of causal inferences because of its cross-sectional design. In addition, the survey only included community-dwelling adults, meaning its findings cannot be extended to institutionalized and homeless individuals. Also, each friendship variable was assessed through a single question. “Future research,” they noted, “should assess these relationship dimensions using multi-item scales, as they tend to be more stable, reliable, and precise.”

No conflicts of interest were reported.

SOURCE: Nguyen AW et al. J Affect Disord. 2019 Jun 15. doi: 10.1016/j.jad.2019.04.013

SAN ANTONIO – A mindfulness-based relapse prevention program resulted in significantly greater declines in anxiety and depressive symptoms among participants in an opioid addiction treatment program than those seen in patients who received treatment as usual, suggest results of a small nonrandomized controlled trial. Relapse rates trended downward with mindfulness but were not significantly different from the treatment-as-usual (TAU) group.

“Mindfulness-based relapse prevention (MBRP) can be successfully implemented in an outpatient setting with as good as or better results as treatment as usual,” Keith J. Zullig, PhD, MSPH, chair and professor in the department of social and behavioral sciences at the West Virginia University School of Public Health in Morgantown, said at the annual meeting of the College on Problems of Drug Dependence.

Though relapse rates did not show a statistically significant drop with mindfulness treatment compared with treatment as usual, the downward trend suggests that it is worthwhile to conduct a larger scale study, Dr. Zullig said.

The significant reductions in anxiety and depression scores among those practicing mindfulness suggest that MBRP particularly benefits patients with co-occurring mood disorders, he added.

The researchers recruited 60 participants from a Comprehensive Opioid Addiction Treatment program who had been substance free for at least 90 consecutive days. Participants chose whether to enter the MBRP group or the treatment-as-usual group.

The treatment-as-usual group attended biweekly 60-minute sessions with a cognitive-based therapy process group led by a licensed therapist for 36 weeks. The MBRP group involved 24 weeks of biweekly attendance at 60-minute sessions, also led by a licensed therapist, followed by 12 weeks in the treatment-as-usual group.

The MBRP instruction involved the following:

• Mindful skill building
• Breathing
• Meditation
• Mindful movement (“gentle yoga practiced with mindful awareness of the body”)
• Using all the senses
• Increasing awareness of breath, body sensations, thoughts, and emotional energy
• Mindfulness in everyday life
• Daily home practice of formal mindfulness meditation for 30 minutes per day, 5-6 days a week
• Discussing practice/exercises both in and outside class

Researchers tracked retention rates, any prohibited substance relapse, and four self-reported measures at 12, 24, and 36 weeks’ follow-up. The self-reported measures looked at craving, with the Desire for Drug Questionnaire; anxiety, with the Overall Anxiety Severity and Impairment Scale, range 0-20); depression, with the Overall Depression Severity and Impairment Scale, range 0-20; and mindfulness, with the Five Facet Mindfulness Questionnaire.

Participants in both groups were statistically similar in gender, employment, education, insurance, and marital status at baseline.

Of the 24 patients who entered the MBRP program, 14 completed the full 24 weeks of intervention and 12 subsequent weeks. Among the 36 participants who entered the treatment-as-usual group, 20 completed the 36 weeks.

Retention was 75% in both groups at 24 weeks, but retention from 24 to 36 weeks was nonsignificantly greater in the mindfulness group (93% vs. 91% treatment as usual).

Relapse at both 24 and 36 weeks was lower among those using mindfulness but without a statistically significant difference. At 24 weeks, 44% of the treatment-as-usual participants had relapsed at least once, compared with 33% of the MBRP participants (intent to treat).

At 36 weeks (n = 37), 45% of the 22 remaining in the treatment-as-usual group had relapsed, compared with 40% of the 15 in the MBRP group. However, 20% of those in MBRP (3 of 15) relapsed between the 24 and 36 week follow-ups, compared with 5% (1 of 22) in the treatment-as-usual group, still a nonsignificant difference.

Anxiety scores were higher at baseline in the MBRP group (11 MBRP vs. 7.25 TAU) but were similar in both groups at 36 weeks (5.79 MBRP vs. 5.6 TAU). Depression scores also were higher at baseline in the MBRP (8 vs. 6.3) but ended slightly lower than the treatment-as-usual group at 36 weeks (3.71 MBRP vs. 4.35 TAU). The reductions in depression and anxiety scores for the MBRP group were significantly greater than in the treatment-as-usual group.

Mindfulness scores were not significantly different at baseline between the groups but were significantly higher at 36 weeks in the mindfulness groups (3.47 vs. 3.3, range 1-5).

“Relapse rates were trending lower in the MBRP group although not statistically significant,” Dr. Zullig said. “Significant decreases occurred in craving in both MBRP and treatment-as-usual groups.”

The Centers for Disease Control and Prevention funded the research. The authors had no disclosures.

SAN ANTONIO – A mindfulness-based relapse prevention program resulted in significantly greater declines in anxiety and depressive symptoms among participants in an opioid addiction treatment program than those seen in patients who received treatment as usual, suggest results of a small nonrandomized controlled trial. Relapse rates trended downward with mindfulness but were not significantly different from the treatment-as-usual (TAU) group.

“Mindfulness-based relapse prevention (MBRP) can be successfully implemented in an outpatient setting with as good as or better results as treatment as usual,” Keith J. Zullig, PhD, MSPH, chair and professor in the department of social and behavioral sciences at the West Virginia University School of Public Health in Morgantown, said at the annual meeting of the College on Problems of Drug Dependence.

Though relapse rates did not show a statistically significant drop with mindfulness treatment compared with treatment as usual, the downward trend suggests that it is worthwhile to conduct a larger scale study, Dr. Zullig said.

The significant reductions in anxiety and depression scores among those practicing mindfulness suggest that MBRP particularly benefits patients with co-occurring mood disorders, he added.

The researchers recruited 60 participants from a Comprehensive Opioid Addiction Treatment program who had been substance free for at least 90 consecutive days. Participants chose whether to enter the MBRP group or the treatment-as-usual group.

The treatment-as-usual group attended biweekly 60-minute sessions with a cognitive-based therapy process group led by a licensed therapist for 36 weeks. The MBRP group involved 24 weeks of biweekly attendance at 60-minute sessions, also led by a licensed therapist, followed by 12 weeks in the treatment-as-usual group.

The MBRP instruction involved the following:

• Mindful skill building
• Breathing
• Meditation
• Mindful movement (“gentle yoga practiced with mindful awareness of the body”)
• Using all the senses
• Increasing awareness of breath, body sensations, thoughts, and emotional energy
• Mindfulness in everyday life
• Daily home practice of formal mindfulness meditation for 30 minutes per day, 5-6 days a week
• Discussing practice/exercises both in and outside class

Researchers tracked retention rates, any prohibited substance relapse, and four self-reported measures at 12, 24, and 36 weeks’ follow-up. The self-reported measures looked at craving, with the Desire for Drug Questionnaire; anxiety, with the Overall Anxiety Severity and Impairment Scale, range 0-20); depression, with the Overall Depression Severity and Impairment Scale, range 0-20; and mindfulness, with the Five Facet Mindfulness Questionnaire.

Participants in both groups were statistically similar in gender, employment, education, insurance, and marital status at baseline.

Of the 24 patients who entered the MBRP program, 14 completed the full 24 weeks of intervention and 12 subsequent weeks. Among the 36 participants who entered the treatment-as-usual group, 20 completed the 36 weeks.

Retention was 75% in both groups at 24 weeks, but retention from 24 to 36 weeks was nonsignificantly greater in the mindfulness group (93% vs. 91% treatment as usual).

Relapse at both 24 and 36 weeks was lower among those using mindfulness but without a statistically significant difference. At 24 weeks, 44% of the treatment-as-usual participants had relapsed at least once, compared with 33% of the MBRP participants (intent to treat).

At 36 weeks (n = 37), 45% of the 22 remaining in the treatment-as-usual group had relapsed, compared with 40% of the 15 in the MBRP group. However, 20% of those in MBRP (3 of 15) relapsed between the 24 and 36 week follow-ups, compared with 5% (1 of 22) in the treatment-as-usual group, still a nonsignificant difference.

Anxiety scores were higher at baseline in the MBRP group (11 MBRP vs. 7.25 TAU) but were similar in both groups at 36 weeks (5.79 MBRP vs. 5.6 TAU). Depression scores also were higher at baseline in the MBRP (8 vs. 6.3) but ended slightly lower than the treatment-as-usual group at 36 weeks (3.71 MBRP vs. 4.35 TAU). The reductions in depression and anxiety scores for the MBRP group were significantly greater than in the treatment-as-usual group.

Mindfulness scores were not significantly different at baseline between the groups but were significantly higher at 36 weeks in the mindfulness groups (3.47 vs. 3.3, range 1-5).

“Relapse rates were trending lower in the MBRP group although not statistically significant,” Dr. Zullig said. “Significant decreases occurred in craving in both MBRP and treatment-as-usual groups.”

The Centers for Disease Control and Prevention funded the research. The authors had no disclosures.

SAN ANTONIO – A mindfulness-based relapse prevention program resulted in significantly greater declines in anxiety and depressive symptoms among participants in an opioid addiction treatment program than those seen in patients who received treatment as usual, suggest results of a small nonrandomized controlled trial. Relapse rates trended downward with mindfulness but were not significantly different from the treatment-as-usual (TAU) group.

“Mindfulness-based relapse prevention (MBRP) can be successfully implemented in an outpatient setting with as good as or better results as treatment as usual,” Keith J. Zullig, PhD, MSPH, chair and professor in the department of social and behavioral sciences at the West Virginia University School of Public Health in Morgantown, said at the annual meeting of the College on Problems of Drug Dependence.

Though relapse rates did not show a statistically significant drop with mindfulness treatment compared with treatment as usual, the downward trend suggests that it is worthwhile to conduct a larger scale study, Dr. Zullig said.

The significant reductions in anxiety and depression scores among those practicing mindfulness suggest that MBRP particularly benefits patients with co-occurring mood disorders, he added.

The researchers recruited 60 participants from a Comprehensive Opioid Addiction Treatment program who had been substance free for at least 90 consecutive days. Participants chose whether to enter the MBRP group or the treatment-as-usual group.

The treatment-as-usual group attended biweekly 60-minute sessions with a cognitive-based therapy process group led by a licensed therapist for 36 weeks. The MBRP group involved 24 weeks of biweekly attendance at 60-minute sessions, also led by a licensed therapist, followed by 12 weeks in the treatment-as-usual group.

The MBRP instruction involved the following:

• Mindful skill building
• Breathing
• Meditation
• Mindful movement (“gentle yoga practiced with mindful awareness of the body”)
• Using all the senses
• Increasing awareness of breath, body sensations, thoughts, and emotional energy
• Mindfulness in everyday life
• Daily home practice of formal mindfulness meditation for 30 minutes per day, 5-6 days a week
• Discussing practice/exercises both in and outside class

Researchers tracked retention rates, any prohibited substance relapse, and four self-reported measures at 12, 24, and 36 weeks’ follow-up. The self-reported measures looked at craving, with the Desire for Drug Questionnaire; anxiety, with the Overall Anxiety Severity and Impairment Scale, range 0-20); depression, with the Overall Depression Severity and Impairment Scale, range 0-20; and mindfulness, with the Five Facet Mindfulness Questionnaire.

Participants in both groups were statistically similar in gender, employment, education, insurance, and marital status at baseline.

Of the 24 patients who entered the MBRP program, 14 completed the full 24 weeks of intervention and 12 subsequent weeks. Among the 36 participants who entered the treatment-as-usual group, 20 completed the 36 weeks.

Retention was 75% in both groups at 24 weeks, but retention from 24 to 36 weeks was nonsignificantly greater in the mindfulness group (93% vs. 91% treatment as usual).

Relapse at both 24 and 36 weeks was lower among those using mindfulness but without a statistically significant difference. At 24 weeks, 44% of the treatment-as-usual participants had relapsed at least once, compared with 33% of the MBRP participants (intent to treat).

At 36 weeks (n = 37), 45% of the 22 remaining in the treatment-as-usual group had relapsed, compared with 40% of the 15 in the MBRP group. However, 20% of those in MBRP (3 of 15) relapsed between the 24 and 36 week follow-ups, compared with 5% (1 of 22) in the treatment-as-usual group, still a nonsignificant difference.

Anxiety scores were higher at baseline in the MBRP group (11 MBRP vs. 7.25 TAU) but were similar in both groups at 36 weeks (5.79 MBRP vs. 5.6 TAU). Depression scores also were higher at baseline in the MBRP (8 vs. 6.3) but ended slightly lower than the treatment-as-usual group at 36 weeks (3.71 MBRP vs. 4.35 TAU). The reductions in depression and anxiety scores for the MBRP group were significantly greater than in the treatment-as-usual group.

Mindfulness scores were not significantly different at baseline between the groups but were significantly higher at 36 weeks in the mindfulness groups (3.47 vs. 3.3, range 1-5).

“Relapse rates were trending lower in the MBRP group although not statistically significant,” Dr. Zullig said. “Significant decreases occurred in craving in both MBRP and treatment-as-usual groups.”

The Centers for Disease Control and Prevention funded the research. The authors had no disclosures.

Isotretinoin use may increase vulnerability to psychiatric conditions, but available evidence does not support a causal relationship, on the basis of data from a retrospective study of 17,829 psychiatric adverse events reported to the Food and Drug Administration over 2 decades.

“Although one study highlighted consistent reporting of depression and suicide in patients taking isotretinoin in the United States from 1982 to 2000, few studies have examined reports of psychiatric adverse events at the national level since 2000,” wrote Sean Singer of Harvard University, Boston, and his colleagues.

In a study published in JAMA Dermatology, the researchers reviewed data from the FDA’s Adverse Event Reporting System between 1997 and 2017.

A total of 17,829 psychiatric adverse events in which isotretinoin was the primary suspect drug were reported during the study period. The researchers classified the events into 12 categories; the most common were depressive disorders (42%), emotional lability (17%), and anxiety (14%). The number of reported psychiatric adverse events was similar between men and women (8,936 and 8,362 events, respectively).

The researchers also identified 2,278 reports of suicidal ideation, 602 reports of attempted suicide, and 368 reports of completed suicide.

In addition, the researchers examined data from the iPLEDGE program and found completed suicide rates of 8.4 per 100,000 patients in 2009 and 5.6 per 100,000 patients in 2010. However, these rates were lower than national suicide rates in the general population of 11.8 per 100,000 people in 2009 and 12.1 per 100,000 people in 2010.

Patient age was available for 13,553 adverse event reports, and patients aged 10-19 years accounted for 53% of the reports overall and 58% of completed suicides for which age was reported.

The high number of psychiatric adverse events in the youngest age group “could reflect more isotretinoin prescriptions in this age group or may suggest that teenagers are particularly vulnerable to psychiatric adverse events while taking isotretinoin,” the researchers said.

The findings were limited by several factors, including the reliance on proper clinician reports to the Adverse Event Reporting System database and the separation of some psychiatric terms into categories that may reflect symptoms of other psychiatric diagnoses, the researchers said.

However, “Our data showed high numbers of reports of emotional lability, anxiety disorders, insomnia, self-injurious behavior, and psychotic disorders with isotretinoin as the primary suspect drug,” they noted.

“Although no causal link has been established between isotretinoin and psychiatric adverse events, it is important to recognize that there are data that suggest patients using this drug may be vulnerable to a number of psychiatric conditions” and that monthly iPLEDGE visits are an opportunity to screen patients for these conditions, they said.

They also stressed that “the risk of psychiatric adverse events in patients taking isotretinoin must be considered in the context of a known increased risk of suicidal ideation in patients with acne independent of isotretinoin therapy.”

Mr. Singer had no financial conflicts to disclose. Study coauthor John S. Barbieri, MD, disclosed partial salary support from Pfizer and grand support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and Arash Mostaghimi, MD, disclosed personal fees from Pfizer.

SOURCE: Singer S et al. JAMA Dermatol. 2019. Jul 3. doi: 10.1001/jamadermatol.2019.1416.

Isotretinoin use may increase vulnerability to psychiatric conditions, but available evidence does not support a causal relationship, on the basis of data from a retrospective study of 17,829 psychiatric adverse events reported to the Food and Drug Administration over 2 decades.

“Although one study highlighted consistent reporting of depression and suicide in patients taking isotretinoin in the United States from 1982 to 2000, few studies have examined reports of psychiatric adverse events at the national level since 2000,” wrote Sean Singer of Harvard University, Boston, and his colleagues.

In a study published in JAMA Dermatology, the researchers reviewed data from the FDA’s Adverse Event Reporting System between 1997 and 2017.

A total of 17,829 psychiatric adverse events in which isotretinoin was the primary suspect drug were reported during the study period. The researchers classified the events into 12 categories; the most common were depressive disorders (42%), emotional lability (17%), and anxiety (14%). The number of reported psychiatric adverse events was similar between men and women (8,936 and 8,362 events, respectively).

The researchers also identified 2,278 reports of suicidal ideation, 602 reports of attempted suicide, and 368 reports of completed suicide.

In addition, the researchers examined data from the iPLEDGE program and found completed suicide rates of 8.4 per 100,000 patients in 2009 and 5.6 per 100,000 patients in 2010. However, these rates were lower than national suicide rates in the general population of 11.8 per 100,000 people in 2009 and 12.1 per 100,000 people in 2010.

Patient age was available for 13,553 adverse event reports, and patients aged 10-19 years accounted for 53% of the reports overall and 58% of completed suicides for which age was reported.

The high number of psychiatric adverse events in the youngest age group “could reflect more isotretinoin prescriptions in this age group or may suggest that teenagers are particularly vulnerable to psychiatric adverse events while taking isotretinoin,” the researchers said.

The findings were limited by several factors, including the reliance on proper clinician reports to the Adverse Event Reporting System database and the separation of some psychiatric terms into categories that may reflect symptoms of other psychiatric diagnoses, the researchers said.

However, “Our data showed high numbers of reports of emotional lability, anxiety disorders, insomnia, self-injurious behavior, and psychotic disorders with isotretinoin as the primary suspect drug,” they noted.

“Although no causal link has been established between isotretinoin and psychiatric adverse events, it is important to recognize that there are data that suggest patients using this drug may be vulnerable to a number of psychiatric conditions” and that monthly iPLEDGE visits are an opportunity to screen patients for these conditions, they said.

They also stressed that “the risk of psychiatric adverse events in patients taking isotretinoin must be considered in the context of a known increased risk of suicidal ideation in patients with acne independent of isotretinoin therapy.”

Mr. Singer had no financial conflicts to disclose. Study coauthor John S. Barbieri, MD, disclosed partial salary support from Pfizer and grand support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and Arash Mostaghimi, MD, disclosed personal fees from Pfizer.

SOURCE: Singer S et al. JAMA Dermatol. 2019. Jul 3. doi: 10.1001/jamadermatol.2019.1416.

Isotretinoin use may increase vulnerability to psychiatric conditions, but available evidence does not support a causal relationship, on the basis of data from a retrospective study of 17,829 psychiatric adverse events reported to the Food and Drug Administration over 2 decades.

“Although one study highlighted consistent reporting of depression and suicide in patients taking isotretinoin in the United States from 1982 to 2000, few studies have examined reports of psychiatric adverse events at the national level since 2000,” wrote Sean Singer of Harvard University, Boston, and his colleagues.

In a study published in JAMA Dermatology, the researchers reviewed data from the FDA’s Adverse Event Reporting System between 1997 and 2017.

A total of 17,829 psychiatric adverse events in which isotretinoin was the primary suspect drug were reported during the study period. The researchers classified the events into 12 categories; the most common were depressive disorders (42%), emotional lability (17%), and anxiety (14%). The number of reported psychiatric adverse events was similar between men and women (8,936 and 8,362 events, respectively).

The researchers also identified 2,278 reports of suicidal ideation, 602 reports of attempted suicide, and 368 reports of completed suicide.

In addition, the researchers examined data from the iPLEDGE program and found completed suicide rates of 8.4 per 100,000 patients in 2009 and 5.6 per 100,000 patients in 2010. However, these rates were lower than national suicide rates in the general population of 11.8 per 100,000 people in 2009 and 12.1 per 100,000 people in 2010.

Patient age was available for 13,553 adverse event reports, and patients aged 10-19 years accounted for 53% of the reports overall and 58% of completed suicides for which age was reported.

The high number of psychiatric adverse events in the youngest age group “could reflect more isotretinoin prescriptions in this age group or may suggest that teenagers are particularly vulnerable to psychiatric adverse events while taking isotretinoin,” the researchers said.

The findings were limited by several factors, including the reliance on proper clinician reports to the Adverse Event Reporting System database and the separation of some psychiatric terms into categories that may reflect symptoms of other psychiatric diagnoses, the researchers said.

However, “Our data showed high numbers of reports of emotional lability, anxiety disorders, insomnia, self-injurious behavior, and psychotic disorders with isotretinoin as the primary suspect drug,” they noted.

“Although no causal link has been established between isotretinoin and psychiatric adverse events, it is important to recognize that there are data that suggest patients using this drug may be vulnerable to a number of psychiatric conditions” and that monthly iPLEDGE visits are an opportunity to screen patients for these conditions, they said.

They also stressed that “the risk of psychiatric adverse events in patients taking isotretinoin must be considered in the context of a known increased risk of suicidal ideation in patients with acne independent of isotretinoin therapy.”

Mr. Singer had no financial conflicts to disclose. Study coauthor John S. Barbieri, MD, disclosed partial salary support from Pfizer and grand support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and Arash Mostaghimi, MD, disclosed personal fees from Pfizer.

SOURCE: Singer S et al. JAMA Dermatol. 2019. Jul 3. doi: 10.1001/jamadermatol.2019.1416.

Adolescents who attempt self-harm using bupropion are at a significantly higher risk of serious morbidity and poor outcomes, compared with those who attempt self-harm with selective serotonin reuptake inhibitors (SSRIs), according to Adam Overberg, PharmD, of the Indiana Poison Center in Indianapolis and associates.

In a study published in Pediatrics, the researchers analyzed 30,026 cases that were coded as “suspected suicide” and were reported to the National Poison Data System between June 2013 and December 2017. All cases were in adolescents aged 10-19 years. A total of 3,504 cases were exposures to bupropion; the rest were exposures to SSRIs.

Cases involving SSRIs were significantly more likely to result in either minor or no outcomes, compared with bupropion (68.0% vs 33.2%); cases resulting in moderate or major outcomes were much more likely to involve bupropion, compared with SSRIs (58.1% vs 19.0%). Among the 10 most common effects in cases with a moderate or major outcome, bupropion was more likely to cause tachycardia (83.7% vs. 59.9%), vomiting (24.8% vs. 20.6%), cardiac conduction disturbances (20.0% vs. 17.1%), agitation (20.2% vs. 11.7%), seizures (27.0% vs. 8.5%), and hallucinations (28.6% vs. 4.3%). Cases involving SSRIs were more likely to cause hypertension (25.3% vs. 17.6%). Eight deaths were reported in the study population; all were caused by bupropion ingestion.

Medical therapies that were more common with bupropion overdose included intubation (4.9% vs. 0.3%), vasopressor use (1.1% vs. 0.2%), benzodiazepine administration (34.2% vs. 5.4%), supplemental oxygen requirement (8.2% vs. 0.8%), and CPR (0.5% vs. 0.01%); three patients in the bupropion group required extracorporeal membrane oxygenation, compared with none in the SSRI group.

“Suicidal ingestions are increasing steadily, as are the numbers of adolescents treated with medication for depression. In light of bupropion’s disproportionately significant morbidity and mortality risk, it would be prudent for practitioners to avoid the use of this medication in adolescents that are at risk for self-harm,” the investigators concluded.

The study investigators reported that there were no conflicts of interest.

lfranki@mdedge.com

SOURCE: Overberg A et al. Pediatrics. 2019 Jul 5. doi: 10.1542/peds.2018-3295.

Adolescents who attempt self-harm using bupropion are at a significantly higher risk of serious morbidity and poor outcomes, compared with those who attempt self-harm with selective serotonin reuptake inhibitors (SSRIs), according to Adam Overberg, PharmD, of the Indiana Poison Center in Indianapolis and associates.

In a study published in Pediatrics, the researchers analyzed 30,026 cases that were coded as “suspected suicide” and were reported to the National Poison Data System between June 2013 and December 2017. All cases were in adolescents aged 10-19 years. A total of 3,504 cases were exposures to bupropion; the rest were exposures to SSRIs.

Cases involving SSRIs were significantly more likely to result in either minor or no outcomes, compared with bupropion (68.0% vs 33.2%); cases resulting in moderate or major outcomes were much more likely to involve bupropion, compared with SSRIs (58.1% vs 19.0%). Among the 10 most common effects in cases with a moderate or major outcome, bupropion was more likely to cause tachycardia (83.7% vs. 59.9%), vomiting (24.8% vs. 20.6%), cardiac conduction disturbances (20.0% vs. 17.1%), agitation (20.2% vs. 11.7%), seizures (27.0% vs. 8.5%), and hallucinations (28.6% vs. 4.3%). Cases involving SSRIs were more likely to cause hypertension (25.3% vs. 17.6%). Eight deaths were reported in the study population; all were caused by bupropion ingestion.

Medical therapies that were more common with bupropion overdose included intubation (4.9% vs. 0.3%), vasopressor use (1.1% vs. 0.2%), benzodiazepine administration (34.2% vs. 5.4%), supplemental oxygen requirement (8.2% vs. 0.8%), and CPR (0.5% vs. 0.01%); three patients in the bupropion group required extracorporeal membrane oxygenation, compared with none in the SSRI group.

“Suicidal ingestions are increasing steadily, as are the numbers of adolescents treated with medication for depression. In light of bupropion’s disproportionately significant morbidity and mortality risk, it would be prudent for practitioners to avoid the use of this medication in adolescents that are at risk for self-harm,” the investigators concluded.

The study investigators reported that there were no conflicts of interest.

lfranki@mdedge.com

SOURCE: Overberg A et al. Pediatrics. 2019 Jul 5. doi: 10.1542/peds.2018-3295.

Adolescents who attempt self-harm using bupropion are at a significantly higher risk of serious morbidity and poor outcomes, compared with those who attempt self-harm with selective serotonin reuptake inhibitors (SSRIs), according to Adam Overberg, PharmD, of the Indiana Poison Center in Indianapolis and associates.

In a study published in Pediatrics, the researchers analyzed 30,026 cases that were coded as “suspected suicide” and were reported to the National Poison Data System between June 2013 and December 2017. All cases were in adolescents aged 10-19 years. A total of 3,504 cases were exposures to bupropion; the rest were exposures to SSRIs.

Cases involving SSRIs were significantly more likely to result in either minor or no outcomes, compared with bupropion (68.0% vs 33.2%); cases resulting in moderate or major outcomes were much more likely to involve bupropion, compared with SSRIs (58.1% vs 19.0%). Among the 10 most common effects in cases with a moderate or major outcome, bupropion was more likely to cause tachycardia (83.7% vs. 59.9%), vomiting (24.8% vs. 20.6%), cardiac conduction disturbances (20.0% vs. 17.1%), agitation (20.2% vs. 11.7%), seizures (27.0% vs. 8.5%), and hallucinations (28.6% vs. 4.3%). Cases involving SSRIs were more likely to cause hypertension (25.3% vs. 17.6%). Eight deaths were reported in the study population; all were caused by bupropion ingestion.

Medical therapies that were more common with bupropion overdose included intubation (4.9% vs. 0.3%), vasopressor use (1.1% vs. 0.2%), benzodiazepine administration (34.2% vs. 5.4%), supplemental oxygen requirement (8.2% vs. 0.8%), and CPR (0.5% vs. 0.01%); three patients in the bupropion group required extracorporeal membrane oxygenation, compared with none in the SSRI group.

“Suicidal ingestions are increasing steadily, as are the numbers of adolescents treated with medication for depression. In light of bupropion’s disproportionately significant morbidity and mortality risk, it would be prudent for practitioners to avoid the use of this medication in adolescents that are at risk for self-harm,” the investigators concluded.

The study investigators reported that there were no conflicts of interest.

lfranki@mdedge.com

SOURCE: Overberg A et al. Pediatrics. 2019 Jul 5. doi: 10.1542/peds.2018-3295.

The consumption of some probiotic supplements appears linked to a reduced susceptibility to depressive symptoms, preliminary results of a randomized trial of 71 participants show.

“Results from the current study provide further evidence that some probiotic mixtures can influence thinking and cognition,” reported Bahia Chahwan of the University of Technology Sydney in New South Wales, Australia, and associates. “Although probiotics did not appear to have had a direct effect on depressive symptoms, our results suggest that probiotics potentially act on cognitive processes contributing to depression.” The study was published in the Journal of Affective Disorders.

To conduct the study, the investigators recruited 71 adults over a 12-month period. A nondepressed control group consisting of 20 adults was recruited over 2 months. Across both groups, about 70% of the participants were women, 67% were white, 80% had no abdominal conditions, 78% did not smoke, and 92% did not consume alcohol above the daily recommended intake. The participants were randomly assigned to either the probiotic or placebo group. Members of both groups received instructions on how to consume their respective product, which was a 2-g freeze-dried powder mixture, twice a day over 8 weeks, and were scheduled for weekly monitoring visits.

Several pre- and postintervention measures of depression were compared using several scales, including the MINI International Neuropsychiatric Interview, the Depression Anxiety Stress Scale-21, and the Beck Anxiety Inventory.

Participants in both groups experienced a reduction in depressive symptoms during the trial period. “This is in line with the evidence suggesting that routines and engagement in planned activities [are] beneficial for reducing symptoms of depression, which forms the basis of activity scheduling as a component for [cognitive-behavioral therapy] for depression,” they wrote.

However, in contrast to the investigators’ hypotheses, participants in the probiotics group did not experience a greater reduction in depressive symptoms than did those on placebo. Instead, the differences between the groups were seen on a measure for depression called cognitive reactivity. Specifically, people with mild/moderate depression who took the probiotics reported lower psychological test scores on cognitive reactivity, compared with controls (45.00 vs. 53.78).

Additional research is needed to look at the impact of differences in gut microbiota strains on people with depressive symptoms, the researchers said. In the meantime, clinicians might do well to consider probiotics as an adjunctive intervention. “Probiotics may be a useful adjunct to potentiate the effects of therapies, such as CBT, which changes cognitive patterns.”

One of the authors, Saskia van Hemert, is an employee of Winclove Probiotics. The other authors reported having no conflicts of interest.

ghenderson@mdedge.com

SOURCE: Chahwan B et al. J Affect Disord. 2019. doi: 10.1016/j.jad.2019.04.97.

The consumption of some probiotic supplements appears linked to a reduced susceptibility to depressive symptoms, preliminary results of a randomized trial of 71 participants show.

“Results from the current study provide further evidence that some probiotic mixtures can influence thinking and cognition,” reported Bahia Chahwan of the University of Technology Sydney in New South Wales, Australia, and associates. “Although probiotics did not appear to have had a direct effect on depressive symptoms, our results suggest that probiotics potentially act on cognitive processes contributing to depression.” The study was published in the Journal of Affective Disorders.

To conduct the study, the investigators recruited 71 adults over a 12-month period. A nondepressed control group consisting of 20 adults was recruited over 2 months. Across both groups, about 70% of the participants were women, 67% were white, 80% had no abdominal conditions, 78% did not smoke, and 92% did not consume alcohol above the daily recommended intake. The participants were randomly assigned to either the probiotic or placebo group. Members of both groups received instructions on how to consume their respective product, which was a 2-g freeze-dried powder mixture, twice a day over 8 weeks, and were scheduled for weekly monitoring visits.

Several pre- and postintervention measures of depression were compared using several scales, including the MINI International Neuropsychiatric Interview, the Depression Anxiety Stress Scale-21, and the Beck Anxiety Inventory.

Participants in both groups experienced a reduction in depressive symptoms during the trial period. “This is in line with the evidence suggesting that routines and engagement in planned activities [are] beneficial for reducing symptoms of depression, which forms the basis of activity scheduling as a component for [cognitive-behavioral therapy] for depression,” they wrote.

However, in contrast to the investigators’ hypotheses, participants in the probiotics group did not experience a greater reduction in depressive symptoms than did those on placebo. Instead, the differences between the groups were seen on a measure for depression called cognitive reactivity. Specifically, people with mild/moderate depression who took the probiotics reported lower psychological test scores on cognitive reactivity, compared with controls (45.00 vs. 53.78).

Additional research is needed to look at the impact of differences in gut microbiota strains on people with depressive symptoms, the researchers said. In the meantime, clinicians might do well to consider probiotics as an adjunctive intervention. “Probiotics may be a useful adjunct to potentiate the effects of therapies, such as CBT, which changes cognitive patterns.”

One of the authors, Saskia van Hemert, is an employee of Winclove Probiotics. The other authors reported having no conflicts of interest.

ghenderson@mdedge.com

SOURCE: Chahwan B et al. J Affect Disord. 2019. doi: 10.1016/j.jad.2019.04.97.

The consumption of some probiotic supplements appears linked to a reduced susceptibility to depressive symptoms, preliminary results of a randomized trial of 71 participants show.

“Results from the current study provide further evidence that some probiotic mixtures can influence thinking and cognition,” reported Bahia Chahwan of the University of Technology Sydney in New South Wales, Australia, and associates. “Although probiotics did not appear to have had a direct effect on depressive symptoms, our results suggest that probiotics potentially act on cognitive processes contributing to depression.” The study was published in the Journal of Affective Disorders.

To conduct the study, the investigators recruited 71 adults over a 12-month period. A nondepressed control group consisting of 20 adults was recruited over 2 months. Across both groups, about 70% of the participants were women, 67% were white, 80% had no abdominal conditions, 78% did not smoke, and 92% did not consume alcohol above the daily recommended intake. The participants were randomly assigned to either the probiotic or placebo group. Members of both groups received instructions on how to consume their respective product, which was a 2-g freeze-dried powder mixture, twice a day over 8 weeks, and were scheduled for weekly monitoring visits.

Several pre- and postintervention measures of depression were compared using several scales, including the MINI International Neuropsychiatric Interview, the Depression Anxiety Stress Scale-21, and the Beck Anxiety Inventory.

Participants in both groups experienced a reduction in depressive symptoms during the trial period. “This is in line with the evidence suggesting that routines and engagement in planned activities [are] beneficial for reducing symptoms of depression, which forms the basis of activity scheduling as a component for [cognitive-behavioral therapy] for depression,” they wrote.

However, in contrast to the investigators’ hypotheses, participants in the probiotics group did not experience a greater reduction in depressive symptoms than did those on placebo. Instead, the differences between the groups were seen on a measure for depression called cognitive reactivity. Specifically, people with mild/moderate depression who took the probiotics reported lower psychological test scores on cognitive reactivity, compared with controls (45.00 vs. 53.78).

Additional research is needed to look at the impact of differences in gut microbiota strains on people with depressive symptoms, the researchers said. In the meantime, clinicians might do well to consider probiotics as an adjunctive intervention. “Probiotics may be a useful adjunct to potentiate the effects of therapies, such as CBT, which changes cognitive patterns.”

One of the authors, Saskia van Hemert, is an employee of Winclove Probiotics. The other authors reported having no conflicts of interest.

ghenderson@mdedge.com

SOURCE: Chahwan B et al. J Affect Disord. 2019. doi: 10.1016/j.jad.2019.04.97.

Responders to repeated transcranial magnetic stimulation for treatment of depression are more likely to engage in light physical activity, compared with those who do not respond to treatment, recent research shows.

“It is remarkable that there is so little evidence on whether treatments for depression among adults have an impact on physical activity and whether changes in physical activity mediate the outcomes of these treatments,” Matthew James Fagan, a PhD student at the University of British Columbia, Vancouver, and colleagues wrote. “Further research is required in understanding the covariation of [physical activity] with depression treatment response.”

The researchers performed a secondary analysis of 30 individuals with major depressive disorder (MDD) who underwent either repeated transcranial magnetic stimulation or intermittent theta burst stimulation for 4-6 weeks. The participants’ 17-item Hamilton Rating Scale for Depression was measured along with their level of physical activity before and after treatment. Physical activity was classified as either light physical activity (LPA) – defined as any waking activity between 1.5 and 3.0 metabolic equivalents – or moderate to vigorous physical activity (MVPA), which was defined as waking behavior at 3.0 metabolic equivalents or higher.

A total of 16 participants responded to treatment (greater than or equal to 18 on the Hamilton Rating Scale for Depression) and 14 participants were deemed nonresponders. The researchers found no significant differences in LPA or MVPA between groups at baseline, but a significant treatment effect was seen among responders who increased LPA by 55 min/day, compared with nonresponders (P = .009). There was also a nonsignificant treatment effect that increased MVPA favoring responders, according to an analysis of covariance.

“Simply, our findings indicate that patients moved more after r-TMS treatment, and this may reinforce the treatment effect,” Mr. Fagan and colleagues reported.

The researchers noted that, because the study was a secondary analysis, it did not show the long-term effect of treatment on physical activity. “Future work should systematically examine the role of PA before, during, and after depression treatments as important synergistic mechanisms may be at play in the treatment of MDD,” they wrote.

Mr. Fagan reported no relevant financial disclosures. One or more authors reported support from several entities, including Brainsway, the Canadian Institutes of Health Research, the National Institutes of Health, and the Vancouver Coastal Health Research Institute, and reported relationships with ANT Neuro, BrainCheck, Brainsway, Lundbeck, Restorative Brain Clinics, and TMS Neuro Solutions.

SOURCE: Fagan MJ et al. Ment Health Phys Act. 2019 Apr 24. doi: 10.1016/j.mhpa.2019.03.003.

Responders to repeated transcranial magnetic stimulation for treatment of depression are more likely to engage in light physical activity, compared with those who do not respond to treatment, recent research shows.

“It is remarkable that there is so little evidence on whether treatments for depression among adults have an impact on physical activity and whether changes in physical activity mediate the outcomes of these treatments,” Matthew James Fagan, a PhD student at the University of British Columbia, Vancouver, and colleagues wrote. “Further research is required in understanding the covariation of [physical activity] with depression treatment response.”

The researchers performed a secondary analysis of 30 individuals with major depressive disorder (MDD) who underwent either repeated transcranial magnetic stimulation or intermittent theta burst stimulation for 4-6 weeks. The participants’ 17-item Hamilton Rating Scale for Depression was measured along with their level of physical activity before and after treatment. Physical activity was classified as either light physical activity (LPA) – defined as any waking activity between 1.5 and 3.0 metabolic equivalents – or moderate to vigorous physical activity (MVPA), which was defined as waking behavior at 3.0 metabolic equivalents or higher.

A total of 16 participants responded to treatment (greater than or equal to 18 on the Hamilton Rating Scale for Depression) and 14 participants were deemed nonresponders. The researchers found no significant differences in LPA or MVPA between groups at baseline, but a significant treatment effect was seen among responders who increased LPA by 55 min/day, compared with nonresponders (P = .009). There was also a nonsignificant treatment effect that increased MVPA favoring responders, according to an analysis of covariance.

“Simply, our findings indicate that patients moved more after r-TMS treatment, and this may reinforce the treatment effect,” Mr. Fagan and colleagues reported.

The researchers noted that, because the study was a secondary analysis, it did not show the long-term effect of treatment on physical activity. “Future work should systematically examine the role of PA before, during, and after depression treatments as important synergistic mechanisms may be at play in the treatment of MDD,” they wrote.

Mr. Fagan reported no relevant financial disclosures. One or more authors reported support from several entities, including Brainsway, the Canadian Institutes of Health Research, the National Institutes of Health, and the Vancouver Coastal Health Research Institute, and reported relationships with ANT Neuro, BrainCheck, Brainsway, Lundbeck, Restorative Brain Clinics, and TMS Neuro Solutions.

SOURCE: Fagan MJ et al. Ment Health Phys Act. 2019 Apr 24. doi: 10.1016/j.mhpa.2019.03.003.

Responders to repeated transcranial magnetic stimulation for treatment of depression are more likely to engage in light physical activity, compared with those who do not respond to treatment, recent research shows.

“It is remarkable that there is so little evidence on whether treatments for depression among adults have an impact on physical activity and whether changes in physical activity mediate the outcomes of these treatments,” Matthew James Fagan, a PhD student at the University of British Columbia, Vancouver, and colleagues wrote. “Further research is required in understanding the covariation of [physical activity] with depression treatment response.”

The researchers performed a secondary analysis of 30 individuals with major depressive disorder (MDD) who underwent either repeated transcranial magnetic stimulation or intermittent theta burst stimulation for 4-6 weeks. The participants’ 17-item Hamilton Rating Scale for Depression was measured along with their level of physical activity before and after treatment. Physical activity was classified as either light physical activity (LPA) – defined as any waking activity between 1.5 and 3.0 metabolic equivalents – or moderate to vigorous physical activity (MVPA), which was defined as waking behavior at 3.0 metabolic equivalents or higher.

A total of 16 participants responded to treatment (greater than or equal to 18 on the Hamilton Rating Scale for Depression) and 14 participants were deemed nonresponders. The researchers found no significant differences in LPA or MVPA between groups at baseline, but a significant treatment effect was seen among responders who increased LPA by 55 min/day, compared with nonresponders (P = .009). There was also a nonsignificant treatment effect that increased MVPA favoring responders, according to an analysis of covariance.

“Simply, our findings indicate that patients moved more after r-TMS treatment, and this may reinforce the treatment effect,” Mr. Fagan and colleagues reported.

The researchers noted that, because the study was a secondary analysis, it did not show the long-term effect of treatment on physical activity. “Future work should systematically examine the role of PA before, during, and after depression treatments as important synergistic mechanisms may be at play in the treatment of MDD,” they wrote.

Mr. Fagan reported no relevant financial disclosures. One or more authors reported support from several entities, including Brainsway, the Canadian Institutes of Health Research, the National Institutes of Health, and the Vancouver Coastal Health Research Institute, and reported relationships with ANT Neuro, BrainCheck, Brainsway, Lundbeck, Restorative Brain Clinics, and TMS Neuro Solutions.

SOURCE: Fagan MJ et al. Ment Health Phys Act. 2019 Apr 24. doi: 10.1016/j.mhpa.2019.03.003.

Adults with obesity and depression who participated in a program that addressed weight and mood saw improvement in weight loss and depressive symptoms at 12 months, results of a randomized, controlled trial of almost 350 patients show.

“To our knowledge, this study was the first and largest RTC of integrated collaborative care for coexisting obesity and depression,” wrote Jun Ma, MD, PhD, of the Institute of Health Research and Policy at the University of Illinois at Chicago, and colleagues.

Dr. Ma and colleagues enrolled 409 patients in the RAINBOW (Research Aimed at Improving Both Mood and Weight) trial between September 2014 and January 2017 from family and internal medicine departments at four medical centers in California. The RAINBOW intervention combined usual care with a weight loss treatment program used in diabetes prevention, problem-solving therapy, and prescriptions for antidepressants if indicated. About 71% of the trial participants were non-Hispanic white adults, 70% were women, and 69% had a college education.

Half the patients were randomized to receive usual care consisting of seeing personal physicians, receiving information on obesity and depression services at the clinic, and wireless activity-tracking devices. Patients were enrolled in the trial if they scored at least 10 points in the nine-item Patient Health Questionaire (PHQ-9) and had a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher in Asian adults. The mean age in the cohort was 51.0 years, the mean BMI was 37.7, and the mean PHQ-9 score was 13.8.

Of the 344 patients (84.1%) who completed follow-up at 12 months, there was a decrease in mean BMI from 36.7 to 35.9 for patients who received the collaborative care intervention, compared with no change in BMI for patients who received usual care alone (between-group mean difference, −0.7; 95% confidence interval, −1.1 to −0.2; P = .01). Depressive symptoms also improved in the intervention group, with mean 20-item Depression Symptom Checklist scores decreasing from 1.5 at baseline to 1.1 at 12 months, compared with a decrease from 1.5 at baseline to 1.4 at 12 months in the usual-care group (between-group mean difference, −0.2; 95% CI, −0.4 to 0; P = .01). Overall, there were 47 adverse events or serious adverse events, with 27 events in the collaborative-care intervention group and 20 events in the usual-care group involving musculoskeletal injuries such as fracture and meniscus tear.

The authors said it is unknown whether the outcomes they observed can be sustained over longer periods of time. In addition, they cited the relative demographic homogeneity of the study sample as one of several limitations.

The study was funded in part by Palo Alto Medical Foundation Research Institute, the University of Illinois at Chicago, and an award from the National Heart, Lung, and Blood Institute. One author, Philip W. Lavori, PhD, reported receiving personal fees from Palo Alto Medical Foundation Research Institute. The other authors reported no relevant financial disclosures.

SOURCE: Ma J et al. JAMA. 2019. doi: 10.1001/jama2019.0557.

Adults with obesity and depression who participated in a program that addressed weight and mood saw improvement in weight loss and depressive symptoms at 12 months, results of a randomized, controlled trial of almost 350 patients show.

“To our knowledge, this study was the first and largest RTC of integrated collaborative care for coexisting obesity and depression,” wrote Jun Ma, MD, PhD, of the Institute of Health Research and Policy at the University of Illinois at Chicago, and colleagues.

Dr. Ma and colleagues enrolled 409 patients in the RAINBOW (Research Aimed at Improving Both Mood and Weight) trial between September 2014 and January 2017 from family and internal medicine departments at four medical centers in California. The RAINBOW intervention combined usual care with a weight loss treatment program used in diabetes prevention, problem-solving therapy, and prescriptions for antidepressants if indicated. About 71% of the trial participants were non-Hispanic white adults, 70% were women, and 69% had a college education.

Half the patients were randomized to receive usual care consisting of seeing personal physicians, receiving information on obesity and depression services at the clinic, and wireless activity-tracking devices. Patients were enrolled in the trial if they scored at least 10 points in the nine-item Patient Health Questionaire (PHQ-9) and had a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher in Asian adults. The mean age in the cohort was 51.0 years, the mean BMI was 37.7, and the mean PHQ-9 score was 13.8.

Of the 344 patients (84.1%) who completed follow-up at 12 months, there was a decrease in mean BMI from 36.7 to 35.9 for patients who received the collaborative care intervention, compared with no change in BMI for patients who received usual care alone (between-group mean difference, −0.7; 95% confidence interval, −1.1 to −0.2; P = .01). Depressive symptoms also improved in the intervention group, with mean 20-item Depression Symptom Checklist scores decreasing from 1.5 at baseline to 1.1 at 12 months, compared with a decrease from 1.5 at baseline to 1.4 at 12 months in the usual-care group (between-group mean difference, −0.2; 95% CI, −0.4 to 0; P = .01). Overall, there were 47 adverse events or serious adverse events, with 27 events in the collaborative-care intervention group and 20 events in the usual-care group involving musculoskeletal injuries such as fracture and meniscus tear.

The authors said it is unknown whether the outcomes they observed can be sustained over longer periods of time. In addition, they cited the relative demographic homogeneity of the study sample as one of several limitations.

The study was funded in part by Palo Alto Medical Foundation Research Institute, the University of Illinois at Chicago, and an award from the National Heart, Lung, and Blood Institute. One author, Philip W. Lavori, PhD, reported receiving personal fees from Palo Alto Medical Foundation Research Institute. The other authors reported no relevant financial disclosures.

SOURCE: Ma J et al. JAMA. 2019. doi: 10.1001/jama2019.0557.

Adults with obesity and depression who participated in a program that addressed weight and mood saw improvement in weight loss and depressive symptoms at 12 months, results of a randomized, controlled trial of almost 350 patients show.

“To our knowledge, this study was the first and largest RTC of integrated collaborative care for coexisting obesity and depression,” wrote Jun Ma, MD, PhD, of the Institute of Health Research and Policy at the University of Illinois at Chicago, and colleagues.

Dr. Ma and colleagues enrolled 409 patients in the RAINBOW (Research Aimed at Improving Both Mood and Weight) trial between September 2014 and January 2017 from family and internal medicine departments at four medical centers in California. The RAINBOW intervention combined usual care with a weight loss treatment program used in diabetes prevention, problem-solving therapy, and prescriptions for antidepressants if indicated. About 71% of the trial participants were non-Hispanic white adults, 70% were women, and 69% had a college education.

Half the patients were randomized to receive usual care consisting of seeing personal physicians, receiving information on obesity and depression services at the clinic, and wireless activity-tracking devices. Patients were enrolled in the trial if they scored at least 10 points in the nine-item Patient Health Questionaire (PHQ-9) and had a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher in Asian adults. The mean age in the cohort was 51.0 years, the mean BMI was 37.7, and the mean PHQ-9 score was 13.8.

Of the 344 patients (84.1%) who completed follow-up at 12 months, there was a decrease in mean BMI from 36.7 to 35.9 for patients who received the collaborative care intervention, compared with no change in BMI for patients who received usual care alone (between-group mean difference, −0.7; 95% confidence interval, −1.1 to −0.2; P = .01). Depressive symptoms also improved in the intervention group, with mean 20-item Depression Symptom Checklist scores decreasing from 1.5 at baseline to 1.1 at 12 months, compared with a decrease from 1.5 at baseline to 1.4 at 12 months in the usual-care group (between-group mean difference, −0.2; 95% CI, −0.4 to 0; P = .01). Overall, there were 47 adverse events or serious adverse events, with 27 events in the collaborative-care intervention group and 20 events in the usual-care group involving musculoskeletal injuries such as fracture and meniscus tear.

The authors said it is unknown whether the outcomes they observed can be sustained over longer periods of time. In addition, they cited the relative demographic homogeneity of the study sample as one of several limitations.

The study was funded in part by Palo Alto Medical Foundation Research Institute, the University of Illinois at Chicago, and an award from the National Heart, Lung, and Blood Institute. One author, Philip W. Lavori, PhD, reported receiving personal fees from Palo Alto Medical Foundation Research Institute. The other authors reported no relevant financial disclosures.

SOURCE: Ma J et al. JAMA. 2019. doi: 10.1001/jama2019.0557.