A study published online in the Proceedings of the National Academy of Sciences, suggests that anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants. Researchers at the Fisher Center for Alzheimer’s Disease Research at The Rockefeller University found that mice that were treated concurrently with SSRI antidepressants and anti-inflammatory drugs had diminished behavioral responses compared to mice treated with SSRI antidepressants alone.  To see if this finding had the same effect on humans, the researchers examined data extracted from the completed National Institute of Mental Health funded STAR*D study. The findings from the STAR*D data showed that individuals that were depressed and taking an SSRI antidepressant and an anti-inflammatory drug were less likely to have their symptoms relieved (40%), compared with individuals that were depressed and taking an SSRI depressant, but not taking an anti-inflammatory (54%).

Experts caution that this is a preliminary study and further studies need to be done. Individuals should not change their medication regimen based upon these recent findings, but should follow the advice of their prescribing physician.

Care Manager vs. Primary Care Provider…does it matter who you are seeing in regards to your health?  In some cases it may.  NIMH supported research has shown benefits for people with multiple medical conditions who use primary care plus case-managed care.

According to CMSA, the term “case management” is defined as “collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.”

To evaluate the effectiveness of this combined approach, Wayne Katon, M.D., of the University of Washington, and other colleagues conducted a study that zeroed in on methods of care for patients with diabetes or heart disease and depression.  Patients such as these, on average, tend to practice poorer self-care methods and experience more complications due to treatment.

To aid in decreasing these detrimental issues researchers developed a model in which a nurse care manager and primary care provider coordinated care.  This approach was used to ease depression symptoms and improve medical conditions.  Of the 214 patients that participated in this study, half experienced a 12-month trial with the additional case management. In this trial the nurse care manager’s role was to act as an advocate for the patients by informing them about their medical condition and by motivating them to take a more proactive role in their treatment.  The remaining half of the patients were treated with usual care, solely by a primary care provider.

The two groups were compared and the result of this study showed that patients experiencing the case management found it to be a successful approach.  More  of these patients reported a decrease in depressive symptoms, improved blood glucose levels, and improved blood pressure when compared to patients that only received the primary care.   The recipients of the additional resources also reported better overall wellness and felt their care had improved.

Currently in action, The Diamond Program and MN 10 by 10 have been implemented in Minnesota to promote  holistic approaches to mental illness.  The Diamond program includes primary care physicians, consulting psychiatrists, care managers, and other mental health specialists working together to provide the best care for patients.  The care manager plays an important role in this process in that they manage the components of the program for the patient.  The patient is responsible for taking an active part in their own care. MN 10 by 10 aims to reduce early mortality of the persons with mental illnesses by 10 years in 10 years. Similarly, this program focuses on improving primary care by educating health care professionals (social workers , case managers, primary care physicians, counselors etc…).  They also provide information such as health check lists are available to patients so they can learn how to get the most for their doctor visits.

At the end of the day it is important for these programs to continue educating health care professionals on how to built the best possible care for individuals faced with multiple medical conditions.  This will hopefully generate more satisfied patients who then become motivated to take better care of themselves.

At MHAM we offer Steps to Wellness that can be use as a helpful guide in learning how to motivate yourself in terms of improving your own wellness. To order the Steps to Wellness kits, please call us at 651-493-6634 or kits can also be ordered online. Individual items from these kits can be downloaded from our website as well. Providers that need multiple copies, please contact Brett Dumke, Education Coordinator, at [email protected].

This post was written by Jahna Sandkamp, who is interning with MHAM this Spring.

In the United States alone, nearly 15 million adults suffer from a major depressive disorder. Though there are several treatment options, many of the medications that are prescribed to patients with depression have a delay in their onset of action. During this time, the patients’ condition may even deteriorate to dangerous levels.  Despite this, there are signs that research by pharmaceutical companies on depression medications has slowed.

This creates a strong need to find a drug that will begin to work soon after beginning therapy.  One possibility has come through drug studies on Ketamine by the National Institute of Mental Health.  This research has shown a possible route to more quickly treat patients who suffer from depression and bipolar disorder.  Previous NIMH studies have learned more about the receptors that are acted on by this drug.  Now, they have focused on predicting which patients will see the benefit of this kind of treatment.

In this recent study, researchers found that activity in the pregenual anterior cingulate cortex (pgACC), the area of the brain that has connections to both emotional and cognitive brain centers, provided indicators that patients would respond to therapy using Ketamine.  For patients with certain activity patterns, the drug worked quickly and effectively to relieve symptoms of depression.  The authors noted that areas of the brain normally associated with emotional control were at work for these patients, even when given a task with no emotional content.

Unfortunately, Ketamine has far too many side effects to be used widely.  In fact, it can be abused as a recreational drug.   Side effects can include hallucinations and euphoria when the drug is given in high doses.  Ketamine is a most often used as an anesthetic during minor surgery and is approved by the Food and Drug Administration at much higher doses. Nonetheless, its use is limited because there have been cases where patients have hallucinated while recovering from anesthesia.

While this particular drug may never be used to specifically treat depression, this research has revealed a great deal about how this drug works, and the function of brain receptors in the treatment of depression.  Hopefully, this will lead the way to developing a new generation of faster-acting medications. However, until more research has been done, it is important to be patient with trying new medications.  Working with your doctor by discussing improvements or side effects of certain medications is a good start to creating a treatment plan that works for you.

This post comes from our guest blogger, Margo Tell.