Journal Digest

Depression Linked to Higher Risks for Cardiovascular Events in Some Women

Having comorbid depression and cardiovascular disease may be even more dire for young and middle-aged women than for young and middle-aged men, according to a study published in the Journal of the American Heart Association.

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Researchers from the departments of cardiology and epidemiology at Emory University School of Medicine conducted a study to assess whether depression in women aged 55 and younger is associated with higher risk for coronary artery disease and adverse outcomes compared with age-matched men and older women with depression. The study included more than 3,200 patients with depression, assessed by the Patient Health Questionnaire depression scale (PHQ-9,) and with known or suspected coronary artery disease. Participants were required to undergo coronary angiography and three years of follow-up.

The results showed that each 1-point increment in symptoms of depression was associated with a 7 percent increased risk for coronary artery disease in women aged 55 and younger, but not aged-matched men and older women with depression. Young women with moderate to severe depression were twice as likely to suffer a heart attack, die of heart disease, or require an artery-opening procedure during the follow-up, compared with aged-matched men and older women.

Viola Vaccarino, M.D., Ph.D., senior author of the study and chair of epidemiology and a professor cardiology at Emory, said, “Although the risks and benefits of routine screening for depression are still unclear, our study suggests that young women may benefit for special consideration . . . unfortunately this age group has largely been understudied.”

In March, the American Heart Association issued a statement—endorsed by APA—recommending that depression be formally considered as a risk factor, like diabetes and hypertension, for coronary artery disease. “Our data are in accordance with this recommendation, but suggest that young and middle-aged women may be especially vulnerable to depression as a risk factor,” Vaccarino concluded.

Adverse Effects Differ Among Generations of Long-Acting Antipsychotics

A study in the Journal of the American Medical Association (JAMA) appears to be the first to compare the effectiveness and safety of a second-generation long-acting injectable antipsychotic with an older long-acting injectable antipsychotic.

The study was conducted by researchers at the psychiatry departments at Georgia Regents University and Columbia University. They randomized 311 adults with schizophrenia or schizoaffective disorder to receive monthly injections of either haloperidol decanoate (the older long-acting antipsychotic) or paliperidone palmitate (the second-generation long-acting antipsychotic; trade name Invega Sustenna) for 24 months. Rates for efficacy failure were determined by a need for psychiatric hospitalization or crisis stabilization and a substantial increase in frequency of outpatient visits. Patients were also monitored for adverse health effects.

The analysis revealed no significant difference in the rate of efficacy failure among the two treatment groups. However, participants taking paliperidone gained weight progressively over time, while those taking haloperidol lost weight. Treatment with paliperidone was associated with elevated serum levels of the prolactin hormone, whereas haloperidol was associated with more akathisia.

In an accompanying editorial, JAMA Associate Editor Donald Goff, M.D., said, “The results from [this] trial suggest that drug selection should be based on anticipated adverse effects rather than efficacy.”

Goff, who is the vice chair for psychiatry research at New York University Langone Medical Center, emphasized that additional data are needed to investigate how long-term exposure to extended-release drugs and a wider range of antipsychotics contribute to adverse effects. “Not only is the compilation of reliable data about these drugs essential, so also is the clear communication of this information to patients as part of the shared decision-making process,” Goff concluded.

Brain Activity Differs in Youth, Adults With Bipolar Disorder

A new study sheds light on ways in which brain activity differs between children and adults with bipolar disorder and may suggest targets for future research that could lead to new treatments for youngsters with the disorder.

Researchers at the PediMind Program at Bradley Hospital at Brown University performed a meta-analysis comparing the brain activity of youth and adults with bipolar disorder. Their analysis included data from 100 studies that used functional magnetic resonance imaging (fMRI) to measure changes in the brain in response to various forms of stimuli. The researchers focused on regions of the brain that are significant for emotional reactions.

The results, published in JAMA Psychiatry, showed that when participants viewed images of faces showing strong emotions, youth with bipolar disorder displayed greater amygdala activity than adults with the disorder. When using nonfacial emotional stimuli—such as scenes, words, and voices—the researchers found that brain activity was greater in the inferior frontal gyrus and precuneus areas of youth than of adults. Nonemotional stimuli were associated with significantly lower brain activity in the anterior cingulate cortex in youth when compared with that in adults.

“Despite our best current treatments, bipolar disorder exacts a considerable toll on youth, including problems with friends, parents, and at school, and high rates of psychiatric hospitalization and suicide attempts,” said Daniel Dickstein, M.D., senior author and an associate professor of psychiatry and of pediatrics at Brown. “More research into targeted treatments is needed now that we know children’s brains are impacted in specific, identifiable ways by bipolar disorder. Locating the underlying brain change in bipolar youth could lead us to new, brain-based ways to improve how we diagnose and treat this disorder.”

Having Child With Autism Affects Decision To Have More Children

Parents who have a child with autism spectrum disorder (ASD) are more likely to curtail reproduction than are those without an affected child, according to a study published in JAMA Psychiatry.

Epidemiologists from the Institute for Human Genetics at the University of California, San Francisco (UCSF), conducted a study with approximately 56,000 families to compare the likelihood of “reproductive stoppage” in families in which a child was born with ASD, with families without a child born with ASD.

The analysis showed that families whose first child was given an ASD diagnosis were 33 percent less likely to have a second child when compared with control families. Families in which a later-born child was the first to have ASD were equally less likely to have more children. The authors noted that reproductive behaviors between the two family cohorts were similar until the child started to show symptoms—indicating that stoppage was a result of parental choice, rather than a reproductive problem.

“Unfortunately, we still don’t know what causes autism or which specific conditions make it more likely,” said co-author Lisa Croen, Ph.D., a professor of epidemiology at UCSF and director of the Autism Research Program at Kaiser Permanente Northern California. “We are hoping that further research will enable us to identify both effective treatment strategies and, ultimately, modifiable causes of the disorder, so parents won’t have to curtail their families for fear of having another affected child.” ■