Earlier this year, a Michigan judge incarcerated three children after they refused to see their father. The children say their father is abusive, but the father claims the mother has initiated a campaign to alienate him from his children. After swift public outcry, the judge released the children, ordering instead that they participate in parental reunification therapy.

Divorced parents often engage in acrimonious custody fights, and some parents may launch extended campaigns to destroy their children’s relationship with the other parent. Parental alienation syndrome, originally coined in the 1980s, remains a controversial diagnosis and is not listed in the DSM-5.

A broken relationship with one parent can be destructive to children, but so can spending time with an abusive parent the child fears. Parental reunification therapy requires children to spend extended periods of time with the alienated parent, often without contact from the other parent. The theory is that this is the only way to break the cycle of parental alienation, but controversy swirls around the practice. Critics say the therapy could be used to force contact with abusive parents, and the treatment may amount to “deprogramming” that can be traumatizing.

Alzheimer’s Disease Consists of 3 Distinct Subtypes, According to UCLA Study

A UCLA study has identified three potential subtypes of Alzheimer’s. Though more research will be necessary, the subtypes could shed light on Alzheimer’s causes as well as potential treatment. Inflammatory Alzheimer’s is characterized by an increase in C-reactive proteins, as well as an increase in serum albumin and globulin levels. Non-inflammatory Alzheimer’s does not produce the same increases, but does lead to other metabolic abnormalities. Cortical Alzheimer’s—which often affects relatively young individuals—affects language first and produces effects that are more widely distributed across the brain.

The Sinister Science of Addiction

Research has long suggested that addiction is a disease rather than a personal failing, and measurable differences in brain chemistry account for much of the behavior associated with addiction. A new video in the Reaction series—a group of videos produced by the American Chemical Society—shows how addiction functions in the brain.

Criminals Acquire Guns Through Social Connections

[fat_widget_right]Popular myths suggest most guns used in crimes are stolen, but new research suggests that friends and family are a more likely option for acquiring guns. Research on the Cook County Jail in Chicago about how jail inmates obtained guns suggests that 60% of the guns were purchased or the product of a trade. Chicago gun laws prohibit selling guns to people with criminal records, so many former inmates are unable to acquire guns at gun stores or through other traditional avenues.

Trial Review Confirms Common Antidepressant is ‘Unsafe and Ineffective’ for Teens

Paroxetine—better known under its brand name of Paxil—has been prescribed to teens to treat depression since 2001, but new research argues the practice should end. Not only was the drug no better than a placebo; it was also potentially dangerous. In 2012, GlaxoSmithKline, the pharmaceutical company that markets the drug, was fined $3 billion for failing to report drug safety information to the Food and Drug Administration and for illegally marketing some of its drugs.

The Psychology of Why People Like Steve Rannazzisi Lie About Having Survived 9/11

A handful of people have been accused of lying about being present at the 9/11 terrorist attacks. This week, comedian Steve Rannazzisi came clean, admitting he had been lying about his presence at the World Trade Center that day. Experts are unsure why some people feel compelled to lie about a history of trauma. Theories include a need to feel involved, a craving for attention, serious mental health issues, and false memories.

More Time Outside Tied to Less Nearsightedness in Children

According to a study of Chinese schoolchildren, spending time outside could reduce the rate of nearsightedness. As many as 90% of Chinese high school graduates are nearsighted. But the study, which followed almost 2,000 schoolchildren for three years, suggests that as little as 45 minutes outside each day could reduce the country’s rate of nearsightedness.

Eating a Lot of Fish May Help Curb Depression Risk—at Least in Europe

A number of studies have tied Omega-3 fatty acids—present in high quantities of fish—to a potential treatment for depression. A pooled analysis of 26 studies involving 150,278 participants suggests that Europeans who consume fish can reduce their depression risk by as much as 17%. This correlation was found only in European studies. The reduction in depression risk as a result of high fish consumption was higher among men, who saw a 20% reduction. Women’s risk of depression dropped by about 16%.

Major depressive disorder (MDD) is a mental health problem with both psychological and physical effects. Someone diagnosed with depression may have strong feelings of sadness or a loss of interest in normal activities; physical symptoms may include lethargy, body pains, insomnia, and headaches. Despite decades of research and study, fast and effective treatment for depression remains an unfulfilled goal. Currently, the preferred approach for depression treatment begins with cognitive behavioral therapy and may include one or more psychotropic medications. 

Suicide risk is a serious complicating factor in the treatment of major depressive disorder, and choosing the appropriate drug intervention remains a haphazard procedure. Because many antidepressants are potentially linked with a heightened risk of suicidal behavior, doctors must exercise caution. Response to psychotropic drugs, particularly antidepressants, is highly individual. A period of trial and error is often necessary before doctors can identify the optimum drug or drug combination. In cases of possible suicidal thoughts and behavior, the best course of action is often observation, possibly in an inpatient facility.

A recently completed study at the New York State Psychiatric Institute promises to offer some guidance in the selection of treatment for severely depressed individuals with suicidal tendencies. The study consisted of two groups, one receiving Paxil (paroxetine) and the other receiving Wellbutrin (bupropion). The choice of these specific drugs was deliberate: Paxil belongs to the selective serotonin reuptake inhibitors (SSRI) category and is among the most frequently prescribed antidepressants; Wellbutrin is a non-SSRI medication with a different mechanism of action. However, both medications still carry the “black box” warning to notify doctors and pharmacists of potentially dangerous side effects, namely the increased suicide risk. A second aspect of the study included functional MRI scanning of each participant’s brain—once at the beginning of the 8-week trial and once more at the conclusion. Participants were given a cognitive task during the scan to assess how each of them processed sensations of reward.

The initial phase of the study is complete. Data on the 125 participants is currently being compiled and analyzed. Researchers hope that one of the drugs will reveal itself as a more effective remedy for major depression, although they may find that one of the drugs leads to a higher rate of side effects. In any event, the data from this study will help attending physicians and therapists make better choices when treating their most severely depressed patients.

References:

1. Bupropion, t. c. (n.d.). WELLBUTRIN XL® (bupropionhydrochloride extended-release tablets). DailyMed. Retrieved July 18, 2012, from http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=14812
2. Depression (major depression). (n.d.). Mayo Clinic. Retrieved July 18, 2012, from http://www.mayoclinic.com/health/depression/DS00175
3. Paroxetine/Bupropion in Suicide Attempters/Ideators With Major Depression. (n.d.). ClinicalTrials.gov. Retrieved July 18, 2012, from http://clinicaltrials.gov/ct2/show/NCT00429169?recr=Open&intr=%22Bupropion%22&rank=16

When assessing a patient for major depressive disorder (MDD) and choosing the most appropriate course of treatment, personality type is a major consideration. Research has demonstrated that people with high levels of neuroticism and/or low levels of extraversion often respond less well to treatment and have higher relapse rates. Briefly, neuroticism is a personality trait that includes a tendency toward negative emotions and emotional instability. Extraversion, on the other hand, describes a tendency toward positive feelings, including but not limited to higher levels of socialization and self-confidence. A recent study published in the Archives of General Psychiatry examined the links between personality type, cognitive therapy, and the antidepressant medication Paxil (paroxetine).

In multiple studies of the drug Paxil, participants who showed significant improvement in their depression also reported greater feelings of confidence and liveliness. The authors of these studies generally describe these personality changes as effects of the overall improving mood of the patients. A more recent study ponders whether selective serotonin reuptake inhibitors (SSRI) medications, Paxil in this case, do in fact work to change personality states resulting in a lessening of depressive symptoms. The study was broken into three groups: a placebo group, a therapy group, and a group receiving Paxil. Depression and personality ratings were gathered from each participant at regular intervals throughout the 16-week study.

As many previous studies have shown, even people receiving placebo showed noteworthy improvement in their depression. However, the personality trait scores underlined a potentially significant fact. Neuroticism and extraversion were both relatively unchanged in the placebo group, while those receiving Paxil or cognitive therapy showed improvement in both of these key areas. This suggests that Paxil may work to alter personality traits on the molecular level. Cognitive therapy also led to decreased neuroticism and increased extraversion, but the reasons for these changes are not as clear. What is clear is that these personality changes predict a better long-term outcome for patients and a lower chance of relapse.

The lesson from this research is that clinicians should be mindful of specific personality traits when treating an individual with MDD. Paxil, and possibly all of the SSRI medications, may work to improve depression on a more fundamental level than anyone realized. The data has always been there, in a sense, but perhaps the interpretation was lacking. As researchers unlock the mysterious relationship between moods and chemical neurotransmitters, more specifically targeted drugs will be developed. Furthermore, as the early warning signs of depression—neuroticism, low extraversion—are better identified, interventions will be possible to prevent this debilitating mental health condition before it occurs.

References

1. Depression (major depression) – MayoClinic.com. (n.d.). Mayo Clinic. Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175
2. Tang, T.Z., DeRubeis, R.J., Hollon, S.D., Amsterdam, J., Shelton, R., & Schalet, B. (2009). A placebo-controlled test of the effects of paroxetine and cognitive therapy on personality risk factors in depression. Archives of General Psychiatry, 66, (12), 1322-1330.

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

Since my last blog, Depression Medications: How Can You Get Your Libido Back? a number of you have asked for more information about possible sexual side effects caused by antidepressants. Before I say more—a cautionary word—I’m a psychotherapist/counselor, not a medical doctor/psychiatrist. So what I write in this blog is drawn from my (extensive) experience working with people who have challenges and/or difficulties with sex—I’m a sexologist, not a psychopharmacologist!

Some of the worst culprits, or libido smashers, are the selective serotonin reuptake inhibitors (SSRIs) such as Effexor, Paxil, Prozac, and Zoloft. Unfortunately, these are all heavily prescribed. I mentioned last month that many folks can benefit from a so-called “drug holiday,” when they forgo their medication for a few days. Be aware that this intervention does not work for Prozac. This is due to the much longer period of time that Prozac remains in the bloodstream, compared to the other shorter-acting SSRIs, like Zoloft.

Several types of antidepressants have virtually no side effects. The most common ones that I hear about are Wellbutrin, Xanax, and Klonopin. I’ll often suggest, to the new people I see, substituting (with the agreement of their medical doctor, of course) Xanax or Klonopin for Wellbutrin because the latter can exacerbate anxiety or “agitated depression,” as it’s called by psychiatrists.

Wellbutrin is also infamous for causing insomnia and headaches, which tend to make most of us anxious, and it certainly doesn’t contribute to an enjoyable sexual connection! Wellbutrin is pharmacologically distinct from the SSRIs, as it enhances the neurotransmitter dopamine, which has the opposite effect on libido and orgasm of serotonin. Xanax and Klonopin are usually prescribed to combat anxiety, not serotonin, so they tend to have very few sexual side effects.

I will often recommend that people who are leery about psychotropics try St. John’s Wort, which is most effective, I’ve found, for Type A blood types (remember, I’m not prescribing, just using anecdotal experience to make these suggestions!). Because it’s not regulated as a pharmaceutical substance, I’m told that efficacy can vary widely.

[fat_widget_left] The individuals I see in my office have reported that Viagra is effective for SSRI-induced absence of orgasm, and I’ve known people of both genders who swear by the botanical preparation ginkgo biloba to reverse libido, arousal, and/or orgasm problems. One sex therapist colleague tells me that Viagra can be helpful for women as well, but no one I work with has directly reported this to me.

If switching to an alternative psychotropic is not clinically appropriate or effective, some doctors might recommend adding another medication on a daily or as-needed basis. Many people are hesitant about taking one drug, let alone two! But for those who are comfortable with it, a second medication can often offer an antidote to the side effects of an otherwise helpful medication.

Most commonly, a sexual-savvy psychiatrist will prescribe a single low dose of Wellbutrin for people complaining of sexual side effects from other antidepressants—employing lower does of Wellbutrin than would be necessary to treat depression alone. These small doses can restore the serotonin-dopamine balance that I mentioned earlier, alleviating sexual side effects.

People starting out with me often ask if I suspect that their sexual problems are relationship issues or caused by medication. I always ask them how long the sexual challenges have been occurring. SSRI-induced sexual dysfunction follows a fairly typical pattern: it begins within days or weeks of starting the new psychotropic medication. For example, a woman may report that she can no longer reach orgasm with her husband within weeks of beginning Prozac for obsessive compulsive disorder.

Women rarely volunteer this immediately, but I ask LOTS of questions, which makes it easier to discuss sexual concerns. Men usually have less hesitation talking about such problems, and as one man said to me recently, “that’s why we came to a sex therapist and not the marriage therapist down the street!” The fact that I coach by phone also seems to help, especially for men, who might have difficulty opening up “when the plumbing doesn’t work!”

Don’t forget—if you have questions about your medications, make sure to discuss them with your medical doctor or psychiatrist.