I have heard that Vyvnase can help reverse symptoms of depression. Is this true? Part 2

Only four patients dropped out of the drug study because of adverse effects. The four events that led to the four people dropping out include loss of concisions, skin rash, suicidal ideations and worsening of depression. Other side effects of vyvnase include diminished appetitive, trouble sleeping, profuse sweating and lethargy.

The company has now submitted its results for an expanded study and hopefully will seek approval by the FDA for treatment of depression.

For the consumer this is good news but one should always be cautious about new drugs. In my opinion when companies perform their own studies, the results are usually positive and negative results are usually hidden. In addition, the study only lasted 9 weeks and it is not known if the positive cognitive function is sustained.  Vyvnase is also relatively expensive with each pill costing anywhere from $3-4. 

The good news is that most reports from people who take the drug for ADHD are positive.

I have heard that Vyvnase can help reverse symptoms of depression. Is this true? Part 1

Depression affects millions of people. The disorder can create havoc in the individual and everyone around them. While there are effective drug treatments, many have undesirable side effects. In addition, for some unknown reason the conventional anti-depressants gradually stop working. Therefore, pharmaceutical companies are continuously developing newer and better drugs. 

Now there is a report from a phase ll clinical study that the stimulant drug (vyvnase) used to treat attention deficit hyperactive disorder, may help improve cognitive function in adults with depression. Vyvnase (lisdexamfetamine dimesylate) is currently approved by the FDA for use in adults and children with ADHD.

The recent study conducted by the manufacturer of the drug showed that some patients achieved partial or full remission of depression symptoms and improved cognitive function when Vyvnase was added to their daily treatment regimen.

How common is depression? I feel like I am the only one who has it!

Depression is a very common medical disorder that affects the mind. Most people who do not have this agonizing disorder are not able to appreciate the fact that depression can significantly alter the way one behaves and thinks. It is a life long illness which is not easy to treat. The disorder leads to a variety of emotional and physical problems.  

The precise numbers of individuals who have severe depression are not known but estimates indicate that about 12 million adults in USA have depression. Depression cuts across all barriers and affects all races, cultures and social class. The disorder generally begins in early adulthood but can occur at any age. While hospital data reveal that more women have depression, this is simply because most men do not seek treatment. Depression occurs in various grades and symptoms do vary in intensity.

I have just lost my job and feel depressed. Do I really need treatment for my depression?

Slight depression is of minor consequence. One may become slightly depressed over a loss of job; break up of a romantic relationship or divorce. Other causes of slight depressions include loss of a parent, sibling, marrriage stress, job anxiety, moving or not having a great job. Slight depression may present with feelings of sadness, problems sleeping, irritability, being easily annoyed and feeling tired. Slight depression is reversible and short term. Most people get over slight depression with time and supportive therapy. However, if the depression is severe enough to affect your lifestyle and is getting worse, there is no harm in speaking to your doctor.

I am 27 and think I have mild depression. What sort of symptoms usually occur with depression?

There are some individuals who may develop mild depression which may start gradually for no reason. The individual may start to feel tired, restlessness, feel lonely and have difficulty sleeping. In many cases, the individual loses interest in sex and wants to be left alone. One may be able to go to work but not have any enjoyment. Mild depression may last a lot longer than severe depression but can be overcome with changes in lifestyle, psychotherapy and social support.

 However, some individuals develop severe depression which may induce feelings of not wanting to live anymore. Suicidal ideations are common in severe depression. In severe depression one may feel sad all the time, cry for no apparent reason, have trouble sleeping and focusing, become fatigued, feel worthless, develop headaches or backache and may increasingly have thoughts of self harm/suicide.

What causes depression? I am only 28 years old and have been diagnosed with this disorder

While mild depression has a cause, both moderate and severe depression generally are complex brain disorders which are not well understood. Mild depression may be related to the environment, such as being unable to cope with the job, unemployment, financial problems or loss of a loved one. No one understands why severe depression occurs. Even though many brain imaging studies have been done, the exact neurotransmitters in the brain which play a role in depression are still in question. Some studies do show that severe depression may be more common in families. In most cases, the cause of depression is simply bad luck

Is light treatment of any benefit for non-seasonal depression?

It is well known that light therapy is of benefit to people who have seasonal depression. Now some practitioners are recommending light therapy for people who have non-seasonal depression. The few studies conducted indicate that light therapy is of some benefit for non-seasonal depression. Light therapy administered in the morning was of most benefit to depressed people who were also sleep deprived. The only mild side effect was hypomania in a few individuals. However, at the moment light therapy is considered a supplementary treatment and not a substitute for the established methods of depression treatment. If you want to try out light therapy speak to your doctor.

 

Does ECT for depression hurt and do I need to give consent?

ECT does not hurt because you are asleep. ECT therapy is not used to punish any individual and like any procedure requires consent and approval. The patient has absolute right to refuse the procedure. Not the government, doctor or any other person can force this procedure on anyone. Under the APA's recommended "informed consent" protocol, permission to administer ECT is usually thoroughly reviewed and each case is individually analyzed. The consent is not just an oral mumbling of vague dry confusing concepts. It is the psychiatrist’s responsibility to detail and explain the basic principles of ECT and the possible benefits and risk that may occur. The individual and the family members need to be informed of when, where, and by whom the treatment will be administered and the number of treatments expected. 
Unlike the days gone by, just simple signing a consent does not give the doctor permission to perform an ill understood procedure and thus, all questions must be asked. The patient has the complete right to withdraw a consent and seek alternative care. No consent is binding to the extent that the patient has no choice. Gone are the days when doctors were the sole decision makers. Today, patients have more rights than they care to know.  And if the doctor screws up, you can always go to a lawyer.

Is it true that ECT causes brain damage?

So far, ECT has been thoroughly analyzed and there is no evidence to reveal that the procedure causes brain damage. Even though the procedure does induce a seizure, the brain is not damaged. CT scans, MRIs and PET scans have revealed that there is no structural damage after ECT. Most studies indicate that the amount of electricity induced to cause the seizure is not harmful to the brain because of its short duration and intensity. The myth that most people turn into brain damaged zombies is absolute nonsense.
There are many different views and reasons why people object to ECT and it is wrong to generalize.  Many people say that ECT is an inhumane and degrading treatment which belongs to the past. They claim that the side effects of ECT are severe and that these are hidden from the public. They also claim that patients are locked up against their will and continually shocked. Various claims of brain damage are made and they would like to see ECT banned. 


Unfortunately, individuals who make such statements do not have a clue about psychiatry-much less know the difference between the arse and the mouth. 


Psychiatrists may not know a lot about mental health disorders, but what little they know has made the discipline safer and more effective than all the previous centuries.

I am thinking about ECT for my depression, but what should I ask my doctor?

ECT is not a common form of treatment for depression but still every year close to 100,000 individuals in North America undergo this therapy each year. Because of misconceptions and myths associated with ECT, many individuals do not know that the therapy is safe and beneficial. If you wish to consider ECT for your  depression,  discuss with your doctor and consider the following benefits:

-         rapid relief of symptoms

-         alternative therapy when drug therapy fails

-         if you are unable to tolerate side effects of drugs, ECT is a good alternative

-         benefits are long lasting but not permanent

Can acupuncture help my depression?

The failure of conventional drug therapy to reverse depression has led many people to turn towards alternative remedies. Acupuncture has been widely touted to cure almost everything underneath the sun including the American economy. Reports from China are always positive on acupuncture. Today, alternative health care practitioners and every Tom, Dick and Harry have set up acupuncture clinics on street corners for the treatment of all types of medical disorders. As far as depression is concerned analysis of all the recent trials leads to one conclusion- the benefit from acupuncture was as good as one obtained from a sugar pill. There is at present insufficient evidence to recommend acupuncture as a treatment for depression.

Moreover acupuncture is not cheap. Each session can cost anywhere from $80-$150 and just like the plastic surgeon, nothing is ever cured in one session. One must undergo at least 20-30 sessions with no guarantee of any benefit.

Best advice is leave acupuncture for the suckers. If you are depressed go and see a real psychiatrist. The anti depressant medications may have side effects but at least they work- acupuncture does not.

I just had two sessions of ECT for my depression. Will I ever regain my memory?

ECT therapy is known to be associated with immediate memory loss, confusion and loss of concentration. These problems usually appear 2-3 weeks after therapy. The intensity of memory loss does vary from person to person but most people do develop some degree of memory loss.

Unfortunately, you will never regain all the memory you lost. The more sessions you have, the greater will be the loss in memory. In most people, the memory loss persists for 2-4 years and but in others it continues to persist. Memory loss is one of the negatives about ECT therapy and must be weighed against the benefits. For most people the reversal of depression is worth sacrificing some amount of memory loss. But the final choice is strictly yours.

Can my depression return if I stop my medications? I want to stop these medications because of side effects.

Unfortunately, you can rest assured you will develop some type of reaction. It could be that your depression symptoms return or you may develop withdrawal symptoms from the drug. The symptoms of depression are easy to identify, as they will be similar to what you had before. 

Drug withdrawal symptoms can vary from anxiety, flu like illness, fast heart rate, tremors, lack of sleep, sweating, and a generalized sensation of feeling unwell. These symptoms may last anywhere form 3-28 days. The symptoms are not life threatening and simply indicate that your body is now adjusting to a life without drugs in the body.

Of all anti depressants, withdrawal symptoms are most common after discontinuation of Paxil and Effexor.

It is difficult to predict who will develop these withdrawal symptoms. However, experts recommend that the best way to discontinue an anti depressant is to gradually taper the dose over a few weeks or months. If you find the symptoms of drug withdrawal unbearable, you may want to take a small dose of Prozac because it will neutralize these side effects and also diminish the signs of depression.

I have been diagnosed with severe depression, how long do I need to stay on these medications? I hate the side effects.

Unfortunately, most patients with depression are at a risk for relapse and thus long-term treatment is required. In general, patients with depression are usually assessed each year and the doctor then decides whether to continue the medication.

The current custom of clinically prescribing continuous antidepressant medications is to prevent relapse or recurrence after the third lifetime episode of depression. Other individuals who also require long term anti depressant treatment are those who have had two episodes of depression within a five-year span. If for any reason, the depression was severe enough that you attempted suicide or caused some type of self-injury, then long-term maintenance is required after just one such episode.

In the USA, most psychiatrists continue the medications for life and evaluate the patient regularly. 

You have to understand that if the doctor stops your medication and you hurt yourself or commit suicide, the doctor is in big shit with malpractice lawsuits.

Mother’s depression worsens asthma in children

US researchers say that a mother’s depression can worsen her child’s asthma symptoms. The 6-month study done by researchers at John Hopkins University looked at 262 black mothers and their children. What they observed was that mothers who had severe depression also often had children with frequent asthmatic attacks. On the other hand women who has less depression, has children with fewer asthmatic symptoms.


Says lead investigator Kristin Riekert, a pediatric psychologist and co director of the John Hopkins Adherence Research Center, "Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier. “


On the other hand, children who has less asthma did not necessary have mothers with less depression. Based on these observations the researcher say that depression may be an independent risk factor that can predict the severity of child.


"Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise. The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first," Riekert said.


Since depression can profoundly affect mental health concentration, causes fatigue, leads to low concentration, it may impair the mother’s inability to mange her child asthma, which often requires daily drug treatment and frequent doctor visits say the researchers.


"Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," study lead investigator Michiko Otsuki said in the news release.


This simple observational study may be true but there are many other factors in African American that have not been looked at. Economy, availability of health care facilities, finances, physical health, obesity, single parent or lack of transport- all these can lead to worsening of not only asthma but also any other medical disorder

I feel down and feel that I am depressed but am afraid to see a doctor, I do not have any desire to live and don’t have any motivation?

I am sorry to hear that. You are right, you are depressed. However, you must know that depression is a treatable disease. 

It is vital that you seek help from a doctor as soon as possible because the symptoms will only get worse. Treatment for depression is a combination of drugs and psychotherapy. 

Your symptoms will resolve rather quickly and you will feel better. Take a chance and see your doctor today. Do not give up. Wish you all the best.

Can vagus nerve stimulation reverse depression?

Many people with depression struggle and are always searching for a treatment that lasts long. While drugs have been the primary therapy for depression, many people do not always respond to them. Even when they respond, the benefits are short lived and plus the drugs also have potent side effects.

Recently vagus nerve stimulation has been introduced as a treatment for depression. Vagus nerve stimulation has been used for the treatment of certain epileptic disorders. Over time, it became obvious that these individuals started to develop an improvement in their mood. So now vagal nerve stimulation is being tried as a therapy for chronic depression.

Vagal nerve stimulation is a small surgical procedure. A thin electrode is placed near the vagus nerve in the neck and the wire is then connected to a pulse generator, which is implanted in the upper chest. The pulse generator emits electrical signals which stimulates the vagus nerve. Vagus nerve stimulation in turn results in mood improvement- at least that is the theory.

Vagus nerve stimulation is not standard therapy and only used in people in whom the standard anti-depressant therapies have failed. In addition, vagus nerve stimulation may be an option for people who are taking multiple drugs and have failed electroconvulsive therapy. Unfortunately, vagus nerve stimulation does not work in all depressed people. The few studies have not always shown convincing results and the result are also variable. Even among psychiatrists, the therapy is not accepted and many health insurance companies do not cover the procedure. In addition, the costs of vagal nerve stimulation are not trivial- considering that it may not even work.

While the procedure is easy to perform, it does have side effects that range from neck pain, infection, damage to the vague nerve, difficulty breathing, nausea and slowing of heart rate. In rare cases, one may develop vocal cord paralysis, voice changes, persistent cough and throat pain. While most side effects are tolerable, many people find the side effects annoying in the long run. However, of more concern is that in a few cases, vagal nerve stimulation may also lead to worsening of depression, suicidal thoughts and anxiety.

The surgery for implantation of the device is done as an outpatient and done under local anesthesia. After implantation, the device is programmed to deliver electrical impulses at various frequencies. Most people are started at low electrical current, which is gradually increased to get the desired result. Each stimulation lasts 30 seconds and occurs every 5 minutes. During this period, the side effects are most common. All individuals are given a small hand-held magnet to control the device. The machine has to be turned off while eating or speaking.

The results of vagus nerve stimulation are not immediate and often take months before the desired electrical impulse is obtained. As soon as the stimulation stopped, the depressive symptoms return. The decision to undergo vagal nerve stimulation is difficult. The procedure is very costly and there is no guarantee it will work. So before you decide to get the procedure, speak to people who have had it done. Remember even after vagal stimulation, you may still need to take anti depressant medications and continue with psychotherapy.

Is there an anti depressant which won’t cause weight gain?

Unfortunately weight gain is a universal problem with all anti depressants. The longer one uses them, the greater the likelihood of gaining weight. So far, every anti depressant, save for bupropion (wellbutrin), has been found to cause weight gain. Even the newer SSRIs can cause profound weight gain.

Bupropion does cause an initial weight loss but this is only a transient phase and with time, one starts to regain weight. There are some anecdotal reports that effexor may not cause as much weight gain as the other antidepressants, but it can induce sleepiness. 

All patients who do take anti depressants should be advised to  change their dietary habits and enter into an exercise program if they want to prevent the weight gain.  Unfortunately, the world of depression is not easy and there is no other way out of this dilemma.

Can a change in neuroticism improve depression? Part 2

Tang and colleagues looked to see if the SSRI, Paxil (brand name Seroxat), had effects beyond just treating depression symptoms. In their study they noticed dramatic changes not only in depression but a significant drop in neuroticism and marked increases in extroversion. "Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extroversion as placebo patients matched for depression improvement," said Tong Tang

"Those are very dramatic, notable changes. At the beginning of the treatment, they were way out there. Their neuroticism was abnormally high. By the end of treatment, they moved back into the boundary of the normal range." Tang mentioned that all SSRI would possibly have a similar effect.

If these studies can be duplicated, then it will change the way physicians treat depression. Says Dr Ian Cook of the David Geffen School of Medicine at the University of California Los Angeles, "The conventional wisdom has been for many years that the changes in personality that one sees during treatment tend to be thought of as a reflection of getting the depression under control," he said. He further stated that these observations may help better predict who is at risk for depression and which of these individuals may benefit most from treatment.

Archives of General Psychiatry 2009.