Depression

A 75-year-old woman presented with worsening dyspnea of about 6 to 8 months' duration. Her symptoms were initially associated with exercise, after about 30 minutes on the treadmill, and now were present at rest. Her breathing pattern had changed to "panting" to improve airflow during minimal activity.

Results of a large study showed that electroconvulsive therapy (ECT) might be equally effective in both patients with unipolar depression and those with bipolar depression.1

Current guidelines for the management of bipolar depression are outdated because they are based on the definition and treatment of unipolar depression, accor

Repetitive transcranial magnetic stimulation (rTMS) may be an effective therapy for treatment-resistant bipolar depression, according to the results of a recent pilot study led by Guohua Xia,

Although rapid-cycling bipolar disorder has been linked to the use of antidepressants, these treatments may still have a role in the management of patients with bipolar depression, said Stephen V. Sobel, MD, clinical instructor at the University of California, San Diego School of Medicine, in a presentation at the US Psychiatric and Mental Health Congress in Las Vegas.1 Patients with bipolar disorder spend most of their time in depression, and antidepressants can alleviate the symptoms, he said.

Almost 90% of employers consider employee medication compliance to be a prime health management objective, according to a study by the National Pharmaceutical Council (NPC).1 The majority of study respondents reported that they are analyzing or have plans to analyze prescription data to determine medication compliance for select health conditions.

What is the role of the primary care practitioner in the care of patients with HIV infection?Although the treatment of human immunodeficiency virus type 1 (HIV-1) infection is usually directed by subspecialists, many patients who are taking highly active antiretroviral therapy (HAART) continue to see their primary care physician. What is the most effective regimen-and what complications should we be on the lookout for?

Dozens of guidelines and algorithms are available from a range of authoritative sources to guide selection of psychopharmacology.

SSRIs and related antidepressants are great drugs for the treatment of depression, anxiety, premenstrual disorders, and other conditions. However, sexual dysfunction is very common and affects 30% to 70% of patients,1 or 36% to 43% of patients depending on the particular medications and the study protocol.2 Men are somewhat more likely than women to have difficulty, especially with the desire phase of sexual function. However, it is clear that patients of both sexes may have either phase-specific or global sexual dysfunction while taking antidepressants.

Huskamp and associates recently reported that in the year following the implementation of Part D, many patients dually eligible for Medicaid and Medicare benefits had difficulty gaining access to psychiatric medications.

The medications currently approved for the treatment of insomnia include 9 benzodiazepine receptor agonist (BZRA) hypnotics and the selective melatonin receptor agonist ramelteon.

Estimates for the costs of treating breast cancer vary considerably, depending on patient population, time horizon, methodology, and other variables. According to a recent review by Campbell and Ramsey1 from the Fred Hutchinson Cancer Research Center in Seattle, estimates of lifetime per patient costs associated with breast cancer ranged from $20,000 to $100,000. As a result of the relatively long survival of patients with breast cancer, the costs of continuing care account for the largest proportion of lifetime costs.

Major depressive disorder (MDD) does not always respond to antidepressants. Whether we are using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclics, monoamine oxidase inhibitors, or heterocyclics (trazodone, nefazodone, bupropion), the result often falls short of full remission of symptoms.

Patients with migraine accompanied by depression or anxiety disorders had greater improvements in headache-related disability than those without a psychiatric disorder, according to results of the Treatment of Severe Migraine trial.

Tonabersat is effective in the prophylaxis of aura in patients with migraine, according to a recent study led by Jes Olesen, MD, a professor of neurology at the Danish Headache Center at Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.

Patients with migraine are more likely than nonmigraineurs to have temporomandibular disorder (TMD). According to the results of a new study presented at the 14th annual International Headache Conference in Philadelphia, TMD may also be associated with increased headache frequency.

Physicians rate 15% of patient visits as “difficult,” according to the results of a classic study.

Diabetes is the most demanding chronic illness. It challenges every fiber of a patient’s body and spirit and demands a system of care that ministers to the biological, social, and psychological aspects of the illness. It takes a “village” to accomplish this task.

Since the 2006 launch of the Medicare Part D prescription drug benefit, the Centers for Medicare & Medicaid Services (CMS) has required all Part D sponsors, including Health Net, to offer free medication therapy management program (MTMP) services to members at high risk for drug-related problems.

Many women who are taking antidepressants discontinue therapy during pregnancy because of safety concerns. However, a study conducted in Canada demonstrates that the costs of discontinuing antidepressants are considerable. O’Brien and colleagues1 analyzed the direct medical costs associated with the discontinuation of antidepressant therapy in pregnant women in Ontario. They estimated that a relapse of depression occurred annually in about 2953 pregnant women who discontinued antidepressant therapy.

I hear from my physician friends that the “hassle factor” to obtain health plan coverage of prescribed therapy is increasing exponentially and that many of them are thinking of retiring or cutting back their practices. That is my experience and reaction as well.

The objective of this study was to estimate the annual cost burden of Parkinson disease (PD) in the United States. Resource use and cost profiles were developed using all-payer statewide hospital discharge data from 6 states; emergency department visit, long-term–care, and national survey data; fee schedules; and published study findings. (Average direct and indirect costs per patient were calculated in 2007 US dollars.) The annual cost per patient was $21,626 (direct cost: $12,491). When applied to the US PD population (N = 500,000), the annual average cost was approximately $10.78 billion (direct costs, $6.22 billion; indirect costs, $4.56 billion). PD has substantial economic consequences for patients and their families, insurers, and society. (Drug Benefit Trends. 2009;21:179-190)

Recently, after getting her regular prescription for Synthroid filled at the pharmacy, my mother called the physician to complain that she just didn’t feel well. The doctor was considering increasing the dosage when my mother noticed that the pills looked different. She had been given a generic version. Her prescription was changed back to Synthroid and she felt fine again.

Lecturing around the country has left us with the powerful impression that both primary care physicians and psychiatrists are hungry for new ways to think about and manage depression and the myriad symptoms and syndromes with which it is associated-including attention-deficit disorder, insomnia, chronic pain conditions, substance abuse, and various states of disabling anxiety.

Premenopausal women with major depressive disorder (MDD) have less bone mineral density (BMD) than those without MDD, according to findings of a study published in the November 26 issue of Archives of Internal Medicine.

Sometimes we try to distill long experience into words, whether aphorisms or full paragraphs. Rilke’s wonderful prose poem expresses this very well in the part that begins, “For the sake of a single verse, one must see many cities, men and things. . . . ” While medicine has only some features in common with poetry, what reverberates is the wish to impart an affecting draught of beauty or wisdom or insight, in the case of poetry, after many years and decades of immersion in life; and I here offer some fruits of long observation and participation “hip deep” in clinical care and in the teaching of residents.

A study published in the November issue of the Journal of Adolescent Health shows that young persons with asthma are twice as likely to have anxiety and depressive disorders than youths without asthma. Researchers at the University of Washington School of Medicine, Seattle; Group Health Cooperative (GHC); and Seattle Children’s Hospital Research Institute interviewed 1379 youths aged 11 to 17 years enrolled in the GHC HMO. Of the study participants, 781 had received a diagnosis of asthma or had been treated for asthma; 598 participants were randomly selected youths with no history of asthma.

About 50% of pregnanciesin the United States areunplanned.

Nearly one-fifth (19%) of US employers are taking steps to discontinue providing health care benefits during the next 3 to 5 years, up from just 4% in 2008, according to results of The Road Ahead: Emerging Health Trends 2009, a survey conducted for Hewitt Associates by project leader Jeffrey D. Munn. The team interviewed benefit executives at 343 large employers representing more than 5 million employees in December 2008 and January 2009.

Persons with chronic pain who participated in a collaborative care program with primary care physicians and psychologists showed improvement in depression, pain severity, and pain-related disability compared with those who received treatment by primary care physicians only, according to a study published in the March 25 issue of the Journal of the American Medical Association.