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Tag Archives: Depression

Stroke Tied to Higher Risk for Depression and Other Mood Disorders

Thor Christensen wrote . . . . . . . . .

Stroke survivors may have a higher risk of developing depression or another mood disorder within the first year, according to new research that compared their risk to the general public as well as people who survived a heart attack.

Past research shows depression is common after stroke, affecting nearly one-third of survivors. For the new study, researchers wanted to dig deeper and see how stroke impacts other mental disorders.

The study, published in the American Heart Association journal Stroke, focused on 86,111 people in Danish hospitals from 2004 to 2018 with no history of mental health disorders who had a stroke.

It found that stroke survivors had a 15% risk of developing a mood disorder, primarily depression, within the first year. This risk corresponded to an approximately 2.3-fold increased risk compared with matched individuals from the Danish general population. Stroke survivors also had an increased risk for other mental health problems, including substance abuse disorders and stress and anxiety disorders, as well as brain disorders such as dementia. But these conditions were less common.

“Prevention of these outcomes has obvious importance. But unfortunately, that is easier said than done,” said Nils Skajaa, the study’s lead author. He called for increased recognition of post-stroke mental disorders and early interventions, including counseling.

“Although risks tended to be higher after severe stroke, risks were still increased in patients with mild stroke – which emphasizes a need for mental health evaluation even in patients with seemingly full physical recovery,” said Skajaa, a Ph.D. student in clinical epidemiology at Aarhus University Hospital in Denmark.

The study also showed stroke survivors’ chances of developing depression are nearly 70% higher than people who survive a heart attack. A U.S. study published last year in the journal Neurology came to a similar conclusion: Stroke patients were 50% more likely than heart attack patients to develop depression.

Skajaa said the study was limited by the use of hospital data, which might have missed mild cases, and by surveillance bias – the idea that hospitalization and follow-up care might lead to an increased probability of a diagnosis for a mental disorder. While the study was conducted in Denmark, he said the findings also are applicable in the U.S.

Dr. Laura K. Stein, who was not involved in the research, said the study “gives us more insight into the mental health complications following stroke, which may be, at least in part, related to biological changes in the brain. It expands what we know about mental health disorders after stroke and shows us just how much more likely patients with stroke are to develop mental health disorders than people in the general population.”

Stein, an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai in New York City, called for future research to uncover the biological and psychosocial factors that might contribute to post-stroke depression. She also would like to see studies on the best methods of treating post-stroke depression – not just with medication, but with counseling, cognitive behavioral therapy, exercise and other lifestyle interventions.

Stein pointed out that while post-stroke depression is most common in the first year after a stroke, patients are still at risk for a long time after that.

“Patients, family members and caregivers need to be on the lookout for any signs of depression or other mental health disorders. They need to have a conversation with their doctors about any change in someone’s post-stroke trajectory,” said Stein, who also is an attending physician at the Mount Sinai and Mount Sinai Queens stroke centers.

“Post-stroke depression and other mental health disorders are treatable illnesses. If we take them seriously and investigate all causes and treatment options, it will improve the outcomes and quality of life for stroke survivors in the U.S. and around the world.”

Source: American Heart Association

Newer Hormone Treatments for Prostate Cancer May Raise Risk of Depression

Dennis Thompson wrote . . . . . . . . .

Advanced forms of hormone therapy are very effective at keeping prostate cancer in check, but they also can double a man’s risk of falling into depression, researchers have found.

Prostate cancer patients treated with the latest forms of hormone blockers were twice as likely to develop depression compared with men treated with older forms of hormone therapy or those who received no such medication at all, results from a new study show.

It’s a risk that cancer doctors will need to keep in mind when prescribing these drugs to patients, said lead researcher Dr. Kevin Nead, an assistant professor of epidemiology at the University of Texas MD Anderson Cancer Center in Houston.

“Our study does not suggest that any men who are eligible for these medications should not be on them because of the risk of depression,” he said. “What it does reinforce is that we have people who we know, because they have cancer, are already at increased risk for depression.”

Putting them on these medications is potentially doubling their risk, and Nead said, depression in cancer patients is associated with worse survival.

“These are patients we need to pay a lot of attention to and try to have early interventions to prevent or treat their depression, because it will impact their overall outcomes,” he said.

Prostate cancer feeds on male hormones like testosterone, which are also known as androgens. Doctors have long treated prostate cancer in part by blocking androgen, depriving cancer cells of their fuel.

They now have second-generation anti-androgen drugs like abiraterone and apalutamide that are even better at blocking testosterone than earlier medications, researchers said.

But a lack of testosterone increases a man’s overall risk of depression, whether or not he has prostate cancer.

“Men with low testosterone are at an increased risk of depression,” Nead said. “In men who have low testosterone, if you give them testosterone back, it actually improves their mood and decreases the risk of depression.”

Cancer patients are at increased risk of depression anyway, given their battle with a deadly disease. Worse, depression tends to profoundly impact the outlook for cancer patients.

“We know depression in cancer patients is particularly bad in that it’s associated with patients having worse cancer outcomes, including worse overall survival,” Nead said.

Depression “might impact people’s interest in being aggressive” with their cancer treatment, he added. “It might affect their overall health and how they can tolerate different therapies. It might affect their decisions on how they pursue their cancer care or how often they see their doctor.”

To see how much additional risk of depression comes with the newer androgen blockers, Nead’s team analyzed data from nearly 30,100 prostate cancer patients.

They broke the men into three groups — those who received no hormone therapy, those who got the more established medications, and those treated with second-generation anti-androgen drugs.

“If you look across all three of these groups, the men that received second-generation anti-androgens had an increased risk of depression,” Nead said.

The risk likely increases so dramatically because the second-generation drugs are so much more better at their job, said Dr. Bobby Liaw, clinical director of genitourinary oncology for the Mount Sinai Health System in New York City.

The older drugs “do very well in bringing your testosterone levels down, but they only stop testosterone production at the main factory of testosterone, which is the testes,” Liaw explained.

“In reality, you do have some small amounts of androgen production from other places in the body that traditional hormone therapy would not shut down,” he added. For example, the adrenal gland produces a small amount of male hormone, as do fat cells.

“You come along with a much more potent androgen receptor antagonist, it will further deprive cells already kind of starved for testosterone of even more of it,” Liaw said. “It’s not a big surprise it could worsen moods and depression.”

Neither Nead nor Liaw felt that the depression risk from the newer drugs outweighs their benefits for prostate cancer patients, however.

“It’s not to say that just because there’s that risk of depression that we should entirely shy away from an otherwise very efficacious treatment, but I think it definitely warrants us being a little bit more cognizant,” Liaw said. “We do need to be much more cognizant of these long-term side effects. We need to be more prepared to catch early signs of depression.”

Family members and friends of prostate cancer patients can help by watching their loved ones as they undergo hormone therapy for signs of depression, the doctors said.

“Often times the patient themselves may not always be the best judge of it. From day to day, if it’s a small change, they might not notice it,” Liaw said.

The new study was recently published in JAMA Network Open.

Source: HealthDay

Beta-blockers Not Likely to Cause Depression Yet May Contribute to Sleep Disturbances

Beta-blockers treat various cardiovascular diseases and were not more likely to cause depression compared to other similar treatments, according to new research published today in Hypertension, an American Heart Association journal. While depression may occur during beta-blocker therapy, the research suggests beta-blockers are not the likely cause.

Beta-blockers are a class of medications that reduce the heart rate, the heart’s workload and the heart’s output of blood, which, together, lower blood pressure. They are a common treatment for cardiovascular diseases, including heart failure, arrhythmias, chest pains and high blood pressure. Researchers have suspected beta-blockers of having negative psychological side effects, including depression, anxiety, drowsiness, insomnia, hallucinations and nightmares.

“The possible mental health side effects of beta-blockers have been the subject of discussion in the scientific community for many decades,” says Reinhold Kreutz, M.D., Ph.D., a professor at the Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology and the study’s supervising and corresponding author. “So, our results showing beta-blockers are not the cause of so many of these negative side effects are quite consequential.”

The study is the first of its kind to examine the entire spectrum of mental health side effects in relation to beta-blockers. The researchers analyzed data for more than 50,000 individuals from 258 studies including beta-blockers in double-blind, randomized controlled trials. Nearly 70% of the studies were clinical trials focused on high blood pressure treatment, and 31 assessed depression in placebo-controlled trials.

Results from the comprehensive analysis revealed:

  • Despite being the most frequently reported mental health side effect, depression did not occur more frequently during beta-blocker treatment compared to placebo treatment.
  • The rate of discontinuing medication use due to depression was not any different for those taking beta-blockers compared to those on other treatments.
  • Unusual dreams, insomnia and sleep disorders may be linked to beta-blockers.
  • Among the mental health events analyzed, the most common reason for discontinuing beta-blockers was fatigue/tiredness.

“Our results indicate that concerns about adverse mental health events, especially depression, should not affect the decision about beta blockers. Beta-blockers are mostly safe regarding psychological health,” said Kreutz. “We found no indication of an association between beta-blocker use and depression. The same was true for most of the other mental health symptoms, as reported in the studies that were included in our analyses. However, sleep-related symptoms such as unusual dreams or insomnia did emerge during beta‑blocker therapy for some patients.”

Kreutz added, “Patients with a history of cardiovascular events such as a heart attack or stroke were prone to develop psychological complications. Though we found beta-blockers were not causally linked, these patients should be monitored.”

The original studies did not include individual patient data, so for this analysis, researchers were unable to investigate whether sleep-related symptoms were persistent for those taking beta-blockers. Additional research is needed to address this question.

The researchers report there an important limitation to consider when interpreting the results of their analysis: most beta-blocker trials were conducted more than 20 years ago, before a uniform language to describe adverse events was established. Additionally, the authors only considered randomized, double-blind trials for their analysis, which left out some studies that might provide more data on long-term beta-blocker treatment.

Source: American Heart Association