Tai Chi Helps Fight Depression, Gentle Exercise, Movement Meditation - AARP Bulletin

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Older adults who suffer from depression may find lasting relief by practicing a flowing Chinese martial art called tai chi in addition to receiving more traditional treatment, according to a new study.
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Depression Care in Hospital Helps Cardiac Patients

By Crystal Phend, Senior Staff Writer, MedPage Today

A collaborative program to manage depression among heart patients before hospital discharge appears to ease both mood and cardiac symptoms, researchers found.

A prospective, randomized trial also found that the program improved self-reported adherence to medication and advice on diet, exercise, and stress reduction six months later, Jeff C. Huffman, MD, of Massachusetts General Hospital in Boston, and colleagues, reported in the March issue of Circulation: Cardiovascular Quality and Outcomes.

Such programs have proven successful before, but were only conducted among patients after discharge, the group noted.

Their program showed the feasibility of screening for depression and starting treatment during a "teachable moment" while patients were still in the cardiac unit, Huffman and colleagues explained.

Thus "these results may represent a substantial first step in the systematic treatment of depression in hospitalized cardiac patients, a population for whom depression is independently associated with cardiac morbidity and mortality, and effective therapy remains greatly underrealized," they wrote.

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Clearing the Fog in Nursing Homes - NYTimes.com

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By PAULA SPAN

“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home,” said Laurel Baxter, the Awakenings project manager.

Any visitor can see what she means. Even in quality nursing homes, some residents sit impassively in wheelchairs or nod off in front of televisions, apparently unable to interact with others or to summon much interest in their lives. Nursing home reformers and regulators have long believed that this disengagement results in part from the overuse of psychotropic medication to quell the troublesome behaviors that can accompany dementia — yelling, wandering, aggression, resisting care. For nearly 25 years, federal law has required that psychotropic drugs (which critics call “chemical restraints”) be used only when necessary to ensure the safety of a resident or those around her.

The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)

Though they may be prescribed less frequently following the F.D.A.’s warnings, these drugs are still overused in long-term care, said Dr. Mark Lachs, chief of geriatrics at Weill Cornell Medical College. And once the pills are prescribed, residents keep taking them. “They get perpetualized, like insulin,” he told me, even though the behaviors they’re meant to soothe may wane anyway as dementia progresses.

“If a place is understaffed, if it takes particularly unruly patients, you can see how it happens,” Dr. Lachs added. “Behavioral interventions are far more time-consuming than giving a pill.”

Nevertheless, Ecumen’s Awakenings project emphasizes nondrug responses. “Medications have a place, but that shouldn’t be the first thing you try,” said Eva Lanigan, director of nursing at the Two Harbors facility.

So the home trained its entire staff (housekeepers, cooks, dining room servers, everyone) in a variety of tools to calm and reassure its 55 residents: exercise, activities, music, massage, aromatherapy. It taught people the kind of conversation known as “redirecting” — listening to elders and responding to them without insisting on facts that those with dementia can’t absorb or won’t recall.

“The hands-on, caring part is the most important,” Ms. Lanigan said. “Sometimes, people just want a hug. You sit and hold their hand.”

At the same time, consulting with a geriatric psychiatrist and a pharmacist, the home began gradually reducing the doses of antipsychotics and antidepressants for patients whose families agreed. Among them: the woman with the mysterious cries.

As Dr. Lachs pointed out, behavioral interventions are labor-intensive. Two Harbors hired an additional nurse to oversee those efforts, and Ms. Lanigan was available to answer staff questions around the clock. Ecumen estimates that introducing the program to a 60-bed nursing home cost an additional $75,000 a year for two full-time employees.

The results startled even the believers, however. Every resident on antipsychotics (about 10) was able to stop taking them, and 30 to 50 percent of those taking antidepressants also did well without them. When drugs still seemed necessary, “we tried to reduce them to the lowest dose possible,” Ms. Lanigan said.
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Light Therapy May Brighten Up Depressed Seniors

By Charles Bankhead, Staff Writer, MedPage Today

Literally shining a light on a darkened mind may help older patients with major depression -- with three weeks of home-based light therapy producing a significant improvement in mood and sleep, according to the results of a Dutch randomized trial.

The trial, conducted among almost 90 outpatients ages 60 and older treated for major depressive disorder (MDD), also showed that the positive effects associated with light therapy persisted during three weeks of follow-up after the treatment ended (P=0.01 to P<0.001), Ritsaert Lieverse, MD, of VU University Medical Center in Amsterdam, and colleagues reported.

"We showed that bright-light therapy had beneficial effects in elderly patients with nonseasonal major depressive disorder and found indirect support for the contention that therapeutic effects may in part be mediated by enhancements of circadian system functioning," Lieverse and co-authors commented.

"These results support inclusion of chronotherapeutic strategies in the treatment options for nonseasonal major depressive disorder in elderly patients. Bright light treatment may provide a viable alternative for patients who refuse, resist, or do not tolerate antidepressant treatment," the team concluded.
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Healthy brain gene linked to depression - Telegraph

By Richard Alleyne, Science Correspondent

Researchers hope that the discovery could lead to new treatments and early diagnosis of the condition that affects one in five people in Britain during their lifetime.

The team at Yale University have found that a gene called MKP-1 is twice as active in those that are depressed than those with good mental health.

When activated the gene appears to blocks pathways crucial to the survival and function of neurons in the brain.

Neurons are used to transfer and process information across the brain by a process of electrical and chemical signaling.

Professor Ronald Duman, the study leader, said it was "particularly exciting" because of the genes link with maintaining healthy brain function.

"This could be a primary cause, or at least a major contributing factor, to the signalling abnormalities that lead to depression," he said
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Geriatrics: Dementia Delirium and Depression

Current Depression Among Adults --- United States, 2006 and 2008

Image via WikipediaMajor depression is a common and treatable mental disorder; a study conducted during 2001--2002 estimated that 6.6% of the U.S. adult population had experienced a major depressive disorder during the preceding 12 months.

Depressive disorders are more common among persons with chronic conditions (e.g., obesity, cardiovascular disease, diabetes, asthma, arthritis, and cancer) and among those with unhealthy behaviors (e.g., smoking, physical inactivity, and binge drinking.

To estimate the prevalence of current depression, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2006 and 2008. Current depression was defined as meeting BRFSS criteria for either major depression or "other depression" during the 2 weeks preceding the survey.

This report summarizes the results of that analysis, which indicated that, among 235,067 adults (in 45 states, the District of Columbia [DC], Puerto Rico, and the U.S. Virgin Islands), 9.0% met the criteria for current depression, including 3.4% who met the criteria for major depression.

By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi. State health departments that include depression measures in their BRFSS surveys can track prevalence, set health goals for prevention and control, and monitor the effectiveness of relevant programs and policies.
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More B Vitamins May Cut Risk of Elderly Depression from MedPage Today

By Kristina Fiore, Staff Writer, MedPage Today

Higher intakes of two B vitamins -- but not folate -- may help ward off depression among older people, particularly if they take supplements, according to a large population study.

The prospective study, which followed more than 3,000 people ages 65 and older, found that higher intakes of vitamins B-12 and B-6 were both associated with a slightly reduced risk of depression (P=0.01 and P=0.05, respectively) for up to 12 years of follow-up, reported Kimberly A. Skarupski, MD, of Rush University in Chicago, and colleagues.


"In the assessment and treatment of depressive symptoms in older adults, clinicians and other healthcare professionals should be mindful of the patient's nutritional status in general, and whether there are vitamin insufficiencies in these nutrients before treatment," they wrote in the August issue of the American Journal of Clinical Nutrition.

Recent data show that 6% of older people are deficient in vitamin B-12, and 20% may have marginal depletion, according to background information supplied by the authors. Vitamin B insufficiency among individuals over 65 can be caused by reduced absorption and by medical conditions.
The prevalence of depression in later life ranges from 7% to 49%, they further noted. Depression among older people is associated with adverse health outcomes (including risk of mortality) and increased health costs.

While B-vitamin deficiencies have been associated with depression, there's little prospective evidence on this association in population-based studies of older adults, the researchers added.
The researchers analyzed data from 3,503 participants in the ongoing Chicago Health and Aging Project. The average age of the study cohort was 73.5; 59% were African American, and 59% were female. One-third reported being widowed.

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Attitudes Toward Mental Illness --- 35 States, District of Columbia, and Puerto Rico, 2007

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Morbidity and Mortality Weekly Report (MMWR)

Negative attitudes about mental illness often underlie stigma, which can cause affected persons to deny symptoms; delay treatment; be excluded from employment, housing, or relationships; and interfere with recovery (1). Understanding attitudes toward mental illness at the state level could help target initiatives to reduce stigma, but state-level data are scant. To study such attitudes, CDC analyzed data from the District of Columbia (DC), Puerto Rico, and the 35 states participating in the 2007 Behavioral Risk Factor Surveillance System (BRFSS) (the most recent data available), which included two questions on attitudes toward mental illness. Most adults (88.6%) agreed with a statement that treatment can help persons with mental illness lead normal lives, but fewer (57.3%) agreed with a statement that people are generally caring and sympathetic to persons with mental illness. Responses to these questions differed by age, sex, race/ethnicity, and education level. Although most adults with mental health symptoms (77.6%) agreed that treatment can help persons with mental illness lead normal lives, fewer persons with symptoms (24.6%) believed that people are caring and sympathetic to persons with mental illness. This report provides the first state-specific estimates of these attitudes and provides a baseline for monitoring trends. Initiatives that can educate the public about how to support persons with mental illness and local programs and media support to decrease negative stereotypes of mental illness can reduce barriers for those seeking or receiving treatment for mental illness (2,3).

To measure attitudes about mental illness through BRFSS and other surveys, the Substance Abuse and Mental Health Services Administration (SAMHSA) and CDC collaborated in 2005 to develop brief questions suitable for surveillance (4). BRFSS is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized civilian population aged ≥18 years.* With SAMHSA and CDC support, 35 states, DC, and Puerto Rico questioned survey respondents to the 2007 BRFSS about mental illness. Questions included the Kessler-6 scale of serious psychological distress (5), frequent mental distress, one question about current treatment for an emotional problem, and two attitudinal questions.

Attitudes Toward Mental Illness --- 35 States, District of Columbia, and Puerto Rico, 2007

Nearly 45% of Seniors in Residential Care Live with Depression or Symptoms of Depression

More than two in five (44%) Canadian seniors living in residential care homes are diagnosed with or have symptoms of depression, according to a new study released today by the Canadian Institute for Health Information (CIHI).

The study, Depression Among Seniors in Residential Care, is one of the largest of its kind in Canada to examine the prevalence of depression and the impact it has on persons living in residential care facilities, such as long-term care, nursing or personal care homes. Based on data from CIHI’s Continuing Care Reporting System, the study included nearly 50,000 residents age 65 and older across four provinces and one territory (Nova Scotia, Ontario, Manitoba, Saskatchewan and the Yukon).

CIHI’s study found that, while about one in four (26%) seniors living in a residential care facility had a diagnosis of depression, a further one in five (18%) had symptoms of depression with no documented diagnosis. Residents were considered to have symptoms of depression if they had a score of at least 3 on the Depression Rating Scale, which measures symptoms such as persistent anger, tearfulness and repetitive anxiety.

“Depression can have a major impact on individuals’ quality of life and also represents significant costs to society. Research also suggests that among seniors depression often goes unrecognized and therefore untreated,” explains Nancy White, Manager of Home and Continuing Care Development at CIHI. “As Canada’s population ages, and more people could potentially move into residential care, it is important to understand how this population is affected by depression or depression symptoms in order to be able to identify the right treatment options and improve quality of life for these seniors.”

Quality of life worse for seniors with symptoms of depression

CIHI’s study shows seniors with symptoms of depression experienced significant medical, social, functional and quality-of-life challenges, regardless of whether they were diagnosed with the mental disorder.

Seniors with symptoms of depression were more likely to display aggressive behaviour, have conflicts with family members or staff and withdraw from activities of interest. They were also three times more likely to experience sleep disturbances, were less self-sufficient than seniors with no symptoms of depression and were more likely to have difficulty communicating.

Dr. Marie-France Rivard, chair of the Seniors’ Advisory Committee of the Mental Health Commission of Canada and professor of psychiatry at the University of Ottawa, explains, “Moving into a care facility is usually quite stressful and often prompted by significant losses in terms of health, degree of independence and/or social supports. This can contribute to the development of a depressive disorder that may include feelings of hopelessness, self-blame and loneliness, possibly accompanied by physical symptoms such as poor sleep, decreased appetite and lack of energy, often leading to social withdrawal.”

People diagnosed with depression more likely to receive mental health evaluations

The study showed that seniors who were diagnosed with and had symptoms of depression were twice as likely to receive a mental health evaluation from a licensed mental health practitioner and more than twice as likely to receive antidepressant medication than those with symptoms but no diagnosis. Very few residents received psychological therapy, regardless of the presence of symptoms and/or a diagnosis. Two-thirds of seniors with a documented diagnosis showed no or only mild symptoms of depression on the Depression Rating Scale, suggesting that their symptoms were being effectively managed.

Clinical tools allow for better detection of depression symptoms

Previous research has shown there can be challenges with diagnosing depression among seniors. Standardized clinical assessment instruments like the RAI-MDS 2.0 used in this study offer better information to identify seniors at risk of poor outcomes as a result of depression or depression symptoms. By focusing on symptoms and behaviours, the RAI-MDS 2.0 provides a more holistic view of the challenges faced by seniors with depression or depression symptoms and can be used to monitor the effectiveness of interventions put into place.

At Copper Ridge Place in Whitehorse, Yukon, care providers have been using the outcome scores of this assessment instrument since 2007 to better understand their patient population and provide more focused and comprehensive care plans.

“We assess our residents with the RAI-MDS 2.0 when they first enter the facility and we often identify people with depression symptoms that would have previously gone undetected,” says Cynthia Fraser, a licensed practical nurse and an MDS assessor at the facility. “Once we identify a problem we present this to the team who can work with the residents to address their needs. As a result, we have seen real success in reducing residents’ depression symptoms and improving the quality of their lives.”

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Even when treated, depression costs employers - Mental health- msnbc.com

Workers with depression stay home sick more often than healthy colleagues, even when their disease is treated, according to a Thomson Reuters report released on Tuesday.

The report, commissioned by drug maker Sanofi Aventis, suggests that employers would benefit from better treatments of their workers for depression. Depression is the leading cause of disability among Americans aged 15 to 44, according to the National Institute of Mental Health.

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TIME GOES BY | GRAY MATTERS: Depression

by Saul Friedman

For those of us along the East Coast, flooded by weeks of rain and buried by five feet of snow since December, this surely is our winter of discontent, or worse. Add to that the state of the economy and the stock market, and as I warned during the approaching winter after 9/11 2001, older people need to be very aware of the danger of depression.

That desire to crawl under the covers and hibernate can be more than the winter blues. I know; I had a brush with depression only because of a fall and a bump on the noggin, which laid me low for a few days and nagged at my thoughts: “Why wasn’t I bouncing back faster? Will I regain my strength?

When last I wrote about depression, an unprecedented surgeon general’s report on mental health in 2000 pointed out that depression, in one form or another “is strikingly prevalent among older people,” too often accompanied by alcohol or drug dependence. But many older people tried to ignore their symptoms as simply a sign of age.

Coincidentally, just after my fall, Ilaina Edison, a vice-president and researcher for the superb Visiting Nurse Service of New York, the nation’s leading home health care provider, told me that ten to 20 percent of older people seen by primary care physicians “have critically significant depression.”

Moreover, many of these physicians, not specializing in geriatrics, don’t diagnose or they under-treat depression. Edison wants home health care nurses, who know their patients best, to be able to diagnose a case of depression before it takes root.

In one of her papers, Edison says that depression “places a significant burden on the health system” and impedes a patient’s ability to comply with medical treatment. The classic symptoms – sad, empty, hopeless feelings, trouble concentrating, a lack of energy, trouble sleeping, a loss of interest in what you like to do, and even vague or passing thoughts of suicide – can complicate getting better from even a routine illness.

The surgeon general’s report noted that there is no need for older people to put up with depression and risk their health further because there are modern and relatively safe drugs, among other treatments. And since the report, Medicare has led the way in recognizing and paying closer to parity for the treatment of mental as well as physical illness.

However, Medicare has been slower in understanding how its regulations can become a barrier to home health care for depression which, in a sense, is the front lines for the discovery and treatment of depression. Says Edison, ”Mental health status is not being addressed by hospitals when discharging a patient, even if he or she is taking an antidepressant.”

When I was discharged from a fine hospital after my fall, a doctor prescribed home health care for my physical problems, including physical therapy. But no one asked after my emotional well-being.

“Another barrier,” said Edison, “is the way Medicare reimburses for depression and mental health services in home health care.” Medicare has been demanding a positive diagnosis before it will pay. But if a home health care nurse discovers a patient’s depression, mild or severe, during a visit for other purposes, reimbursement may be complicated.

Thus she believes Medicare should allow and train the visiting nurse practitioners to diagnose depression and help guide a patient’s treatment with guidance from a psychiatrist.

Medicare Part A helps pay for inpatient mental health care; Part B covers outpatient visits to mental professionals, subject to the yearly deductible ($155). For a visit with a doctor to diagnose your problem, Medicare pays 80 percent of the cost. But to get treatments, such as psychotherapy, the patient now pays 45 percent and that will decline to the parity of 20 percent in 2014.

But to return to the surgeon general’s report, it recommended getting help from modern drugs that can treat and even prevent anxiety and depression. And if you feel you need something, a pre-emptive strike to get you through the winter, consult with your physician but be very careful about what you choose.

The surgeon general reported that certain widely used anti-anxiety drugs, called benzodiazepines – Ativan, Lorazepam, Librium, Valium, Xanax – are immediately effective but have been misused by many older people because they are chemically addictive over time, which means the more you take, the more you need. Some Medicare Part D drug plans are not required to provide these drugs.

These drugs are often over-prescribed and withdrawal from these drugs is likely to be difficult and could be dangerous. Similarly, sedatives and sleeping pills such as barbiturates, including Butisol, Nembutal and Seconal are highly addictive.

Less dangerous or addictive, although they take longer to work, are the anti-depressants including the granddaddy, Prozac, along with Zoloft and Paxil and other newer compounds such as Celexa, which are purged more quickly from the body and present fewer problems for older adults. These are a class of anti-depressants known as selective serotonin reuptake inhibitors (SSRIs), which can prevent mild depression from getting worse.

Other new anti-depressants (SNRIs), including Cymbalta, are being advertised for more serious problems.

However, all these drugs may produce unpleasant side effects and dependency. Your physician can fit the drug to your needs – if you need drugs at all. A pet that you can care for where you live, or perhaps a trip this winter to somewhere sunny could give you the lift you need.

What we’ve been calling the winter blahs has been given an appropriate name, SAD, for Seasonally Affective Disorder. And if you use a computer (which can be a great help in keeping you mentally fit (I play freecell or spider solitaire to check on my mind.), you can find sources for special lamps and lighting which, according to many legitimate-sounding claims, helps brighten those dark days.

You may want to visit the Medicare website and search for “mental health care and Medicare.” To learn more about the services of the Visiting Nurse Service of New York, visit their website.

Write to saulfriedman@comcast.net.

Doctors called on to screen all adults for depression :: American Medical News

By Kevin B. O'Reilly

All adults should be screened for depression, and primary care physicians should do the screening, according to a position statement issued in October by the American College of Preventive Medicine.
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S. 1857: A bill to establish national centers of excellence for the treatment of depressive and bipolar disorders (GovTrack.us)

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Sponsor: Sen. Debbie Ann Stabenow [D-MI]
Cosponsors: Sherrod Brown [D-OH] Kay Hutchison [R-TX] John Kerry [D-MA]George Voinovich [R-OH]

Text

Status:
Introduced Oct 22, 2009
Referred to Committee on Health, Education, Labor & Pensions

Status Updates

New Research: Internet Can Ease Depression Among Elderly

Posted by Shana Glickfield on 10-15-2009 in Home, News and Blog Clips

The Phoenix Center hosted an event today to discuss their new policy paper, which finds that Internet use makes a positive contribution to the mental well-being of America’s seniors. The FCC’s John Horrigan began the event with a short discussion of where we stand with broadband adoption. He has found in his research, both with the FCC and before that with Pew Internet, that broadband adoption is unevenly distributed among age demographics, with seniors falling below the national average. Horrigan believes it is critical to help with broadband adoption in this demographic not only for the reasons that the paper finds, but because the costs of digital exclusion are substantial and growing.

The author of Internet Use and Depression Among the Elderly is Dr. George Ford, Chief Economist for the Phoenix Center. Using a dataset of 7,000 elderly retired persons, Dr. Ford rated well-being in relation to Internet use, considering several variables including education, income and marital status. The research indicates that Internet use leads to about a 20% reduction in depression classification in this group. Dr. Ford noted that since depression is estimated to cost the U.S. about $100 billion annually, Internet use also offers substantial collateral economic benefits.

There were several advocacy organizations representing seniors in attendance at the event to weigh in on the findings. The National Council of the Aged found Dr. Ford’s connection of Internet communications helping reduce loneliness and thereby reducing depression to be consistent with their findings. AARP was excited about the research since they are increasingly moving their communications and information into online formats and need to continue to reach their target demographic. SeniorNet noted that they provide learning centers for older adults across the county and see the benefits of Internet use for seniors every day.

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Mediterranean Diet May Help Prevent Depression - Forbes.com

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(HealthDay News) -- People who followed the Mediterranean diet, an eating regimen that is rich in fruits, vegetables, whole grains, fish and nuts, were less likely to develop depression in a Spanish study.
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Biosignature Discovery for Personalized Treatment in Depression (U01)

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Purpose
The purpose of this initiative is to support exploratory research to discover panels of promising biomarkers (i.e., biosignatures) that are predictive of treatment outcomes in major depressive disorder.

Mechanism of Support:
This FOA will utilize the NIH Cooperative Agreement (U01) award mechanism. Funds Available and Anticipated Number of Awards: The NIMH expects to commit approximately $6 million in total costs in Fiscal Year 2010 to fund one or more U01 awards under this initiative.

Eligible Applicants
State governments,Public and State controlled institutions of higher education,Native American tribal governments (Federally recognized),Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education,Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education,Private institutions of higher education,For profit organizations other than small businesses,Others (see text field entitled "Additional Information on Eligibility" for clarification

Link to Full Announcement

In Need of Psychiatric Care, and Resisting - The New Old Age Blog - NYTimes.com

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By Paula Span

The patient showed symptoms of severe depression. She hallucinated, seeing her dead father across her room. Her family was having trouble taking care of her.

Dr. Cornelia Cremens, the psychiatrist who saw the woman at Massachusetts General Hospital, suggested an evaluation at McLean Hospital — which as everyone in Boston (and anyone who read “Girl, Interrupted”) knows is a psychiatric facility.

“I could never go there,” the woman objected, appalled. “If anybody found out, I’d be stigmatized for the rest of my life.”

She was 98.
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Severe, Lasting Depression Tied to Heart Patient Deaths - Forbes.com

(HealthDay News) -- Certain depressed patients who suffer from heart disease have nearly double the risk of dying over a seven-year period compared with other depressed patients, researchers say.

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Treat Mind, Body in RA Patients: Study - Forbes.com

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Rheumatoid arthritis pain subsided when depression and inflammation were addressed (HealthDay News) -- Treating both depression and inflammation can reduce severe pain in people with rheumatoid arthritis (RA), Japanese researchers say. Read More