Depression Treatment: Glycemia, Insulin Resistance, Insulin Secretion, and Risk of Depressive Symptoms in Middle Age.

Glycemia, Insulin Resistance, Insulin Secretion, and Risk of Depressive Symptoms in Middle Age.

Filed under: Depression Treatment

Diabetes Care. 2012 Dec 10;
Akbaraly TN, Kumari M, Head J, Ritchie K, Ancelin ML, Tabák AG, Brunner E, Chaudieu I, Marmot MG, Ferrie JE, Shipley MJ, Kivimäki M

OBJECTIVEThe extent to which abnormal glucose metabolism increases the risk of depression remains unclear. In this study, we investigated prospective associations of levels of fasting glucose and fasting insulin and indices of insulin resistance and secretion with subsequent new-onset depressive symptoms (DepS).RESEARCH DESIGN AND METHODSIn this prospective cohort study of 3,145 adults from the Whitehall II Study (23.5% women, age 60.6 ± 5.9 years), baseline examination included fasting glucose and insulin level, the homeostasis model assessment of insulin resistance (HOMA2-%IR), and the homeostasis model assessment of ?-cell insulin secretion (HOMA2-%B). DepS (Center for Epidemiologic Studies Depression Scale ?16 or use of antidepressive drugs) were assessed at baseline and at 5-year follow-up.RESULTSOver the 5-year follow-up, DepS developed in 142 men and 84 women. Women in the lowest quintile of insulin secretion (HOMA2-%B ?55.3%) had 2.18 (95% CI 1.25-3.78) times higher odds of developing DepS than those with higher insulin secretion. This association was not accounted for by inflammatory markers, cortisol secretion, or menopausal status and hormone replacement therapy. Fasting insulin measures were not associated with DepS in men, and fasting glucose measures were not associated with new-onset DepS in either sex.CONCLUSIONLow insulin secretion appears to be a risk factor for DepS in middle-aged women, although further work is required to confirm this finding.
HubMed – depression


Screening for major depressive disorder in adults with cerebral glioma: an initial validation of 3 self-report instruments.

Filed under: Depression Treatment

Neuro Oncol. 2012 Dec 9;
Rooney AG, McNamara S, Mackinnon M, Fraser M, Rampling R, Carson A, Grant R

No depression screening tool is validated for use in cases of cerebral glioma. To address this, we studied the operating characteristics of the Hospital Anxiety and Depression Scale (Depression subscale) (HAD-D), the Patient Health Questionnaire-9 (PHQ-9), and the Distress Thermometer (DT) in glioma patients.We conducted a twin-center prospective observational cohort study of major depressive disorder (MDD), according to the Diagnostic and Statistical Manual, 4th edition, in adults with a new diagnosis of cerebral glioma receiving active management or “watchful waiting.” At each of 3 interviews over a 6-month period, patients completed the screening questionnaires and received a structured clinical interview to diagnose MDD. Internal consistency, area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value, and positive likelihood ratio were calculated. A maximum of 154 patients completed the DT, 133 completed the HAD-D, and 129 completed the PHQ-9. The HAD-D and PHQ-9 showed good internal consistency (? ? 0.77 at all timepoints). Median AUCs were 0.931 ± 0.074 for the HAD-D and 0.915 ± 0.055 for the PHQ-9. The optimal threshold was 7+ for the HAD-D, but 8+ had similar operating characteristics. There was no consistently optimal PHQ-9 threshold, but 10+ was optimal in the largest sample. The DT was inferior to the multi-item instruments. Clinicians can screen for depression in well-functioning glioma patients using the HAD-D at the existing recommended lower threshold of 8+, or the PHQ-9 at a threshold of 10+. Due to a modest positive predictive value of either instrument, patients scoring above these thresholds need a clinical assessment to diagnose or exclude depression.
HubMed – depression


Development of a pharmacist-psychiatrist collaborative medication therapy management clinic.

Filed under: Depression Treatment

J Am Pharm Assoc (2003). 2012 Nov 1; 52(6): e252-8
Tallian KB, Hirsch JD, Kuo GM, Chang CA, Gilmer T, Messinger M, Chan P, Daniels CE, Lee KC

OBJECTIVE To describe a needs assessment, practice description, practice innovation and reimbursement of a psychiatric pharmacist medication therapy management (MTM) clinic with related challenges and opportunities. SETTING An MTM clinic established in collaboration with the Outpatient Psychiatric Services (OPS) at the University of California San Diego (UCSD), under contract with the San Diego County Health and Human Services Agency Adult and Older Adult Mental Health Services (A/OAMHS). PRACTICE DESCRIPTION Two board-certified psychiatric pharmacists provided direct patient care using a collaborative practice protocol 3 days per week. Clinical services included pharmacotherapy management, laboratory monitoring, medication counseling, and psychosocial referrals to other providers. PRACTICE INNOVATION Payment to UCSD OPS for clinical services was based on a contract between the San Diego County A/OAMHS and the clinic. Two pharmacists co-managed mental health patients and billed for medication management based on face-to-face contact time (medication minutes) and documentation time with each patient. MAIN OUTCOME MEASURES Number of patients comanaged, dropout rates, visit duration, and billed minutes. RESULTS From May 2009 to December 2010, two pharmacists comanaged 68 patients, mean (± SD) age 48.6 ± 11.6 years,  diagnosed with major depressive, schizophrenic, schizoaffective, and/or bipolar disorder. A total of 56 (82.3%) patients were clinically stable and remained on the pharmacist caseload, but 12 (17.6%) patients were lost to follow-up (10 lost contact, 1 moved, 1 expired). On average, patients had 7.7 patient visits , for 491 total visits (with an average of 26 minutes per visit) that were billed at a rate of $ 4.82 per minute for medication minutes, translating to $ 84,542.80. CONCLUSION With provider education and appropriate physician champions, pharmacists are able to work collaboratively with psychiatrists in a mental health clinic.
HubMed – depression



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