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An ounce of prevention
An Ounce of Prevention
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Wisniewski and his team divided the STAR*D patients
Why Antidepressants Don't Live
into two groups — an "efficacy" sample of patients who would normally be included in a typical Phase III clinical
Up to the Hype
trial for a new antidepressant and a "nonefficacy" sample
of patients who would normally be rejected.
In the '90s, Americans grew fond of the idea that you can
Depressed STAR*D patients who were classified for
fix depression simply by taking a pill — most famously
inclusion had no more than one general medical condition
fluoxetine (better known as Prozac), though fluoxetine is
(like, say, heart disease) and no more than one additional
just one of at least seven selective serotonin reuptake
primary psychiatric disorder besides depression. All
inhibitors (SSRIs) that have been prescribed to treat
patients with multiple comorbidities — along with anyone
hundreds of millions of people around the world.
whose depression had lasted more than two years — were
excluded. Once the authors crunched all the numbers, they
But in the past few years, researchers have challenged the
found that only 22% of STAR*D patients met entry criteria
effectiveness of Prozac and other SSRIs in several studies.
for a conventional antidepressant trial.
in February attributed 68% of the benefit from
All the STAR*D patients were taking citalopram, an SSRI
antidepressants to the placebo effect. Likewise, a
marketed in North America as Celexa. Not surprisingly,
a year earlier suggested that
those who met standard inclusion criteria for a clinical trial
widely used SSRIs, including Prozac, Effexor and Paxil,
had significantly better outcomes on the drug. In the
offer no clinically significant benefit over placebos for
efficacy group, 52% responded to Celexa vs. 40% of the
patients with moderate or severe depression. Meanwhile,
nonefficacy group. Patients in the latter group also took
pharmaceutical companies maintain that their research
longer to respond and had to be readmitted to psychiatric
shows that SSRIs are powerful weapons against
settings more often. "Thus," the authors conclude, "current
depression. that summarizes the
efficacy trials suggest a more optimistic outcome than is
likely in practice, and the duration of adequate treatment
suggested by data from efficacy trials may be too short."
Now a major new study suggests that both critics and
proponents might be right about SSRIs: the drugs can
To bolster their findings, the authors cite a smaller 2002
work, but they appear to work best for only a subset of
study that arrived at similar results: iublished
depressed patients — those with a limited range of
in the American Journal of Psychiatry, Dr. Mark
psychological problems. People whose depression is
Zimmerman of Brown University and his colleagues found
compounded with, say, substance abuse or a personality
that of 315 patients with major depressive disorder who
disorder may not get much help from SSRIs — which is
sought care, only 29, or 9.2%, met typical criteria for an
unfortunate for the 45% to 60% of patients in the U.S. who
efficacy trial. Similarly, psychologist Ronald Kessler of
have been diagnosed with a common mental disorder like
Harvard co-authored ain the Journal of the
depression and al
American Medical Association that concluded that most
ike substance abuse. (Multiple diagnoses are
"real world" patients with major depression would be
known in medical parlance as comorbidities.)
excluded from clinical trials because of comorbidities.
Such findings help explain why antidepressants haven't
Theished online in April by the American
quite lived up to their promise.
Journal of Psychiatry, was conducted using data from a
large, government-funded trial called Sequenced Treatment
But the University of Pittsburgh's Wisniewski, the lead
Alternatives to Relieve Depression, which usually goes by
author of the new study, cautions against interpreting the
the moniker STAR*D. The STAR*D project, which
results as an indictment against greedy drug companies
collected data from 2001 to 2004 at 41 U.S. psychiatric
eager to exclude difficult patients in order to show better
facilities, was one of the most ambitious efforts ever to
results. "If the population in a [clinical] trial were more
understand how best to treat people with major depression.
representative, that would come at a cost," he says.
STAR*D participants comprise a powerful research sample
Researchers expect a certain number of bad reactions
because they are highly representative of all depressed
during clinical trials; some of these reactions can cause
Americans. Very few depressed people were excluded
serious medical problems. If patients enter a trial with
from STAR*D; only women who were pregnant, those
multiple complications — if they are, say, not only
with seizure disorders and a few others with acute
depressed, but also cocaine-addicted, hypertensive and
conditions were kept out. All other psychiatric and medical
diabetic — you dramatically increase the chances of
co-morbidities were allowed.
adverse side effects. "That's why trials to determine
efficacy are done on a relatively homogeneous population,"
The authors of the new paper, a team of 11 researchers led
by University of Pittsburgh professor of epidemiology
Stephen Wisniewski, were curious how the STAR*D
That's understandable, but the new study does shed light on
group would compare with a typical group of patients
the limitations of antidepressants. Conducting clinical trials
selected for a run-of-the-mill drug-company trial for a new
with representative samples would undoubtedly be more
antidepressant — the very trials on which the Food and
complex — and expensive — since patients with multiple
Drug Administration bases its decisions regarding new
risk factors would have to be monitored more carefully.
drug approval. Drawing on their own experiences in
But for a future generation of antidepressants to be truly
helping to conduct such trials, which have far more
effective for most patients, more-inclusive trials may be
stringent inclusion criteria than the STAR*D group,
the best answer.
For the online article please visit:
Alcohol is the third leading lifestyle-related
contributor to death in the U.S. after tobacco
and diet/activity patterns.
Alcohol-related traffic crashes make up the
Change One Thing
fifth leading cause of death for Americans of all ages.
Sometimes we don't make changes because they are
Research suggests alcoholism is more strongly
too difficult of daunting or we are "fixin' to get
related to child abuse than other disorders,
ready," as my friend Helen says. One way to get
such as parental depression.
change going is to consider the smallest change you
Alcohol and/or drugs are very likely involved
can make and begin. Often inertia will continue to
in at least 81% of reported cases of child abuse
take you in the direction of change once you start. If
in this country, according to state welfare
not, at least you are moving forward a little. As
Milton Erickson used to say, "If you fall on your face,
Children of alcoholics are more likely than
at least you are heading in the right direction."
non-COAs to develop disruptive behavioral
problems, anxiety, depression, and poorer
Identify the smallest change you can make and
Children of alcoholics experience greater
If you want to write a book and aren't getting it done,
physical and mental health problems and
try writing one word a day. I used to recommend five
higher health care costs (32% higher) than
minutes a day (which is fine if that works for you),
children from non-alcoholic families.
but if even five minutes seems too much, start with
Only one in 20 children of alcoholics gets
one word a day. Clean up, organize, or toss one piece
any help. Yet, there is growing evidence
from that stack of papers/mail/magazines cluttering
that with help, these children can learn to
your house or office.
thrive, become resilient, and change their
Commit to a limited period of time for the change
You could commit to walking for five minutes a day
National Institute on Alcohol Abuse and Alcoholism
for the next week. Or de-cluttering that pile of papers
for the next three days. Forever is too daunting for
National Association for Children of Alcoholics
most. Time-limited often works better.
National Institutes of Health
Journal of the American Medical Association
Focus on only one thing at a time
Stop multi-tasking and experiment with doing only
the thing you are doing. Or attend only to the person
Here are some web sites you & your family
or experience you are with at the moment. Listen to
may find helpful.
and watch the person you are conversing with (rather
than texting, glancing at the television, thinking about
A video from Alberta Family Wellness Initiative
what you will do or say next, etc.). Eat when you are
changes minds by informing Canadians about effects
eating. Drive when you are driving.
of toxic stress on kids' brains:
Build a new habit one day at a time
Do the new habit for 5 minutes each day until it
becomes ingrained, then expand the time or effort you
TED talks: childhood trauma and how it can affect
your health across a lifetime:
Dismantle an old, unhelpful or unhealthy habit one
piece at a time
Change one small thing about the old habit. Drink half
a soda and half a glass of water with a meal instead of
***Self- Help Corner:***
a soda. Park a little farther away from the store or
your workplace and walk a little. Eat everything that
is unhealthy with your non-dominant hand.
Support Network / Referral Line:
Bill O'Hanlon, 223 N. Guadalupe #278, Santa Fe, NM
Distress Line: _482-4357
Cocaine Anonymous: 780-425-2715
Children of Alcoholics:
Is Alcohol a Form of Depression?
One in four children in America under the age
of 18 is growing up with alcohol abuse or
Are you in a dangerous relationship?
alcoholism in the family.
Children of alcoholics (COAs) are four times
more likely than non-COAs to become
How Much Alcohol Is Too Much?
Electrical Engineering and Computer Science Evaluating Android Anti-malware against Transformation Attacks Vaibhav Rastogi, Yan Chen, and Xuxian Jiang† Northwestern University, †North Carolina State University Technical Report NU-EECS-13-01 Mobile malware threats (e.g., on Android) have recently become a real concern. Inthis paper, we evaluate the state-of-the-art commercial mobile anti-malware productsfor Android and test how resistant they are against various common obfuscationtechniques (even with known malware). Such an evaluation is important for not onlymeasuring the available defense against mobile malware threats but also proposingeffective, next-generation solutions. We developed DroidChameleon, a systematicframework with various transformation techniques, and used it for our study.Our results on ten popular commercial anti-malware applications for Android areworrisome: none of these tools is resistant against common malware transformationtechniques. Moreover, a majority of them can be trivially defeated by applying slighttransformation over known malware with little effort for malware authors. Finally,in the light of our results, we propose possible remedies for improving the currentstate of malware detection on mobile devices.
Peopleclick Authoria Case Study: Exelon Corporation Exelon Corporation At a time of growing awareness of climate change, Exelon Corporation believes environmental at a Glance leadership is not only appropriate, but profitable for an energy company. Headquartered in Chicago, Exelon is one of the nation's largest electric utilities. With a nationwide reach