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• Behavioral treatment may surpass treatment with triptan drugs for adolescents with chronic migraine. Those in the behavior therapy group were given a manual written by Dr. Connie K. Cottrell, of Westerville, Ohio, entitled "STOP" (Strategies to Take Out the Pain). Topics in STOP included how to identify early signs of migraine, management of migraine triggers, relaxation, biofeedback and stress management. The teenagers were also trained in biofeedback therapy, in which they learned how to relax blood vessels in the head by increasing body temperature. Over the course of the study, those in the behavioral therapy group had a significant reduction in total number of migraines. Total disability and quality of life also improved significantly. Average severity and duration of headaches declined, but the difference was not significant. Those using triptans also had a significant decrease in average duration of migraine though the latter improvement was less than that in the behavior therapy group.

• The Edinburgh Postnatal Depression Scale identifies more women at risk of postpartum depression than does routine clinical evaluation. More women who completed the Edinburgh Postnatal Depression Scale were identified as at risk for postpartum depression compared with women who underwent routine clinical evaluation for postpartum depression The investigators also found that among the women in the Edinburgh Postnatal Depression Scale group, a failed attempt at breastfeeding was associated with a high score (10 or greater).
  Am J Obstet Gynecol 2002;186:899-902.

• Older men and women who have a severe physical illness are at an increased risk for suicide. The researchers found that visual impairment, neurological disorders and malignant disease were linked to an increased risk for suicide. Elderly patients be evaluated for depression, because we found that the majority of patients in the study, who had a serious physical illness, also had depression. BMJ 2002;324:1355-1357.

• The US Preventive Services Task Force (USPSTF) now recommends that primary care physicians screen all adult patients for depression. Depression affects 5% to 9% of adult patients in primary care settings, and nearly half of these cases are undetected and therefore, untreated. Risk factors for depression include female sex, family history of depression, unemployment, and chronic disease. The task force did not address relative cost-benefits of different screening instruments, nor optimal frequency of depression screening. It did not find sufficient evidence to recommend for or against routine depression screening of children or adolescents. Although depression increases healthcare utilization and costs $17 billion in lost workdays each year, it can be treated effectively with counseling, medications, or both. Ann Intern Med. 2002;136(10): I56, 760-764, 765-776

• The suggestion that psychological stress is linked to heart disease is not backed up by objective measurement, according to the results of a study published in the British Medical Journal. The UK authors suggest that individuals with high levels of stress may report angina and other cardiovascular symptoms that do not actually reflect physical disease. Men who reported the highest stress levels were also most likely to report the highest level of illness, including angina. High reported stress was also associated with higher levels of general hospital admissions and admissions for cardiovascular disease and psychiatric disorders.
  However, the study authors found that over the 21-year period, reports of high stress were actually related to decreased deaths from cardiovascular and coronary heart disease, and that this decrease was even more pronounced among those in a higher occupational class. The authors note that previous studies suggesting a causal link between high stress and heart disease have often been based on self-reporting of stress and health outcomes. Individuals with negative perceptions may over-reported their symptoms of stress and disease, leading to the perception of a linkage between the two. Coronary heart disease develops as a result of a number of risk factors, such as smoking, high blood pressure and cholesterol, obesity, lack of physical activity and an unhealthy diet. BMJ 2002:324,1247-1251.

• In a randomized trial comparing massage therapy with relaxation therapy for fibromyalgia, only massage therapy offered long-term benefits. During the course of the study, only the massage therapy group reported increased number of sleep hours and decreased frequency of sleep movements. "It would be important to compare massage therapy with other therapies that have been effective with fibromyalgia, including cognitive behavior therapy and other complementary therapies such as acupuncture and EEG-driven stimulation," the authors write. J Clin Rheumatol. 2002;8(2):72-76

• Low levels of depression in the elderly can persist for long periods and may be a risk factor for more serious episodes, minor depression and subsyndromal depression, often persist after 1 year.  Only about one third of the patients with major depression were deemed nondepressed at follow-up. Clinicians should offer treatment to patients with major depression. Patients with lesser depressions were at greater risk than nondepressed patients of developing major depression. Am J Geriatr Psychiatry 2002;10:275-282.

• Stimulation of young infants with "baby talk" helps foster learning. However, when a mother is depressed, this form of stimulation may be muted enough to affect the infant's development. Researchers found that while the 4-month-old infants of women without depression associated the sound of their mother's voice with an image of a smiling female face, the infants of depressed mothers did not. So while infants of depressed mothers showed normal learning ability, the lower level of stimulation they may receive could nonetheless hinder their learning. Compared with mothers without depression, depressed mothers spoke to their babies in flatter tones. Exposure to a caregiver without depression "may ameliorate" such potential learning deficits. Psychol Sci 2002;13:268-271.

• Among patients hospitalized with acute asthma, the prevalence of psychological morbidity is considerable, according to a report in the April issue of Thorax. While specific adverse psychological factors are associated with hospitalization for acute asthma, they do not correlate with severe life-threatening asthma (SLTA).
  Twenty-five percent of patients with SLTA had previous emotional counseling, compared with 35% of controls. Patients hospitalized with acute asthma, including SLTA, had a higher prevalence of anxiety and depression, higher total life events, and higher prevalence of certain specific life events than a community-based control group. Thorax 2002;57:317-322.

• Fetal exposure to cocaine is associated with significant cognitive deficits and significant developmental delays during the first 2 years of life. Although cocaine exposure was not associated with delayed motor development, exposure to tobacco did result in lower motor development at 2 years. Findings indicate that prenatal cocaine exposure is associated with increased risk for cognitive impairment at 2 years of age and suggests the need for public health initiatives for substance abuse prevention and treatment of pregnant women. JAMA 2002;287:1952-1960,1990-1991.

• St. John's wort, a popular herbal remedy used for depression, may reduce the effectiveness of chemotherapy drugs, physicians warned here at the annual meeting of the American Association for Cancer Research. St. John's wort stimulates the enzyme CYP3A4, which is involved in the metabolism of many drugs, including the cancer agent irinotecan (Camptosar). Since about 50% of all drugs are metabolized by CYP3A4, the combination effect might occur with many other anti-cancer agents.

• Older men with dysthymic disorder have lower levels of testosterone compared with men with major depressive disorder and men who do not have symptoms of depression. Dysthymic disorder in older men may be related to hypothalamic-pituitary-gonadal axis functioning. Future studies should focus more specifically on hypothalamic-pituitary-gonadal axis functioning in elderly dysthymic men and on the therapeutic role of testosterone replacement. Am J Psychiatry 2002;159:456-459.

• In the early aftermath of September 11, the rate of depression and post-traumatic stress disorder (PTSD) among New Yorkers was about twice the usual US rate, according to study results.
  Research has suggested that fewer than 4% of Americans experience PTSD in a given year--about half the rate found in the current study. Similarly, about 10% of respondents reported significant current depression, which is twice the estimated national rate.Those who lost friends, relatives or their jobs were, not surprisingly, at increased risk of depression. Hispanic respondents, those who suffered panic attacks and those who said they had low levels of social support were also more likely to report depression, the findings show. N Engl J Med 2002;346:982-987.