A single antidepressant tablet makes a depressed person see the world in a more positive light just four hours after swallowing it, a new study has shown.

Dr Philip Cowen, professor of pharmacology at the Department of Psychiatry at the University of Oxford, told delegates at the Royal College of Psychiatrists' Annual Meeting in London that antidepressant medication starts to work far faster than most clinicians assume.

"Depressed people interpret the world in a negative way," he said. "They become stuck in this state. Negativity causes depression and depression causes negativity and, whatever happens, events will be interpreted in a negative way."

Antidepressants elevate mood, which in turn leads to a depressed person becoming more positive and interpreting things that happen to them in a positive way. Prof Cowen said: "Antidepressants change biases. People who take them begin to see the world in a positive light," said Prof Cowen.

But it does not take weeks for this change to happen. Prof Cowen and his colleagues gave 30 depressed people one single 4mg dose of reboxetine (Edronax^®, Vestra^®) - which inhibits the update of both serotonin and noradrenaline in the brain - and compared them with 30 'controls' who were given a placebo.

The researchers asked both groups to carry out a series of simple tasks, including picking out the 'happy' facial expression from a line of faces, and recalling positive rather than negative words. They found that the placebo group were poor at spotting happy faces. They also tended to remember the negative words and were slow to categorise positive information.

However, four hours after taking a single dose of reboxetine, the drug group were as capable of remembering the positive words and spotting the happy expression as people who were not depressed.

Prof Cowen said: "People with depression interpret their internal and external worlds in a negative way. The current antidepressant drugs take away the automatic feelings of negativity at the first dose."

Antidepressants affect mood indirectly by abolishing the negative bias in the way that depressed people appraise personal and social experience at a subconscious level.

While there might be little change in overall conscious mood, Prof Cowen concluded: "Over time, and with a fair wind, this can lead to feeling better and improve the changes of recovery."

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Cowen P. How antidepressant drugs challenge depressive realism. RCPsych Annual Meeting, London 2008 Jul 3.

By John Gever, Staff Writer, MedPage Today

NEW YORK, July 4 — There's a new wave of research into targeted electromagnetic treatments for resistant depression, all aiming to relegate traditional electroconvulsive therapy (ECT) to obsolescence.

An estimated 15% to 20% of depressed patients don't respond to drug or talk therapies, sending many into the realm of ECT.

Younger Adults More Likely to Have Received Treatment; Stigma and Privacy Less of a Concern

Seeing a psychologist or other mental health professional isn't an unusual thing; in fact it's relatively common. Nearly three in ten U.S. adults (29%) report that they have received treatment or therapy from a psychologist or other mental health professional. The survey also found that younger adults are more open to seeking mental health treatment than those over 50 and that many adults are not discouraged from seeking treatment because of stigma or fear of others finding out.

People caught up in terrorist attacks or natural disasters are more resilient, both as individuals and in groups, than previously thought.

Far from being passive "victims" they can be highly organized survivors, so much so that they should be involved in drafting mental health guidelines to deal with major disasters.

Richard Williams, professor of mental health strategy at the University of Glamorgan, was speaking at a symposium on conflict and mental health at the Annual Meeting of the Royal College of Psychiatrists at Imperial College London.

Prof Williams drew a distinction between distress - a perfectly understandable reaction to a traumatic event - and a post-traumatic stress disorder (PTSD) and said that it was important not to medicalise, 'ordinary processes' such as bereavement.

He defined resilience as a person's ability to adapt psychologically, emotionally and physically to the situation "reasonably well" and without lasting detriment to themselves, or their relationships.

Resilience is not about avoiding short-term distress - indeed resilient people include those who show their distress, he told delegates. It is about adapting to their situation and being realistic about their recovery. "Resilient people may experience a period of distress and then recover with the support of their families and friends."

Strong relationships, an ability to receive help and social support, a belief in their own competence and strong self-esteem, lie at the heart of resilience. "What happens in your past comes alive in you during a disaster and you draw on that," said Prof Williams.

Survivors from disasters and terrorist events should be offered responses that draw on psychological first aid, Prof Williams told the conference. Being protected from further threat, being consoled and comforted and given immediate physical care, are all vital, as is being reunited with loved ones and linking up with other support services, if necessary.

The notion that crowds panic following disaster and terrorist attacks, is a myth. During the London bombings on 7 July 2005, the 'first responders' were the survivors in the bus and underground carriages in which the terrorists chose to detonate their bombs, as well as passengers on an adjacent train, said Prof Williams.

Referring to descriptions in a book by a London journalist who was present, and research, Professor Williams said: "Most of the survivors continued to experience thoughts of threat but the prevailing response was of calm, mutual help, concern and ordered behavior. They remained functional and did not panic. This group of people stuck in a very serious situation were behaving resiliently. This should influence what we do in the aftermath of a disaster."

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Williams R. Resilience in the face of terrorism and disaster Presentation, RCPsych Annual Meeting, London 2008 Jul 2.

Researchers from Denmark reported that patients who are long-term takers of tricyclic antidepressant medications have a 53% increased incidence of non-Hodgkin lymphoma (NHL). These data were also published in the July issue of Epidemiology.

By Jennifer Gibson, PharmD

Could the treatment of psychiatric and mood disorders be as simple as eating more fish? Fish oil contains, specifically docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA), which are known to have positive cardiovascular outcomes. Fish oil intake, through diet or supplementation, has noteworthy effects on lowering total cholesterol, lowering LDL ("bad" cholesterol), and increasing HDL ("good" cholesterol). In addition to the cardiovascular benefits of fish oil, there may be neurological, psychiatric, and emotional benefits, as well.

Pitti C, Peñate W, de la Fuente J, Bethencourt J, Acosta L, Villaverde M, Gracia R.

Hospital Universitario de Canarias, Spain.

[Article in Spanish]

INTRODUCTION: Several validation studies have identified the use of certain psychodrugs, cognitive-behavioral therapy (CBT) and combined treatment as effective procedures for the treatment of agoraphobia. Recent findings suggest that agoraphobia can also be treated with virtual reality techniques (VRET) as an alternative exposure technique to virtual reality stimuli.

METHODOLOGY: Twenty-seven patients with agoraphobia were distributed into two groups of psychoactive drugs (paroxetine and venlafaxine) and into two cognitive- behavioral procedures (with or without exposure to VRET). Seven virtual situations were used.

RESULTS: Preliminary results show significant improvements in all the experimental groups. Regarding the psychodrugs (paroxetine and venlafaxine) both significantly improved the symptoms and in regards to the CBT, patients treated with VRET, especially the chronic patients, seem to obtain the best results.

CONCLUSIONS: Agoraphobia combined treatments including paroxetine, venlafaxine and cognitive-behavioral therapy (with or without VRET) seem to have clear benefits for the patients. VRET seem to be a possible and effective treatment for agoraphobic patients, especially for those with chronic agoraphobia.

(Text has been reformatted for clarity; ed.)