BRAIN SCANS: A NEW TOOL FOR TREATING DEPRESSION

Treating depression can be challenging for clinicians, with no way of knowing how a patient will respond. But brain scans taken before treatment may help predict which treatment is best for an individual patient, according to a study published in JAMA Psychiatry (Volume 70, page 821).

In the study, researchers used a positron emission tomography (PET) scanner to obtain images of the resting brain in 63 people, ages 18 to 60, with depression. They then compared brain activity of patients who were successfully treated with that of those who saw no improvement. Participants had been randomly assigned to either 12 weeks of antidepressants or 16 weeks of psychotherapy.

Based on the PET imaging, activity in the area of the brain known as the anterior insula - responsible for such things as decision-making, emotions and body cues (such as hunger and cravings) - appeared to be able to predict which depression treatment would elicit a patient's response: cognitive behavior therapy or escitalopram (Lexapro). Low activity in the insula was associated with a better chance of successful treatment with cognitive behavior therapy and failure with escitalopram, while high activity in the insula correlated with successful treatment using medication and failure with therapy.

Takeaway - If further research supports these findings, it may mark the beginning of more individualized medicine.

(Source:  John Hopkins Health Alert, 27 May 2014)

From Research: The Link Between Late-Onset Depression and Dementia Risk

Depression that first manifests in midlife or later may be a harbinger of dementia, a new study says.  The study was published in the Archives of General Psychiatry (Volume 69, page 493).

Researchers reviewed data from the records of more than 13,000 adults who were long-term members of the Kaiser Permanente Medical Care Program and who had signed up in the 1960s and 1970s to participate in a research study for middle-aged people.

To identify midlife depression, the researchers reviewed surveys that had asked participants whether they often felt unhappy or depressed, and they examined hospital records to identify admissions related to a diagnosis of depression.  More recent medical records were also reviewed to identify late-life depression and dementia diagnoses.

In participants with depressive symptoms in late life - whether or not they were combined with midlife symptoms - the risk of Alzheimer's was doubled. Combined midlife and late-life depressive symptoms more than tripled the risk of vascular dementia.

Takeaway Message 

These findings don't prove that depression that first occurs in midlife or beyond is a sign of dementia. Moreover, the researchers didn't attempt to determine whether treatment could reduce risk. Still, if you are experiencing depression, it's important to discuss it with your doctor. Effective treatments for depression are available.

(Source:  John Hopkins Health Alert, Posted in Memory, 9 September 2013)

Music Therapy: A Helpful Add-On to Traditional Therapy for Depression

Music has long been known to affect mood - but can it relieve Depression?  According to recent studies, Music Therapy, which typically combines traditional "Talk Therapy" with listening to music or creating it, may work to alleviate Depression in several ways.

·       Playing an instrument allows depressed people to express themselves non verbally when they  can't easily talk about how they feel.

·       Listening to soothing music helps others relax so they're better able to let go of feelings that are troubling.

·        Still others may find that sharing a musical experience with a Therapist - playing or listening -  help them feel more comfortable discussing their problems and feelings.

Music Therapy is either active or receptive and does not require prior musical background or abilities.

·         In Active Music Therapy, the Therapist and the patient improvise, recreate, or compose music using a drum, mallet instrument or the voice. The goal is for the patient to share thoughts and feelings that arise with the music making and, as a result, develop insight into his or her problems.

·         In Receptive Music Therapy, patients listen to music while meditating, drawing or reminiscing. This process allows patients to improve their mood and develop coping and relaxation skills.

The duration and frequency of Music Therapy Sessions vary, but they typically last 20 minutes to one hour. Patients may undergo sessions daily, weekly or monthly. Music Therapy Sessions can take place in a group or individually in a hospital, therapist's office or patient's home.

What the Research shows

Some studies of music therapy for depression have been encouraging. A review of five small randomized, controlled trials found that in four of the studies, depressive symptoms were reduced more in patients who participated in music therapy than in those who received standard treatment. However, the methodological quality of these studies was moderate to poor, and the types of music therapy and standard treatments used and patients studied varied considerably.

Is Music Therapy right for you? 

Although Music Therapy appears to be helpful, it's likely most suitable as an add-on to traditional therapies such as medication and other forms of psychotherapy. Anyone receiving treatment for depression should first discuss the use of Music Therapy with his or her health care provider.

(Source: John Hopkins Health Alert, posted in Depression and Anxiety on April 2, 2013) 

Dementia, Late-Life Depression May Be Linked

Older people with depression may be more likely to experience mild mental impairment or dementia than their peers, Dutch researchers report.

In a study of nearly 2,200 Medicare recipients aged 65 and older, researchers led by Dr. Edo Richard of the University of Amsterdam examined the association between late-life depression and dementia and thinking/memory difficulties known as mild cognitive impairment (MCI).

The study, published online Dec. 31 in the Journal Archives of Neurology, found that people with depression were 40 percent more likely to have mild mental impairment and more than twice as likely to have full-blown dementia. Although depression also was linked to greater risk for incident dementia, it was not associated with incident problems with thinking and memory.

The study authors said those with both mild cognitive impairment and depression were at increased risk for developing dementia, particularly vascular dementia. They noted, however, that these patients were not at greater risk for Alzheimer's disease, the most common form of dementia.

"Our finding ... suggests that depression develops with the transition from normal cognition to dementia," the authors wrote in a journal news release.

Depression affects between 3 percent and 63 percent of people with mild cognitive impairment. Previous studies have found that those with a history of depression are at greater risk for dementia. The researchers added that there is no clear explanation for the link between late-life depression and cognitive impairment, and their study does not establish a direct cause-and-effect relationship.

(Source:  MedicineNet.com, 4 January 2013)