Landmark Study Proves Chronic Depression Treatable
-- Offers Hope to Millions Whose Depression Has Gone Untreated --

Contacts:
Mary S. Hamilton
National DMDA
312/988-1154

Anne Quinn
Chandler Chicco Agency
212/229-8443

CHICAGO, December 1, 1998 -- A just-published landmark study of patients who suffered from untreated chronic depression on average for almost two decades has found that these patients can find relief with antidepressant medication, the National Depressive and Manic-Depressive Association (National DMDA) announced.

This double-blind, randomized, multi-center treatment study is the first to report results of treatment of chronic major depression and double depression with a selective serotonin reuptake inhibitor (SSRI) antidepressant medication. Patients' response to treatment was examined in three phases: acute, continuation and maintenance. Three companion papers of the study are published in the November issue of Journal of Clinical Psychiatry, including the acute phase trial for safety, psychosocial functioning outcomes in the acute phase, and another focused on the rationale for this unique, multi-faceted study design. The maintenance phase, published in the November 18th issue of The Journal of the American Medical Association (JAMA), compared the efficacy of the SSRI versus placebo in preventing recurrence and reemergence of chronic depression in patients. The size of the patient population in the study is the largest database to date in chronic major depression and double depression and their treatment.

"Although the National DMDA was not a sponsor of the research, we are announcing the results because they are of such potential importance to the more than 18 million Americans annually who struggle with depression," said Lydia Lewis, Executive Director of National DMDA. Of these patients, it is estimated that approximately one-third who are treated for a depressive episode suffer from chronic depression. The total medical costs and functional impairments associated with all forms of depression were estimated to cost society $43 billion annually in 1990, of which $23.8billion (55 percent) represents decreased work productivity and lost work days.

Dr. Martin B. Keller, Professor and Chairman of the Department of Psychiatry and Human Behavior at Brown University, and former chair of National DMDA's Scientific Advisory Board was overall director of this research program and lead author of two of these articles. He noted the findings are "of major significance" for a number of reasons. "In measuring the psychosocial impact of chronic depression, for the first time we have quantified the impact on quality of life and worked productivity this devastating illness has on patients, their families and those they work with--so it tells us why this is such an important problem," said Keller."On the hopeful side, it clearly demonstrates that even patients who have suffered for decades can benefit substantially from treatment with modern antidepressants. Most importantly, recovered patients are highly likely to remain well if they stay on medication on the same dose which brought about their recovery."

Lewis was equally enthusiastic about the results. "The results of this study offer enormous hope to the millions of patients who have never received proper medical treatment for the serious medical condition we call chronic depression," Lewis said. "This finally proves that chronic major depression is a treatable illness, and there is no need for patients to struggle for years in the mistaken belief that it is some kind of character defect or personality weakness."

Effective, Well-Tolerated Treatment is Available

The acute phase of the study compared treatment with an SSRI to treatment with a tricyclic antidepressant, and found both treatments were effective in combating symptoms of chronic major depression. However, the researchers found the SSRI was better tolerated than the tricyclic antidepressant; patients randomized to the SSRI were only about half as likely to discontinue treatment because of side effects.

In the final phase of the study, the maintenance phase, researchers compared an SSRI with placebo, and found the SSRI was not only well-tolerated, but had significant efficacy in preventing recurrence or reemergence of depression in chronically depressed patients. Furthermore, the therapy can extend the time in remission. Specifically, after 18 months, patients who received placebo were four times likely to experience a reemergence of depression than patients taking the SSRI. It is unknown whether these results are generalizable to all SSRIs as a class. With an effective and tolerable long-term treatment option, patients who may have battled with chronic depression for most of their lives may have the opportunity to lead more productive social and professional lives, according to Lewis.

The Impact on Quality of Life

One of the major preliminary findings of this study at baseline was the duration and extent to which chronic depression can negatively affect a person's psychosocial functioning -- interpersonal and social functioning. However, by the end of the acute phase of the study, patients who had been suffering with chronic depression on average for nearly two decades exhibited significant improvement in psychosocial functioning by four weeks of treatment and continued to improve through 12 weeks of treatment. Psychosocial functioning variables include overall functioning, quality of life, work functioning and interpersonal functioning.

"This research demonstrates that patients' quality of life is severely limited by their depressive illness," said Lewis, "but that treatment with antidepressants can markedly improve their ability to work, relate to their families and friends, and function in society."

At the beginning of the study, the researchers found that almost 80 percent of the chronically depressed patients had psychosocial adjustment rated as "poor" or "very poor" -- and less than two percent had "good" or "very good" adjustment. For example, there was a remarkable discrepancy between the educational achievements of these patients and their current work status:

By the end of the acute phase of the study, almost 88 percent of those whose depression was in remission (an absence or lessening of symptoms) were rated as having "good" or "very good" psychosocial adjustment, one-half percent fell into the "poor" category, and none was rated as "very poor."

Study Design & Background

The 12-week acute phase was designed to compare the efficacy and safety of two antidepressant treatments in 635 patients. Those patients who exhibited a satisfactory response to either treatment entered a 16-week continuation treatment phase. In the maintenance phase, patients who had successfully completed the continuation phase with the SSRI therapy entered an 18-month trial to compare the efficacy of the SSRI with placebo. These protocols were designed together to provide important descriptive information in the treatment of the chronic depression, a largely understudied area.

Researchers looked at patients with two types of chronic depression:

Investigators from 10 leading universities in the United States conducted the study, including the following members of National DMDA's Scientific Advisory Board: Jan A. Fawcett, M.D., of Rush-Presbyterian St. Luke's Medical Center in Chicago; Alan J. Gelenberg, M.D., of University of Arizona at Tucson; Robert M.A. Hirschfeld, M.D., University of Texas at Galveston; Martin B. Keller, M.D., of Brown University; A. John Rush, M.D., of the University of Texas at Dallas; Alan F. Schatzberg, M.D., of Stanford University and Michael E. Thase, M.D., of University of Pittsburgh. Other investigators included James H. Kocsis, M.D., of Cornell University; Daniel Klein, Ph.D., of State University of New York, Stony Brook and James P. McCullough, Ph.D., of Virginia Commonwealth University.

Based on the study's important results, National DMDA's Lewis encourages patients to seriously consider enrolling in clinical trials. "Because people volunteered for this clinical trial, we now know that chronic depression can be successfully treated," she said. "Without these volunteers we would not have these new findings, which offer a very positive message for those suffering needlessly from depression, and those who care about them. This study shows research can change lives."

Speaking on behalf of all the principal investigators, Dr. Keller expressed "enormous gratitude to all of the people suffering from depression who were willing to participate in this research for over two years not knowing what treatment they were on. Their self-sacrifice and courage is extraordinary, making it possible for new discoveries about treatments to be made. This, in turn, helps millions of other patients."

National DMDA is the nation's larges patient-run illness-specific organization. Founded in 1986 and headquartered in Chicago, IL, National DMDA's mission is to educate patients, families, professionals, and the public concerning the nature of depressive and manic-depressive illnesses as treatable medical diseases; to foster self-help for patients and families; to eliminate discrimination and stigma; to improve access to care; and to advocate for research toward the elimination of these illnesses.

For membership information and free educational materials, please call National DMDA at 800/826-3632.

Depression in Teenaged Girls Carries Over into Adulthood

Adolescent girls are at very high risk of depression and remain at high risk as they enter their early adult years, reports a study in the July 1999 issues of the Journal of the American Academy of Child and Adolescent Psychiatry.

High rates of depression among girls may have significant consequences for the transition from adolescence to young adulthood, suggests the new study, led by child and adolescent psychiatrist Uma Rao, M.D., of the University of California, Los Angeles.

The researchers followed up 155 young women every year for five years, starting in their senior year of high school.  Thirty-seven percent of the women had an initial episode of major depression during this period.

Nearly 50 percent of the women developed a first or repeated episode of major depression within five years after high school graduation.

Risk remained high throughout the age range studied, but the women were most likely to have an initial episode of depression between the ages of 18 and 19 years.   This corresponded to the time they graduated high school and started college or moved away from home.

Depression was more likely to develop in women with other types of psychiatric disorders, especially anxiety and substance abuse.

Depression had a significant negative impact in several areas of the young women's lives.  Depressed girls had difficulties in their school work or in managing the demands of work and school  They also had problems with their romantic relationships, including a possibly increased risk of coercion or abuse by their boyfriends.

Previous child and adolescent psychiatry research has shown high rates of depression among adolescent girls.  However, few studies have looked at what happens to depressed girls they grow into adulthood.

The new results suggest that young women continue to be at high risk of depression through their early twenties, and those who have had an initial episode of depression are at very high risk of recurrent episodes.

The high risk of depression in the years after high school is a particular concern, as this is a time when young women are developing crucial social and occupational skills.  Women's risk for depression during the early reproductive years may also pose a significant social problem in view of the risk to children of depressed mothers.   Child end adolescent psychiatrists need to develop new ways of identifying girls and young women at high risk of depression so as to target them for early intervention.

Uma Rao, M.D.        Continuity of Depression During the Transition to Adulthood:
                                    A 5-Year Longitudinal Study of Young Women

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The American Academy of Child and Adolescent Psychiatry represents over 6,900 child and adolescent psychiatrists with at least five years of additional training beyond medical school in adult, child, and adolescent psychiatry.   AACAP members actively research, diagnose, and treat psychiatric disorders affecting children, adolescents, and their families.  Your Child and Your Adolescent, the AACAP's new books on parenting, give us an in-depth look at child development from infancy to adulthood; discussing what's normal, what's not, and when to seek help.  The AACAP actively refers the media to expert spokespeople on child and adolescent issues.

Dr. Debra Moore

Panic attacks are a set of symptoms that come on suddenly, putting your body into a red flag alert stance. The symptoms build to a peak rapidly, usually in ten minutes or less, although it can feel much longer. The common theme of the feelings and symptoms is one of impending doom and intense fearfulness or nervousness.

What are typical bodily symptoms?

racing or pounding heart
sweating, flushing or feeling chilled
chest pains or tightness
difficulty getting your breath, or a sense of smothering or choking
dizziness, light-headedness, tingling or numbness
trembling or shaking
nausea or abdominal discomfort

What are typical feelings and thoughts during a panic attack?

The overriding feeling is one of fear. People who have panic attacks say they feel like something awful is going to happen at any moment. They may also feel disconnected to their surroundings. Some people have described it as feeling like they are in a bubble. Others have said that suddenly nothing feels
real. They feel out of control and may even fear that they will die. They may also be afraid of going crazy or starting to scream or run or do something embarrassing.

Can panic attacks kill me or make me go crazy?

NO! Even though it may feel that way, a panic attack will not give you a heart attack and it will not kill you, and it will not go on forever. And panic attacks are not the beginning of going crazy. They are panic attacks, pure and simple. The National Institute of Mental Health estimates at least 3 million Americans will have panic disorder at some time in their lives.

What causes panic attacks?

Some people seem especially vulnerable to panic attacks. Sometimes anxiety problems, including panic attacks, seem to run in families. Your nervous system may be easily triggered. We also know that chronic stress can contribute to all kinds of problems with anxiety, including panic attacks. According to one theory, in panic disorder, the body's normal alarm - it's fight or flight reaction, may be triggered unnecessarily. Sometimes the first attack can also be triggered by a change in the body, such as a serious illness or even a medication.

I think I have panic attacks, and I'm worried what others will think. I'be started to avoid people.

Starting to avoid people and places is very common for people who have panic attacks. Many times, they have told no one about their experiences. But to get support and help, you must tell someone. Consider talking with your doctor or a family member or friend. You can explain what you have learned about panic attacks.

I think I'm also getting depressed and I've started drinking to calm my nerves.

Secondary depression is common in sufferers of panic attacks. Once you get help, the depression may lift. If not, there is good, effective help for your depression as well. Many people start to self medicate when they are feeling bad and don't know where to turn. Of course, this only adds an additional problem. And drinking or abusing drugs will not stop panic attacks.

What help is there for panic attacks?

It is very important that you see a qualified, experienced professional to treat your panic attacks. The disorder will seldom go away by itself and may in fact worsen. A professional will assess your unique situation and together you will agree on a treatment plan.