Consumers Rate Medicare Higher Than Employer-Sponsored Insurance

Elderly Medicare beneficiaries are more satisfied with their health care, and experience fewer problems accessing and paying for care, than Americans with employer-sponsored insurance (ESI), according to a study by Commonwealth Fund researchers published May 12 on the Health Affairs Web site. If given the opportunity, many adults under age 65 would likely select a public health insurance option, say lead author Karen Davis, president of the Commonwealth Fund, and colleagues.

The study is based on data from the Commonwealth Fund 2007 Biennial Health Insurance Survey, a nationally representative survey of 3,501 adults age 19 and older conducted between June 4 and October 24, 2007. The gap between consumers’ ratings of Medicare and ESI has widened since a similar survey in 2001.

Health Affairs

AngioScore Receives FDA Clearance To Market AngioSculpt PTA Scoring Balloon Catheter For Additional Peripheral Indications

AngioScore, Inc., a developer of novel angioplasty catheters for use in the treatment of cardiovascular disease, announced that its AngioSculpt® Percutaneous Transluminal Angioplasty (PTA) Scoring Balloon Catheter has received U.S. Food and Drug Administration (FDA) 510(k) clearance to market the device for balloon dilatation of lesions in the iliac, femoral, ilio-femoral, popliteal, and infra-popliteal arteries, and for the treatment of obstructive lesions of native or synthetic arteriovenous dialysis fistulae. The PTA catheter is not labeled for use in the coronary or neuro-vasculature.

The PTA Scoring Balloon Catheter received initial FDA 510(k) clearance to market for the treatment of infra-popliteal peripheral arterial disease in September 2005.

In January 2007, AngioScore’s companion product, the AngioSculpt® Percutaneous Transluminal Coronary Angioplasty (PTCA) Scoring Balloon Catheter, received FDA Pre-market Application (PMA) Approval for the treatment of hemodynamically significant coronary artery stenosis, including in-stent restenosis and complex type C lesions, for the purpose of improving myocardial perfusion.

Both AngioSculpt Scoring Balloon Catheters represent the next generation in angioplasty catheters. Their innovative nitinol elements provide unique circumferential scoring of plaque, leading to precise and predictable luminal enlargement across a wide range of lesion types while avoiding “geographic miss” through its unique anti-slippage properties. The AngioSculpt catheters provide the versatility and effectiveness of a new technology together with the simplicity and deliverability of traditional high-performance balloon catheters.

“We are very pleased to have achieved this significant milestone,” said Thomas R. Trotter, president and CEO of AngioScore. “This latest 510(k) clearance to market for our AngioSculpt PTA catheter now enables us to address several of the largest and fastest growing segments of the peripheral artery disease (PAD) market in the U.S., including the superficial femoral artery (SFA) and stenoses involving hemodialysis of synthetic or native arteriovenous fistulae (A/V fistula). In 2007 an estimated 275,000 SFA and 300,000 A/V fistula procedures were performed in the United States.”

Trotter added: “AngioSculpt catheters have now been used in more than 15,000 procedures worldwide and have achieved an outstanding performance record in the treatment of both coronary and peripheral artery disease.”

About AngioScore

AngioScore, Inc. is a privately funded endovascular company located in Fremont, California.

AngioScore, Inc.

Consumer Perceptions Of Links Between Local Foods, Climate Change, Food Safety

A recent survey shows that American consumers are skeptical about the safety of the global food system and many believe that local foods are safer and better for their health than foods from afar.

These are the views of a representative, nationwide sample of 500 consumers who participated in a web-based survey conducted by the Leopold Center for Sustainable Agriculture in July 2007. Their responses are summarized in a new Leopold Center report, “Consumer perceptions of the safety, health, and environmental impact of various scales and geographic origin of food supply chains.” The paper was Rich Pirog, who leads the Center’s Marketing and Food Systems Initiative, and Iowa State University graduate student Andy Larson.

Objectives of the study were to gauge consumer perceptions regarding:

* Food safety,

* The impact that various scales and production methods of the food system have on greenhouse gas emissions,

* Willingness to pay for a food system that achieves a net reduction in greenhouse gas emissions and

* Health benefits from local and organic foods.

Survey respondents placed high importance on food safety, freshness (harvest date), and pesticide use on fresh produce they purchase, with somewhat lower importance placed on whether the produce was locally grown, the level of greenhouse gas emissions it took to produce and transport the produce, and whether the respondent could contact the farmer who grew it.

Pirog said that while 70 percent of the respondents perceived the U.S. food system to be safe, concern was raised when they were asked about the safety of fresh produce from other continents. Eighty-five percent and 88 percent of respondents, respectively, perceived local and regional food systems to be somewhat safe or very safe, compared to only 12 percent for the global food system.

Health factors also have an effect on consumer attitudes. More than two-thirds of respondents (69 percent) “somewhat” or “strongly” agreed that local food is better for their personal health than food that has traveled across the country. This is in spite of the fact that there is little or no research documenting such benefits, Pirog noted.

Are consumers willing to pay more for food from supply chains that emit half as much greenhouse gas as conventional chains” Nearly half of respondents in the survey were willing to pay a 10 to 30 percent premium, but a similar percentage was not.

“With the dramatic rise in popularity of local foods, the farmers who grow these foods and the organizations that champion both the farmers and the foods will be called upon to prove the existence of economic, environmental and health benefits stemming from these products, and to ensure their continued safety as part of the food supply,” Pirog said.

He pointed out that the findings show a critical need for more research. “Government agencies, universities, health professionals, private companies and non-profit organizations need to work with farmers growing and processing local foods to develop an appropriate research agenda for these food supply chains,” he added.

In 2001, Pirog led some of the first research in the United States on the concept of “food miles,” the distance that food travels from where it is grown to where it is purchased for consumption. He also has investigated consumer perceptions of local, place-based and organic foods.


Click here to access the 45-page report on the Leopold Center web site.

The Leopold Center also offers a competitive grants program across all three research initiatives in Marketing and Food Systems, Ecology, and Policy. Through its research and education programs, the Leopold Center supports the development of profitable farming systems that conserve natural resources. Center funding comes from state appropriations and from fees on nitrogen fertilizer and pesticides, as established by the 1987 Iowa Groundwater Protection Act.

Source: Laura Miller

Iowa State University

AARP: Medicare Anniversary Highlights Need For National Health Care Reform Next Year

AARP issued a statement commemorating the 43rd anniversary
of Medicare and Medicaid. The statement, from AARP Executive Vice President Nancy
LeaMond, follows:

“The passage of Medicare and Medicaid in 1965 was an important event in America’s
history. Congress and the Administration worked together to solve a national crisis by
providing health care to the most vulnerable among us.

“A generation later, our country is in the midst of a new health care crisis. Skyrocketing
costs are pushing access to quality health care further out of reach for families,
employers, states and the federal government. Today’s health care crisis threatens to
make us all vulnerable.

“One of nation’s top priorities must be ensuring that all Americans have access to
affordable health care. With businesses and individuals taking greater responsibility for
themselves, this anniversary is a reminder of the unique and tremendous role of our
elected officials.

“This fall, the American people will have the chance to hear from elected officials and
candidates about their solutions to control health care costs. The next Congress and
Administration will need to overcome gridlock to enact meaningful reform.

“We are looking back today, but only to help us look ahead. Remembering the legacy of
1965 reminds us how important these issues are in 2008. And you better believe we’ll be
watching in 2009.”

AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have
independence, choice and control in ways that are beneficial and affordable to them and society
as a whole. AARP does not endorse candidates for public office or make contributions to either
political campaigns or candidates. We produce AARP The Magazine, the definitive voice for 50+
Americans and the world’s largest-circulation magazine with over 33 million readers; AARP
Bulletin, the go-to news source for AARP’s 39 million members and Americans 50+; AARP
Segunda Juventud, the only bilingual U.S. publication dedicated exclusively to the 50+ Hispanic
community; and our website, AARP. AARP Foundation is an affiliated charity that provides
security, protection, and empowerment to older persons in need with support from thousands of
volunteers, donors, and sponsors. We have staffed offices in all 50 states, the District of
Columbia, Puerto Rico, and the U.S. Virgin Islands.


AAAS Town Hall Event To Feature Penn Childhood Obesity Researchers

Shiriki Kumanyika, PhD, MPH, Professor of Epidemiology and Associate Dean for Health Promotion and Health Prevention, at the University of Pennsylvania School of Medicine, and Virginia A. Stallings, MD, PhD, the Jean A. Cortner Endowed Chair in Pediatric Gastroenterology at Penn and Professor of Pediatrics at The Children’s Hospital of Philadelphia, will be part of a panel at a special public session, Understanding Obesity and Childhood at the 2008 American Association for the Advancement of Science (AAAS) annual meeting in Boston.

The media, teachers, school heath professionals, parents, students, scientists, and the public are invited to attend this free town-hall-style event on understanding the science behind obesity and childhood nutrition.

Dr. Kumanyika will talk about interactions between cultural, social, and environmental factors as they influence child and parent behaviors related to obesity. She will highlight challenges for addressing ethnic disparities in childhood obesity.

Dr. Stallings will speak about nutrition standards for food in schools.

The Obesity and Nutrition Town Hall will take place on Sunday, February 17, 2008 EST from 1:15PM – 5:30PM at the Boston Marriott Copley Place. Seating is limited and advance registration is strongly recommended. To register, click here and select “Go to Registration for the Town Hall”


PENN Medicine is a $3.5 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System.

Penn’s School of Medicine is currently ranked #3 in the nation in U.S. News & World Report’s survey of top research-oriented medical schools; and, according to most recent data from the National Institutes of Health, received over $379 million in NIH research funds in the 2006 fiscal year. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System includes three hospitals – its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation’s “Honor Roll” hospitals by U.S. News & World Report; Pennsylvania Hospital, the nation’s first hospital; and Penn Presbyterian Medical Center – a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.

Source: Karen Kreeger

University of Pennsylvania School of Medicine

Children’s Food Bill put before UK parliament could end junk food advertising aimed at kids

Junk food advertising aimed at children could be banned under proposals contained in a new bill that was last week presented to the UK parliament.

Introduced by Debra Shipley MP, the Children’s Food Bill is designed to regulate the marketing, promotion and sale of food and drink to children. Developed in partnership with Sustain, the alliance for better food and farming, the bill has the support of 114 national organisations, including the British Dental Association, Diabetes UK and the Children’s Society.

Despite the wide support, Ms Shipley said she was ‘realistic’ about the bill’s prospects, and noted that its chances of reaching the statute books within the next few years were limited. She said that the bill would probably only ‘breathe life’ once a parliamentary and public consensus on the problem of childhood obesity had been reached. In the meantime, she planned to lobby government departments and MPs to raise the profile of the issue.

‘We are going to begin a momentum that cannot be stopped,’ Ms Shipley told a press conference.
Under proposals contained in the bill, the Food Standards Agency would be required to specify criteria for healthy and unhealthy food and drink, taking into account nutritional content and other criteria, such as the presence of additives and contaminants.

Based on these criteria, the marketing of unhealthy foods would be prohibited and the government would be required to publish an annual plan to promote healthy foods, such as fruit, to children.
The types of food available to children at school would also be addressed under the bill.
It includes proposals for school meal standards, better food education, and a ban on selling unhealthy food in school vending machines.

Meanwhile, the Liberal Democrats have launched their own strategy, Childhood obesity: a growing problem. Along with calling for a toughening of the code governing the advertising of food and drink to children, the LibDems have called for a ban on junk food advertising on school vending machines, a review of the nutritional standards for school meals, along with a change in the secondary school curriculum to include two hours per week of mandatory physical activity in class time.

Public Health News UK

ASPS And American Society For Aesthetic Plastic Surgery Offer Patient Advisory For Those Affected By Fig LipoDissolve Closures

Responding to recent reports of the Fig LipoDissolve Centers going into Chapter 11 bankruptcy protection, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) offers the following advice to patients currently in treatment there or suffering from unwanted outcomes. Although neither Society recommends the use of injection lipolysis for fat reduction until appropriate research has documented the safety and efficacy of this non-FDA-approved treatment information is available for those patients needing help.

- If you are in the middle of lipolysis treatment and have concerns:

Contact ASAPS at 1.888.272.7711 or surgery or ASPS at plasticsurgery to find a board certified plastic surgeon in your area who can provide you with safe options for continuing your body contouring process.

- If you are in pain, have a complication such as swelling or bleeding or need immediate attention; please contact your nearest hospital emergency room.

- If you are seeking body contouring or are considering your various options please remember the following:

All procedures involving injecting pharmaceutical or other agents into the body are medical procedures and need to be conducted in an appropriate medical setting by a physician. A Board Certified Plastic Surgeon can help you weigh your options to achieve the optimal outcome you desire.

The ASPS and ASAPS do not recommend that their patients undergo injection lipolysis treatments.

All medical procedures have risks. If you decide a procedure is right for you, make sure you have done your homework, that the procedure has been fully explained by your healthcare provider and that you have thoroughly read and signed informed consent documents.

“The proliferation of advertising of such treatments and the abrupt closing of Fig LipoDissolve Centers nationwide has raised many questions from both patients considering treatment, and those who have already been injected with the unproven medical treatments touted to reduce localized fat. Said Alan Gold, MD President – elect of the Aesthetic Society, “To date, injection lipolysis, LipoDissolve or any fat-melting injection has not gone through FDA sanctioned clinical trials or the research necessary to document the results claimed or clearly identify the potential underlying complications.”
“Consumers should not ignore the proliferation of blogs and media that are reporting the ineffectiveness and the complications experienced by fat-melting injections,” said Richard A. D’Amico, ASPS President.” This mixture is not FDA approved nor has it been formally tested for predictable results or safety. That alone should steer consumers away from the marketing hype.”

About ASPS

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons


The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS) is the only plastic surgery organization devoted entirely to the advancement of cosmetic surgery. ASAPS is recognized throughout the world as the authoritative source for cosmetic surgery education. U.S. members are certified by the American Board of Plastic Surgery. Canadian members are certified in plastic surgery by the Royal College of Physicians and Surgeons of Canada.

American Society for Aesthetic Plastic Surgery

Bariatric Surgery Reduces Long-Term Cardiovascular Risk In Diabetes Patients

In the longest study of its kind, bariatric surgery has been shown to reduce the risk of heart attack and stroke in patients with diabetes. These results and other groundbreaking research were presented at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes, hosted by NewYork-Presbyterian Hospital and Weill Cornell Medical College.

“This is a watershed moment for diabetes care. With 20 years of data, we can really see how the surgery can improve a spectrum of health measures — notably cardiovascular risk,” says Dr. Francesco Rubino, director of the Congress and director of gastrointestinal metabolic surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

While Type 2 diabetes is not technically a cardiovascular disease, experts say it might as well be one, given the corrosive effects of unregulated blood sugar on the heart. According to the American Heart Association, at least 65 percent of people with diabetes die of some form of heart disease or stroke.

Dr. Lars Sjöström, professor at the Institute of Medicine in Göteborg, Sweden, presented new data gleaned from the Swedish Obese Subjects (SOS) study. He reported on 20 years of data comparing 2,010 bariatric surgeries with 2,037 non-surgical patients who received medical treatment or lifestyle modification for obesity.

“Type 2 diabetes has always been considered a chronic, lifelong disease, but the long-term data show remission in 70 percent of patients after two years of follow-up,” he says. “Thirty percent are still in remission 15 years after bariatric surgery. Even more remarkable, 20 years out, we have seen that bariatric surgery has reduced new cases of diabetes by 80 percent among obese patients who did not have the disease at the start of the study.”

Dr. SjГ¶strГ¶m concludes that the surgery’s preventive effect seems to be even stronger and more long-lasting than its ability to sustain long-term remission. Equally striking, the incidence of new cardiovascular events — either heart attack or stroke — has been at least 30 percent lower among postsurgical patients than their conservatively treated counterparts.

A Utah-based study presented similar clinical outcomes. After gastric bypass surgery, patients were seen to have greater reductions in blood pressure, heart rate, triglycerides, low-density lipoprotein (LDL) cholesterol, and insulin resistance than did patients in the group of severely obese patients who were treated via medication and lifestyle modification. The surgical group also experienced favorable changes in heart function and “geometry” — a subtle remodeling of the heart’s components leading to greater efficiency. The study’s principal investigator, Dr. Ted Adams of the University of Utah School of Medicine, believes the new data support the use of bariatric surgery to prevent the cardiovascular complications associated with obesity and Type 2 diabetes.

The GI Tract: A New Target for Treatment and Research

“The idea that the gastrointestinal tract can be targeted for the treatment of diabetes is highly promising. It also represents an entirely new way to treat and think about a disease that is notoriously difficult to control,” says Dr. Rubino, who also serves as associate professor of surgery at Weill Cornell Medical College.

Bariatric surgery, especially procedures that involve the rerouting as opposed to restriction of the gastrointestinal (GI) tract, appears to change the hormonal secretions of the gut, explains Dr. Rubino. These changes may be responsible for the surgery’s impressive success in improving or even resolving the disease in a majority of patients.

In bypassing portions of the jejunum or duodenum — the upper part of the small intestine right below the stomach — rerouting procedures such as gastric bypass seem to work via a mechanism of action that occurs too quickly to be related to weight loss. Although scientists are still engaged in lively debate around how and why the surgery works, there is growing consensus that anatomical changes in the GI tract play a far greater role in the control of diabetes than was previously believed.

Dr. Lee Kaplan, a renowned authority on obesity medicine and Congress presenter, elaborates: “The pharmaceutical and biotechnology industries have been developing novel diabetes drugs that target the GI tract, but the process is still at a relatively early stage.

“Recently, for example, we have seen the emergence of a new class of drugs designed to alter the action of gut-based hormones such as incretins, which play an important role in the production of insulin. However, the molecular character of the upper intestine still remains to be mapped and understood,” adds Dr. Kaplan, who is associate professor of medicine at Harvard Medical School and director of the Obesity Research Center at Massachusetts General Hospital.

The Congress also featured presentations by Nobel laureates Michael S. Brown and Joseph L. Goldstein. Their keynote lecture focused on the role of the gastrointestinal hormone ghrelin in regulating key biochemical processes implicated in energy metabolism. Ghrelin has been linked to obesity, mainly because of its ability to stimulate growth hormone release.

Beyond the details of that discussion, adds Dr. Rubino, the entire idea of the GI tract as an endocrine organ — one that could be responsible for the hormonal misfiring seen in diabetes — is still being tested, both in academic medical circles and by industry. At stake are new drugs, new devices and improved surgical methods for people living with and all too often dying from diabetes. “Some of us anticipate a paradigm shift in our understanding of the disease while others question such a shift,” says Dr. Rubino. “But there can be no doubt of how much we’re learning at this Congress about the clinical benefits of diabetes surgery and the basic science that underpins its success.”

The 2nd World Congress on Interventional Therapies for Type 2 Diabetes

The 2nd World Congress on Interventional Therapies for Type 2 Diabetes is a comprehensive, multidisciplinary forum of worldwide specialists whose aim is to craft an agenda of research priorities and health policy initiatives and discuss how the study of gastrointestinal interventions may improve our understanding of diabetes and provide direction for future treatments of curative intent. It offers a review of the existing data and proposes ways to improve patients’ access to surgery when indicated. The 2nd World Congress, hosted by NewYork-Presbyterian Hospital, Weill Cornell Medical College, and the Giovanni Lorenzini Medical Science Foundation, builds significantly on insights gained at the 1st Congress, held in 2008. The 1st Congress was instrumental in raising awareness of the emerging discipline of metabolic surgery for diabetes and stimulated further research support by NIH, the ADA, and other leading professional organizations.


NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Brain’s Visual Circuits Do Error Correction On The Fly

The brain’s visual neurons continually develop predictions of what they will perceive and then correct erroneous assumptions as they take in additional external information, according to new research done at Duke University.

This new mechanism for visual cognition challenges the currently held model of sight and could change the way neuroscientists study the brain.

The new vision model is called predictive coding. It is more complex and adds an extra dimension to the standard model of sight. The prevailing model has been that neurons process incoming data from the retina through a series of hierarchical layers. In this bottom-up system, the lower neurons first detect an object’s features, such as horizontal or vertical lines. The neurons send that information to the next level of brain cells that identify other specific features and feed the emerging image to the next layer of neurons, which add additional details. The image travels up the neuron ladder until it is completely formed.

But new brain imaging data from a study led by Duke researcher Tobias Egner provides “clear and direct evidence” that the standard picture of vision, called feature detection, is incomplete. The data, published Dec. 8 in the Journal of Neuroscience, show that the brain predicts what it will see and edits those predictions in a top-down mechanism, said Egner, who is an assistant professor of psychology and neuroscience.

In this system, the neurons at each level form and send context-sensitive predictions about what an image might be to the next lower neuron level. The predictions are compared with the incoming sensory data. Any mismatches, or prediction errors, between what the neurons expected to see and what they observe are sent up the neuron ladder. Each neuron layer then adjusts its perceptions of an image in order to eliminate prediction error at the next lower layer.

Finally, once all prediction error is eliminated, “the visual cortex has assigned its best guess interpretation of what an object is, and a person actually sees the object,” Egner said. He noted that this happens subconsciously in a matter of milliseconds. “You never even really know you’re doing it,” he said.

Egner and his colleagues wanted to capture the process almost as it happened. The team used functional Magnetic Resonance Imaging, or fMRI, brain scans of the fusiform face area (FFA), a region that deals with recognizing faces. The researchers monitored 16 subjects’ brains as they observed faces or houses framed in different colored boxes that predicted the likelihood of the picture being a face or house. Study participants were told to press a button when they observed an inverted image of a face or house, but the researchers were measuring something else. By changing the face-frame or house-frame color combination, the researchers controlled and measured the FFA neural response to tease apart responses to the stimulus, face expectation and error processing.

If the feature detection model were correct, the FFA neural response should be stronger for faces than houses, irrespective of the subjects’ expectations. But Egner and his colleagues found that if subjects had a high expectation of seeing a face, their neural response was nearly the same whether they were actually shown a face or a house. The study goes on to use computational modeling to show that this pattern of neural activation can only be explained by a shared contribution from face expectation and prediction error.

This study provides support for a “very different view” of how the visual system works, said Scott Murray, a University of Washington neuroscientist who was not involved in the research. Instead of high neuron firing rates providing information about the presence of a particular feature, high firing rates are instead associated with a deviation from what neurons expect to see, Murray explained. “These deviation signals presumably provide useful tags for something the visual system has to process more to understand.”

Egner said that theorists have been developing the predictive coding model for the past 30 years, but no previous studies have directly tested it against the feature detection model. “This paper is provocative and motions toward a change in the preconception of how vision works. In essence, more scientists may become more sympathetic to the new model,” he said.

Murray also said that the findings could influence the way neuroscientists continue to study the brain. Most research assumes that if a brain region has a large response to a particular visual image, and then it is somehow responsible for, or specialized for, processing the content of the image. This research “challenges that assumption,” he said, explaining that future studies have to take into account expectations that participants have for the visual images being presented.

Ashley Yeager
Duke University

Antidepressants Alone: Not For Bipolar Depression

Psychiatrists have cautioned against the use of antidepressants alone in people with bipolar disorders, saying they could worsen a patient’s condition by causing a destabilisation in mood.

Dr Ajeet Singh and Professor Michael Berk, consultant psychiatrists from the University of Melbourne, state in the current edition of Australian Prescriber that the goal of treatment in bipolar disorder is to stabilise mood, and antidepressants may defeat this purpose if they are not taken with other drugs.

“Patients may need an antidepressant, but this must be taken with a mood-stabilising drug. Antidepressants place patients at risk of switching to elevated phases of the disorder and rapid cycling patterns,” they say in the article.

Patients should not simply be left on antidepressants long term without review, say the authors, as there is no good evidence of efficacy in the maintenance phase. If symptoms of elevated mood emerge, the patient should have their dose of the antidepressant reduced or stopped.

Dr Singh says that health professionals should consider the diagnosis of bipolar disorder in patients with treatment-resistant or recurrent depression.

The authors also strongly recommend the need for regular review, education, self-monitoring of mood, mood diaries and social-rhythm training to assist with better long-term patient outcomes. Educating patients about lifestyle changes and a close dialogue with relatives and carers is also essential, they say.

“Including family and carers in the management plan is an important aspect of care. Continuity of care, with good communication and rapport between doctor and patient, is particularly important in fostering compliance with treatment,” the article states.

For the complete article visit the Australian Prescriber website australianprescriber.


Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by the National Prescribing Service Limited (NPS), an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is distributed every two months in hard copy to health professionals, free of charge, and online in full text at australianprescriber.

The Therapeutic Advice and Information Service (TAIS) is a medicines information service specifically for health professionals and is staffed by specialist drug information pharmacists to answer complex drug enquiries. Telephone 1300 138 677 Monday to Friday 9am-7pm Eastern Standard Time for the cost of a local call (mobiles may cost more).

Australian Prescriber