Highlights of 3 new studies show how to choose the best therapy for depression as well as the negative influences of polypharmacy and social media: reward positivity measured by electroencephalography (EEG) can determine if a depressed patient will respond to either antidepressants or cognitive behavioral therapy (CBT); more than one-third of US adults may use medications that lead to depression; and social media experiences affect depressive symptoms.
Reward positivity as measured by EEGs can predict changes in depressive symptoms and serve as an objective index of symptom improvement. A group of 63 adults with a primary DSM-5 anxiety or depressive disorder and 25 healthy controls participated in a monetary award task while their EEG was recorded. In between EEG sessions, patients completed CBT or selective serotonin reuptake inhibitor (SSRI) treatment. At baseline, higher levels of depressive symptoms were associated with more attenuated reward positivity. Among the patients, the extent of increase in reward positivity correlated with the extent of decline in depressive and anxiety symptoms following CBT and SSRI treatment. More attenuated reward positivity at baseline predicted a greater reduction in depressive symptoms following treatment with SSRIs, but not after CBT.
Clinical Implications for Study 1: “About 50 percent of people prescribed either SSRIs or CBT get better with those treatments. We haven’t had an objective way to measure whether a patient is improving with treatment or which patients will do better on SSRIs versus CBT, until now,” said lead author Katie Burkhouse, MD, assistant professor of psychiatry in the University of Illinois at Chicago College of Medicine.
More than one-third of US adults may be using prescription medications that have the potential to cause depression or increase the risk of suicide. A cross-sectional, US population-based survey used data from five 2-year cycles (2005-2006 through 2013-2014) of the National Health and Nutrition Examination Survey and included 26,192 adults, mean age 46.2 years, with depression. More than 200 commonly used prescription drugs, including hormonal birth control medications, blood pressure and heart medications, proton pump inhibitors, antacids and painkillers, have depression or suicide listed as potential side effects. About 15% of adults who simultaneously used three or more of these medications experienced depression while taking the drugs, compared with just 5% for those not using any of the drugs, 7% for those using one medication and 9% for those taking two drugs simultaneously.
Clinical Implications for Study 2: “The take away message of this study is that polypharmacy can lead to depressive symptoms and patients and health care providers need to be aware of the risk of depression that comes with all kinds of common prescription drugs—many of which are also available over the counter. Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis," said lead author Dima Qato, PharmD, MPH, PhD, assistant professor of pharmacy systems, outcomes and policy in the University of Illinois at Chicago College of Pharmacy.
Negative online experiences may increase depressive symptoms. A group of 1179 full-time students, ages 18 to 30, at the University of West Virginia were surveyed about their social media use and experiences, and also completed a questionnaire to assess their depressive symptoms. Each 10% increase in positive experiences on social media was associated with a 4% decrease in odds of depressive symptoms, which was not statistically significant. However, each 10% increase in negative experiences was associated with a 20% increase in the odds of depressive symptoms, a statistically significant result.
Clinical Implications for Study 3: “We found that positive experiences on social media were not related or only very slightly linked to lower depressive symptoms. However, negative experiences were strongly and consistently associated with higher depressive symptoms. Our findings may encourage people to pay closer attention to their online exchanges. Moving forward, these results could assist scientists in developing ways to intervene and counter the negative effects while strengthening the positive ones,” said lead author Brian Primack, MD, PhD, director of the Center for Research on Media, Technology and Health at the University of Pittsburgh.