Archives for March 2008

  In terms of diagnosis, seasonal affective disorder is not really a separate mood disorder from major depression or bipolar disorder. Instead, "seasonal pattern" is a specifier used as additional diagnostic information to describe the regular pattern of the depressive episode associated with major depression or bipolar disorder. For instance, a person could receive the following diagnosis: Major Depressive Disorder, Recurrent Episode, Moderate, With Seasonal Pattern However, since people often refer to this type of depression as "Seasonal Affective Disorder" or "SAD" we will use that terminology here. SAD is a condition that affects a person during specific times or seasons of the year. Typically the depressive symptoms of this condition begin during fall or winter, and end when spring arrives. At other months during the year a person's mood will be normal, or at least will not meet criteria for clinical depression. Those who have SAD may notice that in the winter months they have a lack of energy or feel sluggish, they sleep more than usual, they overeat and gain weight, and they may have a craving for carbohydrates. Of those who have SAD, 60%-90% are women. Rates of SAD are higher in those who live at higher latitudes. It also occurs more frequently in younger people and often begins in a person's twenties.

Diagnosis of a Seasonal Pattern Specific:

This specifier may describe the depressive episode in major depression or bipolar disorder.

A. A person has experienced a regular pattern of depressive episodes that begin at specific time of the year (e.g., fall or winter), and which are not related to specific yearly stressors such as school/college or seasonal unemployment.

B. The depression also ends or changes at a specific time of the year (e.g., spring).

C. The pattern has occurred for the most recent two years with no other symptoms outside of the pattern.

D. A person has had more seasonal depressions than non-seasonal depressions in his/her lifetime.

This is news in the field of research that anti-depressants work only on the severely depressed people which means that the people who are less depressed can not rely on anti-depressants any more. But then what is the option for them if not anti-depressants? While popular antidepressants such as Prozac are widely prescribed for people with varying degrees of depression, the drugs are only effective for those with the most severe depression, a new study suggests."Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great," lead researcher Irving Kirsch, a professor of psychology at the University of Hull in Great Britain, said in a prepared statement. "This means that depressed people can improve without chemical treatments," he added. In the study, Kirsch and his colleagues collected data on 35 clinical trials of antidepressant drugs whose results had been submitted to the U.S. Food and Drug Administration. The antidepressants included in the trials were fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat/Paxil). An analysis of the data showed that patients taking antidepressants fared no better than patients receiving a placebo. This appeared to be the case whether the patients were mildly or moderately depressed.The drugs only seemed to benefit a small group of patients -- those with the severest depression when the study began. Based on these results, there appears to be little reason to prescribe these antidepressants to anyone but the most severely depressed patients, the study authors concluded. Dr. Nada Stotland, president-elect of the American Psychiatric Association, said she wasn't surprised that the study found that not every antidepressant works for every patient. Many people who are depressed don't respond to the first antidepressant they try. It can take up to an average of three different antidepressants until one works for a particular patient, she said. "Medication helps some, but not all, people with depression," Stotland said in a prepared statement. "For people with mild to moderate depression, psychotherapy can work as well as medication. Studies have shown that between 70 and 80 percent of people can and do get better with a combination of treatment approaches, which will often include individual therapy, family therapy and/or medication. "Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve," Stotland added. "There is a small group of depressed individuals who do not respond to any antidepressant." The new study highlights the fact that treatment for depression needs to be tailored to an individual, and that the most effective treatment will often include multiple approaches, Stotland said. The study results also suggest that more long-term follow-up trials are needed to determine which patients are most likely to benefit from specific therapies. "Some of the most exciting research in progress at the present time concerns our attempt to match the antidepressant to the patient from the outset; we may be able to perform laboratory tests or identify clinical factors that let us know in advance which antidepressant will work for each person," Stotland said. "That will be an enormous advance for the millions of people suffering from this very painful and potentially disabling disease." In a prepared statement released late Tuesday, Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson said, "It is true that pharmaceutical products, such as antidepressants, can result in a differential response among different patients. It is for this reason that a variety of therapeutic options is important in health care -- so that each patient can receive the most effective treatment for his or her needs. "Because of this, America's pharmaceutical research companies are dedicated to continuing their research into and development of potential new medicines to treat depression as well as the other disease that affect patients worldwide."