Women With Migraines More Likely to Become Depressed

By Jennifer Warner
WebMD Health News

Reviewed by Brunilda Nazario, MD

Feb. 22, 2012 -- Women who suffer from migraine headaches may be more likely to develop depression.

A new study shows that women who have migraines are about 40% more likely to develop depression than women who have never had migraines.

"This is one of the first large studies to examine the association between migraine and the development of depression over time," researcher Tobias Kurth, MD, ScD, of Brigham and Women's Hospital in Boston, says in a news release. "We hope our findings will encourage doctors to speak to their migraine patients about the risk of depression and potential ways to prevent depression."

The results will be presented in April at the annual meeting of the American Academy of Neurology.

Migraine-Depression Link

In the study, researchers looked at the risk of depression among 36,154 women who took part in the Women's Health Study. None of the women had depression at the start of the study.

The women were divided into four groups: those with active migraine with aura, active migraine without aura, past history of migraine (but not within the past year), and those with no history of migraine. Aura are visual disturbances like flashing lights sometimes associated with migraine headaches.

During about 14 years of follow-up, 3,971 women were diagnosed with depression.

The results showed that women with any history of migraine were 36% more likely to develop depression compared to women with no history of migraine. Women with a past history of migraine were 41% more likely to experience depression.

Researchers say the increased risk of depression associated with migraine was the same whether it was migraine with or without aura.

SOURCES: Rist, P. "Migraine and Risk of Depression Among Women," to be presented at the Annual Meeting of the American Academy of Neurology, April 21-28, 2012, New Orleans.News release, American Academy of Neurology.

WEDNESDAY, Feb. 8 -- Children with depression are at increased risk for bullying, the results of a new study suggest.

The finding challenges the widely held belief that bullying leads to psychological problems such as depression, according to the Arizona State University researchers.

"Often the assumption is that problematic peer relationships drive depression. We found that depression symptoms predicted negative peer relationships," Karen Kochel, an assistant research professor in the School of Social and Family Dynamics, said in a university news release.

"We examined the issue from both directions but found no evidence to suggest that peer relationships forecasted depression among this school-based sample of adolescents," she added.

The researchers analyzed data collected from 486 children from fourth to sixth grade and found that being depressed in fourth grade predicted bullying in fifth grade and lack of peer acceptance in sixth grade.

The findings are published in the Feb. 7 online edition of the journal Child Development.

"Teachers, administrators and parents need to be aware of the signs and symptoms of depression and the possibility that depression is a risk factor for problematic peer relations," Kochel said.

She noted that positive peer relationships are essential for adapting to aspects of life including academic success and good mental health.

"If adolescent depression forecasts peer relationship problems, then recognizing depression is very important at this particular age. This is especially true given that social adjustment in adolescence appears to have implications for functioning throughout an individual's lifetime," Kochel said.

Because kids usually start spending more time with their peers and less time with their parents during adolescence, school may be the best place to uncover and address signs of depression in these children, the researchers noted.

-- Robert Preidt

SOURCE: Arizona State University, news release, Feb. 8, 2012

MONDAY, Feb. 6 -- Antidepressant drugs such as Prozac do not raise suicide risk in young people, a new study says.

The finding should help reassure doctors about prescribing antidepressants to youngsters, said first author Robert Gibbons, a professor of medicine, health studies and psychiatry at the University of Chicago.

In 2004, the U.S. Food and Drug Administration ordered a "black box warning" for Prozac (generic name fluoxetine) after data from 25 clinical trials suggested the medications increased the risk of suicidal thoughts and behaviors in children and young adults up to age 25.

But this analysis of data from 41 clinical trials involving a total of more than 9,000 patients identified no such link in either adults or children.

"I hope that the [black box] warnings will not prevent depressed children and adults from getting treatment for depression," Gibbons said in a university news release.

One expert agreed. Dr. Mark Russ, director of psychiatric services at Zucker Hillside Hospital in Glen Oaks, N.Y., said the study "argues that treatment with the antidepressant medications examined ... is not associated with a higher risk of suicidal ideation and behavior, and should not be withheld for this reason."

The study also found that Prozac and another antidepressant called Effexor ( venlafaxine) reduced suicidal behavior and depression in adults and seniors.

For their study, Gibbons and colleagues used clinical trial data -- some of it unpublished -- from drug makers and a large U.S. National Institute of Mental Health collaborative study of Prozac and Effexor. The study -- funded by the U.S. National Institute of Mental Health and the U.S. Agency for Healthcare Research and Quality -- appears online Feb. 6 in the journal Archives of General Psychiatry.

To assess the effects of antidepressants in children, the researchers examined four trials of Prozac. Until recently, it was the only antidepressant approved for use in children, according to a University of Chicago Medical Center news release.

The studies showed that the drug reduced depression symptoms in children and did not have any effect on their suicide risk.

The results from the trials of Prozac and Effexor in adults and seniors found that the drugs reduced both depression symptoms and suicide risk. This suggests that antidepressants cut the suicide risk in adults and seniors by easing patients' depression, the news release said.

"I think that this paper supports the general idea that the effects of antidepressants in kids and adults are not really the same, since we don't see anything but beneficial effects of antidepressants in adults and geriatrics," Gibbons said in the release. "In kids, we don't see a harmful effect, but we do see a disassociation between the beneficial effects on depression and the potential beneficial effect on suicide."

He added: "This raises continued questions about what's going on in children. Maybe children think about suicide in part because of depression, but also maybe due to other reasons not related to depression that are not affected by antidepressants."

One expert welcomed the study findings.

"This very important study goes a long way to undoing what I consider an ill-conceived FDA issued black box warning for antidepressants and risk of suicide in children and adolescents," said Dr. Norman Sussman, a psychiatrist at NYU Medical Center in New York City. "It was a finding of an increased rate of ideation [suicidal thoughts] and attempts during some clinical trials that formed the entire basis for the FDA black box warning. Yet, as the authors of the current paper point out, no actual suicides occurred in these [trials]."

According to Sussman, who is also professor of psychiatry at NYU School of Medicine, the warning led to a drop in antidepressant prescriptions for depressed children. "In what I hope will lead to a corrective series advisories that encourage antidepressant use, the results of this study confirm what clinicians have observed all along, namely, treatment with antidepressants decreases suicide risk," he said.

Gibbons agreed. "The greatest cause of suicide is untreated or undiagnosed depression," he said. "It's very important that this condition be recognized and appropriately treated and not discarded because doctors are afraid to be sued."

-- Robert Preidt

SOURCES: Mark Russ, M.D., director, psychiatric services, Zucker Hillside Hospital, Glen Oaks, N.Y.; Norman Sussman, M.D., psychiatrist, NYU Medical Center, and professor of psychiatry, NYU School of Medicine, New York City; University of Chicago Medical Center, news release, Feb. 6, 2012

FRIDAY, Feb. 3 -- Depression can be a tough condition to diagnose accurately, but new research suggests that someday a blood test might help.

It's not clear how much the test might cost, and it needs more stringent validation before it will be ready to be used in medical offices. Still, "it appears that these results are promising, after decades of research into finding a biological test for depression," said study author Dr. George Papakostas, an associate professor of psychiatry at Harvard Medical School.

The study was funded by the Ridge Diagnostics Co. and appeared in a recent issue of the journal Molecular Psychiatry.

It may seem like depression is an easy condition to diagnose and doesn't need a test to verify that it exists, but Papakostas said there are several ways that a blood-based depression test might be helpful.

For one, he said, a test could help doctors who aren't as experienced in psychiatric disorders. Also, he said, a test may provide assistance to doctors who aren't sure about the proper diagnosis of a patient: "This could be of help to them, in terms of guiding them in one way or another," he said.

Yet another use for a test would be to verify that a patient has depression, and therefore help him or her accept the diagnosis. "The majority of patients diagnosed with depression have no problem accepting the need for treatment," Papakostas said. However, "there is a minority of patients who feel that validation of an underlying process is helpful," he added.

In their study, Papakostas and his team gave a blood test to 36 patients with depression and 43 people who weren't depressed. The test looked for levels of nine different "biomarkers" in the blood that are associated with depression. These biomarkers are linked to inflammatory processes, the development and maintenance of brain cells, and interactions between brain structures associated with the stress response and other functions.

The researchers found that the test correctly identified patients with depression 91 percent of the time; the rest of the time it gave a false-negative diagnosis (it failed to spot the depression). The test correctly identified patients who weren't depressed about 81 percent of the time, giving false-positives the rest of the time.

The next step is to try to confirm these findings through further research, Papakostas said.

He didn't know how much the test might eventually cost, but he said it won't be as high as thousands of dollars and should be more akin to routine blood tests.

The test appears to detect inflammation in the brain, which has been linked to depression, Papakostas said. "That really doesn't surprise researchers. Chronic inflammation has been tied to a number of other illnesses in the kidneys, lungs and heart," he noted.

One outside expert said such a test would be welcome.

Dr. Michelle Riba, a professor of psychiatry at the University of Michigan who's familiar with the findings, said a blood test for depression could be helpful in several ways.

For one, it would be useful to identify people, especially children and adolescents, who are prone to depression and try to prevent it, she said.

Also, she said, a test could help give physicians insight into how depression treatments are working over time.

SOURCES: George Papakostas, M.D., associate professor, psychiatry, Harvard Medical School, Boston; Michelle Riba, M.D., professor and associate chair, Integrated Medical and Psychiatric Services, Department of Psychiatry, University of Michigan, Ann Arbor; December 2011 Molecular Psychiatry

SATURDAY, Jan. 28 -- For some people a change in the seasons can trigger a loss of energy or even clinical depression, according to an expert who describes how to cope with seasonal affective disorder.

The condition is caused by changes in ambient light, said Dr. Dan Iosifescu, director of the Mount Sinai Mood and Anxiety Disorders Program in New York City.

"A gland in our brain provides a time signal, based on the amount of ambient light, to various parts of the body. Like a metronome, the gland responds to signals from light and uses those cues to orchestrate the day/night cycle," he said in a Mt. Sinai news release. "Ambient light helps our brain determine when our bodies need to be active mentally and physically and when our bodies need to rest. That cycle is thrown off when the days get shorter and darker."

Iosifescu offered the following tips to help people overcome the winter blues:

• Use extra lights. Turn on all the lights to help you wake up in the morning. In more severe cases of depression, a light therapy box, which simulates natural light, can be used for 30 minutes each day. Taking a walk outside on a particularly sunny day can also help.
• Exercise. Working out can help ease depression and improve people's moods. Get a minimum of 30 minutes of vigorous exercise, at least three times each week.
• Stick to a routine. Don't oversleep or avoid the outdoors because it's cold outside. It's important to maintain your normal sleep schedule and continue to make plans and try new activities.
• Consider supplements. Research shows that omega-3 fatty acids can help battle depression, Iosifescu said. Other over-the-counter remedies such as St. John's wort may also have antidepressant effects.
• Talk to your doctor. Seasonal affective disorder could be confused with a more serious case of depression. Visit your doctor if you have symptoms that are severe and persist for more than a few weeks.