Sarah Goodwin

Kathi Ovnic
Holly Korschun
September 15, 1998


DEPRESSION RESEARCH AT EMORY: Magnets for Depression, Antidepressants in Breast Milk, AIDS & Depression, plus more


Dark moods are lightened for many patients with medication-resistant depression who are stimulated with therapeutic magnets, according to recently published data from Emory neuroscience researchers. In the largest study to date of rapid rate transcranial magnetic stimulation (rTMS),

56 percent of young and middle aged study subjects (22-65 years of age) and 23 percent of subjects over age 65 participating in the Emory study conducted at the Atlanta Veterans Affairs Medical Center and Wesley Woods Health Center responded positively to the experimental treatment. Findings of the 50-patient series are published in the March 1998 issue of the Journal of Neuropsychiatry and Clinical Neurosciences. During treatment sessions, doctors place a powerful magnetic coil close to the top of the patient's head, near the portion of the brain believed to improve the mood of depressed patients (the left pre-frontal cortex), and apply several seconds of electromagnetic stimulation. Patients require no anesthesia nor sedation; most feel mild tightening of the scalp muscles, and a small percentage report headaches that end as soon as stimulation ends.

William McDonald, M.D., a psychiatrist in charge of electroconvulsive therapy (ECT) treatment and research at Emory, is currently recruiting more patients with medication-resistant depression for studies to further evaluate rTMS. Patients may call 404/ 728-4558 for information.

(Full story issued April 15, 1998: apr98/apr98.html. Note to Editors/Producers: Doctors and patients are available for interviews and the procedure may be filmed/photographed. Call Sarah Goodwin, Emory Health Sciences Communications, 404/727-3366.)


Emile Risby, M.D., is taking a close look at lithium for the treatment of manic depression, also called bipolar disorder. During the 1800s, many of the so-called medicinal properties of spa water were attributed to lithium salts; since then, the healing qualities of lithium have been scientifically - and unscientifically - espoused. Experts do know that about four of every five manic patients respond to lithium treatment, and that lithium is beneficial to many patients with depression. Dr. Risby is most interested in the mineral's cellular mechanisms of action, specifically at it effects on structures called G proteins. He grows cell cultures from blood taken from manic-depressive patients and healthy patients, and carefully compares the effect of lithium on the cells' G proteins, to the subjects' diagnoses, symptoms and responses to treatment.


The mild "maternity blues" experienced by an estimated 50 to 80 percent of women within two weeks after delivery are quite distinct from the postpartum depression experienced by up to 10 percent of new mothers, according to Zachary N. Stowe, M.D., director of Emory's active Pregnancy and Postpartum Mood Disorders Program. (Likewise, he explains that postpartum depression is distinct from postpartum psychosis, a rare condition that "should be considered a medical emergency.") A higher rate of infanticide and suicide has been observed in women with postpartum depression, and a higher rate of behavioral and cognitive disturbances has been noted in children of these women. An authority on the prevention, treatment and research of postpartum depression, Dr. Stowe conducted the most comprehensive study measuring infants' exposure to mothers' antidepressants through breast milk, has presented guidelines for antidepressant use during breast-feeding, has reviewed studies of lithium use during pregnancy and counsels women with clinical depression about treatment options (including antidepressant use) who are planning to become pregnant.

(Note to Editors/Producers: Doctors and patients are available for interviews. Call Sarah Goodwin, director of Media Relations, Health Sciences Communications, 404/727-3366.)


Emory depression researchers have been able to study suicide from a number of different perspectives with institutional grants from the American Foundation for Suicide Prevention (AFSP). Areas of study include: suicidality in postpartum depression, suicidality in the nursing home population, and social-psychological analyses of suicide. Nadine Kaslow, Ph.D., who serves on the board of AFSP's Southeastern Division, heads the AFSP-supported research program at Emory evaluating the question, "Why does interpersonal violence lead to suicidality in women?" Based on 1995 statistics, the AFSP reports on its Website that, "Over 32,000 people in the United States kill themselves every year; a person commits suicide about every 15 minutes in the U.S. but it is estimated that an attempt is made about once a minute; three-fourths of all suicides are committed by white males; suicide is the second leading cause of death among college students." The foundation's national office may be reached at 1-888-333-AFPS, the Southeastern Division at 404/ 250-0159.


Certainly being diagnosed with a life-threatening medical condition is enough to make anyone depressed. But investigations being carried out by Emory researchers are uncovering links between clinical depression and medical conditions that go far beyond initial dismay after diagnosis. On the one hand, researchers contend physiologic changes caused by a particular disease (a brain tumor, for instance) can incite chemical changes that contribute to depression. On the other hand, they are looking closely at the hypothesis that years of clinical depression takes a toll on one's immune system and autonomic nervous system to the point one may be more "susceptible" to disease.

Dominique L. Musselman, M.D., is an expert in this area. In her recent review of work evaluating depression and cardiovascular disease (Archives of General Psychiatry, July 1998) Dr. Musselman lists "sympathoadrenal hyperactivity, diminished heart rate variability, ventricular instability and myocardial ischemia in reaction to mental stress" among the biologic markers associated with depression that may increase a person's risk of heart disease. She also includes in that list her own lab's work that showed for the first time that blood platelets of depressed persons can become dangerously hyperactive (American Journal of Psychiatry, Oct. 1996). "Serotonin secreted by platelets induces both platelet aggregation and coronary vasoconstriction" Dr. Musselman reports. In the review she co-authored of studies evaluating depression in cancer patients (Archives of General Psychiatry, Feb. 1995), she and her colleagues report that, "Treatment of depression in these patients improves their dysphoria and other signs and symptoms of depression, improves quality of life, and may improve immune function and survival time." First author of the cancer paper, J. Stephen McDaniel, M.D., has distinguished himself as a leader in addressing the mental health of persons with HIV/AIDS, particularly in treating clinical depression. "Both HIV and many opportunistic infections that manifest in patients due to their immunocompromised state also can affect the central nervous system (CNS),"

Dr. McDaniel reports in Clinical Psychology Review (17{3} 1997). CNS-related manifestations of HIV disease include "HIV-related dementia, psychotic disorders, delirium, CNS opportunistic infections and tumors, systemic abnormalities, psychoactive substances, and the adverse effects of certain medical treatments." The Emory researchers urge health professionals to be aware that long-term depression may make some persons susceptible to disease, that even in persons with little or no prior depression, certain medical conditions and treatments (corticosteroids in cancer treatment, for instance) can chemically trigger depression, and that aggressively treating depression can improve not only a medically ill person's mental health profile, but very likely the medical condition and perhaps longevity.


These theories on chronic disease and depression are put into practice daily by Emory psychiatrists who see outpatients and inpatients who also have medical conditions.

In fact, the importance of understanding the symbiotic relation of physical to mental health helps form the basis of the Medical-Psychiatric Unit at Emory University Hospital. Staff at the inpatient unit offer state-of-the-art treatment in a comfortable, home-like environment. Patients with the following diagnoses (and several other diagnoses) are seen in the unit: manic depressive illness, postpartum depression, psychotic depression, and schizophrenia disorders of personality and impulse control. Treatment continuity continues for patients in the outpatient setting, where they also have access to the latest experimental drug and psychotherapy studies at Emory. "Major depression and depressive symptoms are exceedingly common in medical populations," says Emory psychiatrist Stephen J. McDaniel in a study of depression in cancer patients (Archives of General Psychiatry, July 1995). "The lack of recognition of depression in the medically ill among physicians has been well documented. Internists have been found to recognize depression in only one fourth to one half of their depressed medical outpatients. However, recognition and treatment of depression is crucial, especially for medically ill patients, because depressive disorders may adversely affect survival, the length of hospital say, compliance with therapy, the ability to care for oneself, and quality of life."


Doctors long ago replaced the colloquial term "shock therapy" with the more accurate phrase "electroconvulsive therapy" or "ECT" to describe the safe and successful treatment that has given significant relief from major depression to thousands.

The ECT service at Wesley Woods Hospital of Emory Healthcare is the most productive in the United States, providing about 3,500 to 4,000 treatments each year. In addition to overseeing extensive ECT clinical services, ECT director and Emory psychiatrist William McDonald, M.D., conducts related research. He reports in the January 1998 issue of Psychiatric Annals, the success of "maintenance" ECT in preventing relapses of depression in a group of older adults after their "treatment" courses of ECT.

(Note to Editors/Producers: Doctors and patients are available for interviews and the procedure may be filmed/photographed. Call Sarah Goodwin, director of Media Relations, Health Sciences Communications, 404/727-3366.)


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