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Zoloft, Lexapro the Best of Newer Antidepressants

From U.S.News & World Report:

Sertraline (Zoloft) and escitalopram (Lexapro) are the best of 12 new-generation antidepressants, while reboxetine is the least effective, a new analysis shows.

The Italian researchers reviewed 117 studies that included more than 25,000 patients with major depression to come to this conclusion.

The drugs tested in the trials were bupropion (Wellbutrin/Zyban), citalopram (Celexa), duloxetine (Cymbalta), escitalopram, fluoxetine (Prozac), fluvoxamine (Luvox), milnacipran (Savella), mirtazapine (Remeron), paroxetine (Paxil), reboxetine (Edronax/Vestra), sertraline, and venlafaxine (Effexor).

Based on their analysis, the review authors concluded sertraline and escitalopram were the best antidepressants overall in terms of efficacy and patient acceptability. Sertraline was found to be more effective than duloxetine by 30 percent, fluvoxamine (27 percent), fluoxetine (25 percent), paroxetine (25 percent), and reboxetine (85 percent). Escitalopram was more effective than duloxetine by 33 percent, fluoxetine (32 percent), fluvoxamine (35 percent), paroxetine (30 percent), and reboxetine (95 percent).

Mirtzapine and venlafaxine were as effective as sertraline and escitalopram. But the latter two drugs had the best patient acceptability, which meant significantly fewer patients stopped treatment.

The review was published online Jan. 29 and was expected to be published in an upcoming print issue of The Lancet.

"The most important clinical implication of the results is that escitalopram and sertraline might be the best choice when starting a treatment for moderate to severe major depression, because they have the best possible balance between efficacy and acceptability," Dr. Andrea Cipriani, of the University of Verona in Italy, and colleagues said in a news release from the journal.

"Sertraline seems to be better than escitalopram because of its lower cost in most countries. However, in the absence of a full economic model, this recommendation cannot be made unequivocally, because several other costs are associated with the use of antidepressants," they added.

Posted: 1/29/2009 3:51:00 PM

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Investigators make first arson case using DNA

From The Capital (HometownAnnapolis.com):

A Baltimore man faces up to 25 years in prison for torching his nephew's Pasadena home and two of his cars nearly a year ago, county fire officials said.

Charles Earnest Maynard, 50, pleaded guilty earlier this month in county Circuit Court to second-degree arson and manufacturing and using a destructive device, said Battalion Chief Matthew Tobia, county Fire Department spokesman.

County police arrested Maynard last summer after a six-month investigation into the February arson on Bodkin View Drive. Chief Tobia said police used DNA evidence left at the scene to link the arson to Maynard.

It's the first time county investigators have used DNA evidence in an arson case, he said.

"This is a huge case for us," Chief Tobia said. "It signals that we're really raising the bar. Frequently, fire destroys a lot of the evidence, but in these case, we were able to collect DNA from the scene and use advanced techniques to match it (to Maynard)."

Investigators discovered the DNA in a bottle that was used for an unexploded Molotov cocktail they found at the scene.

The arson happened around 2 a.m. on Feb. 10. Police were called to the 7800 block of Bodkin View Drive near Bayside Beach for a reported vehicle fire. When crews arrived on scene, they found a 2006 Chevrolet Impala and a 2003 Volkswagen Jetta on fire. The home nearby also was burning.

"What happened is he lit one car on fire, and that fire spread to another car and then to the house," Chief Tobia said.

Police also learned later that morning that there were three other vehicles on the street with broken windows. One of those vehicles had a Molotov cocktail lying on the driver's seat.

Investigators brought an accelerant-sniffing dog to the scene and were able to confirm the presence of a flammable liquid in the device and in one of the cars damaged in the fire. The water bottle used for the cocktail also had traces of Maynard's DNA.

Damage totaled nearly $26,000, police said.

Posted: 1/27/2009 9:12:00 AM

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ADHD drugs can cause hallucinations in some kids

From Reuters:

Drugs for attention deficit hyperactivity disorder can cause children to have hallucinations even when taken as directed, U.S. government researchers said on Monday.

U.S. Food and Drug Administration researchers analyzed data from 49 clinical studies conducted by makers of the drugs and found they can cause psychosis and mania in some patients, including some with no obvious risk factors. In some cases, children hallucinated that worms, bugs or snakes were crawling on them.

Their analysis provides fresh detail about known risks of the drugs, which include Novartis AG's Ritalin and Focalin XR, Shire Plc's Adderall XR and Daytrana patch, Johnson & Johnson's Concerta, Eli Lilly and Co's Strattera and Celltech Pharmaceuticals Inc's Metadate CD.

It also includes data on Cephalon Inc's modafinil, sold as Provigil, a narcolepsy drug that was rejected as an ADHD treatment in children.

FDA spokeswoman Sandy Walsh said the data formed the basis for recent warnings about psychiatric side effects that have been added to product labels in recent years.

"The numbers of cases of psychosis or mania in pediatric clinical trials were small," Mosholder and colleagues wrote. "However, we noted a complete absence of such events with placebo treatments."

In one account, they described a 7-year-old girl who took an 18 mg dose of Strattera or atomoxetine who started talking nonstop within hours of taking her first dose.

"Two hours after taking her second dose of atomoxetine, the patient started running very fast, stopped suddenly, and fell to the ground. The patient said she had 'run into a wall' (there was no wall there)," they wrote.

"These adverse side effects are rare," said Dr. Harold Koplewicz of New York University Child Study Center, who was not involved in the study, adding that they are reversible, "Once you stop the medicine, the side effects go away," he said in a telephone interview.

Posted: 1/26/2009 3:22:00 PM

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Oprah Endorses Laboratory Tests as Life Savers for 2009

From Dark Daily:

Several key laboratory tests have a prominent place on Oprah Winfrey's "Ultimate Checklist" for a healthy life. Oprah, long a champion of personal accountability for one's own health, kicked off the New Year with a focus on health improvement through self-help activities. It is another example of how consumers are being educated about the importance of using laboratory tests as guideposts to improve their health.

With a theme of "Best Life Week", Oprah featured her medical expert Dr. Oz and his advice on how people can get healthy and peel years off their bodies. Laboratory tests play a prominent role in Dr. Oz's "Ten Step Ultimate Health Checklist. Under step five, "Know Your Numbers", Oprah urged her listeners to pay attention to five laboratory tests:
  • Cholesterol, with LDL less than 100 and HDL greater than 40
  • Blood sugar
  • Vitamin D
  • C-Reactive Protein
  • Thyroid Stimulating Hormone (TSH)
Also included in the "Know Your Numbers" step were recommendations to check waist size and monitor both blood pressure and heart rate.

Other recommendations in the "Ultimate Health Checklist" were to get a medical check-up; recruiting a health advocate; securing a copy of personal medical records; and getting diagnostic and preventive medical tests and screenings on time.

Oprah's promotion of Dr. Oz and his recommendations for better improving personal health makes for good ratings. Lab administrators and pathologists should take that as a sign that consumers are interested in healthcare. Another sign of how important television has become as a source of health information is the selection of CNN's Chief Medical Correspondent, Sanjay Gupta, M.D. to be Surgeon General in the new administration. Expanding media coverage of health and wellness topics plays to the strength of medical laboratories. Media coverage of health issues creates an opportunity for laboratories piggyback on this interest and market directly to consumers.

Posted: 1/22/2009 9:29:00 AM

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Disorder linked to high levels of testosterone in womb

From The Guardian (UK):

A prenatal screening test for autism comes closer today as new research is published that links high levels of the male hormone testosterone in the womb of pregnant women to autistic traits in their children.

The ground-breaking study, published in the British Journal of Psychology by some of Britain's leading autism researchers, was prompted by the fact that autism is four times more common in boys than in girls. It is linked with other traits that are found more commonly in boys, such as left-handedness.

For more than eight years, a team at Cambridge University's autism research centre has been observing and testing the development of a group of 235 children whose mothers had an amniocentesis during pregnancy.

Dr Bonnie Auyeung, Professor Simon Baron-Cohen and colleagues, who publish their findings today, say they have consistently found a link between higher testosterone levels in the womb and autistic traits, such as a lack of sociability and verbal skills, in the children.

These are not autistic children, but many have traits that are more pronounced in those who have a medical diagnosis. Autism has been described as a consequence of an extreme male brain.

In the early years of the study, the scientists could not measure autistic traits in the children, but they noticed some very early indicators. Male babies with higher testosterone levels were less likely to make eye contact at 12 months, their vocabulary was more limited between 12 months and 18 months, and at the age of four they were less sociable and had narrower interests.

Today's paper is a significant step forward because the children, now between eight and 10, are old enough to be psychologically assessed using two separate autism rating tests. Scientists found a clear link, in both tests, between higher testosterone levels when the child was in the womb and autistic traits.

The study highlights for the first time the association between foetal testosterone and autistic traits, and indicates that foetal testosterone not only masculinises the body, it masculinises the mind and therefore the brain, said Baron-Cohen.

The children will continue to be followed for some years, but Baron-Cohen and his team have at the same time expanded their research to look at the relationship between testosterone levels in the womb and children with a diagnosis of autism.

The work opens the way for a screening test for pregnant women, which could potentially involve amniocentesis to draw off fluid from the womb to measure testosterone levels.

A prenatal test would have the advantage of giving parents advance warning, so that they would be able to do everything possible to help their child from birth.

Even if a testosterone test is not developed (scientists may still find that it is not completely reliable), genetic screening will one day be on the cards. Scientists know that autism is partly genetic, because it runs in families, although environmental factors must play a part because there have been occasions where one identical twin was autistic and the other was not. More than 100 genes have been associated with autism, but it is not yet clear which are most important.

Posted: 1/21/2009 12:47:00 PM

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Working with pesticides impacts women's fertility

From Environmental Health News:

As reported in the Journal of Occupational and Environmental Medicine 50(12):1335-1342, women with potential exposure to pesticides at work or at home took longer to get pregnant than women without pesticide connections.

Pregnant women living in a migrant, farmworker community in California participated in the study. Although all women were pregnant, women who worked in agriculture, lived within 200 feet of agriculture fields or used pesticides in their home took significantly longer to conceive than those who did not have these pesticide exposures.

The findings agree with past studies and add more evidence to this sometimes confusing mix of research outcomes. Many studies have found a relationship between pesticides and male fertility, including effects on sperm health and longer time to pregnancy. However, few studies have examined how pesticide exposure might affect women's ability to get pregnant.

In this study, researchers looked at two types of pesticides: those like DDT that were banned in the 1970s and those currently used in agriculture today.

DDT was measured in the women's blood, but was not associated with women's ability to conceive. DDT levels were quite high because most of the women were Mexican immigrants and DDT was used in Mexico until the year 2000.

However, women who reported occupational exposure to currently-used pesticides were 30 percent less likely to conceive in any given month than women without occupational exposure. Women who reported that pesticides were used in their homes were also less likely to conceive each month compared to those who did not use pesticides.

The predominantly low-income, Latina women participating in the study were very similar except for their pesticide exposures. Nonetheless, the study controlled for other factors that might contribute to these differences in conception, including maternal age, immigration status and history of gynecologic condition.

The researchers asked 402 women about their and their partner's home and work pesticide exposure. They also reported how long it took them to get pregnant -- as measured by the number of menstrual cycles before conception.

Only maternal pesticide exposure was associated with longer time to pregnancy; paternal occupational exposure was not associated with fertility. The authors point out that they only interviewed women who were already pregnant. If infertile couples were included in the study, an even stronger effect of pesticides might be seen.

Posted: 1/16/2009 10:17:00 AM

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Study Finds Drug Risks With Newer Antipsychotics

From The New York Times:

The popular drugs known as atypical antipsychotics, prescribed for an array of conditions, including schizophrenia, autism and dementia, double patients’ risk of dying from sudden heart failure, a study has found.

The finding is the latest in a succession of recent reports contradicting the long-held assumption that the new drugs, which include Risperdal, Zyprexa and Seroquel, are safer than the older and much less expensive medications that they replaced.

The risk of death from the drugs is not high, on average about 3 percent in a person being treated at least 10 years, according to the study, published Thursday in The New England Journal of Medicine. Nor was the risk different from that of the older antipsychotic drugs.

But it was significant enough that an accompanying editorial urged doctors to limit their prescribing of antipsychotic drugs, especially to children and elderly patients, who can be highly susceptible to the drugs’ side effects, including rapid weight gain.

In recent years, the newer drugs, which account for about 90 percent of the market, have become increasingly controversial, as prescription rates to children and elderly people have soared. Doctors use the drugs to settle outbursts related to a host of psychiatric disorders, including attention deficit disorder and Alzheimer’s disease. Most are not approved for such use. After an analysis of study data, the Food and Drug Administration required that all antipsychotics’ labels contain a warning that the drugs were associated with a heightened risk of heart failure in elderly patients.

The new study, an analysis of more than 250,000 Medicaid records, is the first to rigorously document that risk for the newer drugs in adults over 30 without previous heart problems.

In the study, researchers at Vanderbilt University and the Nashville Veterans Affairs Medical Center analyzed Tennessee Medicaid records for 276,907 people ages 30 to 74. About a third of them began taking an antipsychotic medication in the period studied, from 1990 to 2005, either a newer atypical or an older drug. Two-thirds made up a control group. The researchers excluded patients with heart disease or other problems that might put them at higher risk of cardiac failure.

They found 478 sudden cardiac deaths among those taking the drugs, about twice the rate of the control group. The risk — equivalent to 3 deaths for every 1,000 patients taking the drugs for a year — was about the same whether people took the newer or older medications. The higher the dose of the drug, the study found, the higher the risk of sudden death.

“The implication of this study is that physicians need to do a very careful cardiovascular evaluation prior to prescribing these drugs,” especially if there are alternative treatments, said the lead author, Wayne A. Ray, a professor of preventive medicine at Vanderbilt and the Nashville veterans’ hospital. “Then, if they’re used, to pay careful attention to using the lowest possible dose.”

Posted: 1/15/2009 10:36:00 AM

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Alzheimer's drugs double death risk in elderly

From The Associated Press:

Anti-psychotic drugs commonly used to treat Alzheimer's disease may double a patient's chance of dying within a few years, suggests a new study that adds to concerns already known about such medications.

The research was published Friday in the medical journal, Lancet Neurology.

Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer's disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos.

Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia.

After two years, 46 percent of Alzheimer's patients taking the anti-psychotics were alive, versus 71 percent of those not on the drugs. After three years, only 30 percent of patients on the drugs were alive, versus 59 percent of those not taking drugs.

In the United Kingdom and the United States, guidelines advise doctors to use anti-psychotic drugs cautiously and temporarily. But in many nursing homes in Europe and North America, up to 60 percent of patients with dementia are routinely given the drugs for one to two years.

"The drug regimen for any person with Alzheimer's needs to be personalized," said William Thies of the Alzheimer's Association in the U.S. Thies was not connected to the study. "At some points, some people will be better off with no medication."

Simon Lovestone of the Institute of Psychiatry at King's College in London said psychiatrists should try environmental or behavioral therapies instead of anti-psychotics.

Experts aren't sure how the anti-psychotics increase patients' risk of dying. But they think the drugs could be damaging to the brain and their sedative effects make patients less able to exercise and more susceptible to deadly infections.

Posted: 1/9/2009 10:14:00 AM

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Heart Drug May Be a Cancer Fighter

From HealthDay:

Digoxin, a drug used for many years to treat irregular heart rhythms and heart failure, may also be a cancer-fighting agent, researchers report.

Cancer cells need to create new blood vessels to survive. But many of these cells are oxygen-deprived and need to switch on genes that produce a protein called hypoxia-inducible factor (HIF-1), which help cells survive in low-oxygen conditions.

Digoxin reduces HIF-1, causing cancer cells to die, the scientists from Johns Hopkins University found.

For the study, Dr. Gregg L. Semenza, director of the vascular program at the Johns Hopkins Institute for Cell Engineering, and his colleagues tested more than 3,000 U.S. Food and Drug Administration-approved drugs for their ability to reduce HIF-1 levels in cancer cells.

They identified 20 drugs that reduced HIF-1 by more than 88 percent; more than half are used to treat heart failure. The researchers then looked specifically at digoxin because it is commonly used and its side effects are well-documented.

The researchers found that prostate cancer cells treated in a laboratory with digoxin grew significantly slower. After three days of treatment, there were fewer cancer cells, and many cells had stopped growing altogether, compared with untreated cells.

To see if digoxin would work on cancer cells in animals, and not just on isolated cancer cells in a lab, the researchers then gave mice with tumors daily injections of digoxin.

They found that in mice not given digoxin, tumors grew to the point where they could be felt after nine days. But, in mice treated with digoxin, tumors couldn't be felt until 15 to 28 days.

And levels of HIF-1 were lower in the tumors of treated mice, compared with untreated mice. The researchers also found that it was digoxin that reduced HIF-1 levels leading to slower tumor growth.

The report was published recently in the Proceedings of the National Academy of Sciences.

There have been previous studies showing that digoxin and other so-called digitalis-based drugs reduce the risk of dying from or developing some cancers, Semenza's team noted.

In one long-term follow-up of 175 breast cancer patients, those taking digitalis drugs had a 6 percent death rate, compared with 34 percent among those not taking these drugs. Another study of more than 9,000 patients taking digoxin found an association between high levels of the drug and a lower risk of leukemia and lymphoma and kidney and urinary tract cancers, according to the study.

Posted: 1/8/2009 12:48:00 PM

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A New Cigarette Hazard: ‘Third-Hand Smoke’

From The New York Times:

Parents who smoke often open a window or turn on a fan to clear the air for their children, but experts now have identified a related threat to children’s health that isn’t as easy to get rid of: third-hand smoke.

That’s the term being used to describe the invisible yet toxic brew of gases and particles clinging to smokers’ hair and clothing, not to mention cushions and carpeting, that lingers long after second-hand smoke has cleared from a room. The residue includes heavy metals, carcinogens and even radioactive materials that young children can get on their hands and ingest, especially if they’re crawling or playing on the floor.

Doctors from MassGeneral Hospital for Children in Boston coined the term “third-hand smoke” to describe these chemicals in a new study that focused on the risks they pose to infants and children. The study was published in this month’s issue of the journal Pediatrics.

Third-hand smoke is what one smells when a smoker gets in an elevator after going outside for a cigarette, he said, or in a hotel room where people were smoking. “Your nose isn’t lying,” he said. “The stuff is so toxic that your brain is telling you: ’Get away.’”

The study reported on attitudes toward smoking in 1,500 households across the United States. It found that the vast majority of both smokers and nonsmokers were aware that second-hand smoke is harmful to children. Some 95 percent of nonsmokers and 84 percent of smokers agreed with the statement that “inhaling smoke from a parent’s cigarette can harm the health of infants and children.”

But far fewer of those surveyed were aware of the risks of third-hand smoke. Since the term is so new, the researchers asked people if they agreed with the statement that “breathing air in a room today where people smoked yesterday can harm the health of infants and children.” Only 65 percent of nonsmokers and 43 percent of smokers agreed with that statement, which researchers interpreted as acknowledgement of the risks of third-hand smoke.

Dr. Philip Landrigan, a pediatrician who heads the Children’s Environmental Health Center at Mount Sinai School of Medicine in New York, said the phrase third-hand smoke is a brand-new term that has implications for behavior.

“The central message here is that simply closing the kitchen door to take a smoke is not protecting the kids from the effects of that smoke,” he said. “There are carcinogens in this third-hand smoke, and they are a cancer risk for anybody of any age who comes into contact with them.”

Among the substances in third-hand smoke are hydrogen cyanide, used in chemical weapons; butane, which is used in lighter fluid; toluene, found in paint thinners; arsenic; lead; carbon monoxide; and even polonium-210, the highly radioactive carcinogen that was used to murder former Russian spy Alexander V. Litvinenko in 2006. Eleven of the compounds are highly carcinogenic.

Posted: 1/5/2009 11:26:00 AM

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