Lessening Of Depression Was About The Same For Either tDCS Or Escitalopram

HealthDay (6/28, Reinberg) reports that in a 245-patient study that “pitted transcranial, direct-current stimulation (tDCS) against the antidepressant escitalopram (Lexapro), researchers found that lessening of depression was about the same for either treatment.” The findings were published June 29 in the New England Journal of Medicine. In an accompanying editorial, Sarah Lisanby, MD, “director of the Division of Translational Research at the US National Institute of Mental Health,” wrote, “People are trying to find ways to treat depression, but it’s important for them to know that tDCS is experimental and not proven to be as effective or more effective than antidepressant medications.”

Related Links:

— “Electric Brain Stimulation No Better Than Meds For Depression: Study,” Steven Reinberg, HealthDay, June 28, 2017.

ECT may reduce psychiatric readmission risk

Medscape (6/28, Brooks) reports that “broader availability of” electroconvulsive therapy (ECT) “may result in fewer readmissions among psychiatric inpatients with severe affective disorders,” researchers found in a study that “included 162,691 inpatients with severe affective disorders in nine states.” Investigators found that “the adjusted predicted proportion of patients who were readmitted within 30 days was 6.6% among those who received ECT compared with 12.3% among those who did not – a statistically significant difference.” The findings were published online June 28 in JAMA Psychiatry.

According to Healio (6/28, Oldt), the author of an accompanying editorial observed that “there are likely a variety of factors that contribute to the low and uneven rate of ECT use,” including “the stigma associated with receiving the treatment on the part of patients and in recommending or administering the treatment on the part of professionals.” The editorial added, “Were we able to overcome these barriers, it is likely that untold numbers of patients would experience better outcomes by receiving an intervention that is often life altering and, for some, lifesaving.”

Related Links:

— “ECT may reduce psychiatric readmission risk,” Eric P. Slade, PhD, Healio, June 28, 2017.

People With Heart Disease May Be At Risk Of Dying Sooner With Chronic Depression, Anxiety

Reuters (6/28, Rapaport) reports that research suggests individuals “with heart disease are at risk of dying sooner when they suffer from chronic depression and anxiety.” Investigators looked at “data on 950 people in Australia and New Zealand with stable coronary artery disease.” Approximately “four percent of participants reported regularly suffering from moderate or severe psychological distress over the first four years of the study, and they were” about “four times more likely to die of heart disease and almost three times more likely to die from any cause during the next 12 years compared to people with no distress.” The findings were published online June 26 in the journal Heart.

Related Links:

— “Mental distress tied to higher odds of early death for heart patients,” Lisa Rapaport, Reuters, June 28, 2017.

Opioids Could Cause 500,000 Deaths In US Over Next Decade

STAT (6/27, Blau) reports that opioids could “kill nearly half a million people across America over the next decade as the crisis of addiction and overdose accelerates,” according to an expert panel assembled by STAT. According to the experts’ “worst-case scenario,” the death toll due to opioids “could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly and the waits for treatment continue to stretch weeks in hard-hit states like West Virginia and New Hampshire.” The projections are based upon expert analysis and “a review of presentations from top Trump administration health officials, including Health and Human Services Secretary Tom Price, National Institutes of Health Director Francis Collins, and the acting chiefs of the Office of National Drug Control Policy, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention.”

Related Links:

— “STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade,” MAX BLAU, STAT, June 27, 2017.

Over 50% Opioid Prescriptions Written For People With Mental Health Disorders

STAT (6/26, Caruso) reports that over half of all prescriptions for opioid pain medications in the US “are written for people with anxiety, depression, and other mood disorders,” according to a study [pdf] published in the Journal of the American Board of Family Medicine. According to the study, 19 percent “of the 38.6 million Americans with mood disorders use prescription opioids, compared to 5 percent of the general population — a difference that remained even when the researchers controlled for factors such as physical health, level of pain, age, sex and race.”

Kaiser Health News (6/26, Connor) reports that patients with mental health disorders are particularly vulnerable to developing addiction to opioid pain medications. One of the study’s authors “suggested that physicians consider using different criteria when prescribing opioids for people with mental illness.”

Related Links:

— “51 percent of opioid prescriptions go to people with depression and other mood disorders,” CATHERINE CARUSO, STAT, June 26, 2017.

Moderate-Intensity Physical Activity Can Protect The Brain From Alzheimer’s Disease

TIME (6/26, MacMillan) reports a study published in the Journal of Alzheimer’s Disease found “people who did more moderate-intensity physical activity were more likely to have healthy patterns of glucose metabolism in their brains—a sign of healthy brain activity—than those who did less.” The authors found large doses of high-intensity exercise may be needed to offer the benefits of “a modest increase” in moderate activity, “suggesting that you don’t have to exercise to the extreme to get brain benefits.” Lead author Ozioma Okonkwo, assistant professor of medicine at the University of Washington School of Medicine and Public, says, in general, the evidence suggests that “light activity is insufficient, and vigorous activity might be unnecessary.”

Related Links:

— “How Exercise May Protect the Brain From Alzheimer’s Disease,” Amanda MacMillan, Time, June ,26 2017.

Some Patients With Anxiety Or Depression May Have An Undiagnosed Physical Disorder.

In “Well,” The New York Times (6/26, Brody, Subscription Publication) reports that symptoms of anxiety or depression can “masquerade as an as-yet undiagnosed physical disorder.” Psychiatric Times recently published a “partial listing” of 47 medical illnesses that may first present as anxiety and a “partial listing” of 30 categories of medications that could cause anxiety, including antidepressants like SSRIs. The lists were included in an article “meant to alert mental health practitioners to the possibility that some patients seeking treatment for anxiety or depression may have an underlying medical condition that must be addressed before any emotional symptoms are likely to resolve.”

Related Links:

— “When Anxiety or Depression Masks a Medical Problem,” JANE E. BRODY, New York Times, June 26, 2017.

Fewer US Teens, Young Adults Are Binge Drinking

HealthDay (6/23, Dotinga) reported that “a new federal report finds that fewer U.S. teens and young adults are indulging in frat-party style drinking because their levels of binge drinking have gone down over the past six years.” However, “fourteen percent of young people from 12 to 20 years old reported binge drinking at least once within the past four weeks.” Frances Harding, director of the Center for Substance Abuse Prevention at the U.S. Substance Abuse and Mental Health Service Administration, said, “We’ve made plenty of progress through prevention efforts, yet the work still needs to continue.”

Related Links:

— “Fewer U.S. Kids Binge Drinking,” Randy Dotinga, HealthDay, June 22, 2017.

Deaths Directly Related To Electroconvulsive Therapy Found To Be Rare.

Medscape (6/23, Davenport) reported that a meta-analysis indicates “deaths directly related to electroconvulsive therapy (ECT) are rare events and seem to be decreasing in incidence.” In “the pooled analysis of more than 750,000 ECT procedures performed since the mid-1970s,” investigators found “that the rate of deaths related to ECT itself was only around two per 100,000 treatments – less than that seen with general anesthesia for surgery.” The research was presented at the 13th World Congress of Biological Psychiatry and published in Acta Psychiatrica Scandinavica.

Related Links:

Medscape (requires login and subscription)

Senate Republicans Unveil ACA Repeal Bill

The New York Times (6/22, Pear, Kaplan, Subscription Publication) reports that on Thursday, Senate Republicans “took a major step” towards their goal of repealing and replacing the Affordable Care Act by “unveiling a bill to cut Medicaid deeply and end the health law’s mandate that most Americans have health insurance.” The measure “would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.” The article says that although GOP senators had promised their ACA repeal bill would significantly modify the American Health Care Act which the House passed last month, the proposal which was put forward maintains the AHCA’s “structure, with modest adjustments.”

USA Today (6/22, Kelly, Collins) reports the Senate’s bill differs from the AHCA in that “it does away with a controversial House provision – which critics dubbed an ‘age tax’ – that would greatly increase costs for older Americans who need subsidies to pay for medical coverage.” In addition, the Senate’s version “would tie subsidies to income rather than age,” but this would “make it harder for people to qualify for the subsidies by tightening the income requirements.” Republican leaders are saying this bill is the party’s best option to keep conservatives’ promise to repeal and replace the ACA.

The Wall Street Journal (6/22, A1, Armour, Peterson, Radnofsky, Subscription Publication) reports on its front page that the bill would unwind major provisions of the ACA, such as its expansion of Medicaid. The article says Republicans are hoping to move quickly to pass an ACA repeal bill before the July 4 recess. However, some GOP lawmakers in the Senate say they are worried about some of the changes included in the measure.

The Los Angeles Times (6/22, Levey, Mascaro) reports that the bill includes “a drastic reduction in federal healthcare spending that threatens to leave millions more Americans uninsured, drive up costs for poor consumers and further destabilize the nation’s health insurance markets.”

On its website, ABC News (6/22, Stracqualursi, Adam Kelsey, Rogin) says top medical groups criticized the bill. For instance, the American Psychiatric Association’s CEO and Medical Director Saul Levin, MD, said, “The Senate proposal represents a significant move in the wrong direction, resulting in fewer people having access to insurance, fewer patient protections, and less coverage for essential behavioral health care.”

The Huffington Post (6/22, Holmes) reports, “Mental health organizations have been expressing concern about how the Republican effort to repeal and replace” the Affordable Care Act “could affect people living with mental illness.” For example, “American Psychiatric Association officials noted that they were not consulted on the House version or the Senate’s draft legislation.”

Psychiatric News (6/22) quotes Dr. Levin, who also said, “We urge the Senate to reject this harmful legislation and start again on a health care bill that puts patients first.” Meanwhile, APA President-Elect Altha Stewart, MD, said in a June 21 press release, “Eliminating requirements for coverage of key benefits, including mental health and substance use disorders and other patient protections that are part of the Affordable Care Act, will have detrimental impacts for millions.” Dr. Stewart added, “Mental health is critical to overall health and needs to be equally accessible.”

Related Links:

— “Senate Health Care Bill Includes Deep Cuts to Medicaid,” ROBERT PEAR and THOMAS KAPLAN, New York Times, June 23, 2017.