No Depression Articles

The Medical Defence Union, the UK’s largest medical defence organisation, has revealed it paid out nearly ??3m in compensation on behalf of GP members to settle 30 claims arising from the treatment of patients with depression during a recent ten-year-period.
In the latest edition of the MDU Journal1, Professor Femi Oyebode, consultant psychiatrist and MDU Council member, analysed the main reasons for claims relating to the diagnosis and management of patients with depression (excluding post-natal depression). He commented:
"Depression is a relatively common presentation in general practice and in most cases, the care of patients with depression is generally straightforward and without incident. However when something does go wrong, the nature of the condition and the type of medication involved means there is significant potential for an adverse outcome, including the risk that the patient will harm themselves in some way, including a small number of tragic cases where a patient has committed suicide"
Generic lasix pills no prescription Examples of cases settled by the MDU include more than ??1m paid out to a patient with a history of depression who was left severely brain damaged following an overdose after being prescribed the antimalarial drug mefloquine; over ??21,000 paid out to a patient who became addicted to an antidepressant; and a GP who missed a fractured hip in an elderly patient with depression after he visited the doctor following a fall. The patient received over ??6,500 in compensation2.
In the article, Professor Oyebode highlights three main areas of risk highlighted when treating depressed patients:
- Problems with medication
- Failure to diagnose or treat an unrelated condition in a depressed patient
- Failure to recognise the risk of suicide in a depressed patient.
The article includes advice for GPs on how to avoid such problems. While some of these points may seem obvious, they are all examples taken from the MDU’s files:
- Take care with prescriptions for drugs with similar names and with dosages, particularly with drugs that come in different formulae and strengths.
- Beware of the risk of drug interactions, for example between lithium and diuretics.
- Have a system in place to review patients on long-term medication.
- Be aware of the current guidance on the prescription of antidepressants.
- Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.
- All patients who present with depression need to be assessed regularly for risk of suicide.
- Under shared care agreements, there should be a clear agreement on the responsibility for monitoring and treatment and the arrangements should be made clear to the patient.
- Be prepared to refer patients for specialist treatment where necessary and have a system in place to track referrals.
References
1. Medico-legal pitfalls in depression, MDU Journal, Volume 24, Issue 1, June 2008
2. All compensation sums quoted exclude legal costs.
The MDU - the UK’s leading medical defence organisation.
Medical Defence Union
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Depression will affect up to 25% of the population at some point in their lives. It also has been shown to have a strong genetic component. For example, if one of your close family members has depression, your chance of also being a sufferer is three to four times the general population risk.
Now University of Aberdeen researchers have joined forces with the University of Liverpool and the Institute of Psychiatry, King’s College London to try to find the genetic causes of depression.
They believe the answers could lie with short DNA sequences which act as ‘genetic switches’ controlling key genes in an area of the brain that influences mood.
These switches ensure that certain genes are only used in the correct parts of the brain at the proper times and in the right dose. Any changes in these can cause imbalances in the amount of critical proteins in the brain that may increase susceptibility to depression.
Unlike genes, little is know of these switches, technically known as enhancers, because up until now they have been very hard to find.
Recently, however, it was found that these switches were so important in evolution that they have been kept, nearly unchanged, through hundreds of millions of years from a time before the dinosaurs.
Dr Alasdair MacKenzie, Senior Lecturer at the University of Aberdeen, and the scientist leading the study, explained: "Only by comparing the genomes of species as diverse as mice, marsupials and birds has it been possible to identify these switches as, in many cases, they are located far away from the genes they control. The distances involved are as surprising as having a light bulb in London with the switch for controlling it in Liverpool."
Comparing the genomes of different species has helped them to identify the switches responsible for controlling genes known to be involved in depression, as well as addiction, obesity and inflammatory pain.
This new study funded by the Medical Research Council will allow them to build on their earlier work and also analyse common sequence differences found in the general population which can result in increased risk of developing depression.
Researchers in Aberdeen and Liverpool will study the functional effect of these ’switch’ sequences. Buy soma pills Scientists at the Institute of Psychiatry at King’s, led by Dr Gerome Breen and Professor Peter McGuffin, will look at common variations found in these sequences using DNA samples taken from thousands of patients with chronic depression.
It is hoped the three year study - which will also examine why some sufferers do not respond to anti-depressant treatments - will ultimately pave the way for new drugs to treat the condition.
Dr Alasdair MacKenzie said: "This study would have been impossible even four years ago. It is only through advances in the sequencing of the DNA of many different species that we can now use powerful computers to pick out the most important bits of the human genome that includes the switches needed to control genes.
"In addition to depression, this technology has the potential for exploring the causes of a number of other disorders including chronic pain, obesity or even cancer."
Professor Quinn at the University of Liverpool said: "This study hopes to discover how the same genes in different people are controlled in slightly different ways in the parts of the brain that control fear and mood.
"We hope to link differences in the switches that control these genes with susceptibility to distressing conditions such as depression and chronic anxiety. Also, we hope to find out how these differences may change the way that depressed patients respond to their medicines."
Dr Breen, jointly leading the Institute of Psychiatry at King’s involvement, said: "We can now analyse millions of genetic variations in the human genome but it is only studies like that that will allows us to track down those that are important in disorders such as depression."
Professor McGuffin added: "We are delighted to be part of such a potentially exciting project and look forward to our collaboration further enlightening clinical research and practice."
Notes
The University of Aberdeen is a centre of excellence for life sciences. Translational research is a particular strength for the University as its health campus is based on one of the largest teaching hospital sites in Europe. Lately the University has made major strategic investments to consolidate its position as one of the world’s key centres for R&D in life sciences and medical research. One of the UK’s most progressive fundraising higher education institutions, Aberdeen has recently recruited more than 50 senior academic leaders from institutions all over the world.
The University of Liverpool is a member of the Russell Group of leading research-intensive institutions in the UK. It attracts collaborative and contract research commissions from a wide range of national and international organisations valued at more than ??108 million annually.
Institute of Psychiatry
The Institute of Psychiatry is part of King’s College London and closely affiliated to the South London and Maudsley NHS Foundation Trust. The Institute is a world-renowned centre for treatment, research and training in psychiatry and mental health. The organisation is involved in pioneering new and improved ways of understanding and treating mental illness and brain disease. Its wide-ranging field of work includes depression, trauma, eating disorders, brain imaging, genetics and psychosis.
King’s College London is one of the top 25 universities in the world (Times Higher 2007) and the fourth oldest in England. A research-led university based in the heart of London, King’s has 19,300 students from more than 130 countries, and 5,000 employees. King’s has an outstanding reputation for providing world-class teaching and cutting-edge research. The College is in the top group of UK universities for research earnings and has an annual income of approximately ??400 million. An investment of ??500 million has been made in the redevelopment of its estate.
Institute of Psychiatry
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An article published in the May 28 issue of JAMA reports
that patients who took the drug escitalopram or participated in a
problem-solving therapy group during the year following a stroke were
found to have a lower risk of depression compared to patients who
received
placebo.
Of the over 700,000 incidences of stroke per year in the United States,
more than half lead to depression. "Post-stroke depression has been
shown in
numerous studies to be associated with both impaired recovery in
activities of daily living and increased mortality. Prevention of
depression thus represents a potentially important goal," write author
Robert. G. Robinson, M.D. (University of Iowa, Iowa City) and
colleagues.
Testing the efficacy of the anti-depressant drug
escitalopram or problem-solving therapy in comparison to placebo,
Robinson and colleagues conducted a randomized controlled trial with
176 stroke patients. Within three months of the stroke, 59 patients
were randomly assigned to take escitalopram for 12 months, 59 were
assigned to the problem-solving
therapy group, and 58 were assigned to the placebo group. In the
problem-solving therapy group, patients received six treatment sessions
and six reinforcement
sessions; part of the program consisted of selecting a problem and
working through
steps to develop a plan of action.
The researchers found that depression had developed in 22.4% of
patients in the placebo group, 8.5% in the escitalopram group,
and 11.9% in the problem-solving therapy group. In other words,
patients in the placebo group were 4.5 times and 2.2 times more likely
to develop depression than the escitalopram and the problem-solving
therapy group, respectively. The authors note that, "Based only on the
frequency of depression
onset during the one year of treatment, 7.2 acute stroke patients would
need to be treated with escitalopram to prevent one case of depression
and 9.1 acute stroke patients would need to be treated with
problem-solving therapy to prevent one case of depression."
Using a more conservative method of data analysis, the researchers
still found that escitalopram resulted in more favorable results than
placebo - 23.1% of escitalopram patients developed depression compared
to 34.5% in the placebo group. However, in these additional analyses,
30.5% of the problem-solving therapy group developed depression - not
significantly better
than placebo. Lastly, on significant difference among the groups was
noted regarding the frequency of adverse events.
"The clinical implications of our findings are that patients who are
given escitalopram or problem-solving therapy following acute stroke
may be spared depression and perhaps its adverse consequences,"
conclude the
authors.
Escitalopram and Problem-Solving Therapy for Prevention of
Poststroke Depression: A Randomized Controlled Trial
Robert G. Buy generic cialis Robinson; Ricardo E. Jorge; David J. Moser; Laura Acion; Ana
Solodkin; Steven L. Small; Pasquale Fonzetti; Mark Hegel; Stephan Arndt
JAMA (2008). 299[20]:2391 - 2400.
Click
Here to View Abstract
Written by: Peter M Crosta
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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While there is a correlation between individuals with depression and
the development of Alzheimer’s disease, it appears that the symptoms of
depression do not increase in the years before an Alzheimer’s
diagnosis, according to a report released on April 7, 2008 in the
JAMA/Archives journal Archives of General Psychiatry.
Previous studies have shown that patients with Alzheimer’s or its
precursor, mild cognitive impairment, have higher levels of depressive
symptoms, which include feeling sad or a diminished ability to feel
pleasure. According to the article, this association’s causality is not
clear. "The basis of this
association is uncertain, however," the authors write. "A leading
hypothesis is that depressive symptoms do not constitute a true risk
factor but rather a consequence of the disease." If hypothesis was
true, the symptoms of depression would coincide with the symptoms of
Alzheimer’s, and thus increase in the early stages of the disease.
To investigate the cause of the correlation, Robert S. Wilson, Ph.D.,
of Rush University
Medical Center, Chicago, and colleagues examined older Catholic nuns,
priests, and monks who did not have dementia. A total 917 patients were
examined beginning in 1994. They were evaluated early
by: neurological examination; cognitive exam investigating
thinking, learning, and memory; classification for Alzheimer’s disease
or mild cognitive impairment; and a ten item scale to access their
symptoms of depression.
When the study began, 53.6% of participants presented no symptoms of
depression, 23.9% reported one symptom, 9.7% reported two, 6.1%
reported three, and 6.8% reported more. In the later examination, 20.7%
of the individuals (190) developed the disease. If someone displayed
symptoms of depression at the beginning of the study, he was more
likely to develop Alzheimer’s disease by the end.
However, the levels of symptoms did not change at the same time: "those
who developed Alzheimer’s
disease showed no increase in depressive symptoms before the diagnosis
was made, and this finding was not modified by age, sex, education,
memory complaints, vascular burden or personality," say the authors.
"Among those without cognitive impairment at baseline, depressive
symptoms did not increase in those who subsequently developed mild
cognitive impairment." This indicates that depression is not a
consequence of Alzheimer’s, but rather a risk factor for the
development of dementia.
The authors offer the explanation that depression may intrinsically
change the brain to make it less resistant to dementia. They add:
"Understanding the mechanisms linking depressive
symptoms with dementia could suggest novel approaches to delaying
dementia onset because animal research suggests diverse means by which
the adverse effects of chronic stress may be modified."
Change in Depressive Symptoms During the Prodromal Phase of
Alzheimer Disease
Robert S. Wilson, PhD; Steven E. Buy propecia pills Arnold, MD; Todd L. Beck, MS; Julia L.
Bienias, ScD; David A. Bennett, MD
Arch Gen Psychiatry. 2008;65(4):439-445.
Click
Here For Abstract
Written by Anna Sophia McKenney
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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Leading mental health charity Mind publishes a shocking new report that shows that debt is a significant factor in worsening our mental health. As the credit crunch hits and the cost of living soars, this worrying new evidence shows the extent of debt’s impact, with over 50% of respondents going without food and heating.
‘In the red: debt and mental health’ (1) is the first ever report to specifically examine the links between mental distress and debt. It includes a survey of over 1,800 people. Of those with problem debt (924 respondents), 91% said that debt had worsened their mental health. It also highlights that people with mental health problems are almost 3 times more likely to be in debt (2) often as they are living on a low income or can’t work - due to difficulties getting a job because of stigma (3) or due to ill health.
Mind found that of those with problem debt:
- 71% ran out of money every week or most weeks
- 87% rely on credit to pay for food and everyday costs
- 56% had gone without food due to debt
- 51% had gone without heating
- 92% reported not being able to socialise
Over 50% were living on a weekly household income of less than ??200 - what the Government defines as ‘living on the poverty line’.
Mind’s recommendations include:
Bank and debt-collection agency staff to receive mental health awareness training.
Banks to adopt a flagging system where customers can choose to have their account monitored for erratic spending to better protect their finances
An inquiry into bailiff practices as they relate to people with mental distress.
Mind launches a new section on its website for Mind week offering advice and information to those struggling with debt and a training programme for our local Mind associations across the country so that they can deliver financial surgeries.
Today, Mind’s Chief Executive Paul Farmer said:
"UK personal debt stands at a staggering ??1.4 trillion but the real cost here is that on our mental health. Money worries aren’t just keeping people awake at night; they are causing high levels of stress, depression and in some cases self harm and suicidal thoughts. At a time when people across the country are anxious about their finances, debt-depression is a real and growing concern."
"People living with mental health problems are particularly vulnerable to being trapped in a cycle of debt and poverty. With many unable to work due to ill health, Mind has found that people are becoming dependent on credit to pay for everyday essentials. Those on lower incomes are also more likely to only be able to get credit from lenders who charge astronomical interest rates. This is a worrying trend as people are left facing a debt mountain that they have no means to repay."
"If we are going to tackle this massive inequality and really help people who are struggling with mental health problems and debt then we need to see action by banks, debt collection agencies and other creditors. Changes in practice such as waiving fees when a customer has been too unwell to manage their finances and introducing mental health awareness training for bank staff will make all the difference. Creditors have a duty to help not hound their customers, especially when they are coping with serious health problems."
Buy levitra without prescription Poorest face highest cost - low income and poor credit ratings mean people may only be able to borrow from private or doorstep lenders who charge extortionate interest rates, some as high as 400% (4), contributing to their spiral of debt.
Bipolar and debt - People with bipolar disorder, which can cause people to spend extravagantly during a manic phase, or schizophrenia, are 4 times more likely to be in debt than the rest of society (5).
Harassed to breaking point - Fewer than 1 in 3 people with problem debt informed the organisation to which they owed money of mental health problems because they did not think that they would be understood (63%) or believed (47%). 83% of those who did tell creditors continued to be harassed about debt repayments. In one case, a woman was called at 15 minute intervals for 13 hours.
Seeking help - 34% of people with problem debt did not seek advice for their debt problems, often because they did not know where to turn.
Mind’s campaign is backed by:
Martin Lewis, finance expert and founder of the website working with Mind on a new advice booklet on financial difficulty and mental health issues. Martin said: "Severe debt isn’t just a financial problem. It causes relationships to break up, people to lose their homes and families to break down. No matter who you are, it can send you to the pits of despair. There is a clear correlation between those in debt and those with mental health problems. Most people have either had issues themselves or have a family member who has. This is a growing blight on our society and one we have to tackle."
Benjamin Fry, presenter of BBC programme Spendaholics, said: "It’s often the way we feel and our mental health that influences the way we spend our money or look after our finances. Money has powerful unconscious associations and the way we use it can often be an attempt to communicate some deeper distress. That needs listening to, otherwise the behaviour just continues, often escalating in an increasing cry for help."
Mind week EVENTS
Photocall opportunity: Monday 12 May 8.45am - Pigs on parade - Canary Wharf Martin Lewis and Paul Farmer will be celebrating the launch of Mind week with a parade of empty piggy banks forming the number 91 to represent the 91% of people in Mind’s research who said that debt has made their mental health worse.
Monday 12 May - Mind Cymru launch Mind week in Wales
Mind Cymru will be holding an event at Neath Mind to mark the start of Mind week.
Thursday 15 May - Mind Awards
Celebrating excellence in challenging discrimination against people with mental health problems, the ceremony will be hosted by Mind President Lord Melvyn Bragg.
Around the country
Many of our independent local Mind associations will be holding events across England and Wales to celebrate Mind week. To find out what’s happening in your area visit:
Mind (2008) In the red: debt and mental health.
Office for National Statistics (2002) The Social and Economic Circumstances of Adults with Mental Disorders
Department of Work and Pensions (2001) Only 37% of employers said they would employ someone with a mental health problem.
Collard S. Kempson E. (2005) Affordable credit. The way forward.
Office for National Statistics (2002) The Social and Economic Circumstances of Adults with Mental Disorders
Notes
Mind’s new research ‘In the red: debt and mental health’ was conducted by the Royal College of Psychiatrists. It includes the results of an online and postal survey across England and Wales completed by 1,804 people. All respondents had experience of debt and mental health problems. It also includes qualitative data gathered at eight focus groups involving 56 people. 924 of the respondents reported problem debt (someone who has been 2 or more consecutive payments behind with a bill in the last 12 months). Previous studies have simply included reports on people with ‘debt’, Mind’s survey uses a more robust definition of ‘problem debt’.
Please note that Mind is not an acronym and should be set in title case, not caps.
Mind’s new report will be available to view online at ww.mind.org.uk/mindweek/report and can be purchased from our online shop from Monday 12 May.
Mind charity shops across the country have been asking people to donate red items for ‘in the red’ themed window displays. Find your nearest Mind shop at
MIND
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