Combined drugs and therapy most effective for severe nonchronic depression

What do you think of this article released by NIMH?

"The odds that a person who suffers from severe, nonchronic depression will recover are improved by as much as 30 percent if they are treated with a combination of cognitive therapy and antidepressant medicine rather than by antidepressants alone. However, a person with chronic or less severe depression does not receive the same additional benefit from combining the two. That is the result of a major new clinical trial published online by the journal JAMA Psychiatry on Aug. 20. In North America, about one in five women and one in 10 men suffer from major depression in her or his lifetime. "Our results indicate that combining cognitive therapy with antidepressant medicine can make a much bigger difference than we had thought to about one-third of patients suffering from major depressive disorder," said Steven Hollon, the Gertrude Conaway Professor of Psychology at Vanderbilt University, who directed the study. "On the other hand, it does not appear to provide any additional benefit for the other two-thirds." Previous studies have found that about two-thirds of all patients with major depressive disorder will improve on antidepressant medications and about one-third of patients will achieve full remission, but half then relapse before fully recovering. Cognitive therapy has proven to be about as effective as medication alone but its effects tend to be longer lasting. Combining the two has been estimated to improve recovery rates by 6 to 33 percent. "Now, we have to reconsider our general rule of thumb that combining the two treatments keeps the benefits of both," said Hollon. The new study was a randomized clinical trial involving 452 adult outpatients with chronic or recurrent major depressive disorder. Unlike previous studies that followed subjects for a set period of time, this study treated them for as long as it took first to remission (full normalization of symptoms) and then to recovery (six months without relapse), which in some cases took as long as three years. "This provided us with enough data so that we could drill down and see how the combined treatment was working for patients with different types and severity of depression: chronic, recurrent, severe and moderate," Hollon said. According to the psychologist, the results could have a major impact on how major depressive disorder is treated. The most immediate effect is likely to be in the United Kingdom, which, he said, is 10 years ahead of the United States in treatment of depression. The use of combined cognitive therapy and antidepressive medicine is standard for severe cases in the UK, and the English National Health Service is actively training its therapists in cognitive therapy and other empirically supported psychotherapies." ### Collaborators in the study were Robert DeRubeis and Jay Amsterdam from the University of Pennsylvania; Jan Fawcett from the University of New Mexico, Albuquerque; Richard Shelton from the University of Alabama, Birmingham; John Zajecka and Paula Young from Rush University; and Robert Gallop from West Chester University. The study was supported by grants MH60713, MH01697, MH60998 and MH060768 from the National Institute of Mental Health. For more information on mental health and counseling related topics, please visit Counselor CEUs

Director's Blog: Robin Williams

What do you think of this blog article  

By Thomas Insel on August 13, 2014

"Once again a tragedy has mental illness in the news. Much has been written about the suicide of Robin Williams this week; print stories, television news, and social media have all covered the loss of an extraordinarily talented man. They’ve also talked about the facts about mental illness: the toxic mix of addiction and depression, the high rates of suicide among middle- and older-aged men, and managing mental illness as a long-term challenge.

In view of the challenges of managing multiple disorders—in this case addiction and depression—what makes the story of Robin Williams so remarkable is his many years of success as a comedic genius. This is like finding out that a world-class marathoner was battling congestive heart failure—an achievement that seems almost too much to believe. The character Williams played in Good Will Hunting, the therapist Sean, has a wonderful line when he talks about people’s imperfections: “That’s the good stuff,” he says. Surely, the “good stuff” in this story with such a tragic ending is the long history of successful struggle to be productive, generous, and authentic in spite of an illness that ultimately prevailed. Despite the energy and focus it often takes to cope with and manage mental illness, Robin Williams was able to bring joy and laughter to millions of people around the world.

We in the mental health community speak a lot about recovery, but the inconvenient truth is that for too many people, mental illness can be fatal. While shame or prejudice, lack of access, or poor quality of care can all contribute to fatal outcomes, even those who have been very public about their struggle and have had access to the best available care still, too often, die from depression. Of course, this is true of many forms of cancer and end stage heart disease as well. But our discussions of mental illness rarely focus on this inconvenient truth: these illnesses are currently just as fatal as the “big killers.” We must continue to invest in research to develop new and more effective treatments for people with depression and other mental illnesses. The goal must be a future in which no lives are lost as a result of suicide.Once again a tragedy has mental illness in the news. Much has been written about the suicide of Robin Williams this week; print stories, television news, and social media have all covered the loss of an extraordinarily talented man. They’ve also talked about the facts about mental illness: the toxic mix of addiction and depression, the high rates of suicide among middle- and older-aged men, and managing mental illness as a long-term challenge.

In view of the challenges of managing multiple disorders—in this case addiction and depression—what makes the story of Robin Williams so remarkable is his many years of success as a comedic genius. This is like finding out that a world-class marathoner was battling congestive heart failure—an achievement that seems almost too much to believe. The character Williams played in Good Will Hunting, the therapist Sean, has a wonderful line when he talks about people’s imperfections: “That’s the good stuff,” he says. Surely, the “good stuff” in this story with such a tragic ending is the long history of successful struggle to be productive, generous, and authentic in spite of an illness that ultimately prevailed. Despite the energy and focus it often takes to cope with and manage mental illness, Robin Williams was able to bring joy and laughter to millions of people around the world.

We in the mental health community speak a lot about recovery, but the inconvenient truth is that for too many people, mental illness can be fatal. While shame or prejudice, lack of access, or poor quality of care can all contribute to fatal outcomes, even those who have been very public about their struggle and have had access to the best available care still, too often, die from depression. Of course, this is true of many forms of cancer and end stage heart disease as well. But our discussions of mental illness rarely focus on this inconvenient truth: these illnesses are currently just as fatal as the “big killers.” We must continue to invest in research to develop new and more effective treatments for people with depression and other mental illnesses. The goal must be a future in which no lives are lost as a result of suicide."

For more resources and education regarding suicide, please see our free course http://www.aspirace.com/courses/course-browser.aspx

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Veterans' alcohol problems linked to stress on the home front

Returning national guardsmen more likely to turn to alcohol than general public when faced with issues at home, according to new study in the American Journal of Preventive Medicine What do you think of this article? "Ann Arbor, MI, July 31, 2014 — Regardless of traumatic events experienced during deployment, returning National Guard soldiers were more likely to develop a drinking problem if faced with civilian life setbacks, including job loss, legal problems, divorce, and serious financial and legal problems — all commonplace in military families. Results of the study by researchers at Columbia University's Mailman School of Public Health are published online in the American Journal of Preventive Medicine. Alcohol abuse is a major concern for reservists returning home. Nearly 7% of Americans abuse or are dependent on alcohol, but among reserve soldiers returning from deployment, the rate of alcohol abuse is 14%, almost double that of the civilian population. The study looked at a group of 1,095 Ohio National Guard soldiers, who had primarily served in either Iraq or Afghanistan in 2008 and 2009. Over three years, the soldiers were interviewed three times via telephone and were asked about their alcohol use, exposure to deployment-related traumatic events and stressors like land mines, vehicle crashes, taking enemy fire, and witnessing casualties, and any stress related to everyday life since returning from duty. "Guardsmen who return home need help finding jobs, rebuilding their marriages and families, and reintegrating into their communities," says Karestan Koenen, PhD, Professor of Epidemiology at the Mailman School and senior author of the study. "Too many of our warriors fall through the cracks in our system when they return home. This is particularly true of Guardsmen who do not have the same access to services as regular military personnel. We need to support our soldiers on the home front just as we do in the war zone." More than half (60%) of the responding soldiers experienced combat-related trauma, 36% of soldiers experience civilian stressors, and 17% reported being sexually harassed during their most recent deployment. Among the group, 13% reported problems consistent with an alcohol use disorder in the first interview, 7% during the second, and 5% during the third. Alcohol use disorder is defined as alcohol abuse or dependence. The researchers found having at least one civilian stressor or a reported incident of sexual harassment during deployment raised the odds of alcohol use disorders. The effect of the stressors was restricted to cases of new-onset alcohol use disorders, and was not seen among those with a history of problem drinking. In contrast, combat-related traumatic events were only marginally associated with alcohol problems. The study highlights the important role civilian life and the accompanying stress play in cases of alcohol use disorder in the National Guard. "Exposure to the traumatic event itself has an important effect on mental health in the short-term, but what defines long-term mental health problems is having to deal with a lot of daily life difficulties that arise in the aftermath — when soldiers come home," explains lead investigator Magdalena Cerdá, DrPH, MPH, Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University. "The more traumatic events soldiers are exposed to during and after combat, the more problems they are likely to have in their daily life — in their relationships, in their jobs — when they come home. These problems can in turn aggravate mental health issues, such as problems with alcohol that arise during and after deployment." With high rates of alcohol abuse among soldiers, there is a critical need for targeted interventions to help soldiers handle stressful life events without alcohol, the investigators observe. More than 1.6 million service members have been deployed in support of war efforts Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. ### The findings from this study are consistent with two reports the Institute of Medicine released this year, which call attention to the serious mental health issues faced by the military population upon return from Iraq and Afghanistan, and highlight the need for the Department of Defense to develop an evidence base on the effectiveness of prevention and treatment programs targeted at service members and their families. A co-author of the current study, Sandro Galea, MD, DrPH, chair of Epidemiology at the Mailman School, led the Commission that issued one of the reports; Dr. Koenen was a co-author of the same." For more information and free clinical resources on drug/alcohol abuse, please visit Alcoholism and Drug Abuse Counselors Continuing Education