Jon-Kar Zubieta, MD, PhD, University of Michigan, reports that depression is rooted in genetic and molecular factors and are unique for each individual. Using PET (positron emission tomography) scans, Zubieta studied patients who met the criteria for major depression, but had not yet received treatment for it. Those scans were compared with scans of non-depressed volunteers.

Serotonin levels were linked to depression as were the ‘feel-good’ (5HT1a) receptor concentrations. The worse the subject scored on the depression assessment the fewer ‘feel-good’ receptors they had. He also found that there was a direct relationship between the effectiveness of medication used to treat depression and the number of ‘feel-good’ receptors. The fewer the ‘feel-good’ receptors the less likely medication was going to relieve signs of depression.

Allison Dempsey, doctoral student, University of Florida College of Education, studied the effects of bullying on 210 college students. Primarily, Dempsey asked participants about their experiences during high school to see if there were any links with a current sense of loneliness, depression, and anxiety. She found there is a link between adolescence victimization and developing depression and anxiety in early adulthood.

Rather than physical threats alone, Dempsey included rumors, gossip, and social shunning as tactics of bullies because of their relationship with psychological symptoms.

Co-author, Eric Storch, PhD, assistant professor of psychiatry, University of Florida College of Medicine, was also interested if ‘friends’ mitigated the effects of bullying. He found that:

• Aggression can be physical and/or emotional.
• Boys tend to bully physically.
• Boys and girls participate in relational (social) bullying.
• Having friends did not lessen rates of depression and anxiety in adulthood.
• Friendships that provide positive support can help a child be more resilient to the slings and arrows from bullies.
• Children can take the words and abuse more to heart and begin to believe what is being said about them.
• Victims of bullying tend to avoid interactions and situations (even when they would be positive).

Dempsey graduated from Columbine High School a year before the shootings took place and now studies school prevention programs. She feels that many people see bullying and victimization as a passage of rite in high school and because of the complexity of the problem one that is difficult to stop. However, reducing the problem will help a tremendous amount.

Almudena Sánchez-Villegas, professor, University of Navarra, based his research on a 6 year study of 8,556 university graduates (average age of 42)  over a 6 year period. During the study 190 smokers, who initially did have signs of depression, were diagnosed with the disease. Also, 65 participants who had been diagnosed with depression indicated they were taking antidepressants at some point during the study period. Overall, smokers have a 41% higher risk of suffering from depression according to the study.

Sánchez-Villegas suggest that both environmental and genetic influences are factors that determine if a person will use a tobacco product, which are also possible factors that may increase the risk the individual will suffer from depression.

Jules Angst, MD, Zurich University Psychiatric Hospital, Switzerland, conducted 6 interviews with 591 young adults over a 20 year period. He was able to distinguish 4 subtypes of insomnia:

• One-month insomnia (associated with significant distress).
• Insomnia lasting 2-3 weeks.
• Recurrent brief insomnia.
• Occasional brief insomnia.

In 40% of the participants over time insomnia developed into the more serious chronic form. Those with ‘one-month insomnia’ gradually increased the number of occurrences. Insomnia lasting 2 weeks, or longer, preceded major depressive episodes and depressive disorder.

Scientist used to think that insomnia was most often a symptom of depression, but research now suggest that insomnia precedes depression. They also found that over time insomnia tends to become a chronic problem unlike depression that is a more intermittent problem.

The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night’s sleep:

• Follow a consistent bedtime routine.
• Establish a relaxing setting at bedtime.
• Get a full night’s sleep every night.
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
• Do not bring your worries to bed with you.
• Do not go to bed hungry, but don’t eat a big meal before bedtime either.
• Avoid any rigorous exercise within six hours of your bedtime.
• Make your bedroom quiet, dark and a little bit cool.
• Get up at the same time every morning.

The article appears in the April 1 issue of the journal Sleep.

Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) interviewed a sample of primary care patients to find the prevalence of traumatic exposure to find incidents of PTSD, major depression, substance dependence, and chronic pain.

Among the participants researchers found:

• 80% had one or more trauma exposures.
• Exposure to trauma was significantly higher in males.
• Males exposed to trauma were more likely to be single, have substance dependence, and depressed.
• The trauma exposed patients had more mental health visits than those not exposed to trauma.

When those diagnosed with PTSD were compared to those without PTSD, researchers found:

• 22% of the study’s participants were currently diagnosed with PTSD.
• PTSD patients were significantly more likely to be female.
• Have an annual income of $20,000 or less.
• To also suffer from substance abuse and depression.
• PTSD participants also had more hospitalizations and mental health visits.

Among urban primary care patients, researchers found:

• PTSD is associated with greater health care use for both mental health visits and hospitalizations.
• Trauma exposure by itself was not associate with increased health care utilization–apart from mental health visits.

Researchers conclude that PTSD has a cost beyond mental health symptoms; it may be on the pathway between trauma experiences and negative health consequences.

Sungho Maeng, affiliated with the Laboratory of Molecular Pathophysiology and Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, and Department of Health & Human Services, Bethesda, Maryland, and associates, studied the use of ketamine as possible treatment for depression.

Ketamine is used in general medicine as anesthetic and has recently been shown to produce improvements in depressed patients within hours of administration. Research indicates that ketamine depends on AMPA receptor stimulation, which suggest that it might have rapid antidepressant properties.

Maeng suggest that by aiming new medications at more direct targets, like AMPA, it might be possible to bypass some of the roundabout routes that current antidepressant medications need. Even though ketamine and SSRIs eventually end up doing the same thing, but SSRIs take the long path to accomplish the task.

Ketamine is not without its drawbacks. Its use can produce transient changes in perception and impairments in cognition. It is in the same class of drugs as phencyclidine (PCP), which can cause hallucinations among other side effects.

Charles B. Nemeroff, affiliated with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, and associates, reviewed 34 double-blind randomized controlled trials that compared a single serotonin-norepinephrine reuptake inhibitor (SNRI), venlafaxine, to other selective serotonin reuptake inhibitors (SSRIs).

Nemeroff found that venlafaxine was superior to SSRIs in overall efficacy. Statistically, venlafaxine was superior to fluoxetine, but not to paroxetine, sertraline, or citalopram. However, venlafaxine had a higher dropout rate because of adverse reactions. Nemeroff also noted that a typical doctor would need to treat 17 patients to have a single patient benefit by being treated with venlafaxine rather than an SSRI. For example, if a doctor was treating 200 patients and switched all of them from a SSRI to venlafaxine, only 12 patients would predictably benefit by the switch in medication.

James E. Aikens, PhD, associate professor of Family Medicine, University of Michigan Health System, studied 573 depressed patients from 37 different practices. The patients were given one of the antidepressants: fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft). All participants were accessed at one month, 3 months, and 9 months after their treatment had begun.

Patients overall responded rapidly to their medication:

• 68% of the patients reported improvement at the end of their first month of treatment.
• 88% of the patients reported improvement after 3 months of treatment.

During the period of improvement patients experienced improved positive emotions, work functioning, and social functioning. Improvements in head, back, and stomach pain plateaued during the first month, with little improvement in the following months. (Aikens feels physicians may want to consider additional treatments that directly target pain in depressed patients if these physical complaints persist after the first few weeks of treatment with antidepressants.)

Aikens found one area that lagged behind in the patient’s improvement was the sense of hopefulness. Patients continued to feel a sense of hopelessness even while their other conditions improved, which could lead them to stop taking their antidepressant medications.

Joseph Boscarino, PhD, MPH, Geisinger Senior Investigator, examined the health status of 4,462 male Vietnam era veterans 30 years after their military service. He found that PTSD predisposes a person to biological risk factors that are not measured with psychological test or a mental health examination. Boscarino found that veterans with high erythrocyte sedimentation rate (ESR)–an indicator of inflammation–could be an indicator of serious neuroendocrine problems.

Boscarino believes that early treatment after a traumatic event is critical to avoid depression, PTSD, and substance abuse-related problems that can result from a traumatic experience.

Hristina Jovanovic, Swedish medical university Karolinska Institute, believes he may be able to show why women are affected by depression and chronic anxiety. Using a PET scanner he was able to show that men and women differ in the number of binding sites for serotonin in certain parts of the brain.

Women have a greater number of the most common serotonin receptors. Women also have lower levels of the protein that transports serotonin back into the nerve cells, which is the same protein that most common antidepressants (SSRIs) block. For women who are symptom free during their menstrual cycle also appear to have a serotonin system that is more flexible and responds to hormone swings.