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• In women free of known coronary artery disease, depression is associated with coronary and aortic calcification, and decreased heart rate variability. Depression is recognized as a risk factor for coronary artery disease (CAD). After adjusting for demographics and other risk factors, a history of recurrent major depression was associated with any coronary calcium, a high coronary calcium score and a high aorta calcium score, compared with no depression or a single episode. Current depression was not associated with coronary calcification..suggests that depression may mediate its effects on coronary calcification through its effects on lifestyle, levels of inflammatory markers, or activation of the hypothalamic-pituitary-adrenal axis. Arch Intern Med 2005;165:1214-1216,1229-1236,1239-1244.

• A history of epilepsy more than doubles the risk of schizophrenia or schizophrenia-like psychosis. Numerous reports have linked epilepsy with schizophrenia. A history of epilepsy raised the risk of schizophrenia and schizophrenia-like psychosis by 2.48- and 2.93-fold, respectively, the authors note. The impact of epilepsy on schizophrenia risk did not differ by gender, but did increase with age. Moreover, the effect of epilepsy on this risk was strongest in subjects lacking a family history of psychosis. The type of epilepsy did not have a differential effect on schizophrenia risk. Increasing number of admissions for epilepsy and epilepsy onset later in life were particularly strong risk factors for schizophrenia. The findings, they add, "corroborate previous results indicating a strong link between these two conditions." BMJ 2005.

• Parents with major depression or panic disorder are more likely to have children with asthma and other atopic conditions. The fact that the association held only for biological children supports the idea of a "shared genetic liability."  Multiple logistic regression analyses demonstrated a significant association between parental major depression and panic attacks and childhood atopic disorders in biological parent-child dyads. Further, in analyses restricted to biological parent-child dyads, the association between parental major depression and panic attacks and childhood atopic disorders was significant only in mothers, not in fathers. "In this context, data from the present study further support the possibility of common genes for depression and panic disorder on the one hand, and allergic disorders on the other hand." Psychosom Med 2005;67:448-453.

• Patients who have a chronic cough start developing symptoms of depression. Slightly more than half of patients with chronic cough lasting a mean of about nine years had significant depressive symptoms. Cough is among the most common complaints for which patients seek medical attention. They do not want to go to restaurants, concerts or the ballet. Their cough affects their relationships and their jobs. Chronic cough has three main causes, either alone or in combination, including postnasal drip, asthma, and gastroesophageal reflux. The diagnosis often is difficult because the only symptom that many patients have is cough. When the cough was treated, 50% of the participants improved significantly with the depression scores. While chronic cough does not kill people, it does cause physical fatigue, muscle aches and pains, poor sleep and in some cases urinary incontinence.

• "When parents or teachers complain about a child being inattentive, restless, and having difficulty sleeping, physicians may want to consider the caffeinated soft drinks in the school vending machine or the home refrigerator before they screen for attention deficit/hyperactivity disorder (ADHD). (In a ) study of first-grade children, they had more behavior problems on the days that they were exposed to caffeinated colas than on the days that they had caffeine-free drinks...exposure to caffeinated cola drinks impaired children's learning ability by causing restlessness, hyperactivity, and inattention. The findings should support physicians' recommendations regarding restricting children's dietary caffeine, and it could also have implications regarding school systems' friendly relationship with vendors. It also underscores why it is so important to completely evaluate young children who are having behavioral and emotional problems and to review the child's dietary habits, including caffeinated beverages, as part of the evaluation. Although questions about caffeine consumption are typically part of the screen for anxiety disorders, pediatric insomnia, and ADHD, the findings are a reminder not to neglect this part of the evaluation."

• Ongoing use of selective serotonin re-uptake inhibitors, or SSRIs, increases the risk of gastrointestinal bleeding to a degree similar to that caused by regular use of non-steroidal anti-inflammatory drugs...physicians must closely monitor for this serious adverse event, especially in patients who are taking both SSRIs and NSAIDs...This is a potent example of the need for doctors to be particularly conscious about potential side effects when prescribing multiple medications for their patients. Eli Lilly and Co., which makes Prozac, said the possibility of bleeding was already listed as a potential side effect of the drug and users were cautioned about it in information provided with the product.

• Atherosclerosis or other vascular disease is a risk factor for depression in the elderly. Evidence of atherosclerosis at baseline or risk factors for vascular disease was associated with a "50% to 90% increased risk for incident depression after 3 years. These findings do suggest that vascular diseases increase the risk for depression in well-functioning, non-depressed elders. In terms of clinical implications and vascular disease, patients may need close monitoring for depression.  Osteoarthritis, cancer or osteoporosis were not associated with increased risk of depression. An exception was chronic pulmonary disease, which was linked for incident depression.

• Adolescents with type 1 diabetes who exhibit high levels of depressive symptoms have an increased risk of hospitalization for diabetes-related complications. It is important for health-care professionals and parents of children with diabetes to know that these teens are more likely than kids without diabetes to become depressed. It is also important "that they educate themselves about the signs and symptoms of depression. Teens with depression should be referred for mental health treatment. We know a lot about helping teens with depression, and in the case of these children, it is important both for their mental health and for their physical health that we do so. Pediatrics 2005;115:1315-1319.

• Obesity in middle age is associated with an increased risk of future dementia. Contrary to findings from cross sectional studies, a recent prospective study found that obesity in elderly women increases the risk of dementia. Assessment of obesity before old age may be a more accurate representation of adiposity as the ratio of lean to fat mass changes with aging, resulting in a decreased body mass index. The investigators determined the predictive value of mid-life adiposity, reflected in body mass index and tricep and subscapular skinfold thickness, on the risk of developing dementia. Body mass index predicted dementia more strongly in women: obese women were 200% more likely to have dementia than women of normal weight, whereas obese men had a nonsignificant 30% increase in risk. Adiposity in mid-life is associated with an increased risk of dementia in old age independent of sociodemographic characteristics and common comorbidities. BMJ. Published online April 28, 2005.

• Low total cholesterol appears to be associated with school suspension or expulsion in non-African American children and adolescents, according to researchers. They suggest that "low total cholesterol may be a risk factor for aggression or a risk marker for other biologic variables that predispose to aggression." Serum total cholesterol was measured in 4852 children between the ages of 6 and 16 years. Interviews with the mothers were conducted regarding the children's history of school suspensions or expulsion and difficulty in getting along with others. Non-African American children with total cholesterol below the 25th percentile (<145 mg/dL) were nearly three times more likely to have been suspended or expelled from school than their peers with total cholesterol at or above the 25th percentile.Am J Epidemiol 2005;161:691-699.

• "Depression is a strong predictor of shock-treated ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs), especially among those with coronary artery disease (CAD). It is important to be aware of symptoms of depression in ICD patients, not only for the sake of emotional health, but also because these symptoms are associated with arrhythmias that require shocks for treatment. Depression predicts mortality in patients with CAD, but whether this is due to an increased risk of fatal ventricular arrhythmias is unclear. Symptoms of depression were significantly associated with an elevated risk of ventricular arrhythmias that required shock. The risk was higher with more severe symptoms of depression, and the relationship was present even after controlling for prior shocks, left ventricular ejection fraction, and multiple other factors. The relationship between depression and shocks "was very strong. One possible explanation for the higher risk of death in depressed patients with CAD may be the occurrence of ventricular arrhythmias that cause sudden cardiac death. Another point of interest, conclude the researchers, is that a "relatively low number" of depressed ICD patients (about 10%) received pharmacologic treatment for their depression, a finding that suggests that "increased surveillance for depression in ICD patients may be needed." J Am Coll Cardiol 2005;45:1090-1095.

• Changes in prefrontal cortex activity just prior to the start of antidepressant drug therapy may identify patients who are vulnerable to side effects. The brain changes that signaled antidepressant side effects emerged before the start of drug. The ability to identify individuals at risk for developing side effects would improve the success rate of antidepressant treatment. Physicians might choose an antidepressant with a lower side-effect profile, start at a lower dose, or opt for psychotherapy alone. Early changes in prefrontal cortex activity, demonstrated by decreases in quantitative electroencephalographic (QEEG) cordance values, correlate with clinical response to antidepressant drug therapy. Common side effects included nausea, difficulty sleeping, and decrease in sexual desire or ability. No subject reported suicidal thoughts or feelings at any point over the study. Changes in prefrontal cordance during the initial week of placebo treatment (placebo lead-in) were strongly associated with the average number of side effects reported during the following 4 weeks of antidepressant treatment. It is possible that the prefrontal brain change observed during brief placebo treatment was a biomarker of subject expectations...beliefs and expectations about taking medication can play an important role in drug effects. To some extent you get what you expect.Whether a person will experience many or few side effects appears to be explained in large part by non-drug-induced changes in brain function...We're used to asking -- how does medication affect the brain? -- But this study gets us to ask -- how might the brain modify medication effects?"
  Neuropsychopharmacology 2005.

• Users of tricyclic antidepressants or serotonin reuptake inhibitors (SSRIs) appear to be briefly at a heightened risk of having a first acute myocardial infarction. However, this may be due to depression-related effects rather than to the agents themselves.
   The researchers found there was an initial increased risk of MI after exposure to either class of drugs. For example, 1 to 7 days after the first prescription for the tricyclic antidepressant dothiepin, the odds ratio for MI was 1.90. The corresponding ratio after the SSRI fluoxetine was 2.59. The increased risk did not persist beyond 28 days. Given that this transient increase in risk was not associated with a particular class of drugs, or a specific agent, the researchers conclude that "the association is unlikely to be a causal drug effect and may be due to underlying depression or health service utilisation." Heart 2005;91:465-471.