Noteworthy News Articles on Mental Health Topics, July 1-7, 2006



Study: 3rd Depression Drug Rarely Helps
Associated Press, 7/1/2006

NEW YORK -- The large group of depression sufferers who haven't recovered with two common medications stand little chance of success from a third drug, says the latest report from the nation's most ambitious study of depression treatment. Only about 16 percent of those in the study became free of symptoms after switching to a third drug, researchers said.
      Combined with previous reports from the project, the new finding suggests that about 60 percent of people who have depression can gain complete remission by the time they've tried three drugs. Each year, about 14.8 million American adults struggle with depressive illness. The six-year, $35 million treatment project has yet to publish its findings from further treatment attempts, including trying a fourth drug.
     The 16 percent success figure for trying a third drug is quite modest, but ''you still have a chance,'' said Dr. Maurizio Fava of Massachusetts General Hospital, lead author of the new report in the July issue of the American Journal of Psychiatry. The finding also suggests that patients should talk to their doctors about other strategies, like taking a combination of antidepressants or boosting the effect of an antidepressant by also taking a different kind of drug, he said. Fava said that maybe 30 percent to 50 percent of depression patients treated with antidepressants will need to try a third drug. The 16 percent success rate is ''pretty consistent with what we've believed before,'' said Dr. Matthew Menza of the Robert Wood Johnson Medical School in New Jersey, who was not involved in the research.
     The study followed 235 people who hadn't gained complete relief from the project's first two attempts to treat them, or who couldn't tolerate the treatment. All had started out with Celexa, made by Forest Laboratories and one of a widely used class of drugs called SSRIs. If that didn't work, they either switched to another antidepressant or continued with Celexa and added a second drug. For the third attempt, they were randomly assigned to take either mirtazapine or nortriptyline, which are sold in generic form by several companies.
     After 14 weeks of treatment, symptoms had disappeared in 12 percent of the mirtazapine users and 20 percent of nortriptyline users. The difference in rates was not statistically significant, but Menza called it a ''tantalizing'' hint that perhaps older drugs like nortriptyline might be worth a renewed look by doctors.
     Menza noted that the overall project did not test some drugs that have emerged as possibilities since the research was begun. ''We have a lot of interesting new treatments now,'' he said. ''We're left today with the impression these things are probably useful, but we're sometimes wrong.'' Dr. Thomas Insel, director of the National Institute of Mental Health, said the overall project shows that ''we need new and more effective antidepressants.'' It also shows that scientists must find ways to predict which patients will respond to particular drugs, and researchers have begun to find clues by studying the DNA of study participants, he said. ''That kind of information will really be very important to us as we got forward and try to make sense of how do we personalize care for depression,'' he said. ''That's the future here.''
     On the Net: Study information: http://www.star-d.org




The Grim Neurology of Teenage Drinking
Kathy Butler, New York Times- 7/4/2006

Teenagers have been drinking alcohol for centuries. In pre-Revolutionary America, young apprentices were handed buckets of ale. In the 1890's, at the age of 15, the writer Jack London regularly drank grown sailors under the table. For almost as long, concerned adults have tried to limit teenage alcohol consumption. In the 1830's, temperance societies administered lifelong abstinence pledges to schoolchildren. Today, public health experts regularly warn that teenage drinkers run greatly increased risks of involvement in car accidents, fights and messy scenes in Cancún.
      But what was once a social and moral debate may soon become a neurobiological one. The costs of early heavy drinking, experts say, appear to extend far beyond the time that drinking takes away from doing homework, dating, acquiring social skills, and the related tasks of growing up. Mounting research suggests that alcohol causes more damage to the developing brains of teenagers than was previously thought, injuring them significantly more than it does adult brains. The findings, though preliminary, have demolished the assumption that people can drink heavily for years before causing themselves significant neurological injury. And the research even suggests that early heavy drinking may undermine the precise neurological capacities needed to protect oneself from alcoholism.
     The new findings may help explain why people who begin drinking at an early age face enormous risks of becoming alcoholics. According to the results of a national survey of 43,093 adults, published yesterday in Archives of Pediatrics & Adolescent Medicine, 47 percent of those who begin drinking alcohol before the age of 14 become alcohol dependent at some time in their lives, compared with 9 percent of those who wait at least until age 21. The correlation holds even when genetic risks for alcoholism are taken into account.
     The most alarming evidence of physical damage comes from federally financed laboratory experiments on the brains of adolescent rats subjected to binge doses of alcohol. These studies found significant cellular damage to the forebrain and the hippocampus. And although it is unclear how directly these findings can be applied to humans, there is some evidence to suggest that young alcoholics may suffer analogous deficits.
     Studies conducted over the last eight years by federally financed researchers in San Diego, for example, found that alcoholic teenagers performed poorly on tests of verbal and nonverbal memory, attention focusing and exercising spatial skills like those required to read a map or assemble a precut bookcase. "There is no doubt about it now: there are long-term cognitive consequences to excessive drinking of alcohol in adolescence," said Aaron White, an assistant research professor in the psychiatry department at Duke University and the co-author of a recent study of extreme drinking on college campuses. "We definitely didn't know 5 or 10 years ago that alcohol affected the teen brain differently," said Dr. White, who has also been involved in research at Duke on alcohol in adolescent rats. "Now there's a sense of urgency. It's the same place we were in when everyone realized what a bad thing it was for pregnant women to drink alcohol."
     One of two brain areas known to be affected is the hippocampus, a structure crucial for learning and memory. In 1995, Dr. White and other researchers placed delicate sensors inside living brain slices from the hippocampi of adolescent rats and discovered that alcohol drastically suppressed the activity of specific chemical receptors in the region. Normally, these receptors are activated by the neurotransmitter glutamate and allow calcium to enter neurons, setting off a cascade of changes that strengthen synapses, by helping to create repeated connections between cells, aiding in the efficient formation of new memories. But at the equivalent of one or two alcoholic drinks, the receptors' activity slowed, and at higher doses, they shut down almost entirely. The researchers, led by Scott Swartzwelder, a neuropsychologist at Duke and at the Veterans Affairs Medical Center in Durham, N.C., found that the suppressive effect was significantly stronger in adolescent rat brain cells than in the brain cells of adult rats. As might be predicted, the cellular shutdown affected the ability of the younger rats to learn and remember. In other experiments, the team found that adolescent rats under the influence of alcohol had far more trouble than did tipsy adult rats when required repeatedly to locate a platform submerged in a tub of cloudy water and swim to it.
     Dr. Swartzwelder said it was likely that in human teenagers, analogous neural mechanisms might explain alcohol "blackouts" — a lack of memory for events that occur during a night of heavy drinking without a loss of consciousness. Blackouts were once thought to be a symptom of advanced adult alcoholism, but researchers have recently discovered just how frequent they are among teenagers as well.
     In a 2002 e-mail survey of 772 Duke undergraduates, Dr. White and Dr. Swartzwelder found that 51 percent of those who drank at all had had at least one blackout in their drinking lifetimes; they reported an average of three blackouts apiece.
     These averages barely suggest the frequency of blackouts among young adults at the extreme end of the drinking scale. Toren Volkmann, 26, is a graduate of the University of San Diego who, at 14, started drinking heavily almost every weekend and at 24 checked himself into a residential alcohol treatment program. "It was common for me to basically black out at least once or twice every weekend in late high school and definitely through college, and it wasn't a big deal to me," said Mr. Volkmann, a co-author, with his mother, Chris, of "From Binge to Blackout: A Mother and Son Struggle With Teen Drinking," to be published in August. "I wouldn't even worry about what happened, because I wouldn't know."
      Blackouts are usually mercifully brief, and once they are over, the capacity to form new memories returns. But younger rats subjected to binge drinking also displayed subtler long-term problems in learning and memory, the researchers found, even after they were allowed to grow up and "dry out." In experiments conducted by the Duke team, the reformed rat drinkers learned mazes normally when they were sober. But after the equivalent of only a couple of drinks, their performance declined significantly more than did that of rats that had never tippled before they became adults. The study was published in 2000 in the journal Alcoholism: Clinical and Experimental Research. Other research has found that while drunken adolescent rats become more sensitive to memory impairment, their hippocampal cells become less responsive than adults' to the neurotransmitter gamma-amino butyric acid, or GABA, which helps induce calmness and sleepiness.
     This cellular mechanism may help explain Jack London's observation, in "John Barleycorn: Alcoholic Memoirs," that when he was a teenager he could keep drinking long after his adult companions fell asleep. "Clearly, something is changed in the brain by early alcohol exposure," Dr. Swartzwelder said in an interview. "It's a double-edged sword and both of the edges are bad. "Teenagers can drink far more than adults before they get sleepy enough to stop, but along the way they're impairing their cognitive functions much more powerfully." Alcohol also appears to damage more severely the frontal areas of the adolescent brain, crucial for controlling impulses and thinking through consequences of intended actions — capacities many addicts and alcoholics of all ages lack.
     In 2000, Fulton Crews, a neuropharmacologist at the University of North Carolina, subjected adolescent and adult rats to the equivalent of a four-day alcoholic binge and then autopsied them, sectioning their forebrains and staining them with a silver solution to identify dead neurons. All the rats showed some cell die-off in the forebrain, but the damage was at least twice as severe in the forebrains of the adolescent rats, and it occurred in some areas that were entirely spared in the adults.
     Although human brains are far more developed and elaborate in their frontal regions, some functions are analogous across species, Dr. Crews said, including planning and impulse control. During human adolescence, these portions of the brain are heavily remolded and rewired, as teenagers learn — often excruciatingly slowly — how to exercise adult decision-making skills, like the ability to focus, to discriminate, to predict and to ponder questions of right and wrong. "Alcohol creates disruption in parts of the brain essential for self-control, motivation and goal setting," Dr. Crews said, and can compound pre-existing genetic and psychological vulnerabilities. "Early drinking is affecting a sensitive brain in a way that promotes the progression to addiction. "Let's say you've been arrested for driving while drunk and spent seven days in jail," Dr. Crews said. "You'd think, 'No way am I going to speed and drive drunk again,' because you have the ability to weigh the consequences and the importance of a behavior. This is exactly what addicts don't do."
     In another experiment, published this year in the journal Neuroscience, Dr. Crews found that even a single high dose of alcohol temporarily prevented the creation of new nerve cells from progenitor stem cells in the forebrain that appear to be involved in brain development. The damage, far more serious in adolescent rats than in adult rats, began at a level equivalent to two drinks in humans and increased steadily as the dosage was increased to the equivalent of 10 beers, when it stopped the production of almost all new nerve cells. Dr. Crews added, however, that adult alcoholics who stop drinking are known to recover cognitive function over time.
     The same may hold true for hard-drinking teenagers. In 1998, Sandra Brown and Susan Tapert, clinical psychologists at the University of California, San Diego, and at the Veterans Affairs Medical Center there, found that 15-to-16-year-olds who said they had been drunk at least 100 times performed significantly more poorly than their matched nondrinking peers on tests of verbal and nonverbal memory. The teenagers, who were sober during the testing, had been drunk an average of 750 times in the course of their young lives. "Heavy alcohol involvement during adolescence is associated with cognitive deficits that worsen as drinking continues into late adolescence and young adulthood," Dr. Tapert said. Two M.R.I. scan studies, one conducted by Dr. Tapert, have found that hard-drinking teenagers had significantly smaller hippocampi than their sober counterparts. But it is also possible, the researchers said, that the heavy drinkers had smaller hippocampi even before they started to drink.
     Teenagers who drink heavily may also use their brains differently to make up for subtle neurological damage, Dr. Tapert said. A study using functional M.R.I. scans, published in 2004, found that alcohol-abusing teenagers who were given a spatial test showed more activation in the parietal regions of the brain, toward the back of the skull, than did nondrinking teenagers.
     When female drinkers in the group were tested in their early 20's, their performance declined significantly in comparison with nondrinkers, and their brains showed less activation than normal in the frontal and parietal regions. Dr. Tapert hypothesized that when the drinkers were younger, their brains had been able to recruit wider areas of the brain for the task. "This is a fairly sensitive measure of early stages of subtle neuronal disruption, and it is likely to be rectifiable if the person stops drinking," Dr. Tapert said. The good news is that the brain is remarkably plastic, she added, and future studies may show that the teenage brain, while more vulnerable to the effects of alcohol, is also more resilient.
     She pointed to test results from the original group of teenagers, recruited from substance abuse treatment centers and brought into the lab when they were 15 by Dr. Brown. When Dr. Tapert retested the teenagers eight years later, those who had relapsed and who continued to get drunk frequently performed the worst on tests requiring focused attention, while those who reported the most hangovers performed the worst on spatial tasks. On the other hand, the relative handful of teenagers and young adults in the group who stayed sober — 28 percent of the total — performed almost as well, at both the four-year and the eight-year mark, as other San Diego teenagers who had rarely, if ever, had a drink.
     Mr. Volkmann, the University of San Diego graduate, was not part of Dr. Tapert's study. While in college, Mr. Volkmann said, he thought he drank for the fun of it. His moment of truth came in the Peace Corps in Paraguay, when he began waking up with sweats and tremors. He discovered he could not control his drinking even when he wanted. The son of an anesthesiologist and a former teacher in Olympia, Wash., Mr. Volkmann spent a month in a residential treatment program and six months in a halfway house. He has since returned to San Diego. He said in an interview that he had no way of knowing exactly how drinking affected his overall brain function. But on one point, he is clear. "My memory is definitely better now," he said. "Every day now, I can count on the fact that when I think back to the night before, I know what happened."



Scientists Testing Vaccines to Help Smokers Quit
David Tuller, New York Times- 7/4/2006

The idea is not so far-fetched. Researchers at the University of California, San Francisco, and eight other institutions have just started a major study of a vaccine that seeks to block the pleasurable sensations of satisfying a nicotine addiction. The vaccine would stimulate production of antibodies that would latch onto nicotine molecules and prevent them from reaching the brain.
      The effort to find a nicotine vaccine is part of an emerging wave of research into vaccines against addictive substances. Researchers and pharmaceutical companies are also investigating vaccines that would generate antibodies against cocaine, heroin and methamphetamine. Even if the trial of the nicotine vaccine, called NicVax, proved successful, it would take at least two years before the product reached the market, researchers said.
     Two other nicotine vaccine candidates are in the pipeline, said Dr. Frank Vocci, director of the National Institute on Drug Abuse's division of pharmacotherapies. But NicVax, made by Nabi Biopharmaceuticals, is further along. Dr. Vocci noted that the Food and Drug Administration had put the NicVax trial on a fast track for approval. "That means they will do a rapid review and get back to the sponsor within so many months," he said. "They've put a spotlight on it and really tried to move it along, because it would be a unique product."
     The financial bonanza for the first company to market a successful nicotine vaccine would be enormous. Although smoking rates in the United States have declined in recent decades, tens of millions of adults continue to smoke, and the habit causes more than 440,000 deaths a year, according to the Centers for Disease Control and Prevention. An effective vaccine could play a major role in reducing smoking around the world, said Dr. Vocci, who estimated that current rates of smoking would lead to one billion deaths in the 21st century.
     Surveys show that about 7 in 10 smokers say they would like to quit, but a vast majority of those who try end up relapsing. While the market for smoking cessation therapies is estimated to be more than $1 billion annually, many smokers continue to fail in their efforts to quit even while using the available products, with long-term success rates generally peaking at about 20 percent. "It's the period between four-week abstinence and one-year abstinence that's the critical period," said Dr. Victor I. Reus, a professor of psychiatry at the University of California, San Francisco, and a lead investigator on the NicVax study. If the vaccine helps smokers quit, Dr. Reus said, a central question will be whether booster shots could help prevent relapse.
     The classic nicotine buzz occurs when the molecule travels in the bloodstream across the "blood-brain barrier" to reach specific receptors in the brain. Nicotine itself does not cause the body to create antibodies as part of an immunological response, the way disease-causing viruses and bacteria do. The anti-nicotine antibodies generated by NicVax are proteins that bind to the nicotine molecule. Because the compound is too big to cross the blood-brain barrier, the vaccine is expected to diminish or eliminate the pleasure associated with puffing a cigarette. This lack of positive physiological reinforcement for smoking is believed to reduce the nicotine craving that causes smokers to fail in their efforts to quit.
     The most widespread therapies currently available are nicotine-replacement products, like nicotine patches and gum, which are designed to wean the smoker by administering trickles of nicotine to the body, replacing the surges delivered by cigarettes. Zyban, a repackaging of the antidepressant Wellbutrin, was approved by the F.D.A. a decade ago for smoking cessation. Most recently, the F.D.A. approved Chantix, which works by binding to the nicotine receptors in the brain.
     The current study will test vaccine dosages and sequences of four or five shots; some subjects will get a placebo. The total number of subjects in the trial is expected to be about 300. Other participating centers include the University of Minnesota; the University of California, Los Angeles; and Massachusetts General Hospital.
     The antibodies produced by a single NicVax injection last about a month, said Dr. Reus, the San Francisco scientist. The multishot sequences being tested are designed to extend the antibody response for many months, although eventually the body will stop producing the anti-nicotine antibodies, he said. Previous NicVax trials were intended to assess vaccine safety and dosing levels rather than efficacy, but researchers reported high short-term rates of quitting.
     Thomas E. Rathjen, a spokesman for Nabi Biopharmaceuticals, said the results of the study should be available sometime next year. Even if they are promising, however, the company will have to conduct a final trial before it can apply for F.D.A. approval.



Philip Rieff, Sociologist and Author on Freud, Dies at 83
Robert D. McFadden, New York Times- 7/4/2006

Philip Rieff, an influential sociologist, author and cultural critic who wrote well-known books on the impact of Sigmund Freud on society and on the direction of morality and Western culture, died on Saturday at his home in Philadelphia. He was 83. The cause was heart failure, said his son, David, the only child of Dr. Rieff's eight-year marriage in the 1950's to the writer Susan Sontag, who died in 2004.
      Dr. Rieff, who taught at the University of Pennsylvania, was best known in scholarly circles for three early works on Freud and culture, published from 1959 to 1973, and for a book that appeared last January, "Sacred Order/Social Order: My Life Among the Deathworks: Illustrations of the Aesthetics of Authority" (University of Virginia Press), which was to have been the first of several volumes on related cultural themes. The book, which uses works by Picasso, Marcel Duchamp, James Joyce and other artists and writers to explore what Dr. Rieff portrays as a battlefield on which culture is under attack, mounts a counterattack and is generally dismissive of feminism, gay rights, the television channel MTV and much of what has come to be regarded as social progress.
     In an interview last year with David Glenn for The Chronicle of Higher Education, Dr. Rieff spoke of the emptiness of modern "anti-culture" and voiced deep pessimism for the future. "He does not believe that any restorative project is actually feasible," Mr. Glenn wrote. "When asked what he believes scholars might do to slow down the process of cultural decline, he says, 'They can become inactivists. They'll do less damage that way. Inactivism is the ticket.'"
     In an academic career that began after World War II, Dr. Rieff taught at the University of Chicago; Brandeis University; the University of California, Berkeley; and from 1961 until his retirement in 1992, at the University of Pennsylvania. Dr. Rieff often dazzled and occasionally puzzled students with multilayered but always authoritative lectures that blended philosophy, theology, economics, history, literature, psychology and dashes of poetry and Plato like ingredients in a sociological mulligatawny. Readers often found his prose style difficult but the ideas behind it rewarding.
     Dr. Rieff's first book, paradoxically titled "Freud: The Mind of the Moralist" (Viking Press, 1959), established him as an important sociologist. It argued that Freudian ideas, which gave rise to the idea of the "psychological man" as the dominant moral type in the 20th century, had had a corrosive effect on Western morality and culture because such an individual tended to relate all public questions not to received traditions of communal morality, but "to himself and his own emotions."
     After editing a 10-volume edition of Freud's papers that appeared in 1961, Dr. Rieff completed his second book, "The Triumph of the Therapeutic: Uses of Faith After Freud" (Harper & Row, 1966), which said that Freudian therapies had gone awry in modern society, aiming not at a healthier life but at "better living," with rationales to replace virtue with value and sidestep consequences.
     In "Fellow Teachers" (Harper & Row, 1973), Dr. Rieff explored the role of teachers in higher education and argued for a "feeling intellect" that avoids preaching or espousing doctrines to students. "My re-educated friends, with their ardor for innovation and the perverse, are too influential as things are," he wrote. "This psychosocialism may destroy what remains of our received culture in order to replace it with permanent therapies."
     Philip Rieff was born in Chicago on Dec. 15, 1922, the son of refugees who had fled political violence in Lithuania in 1921. Some members of his family who remained behind died in the Holocaust. He entered the University of Chicago in 1939, and after military service in World War II, he resumed his studies and earned a bachelor's degree in 1946, a master's in 1947 and a doctorate in 1954. He joined the faculty in 1947 as a teaching instructor. In 1950, Ms. Sontag, then a 17-year-old sophomore at the University of Chicago with a brilliant academic record, audited a class taught by the 28-year-old Dr. Rieff. They talked, were captivated by one another — she later wrote that he was the first person with whom she could ever really talk — and they were married 10 days later.
     In 1952, the couple moved to Boston. Dr. Rieff joined the faculty at Brandeis, Ms. Sontag began graduate work at Harvard, and their son was born. After earning two master's degrees and completing course work for a doctorate, Ms. Sontag received a fellowship to Oxford and Dr. Rieff a fellowship at Stamford; the couple went their separate ways for one academic year, their son was looked after by Dr. Rieff's parents, and the marriage unraveled. In 1959, the couple divorced, and Ms. Sontag reclaimed her son and moved to New York to begin her celebrated career. Dr. Rieff joined the faculty at Berkeley, where he taught until moving to Pennsylvania in 1961. Biographers have suggested that Ms. Sontag contributed significantly to Dr. Rieff's first book, "Freud: The Mind of the Moralist," although she was not listed as a co-author. In 1963, Dr. Rieff married Alison Douglas Knox, a Philadelphia lawyer. Besides his wife and son, of New York, a journalist and author who specializes in foreign affairs, Dr. Rieff is survived by one grandchild.



In Concert With Therapy, Violin Brings a Grace Note
Leslie Jacobs, Chicago Tribune- 7/4/2006

Stephanie Goldman Meis of Northbrook has discovered her true calling. A classical violinist who has performed with the numerous symphonies in the area, including the Chicago Symphony, she was nevertheless frustrated that her musical career did not progress as she would have liked. "I never took off as a full-time, professional violinist, and I didn't understand why," said Meis, who has taught music privately for 30 years. "In my heart, I began to believe the violin had another purpose in my life."
     A longtime student of holistic medicine, she returned to school and earned a master's degree in psychotherapy before becoming a reiki master teacher. In March 2005, she opened her own therapeutic exploration practice in Highland Park, where in 80-minute sessions that begin with one-on-one conversations, she often plays her violin to help clients relax and identify their anxiety or pain before guiding them toward wellness.
     Reiki (pronounced ray-kee) is the ancient art of energy healing, integrating visualization, aromatherapy, crystals and musical vibrations along with touch therapy. "Right from the beginning of school, I learned that the violin is a healing tool," Meis explained. "Sound alters the vibrations of the body, and that's what I'm interested in, loosening up emotions so I can deal with them. However everyone isn't open to my playing, but for those who are, it works like a charm."
     Jane Talesnick of Highland Park can attest to that. Despite having a master's degree in early-childhood development and three decades of experience directing day-care centers, she was struggling with the idea of going out on her own in business. Then she consulted Meis. "I had seen other kinds of therapists, but Stephanie is the one who helped me envision my business before I created it," recalled Talesnick, who has been operating her own successful day care since 2003. "The violin gets you ready for the reiki experience by helping you let go of tensions or bad energy and creating space for new energy."



Study Urges Treating Depression in Parents
Carey Goldberg, Boston Globe- 7/5/2006

Pediatricians usually ask a mother about her baby's sleep pattern or a toddler's eating habits. But a study published today suggests that at routine checkups, they should ask a few questions about the mother's own well-being, too. Just two simple questions -- about whether a mother has lost interest and pleasure in doing things lately, and whether she has been feeling down -- can quickly and easily start the process of getting the estimated 10 percent of mothers who are depressed the help they need, according to the study in this month's issue of the journal Pediatrics.
      A growing body of research suggests that such help can be crucial for both mother and child. Last month, researchers reported that well into adulthood, the children of very depressed parents remain about three times as likely as their peers to suffer from depression, anxiety, or addiction. On the positive side, a major study this spring found that when mothers' depression abated, their children showed improvement in their own psychiatric symptoms within three months. The research is so convincing it practically ``screams" for pediatricians to get involved in treating parents' depression, said Dr. Myrna Weissman, the Columbia University psychiatry professor who oversaw both earlier studies.
     Today, little screening of parents for depression actually takes place, researchers say. Parental depression and its effects on children tend to fall between the cracks in the medical system , between children's doctors and adults' doctors. And even if pediatricians suspect a problem, they are not set up to offer treatment options to parents. ``The convergence of the scientific evidence and the awareness that we can make a huge difference in a large number of people's lives . . . make this a moment of extraordinary opportunity," said Dr. William Beardslee , academic chairman of the psychiatry department at Children's Hospital Boston. ``And at the same time, the poignancy is that we have not yet done it, and a huge amount of unnecessary suffering in families continues to go on."
     The study cited in Pediatrics enrolled doctors in rural practices in Vermont and New Hampshire, and found that the pediatricians generally considered the two-question survey quick and workable. A patient who answers yes to either question may need to be referred for counseling or other treatment for depression.
     The Dartmouth professor who led the study noted that pediatricians are already trying to provide advice in a wide array of areas during routine office visits. ``They were willing to say, `You know, if I don't talk about the importance of wearing bike helmets, but I help a mom with depression, pow! I've made a difference,' " said Dr. Ardis Olson , a professor of pediatrics and community and family medicine.
     Infants whose mothers are withdrawn tend toward feelings of sadness, anger, distrust, and helplessness, they have found. These children may develop more slowly than average, and encounter more trouble in the classroom and with their peers. And depressed mothers are more likely to blame themselves when the child hits a bump in the course of developing. They tend to believe that ``the reason the baby is like that is because of their depression, so they feel, in a sense -- to use a strong word -- toxic to the baby," said Ed Tronick , director of the Child Development Unit at Children's.
     Pata Suyemoto of Somerville, a former professor who volunteers for the group Families for Depression Awareness, describes the period when she struggled to raise her young daughter while experiencing depression as ``torturous." ``I remember being in the park and just crying, letting her play on the swings and just sitting back and crying, because I was in such a state but I knew I had to take care of her," she said. Even now, she said, with her daughter almost 12, she worries: ``I know I've given her the best I could, but was that good enough?" Such concern is familiar to Beardslee. Depressed parents ``worry that they have damaged their kids irrevocably -- they have not, they absolutely have not -- but that is what they think," he said.
     Weissman's long-term study on adult children of depressed parents does suggest long-term damage if nothing is done. Published in the June issue of the American Journal of Psychiatry, it followed 151 children -- 101 of them with depressed parents -- for 20 years, until an average age of 35. The children of depressed parents not only had triple the risk of depression, anxiety, and addiction, they also were starting to show higher rates of medical problems such as heart disease, the study found. But recognition and treatment of depression has improved since those children were young, researchers pointed out, and some of the children's problems were surely tied to genetics rather than parenting. Depression has a strong genetic element.
     Weissman's other recent study offers more hope. It found that when a mother's depression went away within three months of treatment, her children's psychiatric symptoms -- such as behavior or mood problems -- tended to abate as well. Among the children of mothers who got better, there was a drop in those diagnosed with psychiatric problems, from 35 percent to 24 percent. Weissman and her coauthors pointed out that, with all the concern these days about how to safely treat psychiatric disorders in children, one strategy may be to provide ``vigorous treatment" to depressed mothers.
     Tronick has pioneered therapy that focuses on improving the parent-child bond, and Beardslee has led work on helping families cope with a parent's depression. He also works on preventing depression, both by finding support for parents and fostering resilience in children. It helps, he said, for a parent to tell a child such things as, ``This is a medical illness, a biological illness, I'm getting treatment, and your life will be able to continue. This is not your fault, and you're not to blame, even though it's very confusing."

New Drug to Help Smokers Quit
Ronald Kotulak, Chicago Tribune- 7/5/2006

A new medication that reduces the craving for cigarettes and abates withdrawal symptoms appears to be more effective in helping people break the smoking habit than the best therapy currently available, the nicotine-replacement drug bupropion, according to three studies published Tuesday.
      Although the new anti-smoking drug, varenicline, is seen as a step forward, experts cautioned that it is less effective than health officials would like and that there may never be a pill to help most smokers quit. "Varenicline definitely is not a panacea for smoking cessation," Robert Klesges of the University of Tennessee Health Science Center wrote in an editorial accompanying the studies in the Journal of the American Medical Association. "Many participants in these trials experienced adverse events, stopped taking their study medication before they should have, and discontinued participation in the studies. Importantly, the majority of participants in these three studies did not quit smoking even with varenicline." Nevertheless, anti-smoking therapists, as well as smokers wanting to quit smoking, "now have another product available that appears to help increase the probability of smoking cessation," Klesges and his colleagues wrote.
     The drug, approved by the FDA in May, will be marketed under the trade name Chantix and is expected to be available by prescription by August. The Centers for Disease Control and Prevention estimates that 44.5 million U.S. adults smoke and that 8.6 million of them have at least one serious illness, such as cancer or heart disease, caused by smoking.
     Two of the studies in JAMA, involving a total of more than 2,000 smokers, found that 44 percent of people taking varenicline up to 12 weeks continued to abstain from smoking, compared with about 30 percent for bupropion, marketed as Zyban, and 17 percent for those taking an inert placebo. After 52 weeks, 22 to 23 percent of those on varenicline were still not smoking compared with 14 to 16 percent taking bupropion. Only 8 to 10 percent of smokers on placebos were still abstinent after a year. Pfizer, which will manufacture varenicline, supported all of the studies. Four out of 10 smokers attempt to quit each year, but only about 10 percent are successful. Nicotine-replacement compounds, such as bupropion and patches, are commonly used to help people quit, but their success rate is only moderate.
     Varenicline is a non-nicotine drug that appears to work by stimulating the production of dopamine, the brain's reward chemical, said David Gonzales of the Oregon Health and Science University, who led one of the studies published Tuesday. The drug reduces a person's desire for a cigarette, blunts withdrawal symptoms and, for those who do smoke, blocks the reinforcing effects of cigarettes.
     The third study, conducted by Dr. Serena Tonstad of Ulleval University Hospital in Oslo, Norway, found that a booster round of varenicline helped increase the smoking abstinence rate of quitters who had initially taken the drug for 12 weeks. After 52 weeks, 43.6 percent of subjects who were given a second round of varenicline were still not smoking, compared with 36.9 percent of those who were given a placebo.
      "Clearly, quitting smoking, even with pharmacological and behavioral assistance, is extremely difficult," Klesges wrote in the editorial. "Patients currently cannot and probably never will simply be able to `take a pill' that will make them stop smoking. Smokers must want to stop smoking and must be willing to work hard to achieve the goal of smoking abstinence."

Yates Was 'Fragile' in Weeks Before Drownings
Dale Lezon, Houston Chronicle- 7/6/2006

Andrea Pia Yates anxiously paced around the house with her infant daughter on her hip, paying little attention to her four sons, on the day before she drowned all five children in a bathtub, her former mother-in-law testified today. Dora Yates, mother of Russell Yates, who was Andrea Yates' husband at the time, said Andrea Yates' mental health was fragile in the weeks leading up to the killings five years ago. "She seemed distracted from the children, except with Mary," Dora Yates testified, referring to the 6-month-old daughter. "She held her on her hip. She'd walk in circles through the house. I thought it was pacing." Dora Yates testified that Andrea Yates suffered from post-partum depression after Mary's birth, resulting in two stays in mental hospitals.
      Testimony in Yates' second capital murder trial resumed after a five-day break for the July Fourth holiday and because of a jurors' illness Wednesday. Dora Yates testified for the defense, which is attempting to show that Andrea Yates, 42, was insane when she killed the children. Prosecutors contend she knew right from wrong and therefore is guilty of murder.
     Yates was convicted at her first capital murder trial in 2002, and jurors sentenced her to life in prison. An appeals court ordered a new trial because of erroneous testimony by the prosecution's mental health expert. The previous jury's decision to sentence her to life made her ineligible for the death penalty this time.
     Dora Yates said she came to Houston from her Tennessee home to help her daughter-in-law care for the children after Mary was born. She stayed at a hotel near the Yates' Clear Lake-area home, visiting the home each morning to help Andrea Yates clean the house and feed the children after her husband went to work. The killings on June 20, 2001, occurred between the time Russell Yates left for work and Dora Yates came to the house, she said.

Army Cuts 1, 000 for Personality Disorders
Associated Press, 7/7/2006

WASHINGTON -- The Army discharged more than 1,000 soldiers last year for personality disorders, the reason it gave for this year's discharge of a private now accused of raping a young Iraqi woman and killing her and her family. That total represents about 1.2 percent of the 83,000 soldiers given early discharges during the fiscal year that ended Sept. 30, 2005. That was a bit higher than the less than 1 percent discharged for those reasons during the 2001 fiscal year before the war in Iraq began.
      Lt. Gen. Kevin C. Kiley, the Army's surgeon general, told reporters Friday that the disorder usually is not associated with combat trauma and may be a lifelong problem that is not always easy to identify in military screenings. He said soldiers exhibiting such traits would not be automatically discharged because many can continue to perform well.
     Steven D. Green, who pleaded not guilty through his public defenders Thursday, was discharged because of an ''anti-social personality disorder'' according to military officials and documents. That condition is defined as chronic behavior that manipulates, exploits or violates the rights of others, such as someone who repeatedly lies, fights or breaks the law. According to a federal affidavit, Green, 21, and other soldiers targeted a young Iraqi woman after spotting her at a traffic checkpoint near Mahmoudiya. They later went to her house, raped and killed her and shot members of her family, the affidavit said. Green is being tried in federal rather than military court because he no longer is in the Army
     Kiley told Pentagon reporters that personality disorders -- which are not forms of mental illness -- do no necessarily exclude people from serving in the armed forces. In fact, he said that up to 4 percent to 5 percent of the soldiers have taken sleep medications or antidepressant drugs at one time or another during their combat service. Altogether, there were nearly 493,000 people in the Army during the 2005 fiscal year, compared with about 481,000 in 2001. The Army discharged 805 soldiers for personality disorders in 2001, 734 in 2002, 980 in 2003, 988 in 2004 and 1,038 in 2005. Mental disorders represented between less than 1 percent to 1.4 percent of the total early discharges for those years. The total number of early discharges ranged from about 69,000 to more than 87,000. Soldiers can receive early discharges for a number of reasons, but most often they are for physical fitness issues.
     Kiley said the Army is allocating more resources that ever to combat stress and provide mental health counseling for soldiers on the battlefield. Currently, he said, there are about 200 mental health and behavioral health personnel in Iraq and 25 in Afghanistan. Many of them are assigned to different regions of the country and travel in small teams to the forward operating bases to meet with soldiers. The Army, he said, is trying to find ways to encourage soldiers to use the mental health services and overcome the perception among the military that seeking mental health counseling is a sign of weakness. ''There is something very demanding and tough about being in combat,'' said Kiley. ''And anything that would be perceived as being weak and not ready and tough carries with it some stigma.'' As a result, he said, the Army is trying to reach out regularly to soldiers while they are in combat, and officials are encouraging entire units to go through mental health screenings so that soldiers will feel more comfortable doing it if they see their commanders and unit leaders participating.

Journals Reveal Ruminations of Teenage Columbine Killers
Kirk Johnson, New York Times- 7/7/2006

GOLDEN, Colo.— The mind of a teenage killer-in-training is a very dark place. "I have a goal to destroy as much as possible, and I must not be sidetracked by my feelings of sympathy, mercy or any of that," Eric Harris wrote in a journal entry almost exactly six months before he and his friend Dylan Klebold took their bombs and guns to Columbine High School on April 20, 1999. Another entry is even more to the point: "It's cool to hate."
      But as the nearly 1,000 pages of documents released here on Thursday by the Jefferson County sheriff also reveal, evil was hatched amid the utterly ordinary things of teenage life. Immature rants against the world, declarations of invincible superiority and depressed mopes about the love for a girl who did not love back are interspersed with to-do lists that, in retrospect, are the stuff of bleakest horror.
     On one undated page, Mr. Harris, who was 18 when he and Mr. Klebold, 17, killed 13 people and then themselves, wrote down a neatly enumerated list of things still to be done. Get nails. Get gas cans. Fill clips. Finish fuses. At the top of the page was a chipper printed reminder about the virtues of optimism: "Your outlook determines your ability to overcome any challenge."
     The documents, most of which were seized by the police from the Klebold and Harris homes and vehicles, were released by the sheriff as a result of an order by the Colorado Supreme Court, which said last year that the sheriff must review the retained evidence — including videotapes made by the killers — and decide what materials, if any, were in the public interest. The sheriff, Ted Mink, said in a letter posted on the county Web site that after extensive review, and discussions with the family members of the victims and with violent-crime behavior analysts, he had decided that the videotapes should not be released because he feared they could inspire copycat crimes. But the documents passed the court's test. "No one item has held the key," Sheriff Mink wrote.
     What the new trove of documents offers, over and over, is the mixed sense of inevitability — two young men surging toward disaster — and just as often the glimpse of another future that might have unfolded, in which all the detailed plans for mayhem and killing stayed in a drawer, a fantasy only.
     In a school paper written by Mr. Klebold, two months before the killings, according to the handwritten date at the top, he described an intensely violent scene in which a man carrying duffle bags pulled out weapons and began a mass killing. The gore is described in vivid detail: blood spatters under the streetlights, metal objects are thrust though skulls. The teacher appeared somewhat taken aback. "I'd like to talk to you about your story before I give you a grade," the unnamed teacher wrote. "You are an excellent writer/storyteller, but I have some problems with this one."
     The documents also give nuance and texture to some of the myths and caricatures that have grown up around the killers: that they were bullied losers pushed to the edge or angry teenagers fueled by emptiness and techno music. Mr. Klebold, for example, rhapsodized about a girl. Whatever else happened to him in the months and weeks leading up the killings, he loved once, like any other teenager, if only from afar. The girl's name was redacted in the documents. "I hear the sound of her laugh, I picture her face," he wrote. "I just hope she likes me."
     One long typed document, taken from the Harris home, talks about what might happen after the killings. "Do not blame anyone else besides me and V for this," said the unnamed writer, presumably Mr. Harris, who often referred to Mr. Klebold as V. "Don't blame my family, they had no clue and there is nothing they could have done."
     But the sometimes grandiose tone in the documents, that the killers are different, set off from society and better than those they intend to kill, is blunted by the moments of despair and anguish that come through in other journal entries and poems. One entry taken from the Harris home was simply called "Black." "I can't see a [expletive deleted] thing," it said, "so what the hell am I gonna write about, how I can't see anything? My mind is black, sight is black, everything is black." In another entry taken from the Harris home, the author — presumably Mr. Harris — fantasizes being the gun itself. "I am a gun," he wrote. "I was never made for hunting, just for killing humans." He then describes blowing off half the head of a man he did not like. "I am god," the note reads. "He died."