JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, January 23, 2007)
JAMA NEWS RELEASES
MEDICATION EFFECTIVE IN TREATING DEPRESSION IN PATIENTS WITH CORONARY ARTERY DISEASE
AMONG OLDER ADULTS, MEN HAVE SIMILAR REFRACTURE RISK AS WOMEN
TUBERCULOSIS INTERVENTION PROGRAM IMPROVES PATIENT OUTCOMES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
ANTIDEPRESSANT MORE EFFECTIVE THAN PSYCHOTHERAPY IN TREATING DEPRESSION IN HEART DISEASE PATIENTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
This week's JAMA Report video is on the effect of an anti-depressant for patients with coronary artery disease. The report will be fed Tuesday, January 23, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (C-Band), Transponder 09, Downlink Frequency 3880 MHz Vertical, Audio: 6.2/6.8. For more information, call 312/464-JAMA.
Please Note: Because JAMA does not publish on the 5th Wednesday of a month, there will be no JAMA or news releases for January 31.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, January 23, 2007
Media Advisory: To contact Francois Lespérance, M.D., call Marc Tulin at 514-343-7593 or Sophie Langlois at 514-343-7704. To contact editorial co-author Alexander H. Glassman, M.D., call Dacia Morris at 212-543-5421.
MEDICATION EFFECTIVE IN TREATING DEPRESSION IN PATIENTS WITH CORONARY ARTERY DISEASE
CHICAGO—Patients with symptoms of depression who have coronary artery disease showed improvement of their symptoms with use of the drug citalopram, but adding interpersonal psychotherapy did not appear to be of benefit, according to a study in the January 24/31 issue of JAMA.
Since the early 1990s, studies have reported prevalences of major depression between 17 percent and 27 percent in hospitalized patients with coronary artery disease (CAD). Most have also demonstrated that depression can have a negative effect on cardiac outcomes, according to background information in the article. While there is a need for studies evaluating interventions to prevent this, there have also been few adequate trials evaluating whether depression treatments are effective in reducing depressive symptoms in patients with CAD. None of these trials have simultaneously evaluated an antidepressant and short-term psychotherapy.
Francois Lespérance, M.D., of the Université de Montréal, and colleagues with the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial, evaluated the short-term effectiveness and tolerability of two depression treatments in patients with CAD: citalopram, a selective serotonin reuptake inhibitor (SSRI) antidepressant and interpersonal psychotherapy (IPT), a short-term, manual-based psychotherapy focusing on the social context of depression. The 12-week study included 284 patients with CAD from nine Canadian academic centers and was conducted from May 2002 to March 2006. All patients met criteria for a diagnosis of major depression of four weeks’ duration or longer.
Participants were randomized: (1) to receive either 12 weekly sessions of IPT plus clinical management (n = 142) or clinical management only (n = 142) and (2) to receive either 12 weeks of citalopram (n = 142), or matching placebo (n = 142).
Clinical management involved weekly sessions with information about depression and medication use, reassurance, and encouragement of adherence to medication and the study protocol. Interpersonal psychotherapy involved sessions dealing with problems common in patients with CAD, including interpersonal conflicts, life transitions, grief, and loss.
The researchers found that citalopram was superior to placebo in reducing depressive symptoms in all efficacy measures. The remission and response rates and average changes on a depression measurement scale also consistently favored citalopram over placebo. The superiority of citalopram was apparent by 6 weeks. Although patients improved with both IPT and clinical management, there was no evidence of superiority for IPT, and remission and response rates did not differ between those two treatments.
The authors add that the benefits of citalopram extended to changes in perceived social support and daily function.
“Citalopram (or sertraline, as previously shown in [a different] trial) plus clinical management should be considered for the initial acute-phase treatment for major depression in patients with CAD. It remains to be demonstrated that any form of psychotherapy is superior to clinical management in reducing depression symptoms in this group,” the researchers conclude.
(JAMA. 2007;297:367-379. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a Canadian Institutes of Health Research (CIHR) Clinical Trials Program grant, the Fondation du Centre Hospitalier de l’Université de Montréal, and the Fondation de l’Institut de Cardiologie de Montréal. Citalopram and matching placebo were donated by Lundbeck Canada Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: ANTIDEPRESSANTS IN CORONARY HEART DISEASE
In an accompanying editorial, Alexander H. Glassman, M.D., and J. Thomas Bigger, Jr., M.D., of the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, comment on the findings of Lespérance and colleagues.
“The CREATE study, a 12-week trial involving 284 coronary heart disease (CHD) patients, provides further evidence for the antidepressant efficacy of SSRIs for patients with CHD. Because depression is a painful, often chronic condition; because it impairs adherence to physicians’ advice, prescribed medication, and secondary prevention efforts; and because both sertraline and citalopram have evidence of efficacy and safety, clinicians should screen for depression in patients with CHD and maintain a low threshold for treatment with an SSRI. However, although there is suggestive evidence, whether SSRIs reduce cardiac events has not been established. For that a large, randomized clinical trial is urgently needed. Ironically, the compelling rationale for treating post-acute coronary syndrome depression can limit the possibility for studies to definitively establish whether SSRIs influence cardiac morbidity and mortality.”
(JAMA. 2007;297:411-412. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – none reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, January 23, 2007
Media Advisory: To contact Jacqueline R. Center, M.B.B.S., Ph.D., email: j.center{at}garvan.org.au.
AMONG OLDER ADULTS, MEN HAVE SIMILAR REFRACTURE RISK AS WOMEN
CHICAGO—After sustaining an initial low-trauma fracture, older men and women have a similar and substantial risk of subsequent fracture, according to a study in the January 24/31 issue of JAMA.
Despite substantial evidence that a prior fracture results in an increased risk of subsequent fracture, less than 30 percent of postmenopausal women and less than 10 percent of men with prior fracture are treated to help lower this risk. Although some of this deficiency in treatment is due to the overall lack of awareness of osteoporosis by the public and primary caregivers, the relative importance of prior fracture in relation to subsequent fracture risk does not appear to be fully appreciated, particularly in men, according to background information in the article. There are few published long-term studies on absolute risk of refracture in women, and fewer in men.
Jacqueline R. Center, M.B.B.S., Ph.D., of the Garvan Institute of Medical Research, St. Vincent’s Hospital, University of New South Wales, Sydney, Australia, and colleagues examined absolute refracture risks for a variety of osteoporotic fracture types in a group of community-dwelling men (n = 1,760) and women (n = 2,245) age 60 years or older in Australia. The participants were followed up for 16 years, from July 1989 through April 2005.
There were 905 women and 337 men with an initial fracture, of whom 253 women and 71 men experienced a subsequent fracture. Women had nearly twice the risk of refracture, while men had 3.5 times the risk of refracture. The absolute risk of subsequent fracture was similar in women and men. The increase in absolute fracture risk remained for up to 10 years, by which time 40 percent to 60 percent of surviving women and men experienced a subsequent fracture.
For women, the absolute refracture risk was equivalent to or greater than the initial fracture risk of a woman 10 years older. For example, a 60- to 69-year-old woman with an initial fracture had an absolute refracture risk comparable to or greater than an initial fracture risk of a 70- to 79-year-old woman.
For men, the absolute risk of a subsequent fracture was similar to that of women and equivalent to or greater than an initial fracture risk of a woman 10 years older. For example, a 60- to 69-year-old man’s absolute refracture risk was equivalent to or greater than a 70- to 79-year-old woman’s initial fracture risk and similar to the initial risk of a man at least 20 years older.
All fracture locations apart from rib (men) and ankle (women) resulted in increased subsequent fracture risk, with highest risks following hip and clinical vertebral fractures in younger men. In further analyses, femoral neck bone mineral density, age, and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density, physical activity, and calcium intake were predictors in men.
“The critical clinical relevance of these findings is that any incident low-trauma fracture is a signal for increased risk of all types of subsequent osteoporotic fracture, particularly in the next 5 to 10 years. Thus, virtually all low-trauma fractures indicate the clinical need for fracture preventive therapy, and given the early peak of refracture, such preventive treatment should not be delayed. The lack of consideration of osteoporosis and treatment initiatives by the medical profession and the public, particularly in relation to men, should be the focus of education initiatives,” the researchers conclude.
(JAMA. 2007;297:387-394. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was partly funded by a National Health & Medical Research Council (NH&MRC) grant (federal granting body) and with unrestricted educational grants from Merck Sharp and Dohme, Eli Lilly, and GE Lunar Corporation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, January 23, 2007
Media Advisory: To contact corresponding author Christian Lienhardt, M.D., M.Sc., Ph.D., email: clienhardt{at}iuatld.org.
TUBERCULOSIS INTERVENTION PROGRAM IMPROVES PATIENT OUTCOMES
CHICAGO—Patients with tuberculosis in the West African country of Senegal who participated in an intervention program that included improved communication with health personnel and community involvement had higher cure and treatment completion rates, according to a study in the January 24/31 issue of JAMA.
Poor adherence to treatment remains a major obstacle in the global fight against tuberculosis (TB). Reasons for nonadherence are complex and involve more than the patients’ personal characteristics and attitudes, according to background information in the article. Factors such as the chronic nature of the disease, poverty, and interacting with physicians, nurses, and other health care workers, all affect access to and compliance with treatment. New strategies to improve access and adherence to treatment are needed.
Sylla Thiam, M.D., of the Programme Tuberculose, Dakar, Senegal and colleagues conducted a study to determine the effectiveness of a strategy developed to address the problem of low adherence and improve treatment outcomes in Senegal. The randomized controlled trial included 1,522 patients older than 15 years with newly diagnosed pulmonary TB who were randomly assigned to the intervention (n = 778 patients) or control (n = 744 patients) group. The intervention strategy included reinforced counseling through improved communication between health personnel and patients, decentralization of treatment, choice of directly observed therapy (DOT) supporter by the patient, and reinforcement of supervision activities. In the control group, the usual TB control program procedures remained unchanged. The study was conducted between June 2003 and January 2005 at 16 government district health centers in Senegal.
Treatment was successful for 682 patients (88 percent) in the intervention group compared with 563 patients (76 percent) in the control group. The risk of defaulting from treatment was nearly 60 percent lower in the intervention group (43 patients [5.5 percent] defaulted from treatment in the intervention group vs. 125 patients [16.8 percent] in the control group). The intervention also significantly decreased the time to defaulting since the start of treatment.
“Control of TB depends on effective treatment as well as effective strategies to support the process of care from detection of disease through the completion of appropriate treatment. A key aspect of our approach was to identify, based on qualitative studies, an intervention that would be feasible, sustainable, and fully acceptable by the patients and the health care services. This, we believe, is the path toward making TB control more responsive and reflective of local health systems and social constraints and resources.”
“Our results show that the intervention we tested, consisting of a coherent package of sustainable activities targeting altogether health staff, patients, and communities, did improve treatment outcomes. This intervention could now be implemented in a stepwise manner throughout Senegal, and we believe that this approach may be generalized within the context of TB control programs in other resource-poor countries,” the authors conclude.
(JAMA. 2007;297:380-386. Available to the media at www.jamamedia.org)
Editor's Note: This study was funded through a special program from the French Ministry of Research, called PAL+, which was granted in September 2000. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
ANTIDEPRESSANT MORE EFFECTIVE THAN PSYCHOTHERAPY IN TREATING DEPRESSION IN HEART DISEASE PATIENTS
VIDEO:
SOT/FULL
@ :02
Super: Edward Pietrantonio
Depression/Heart patient
Runs : 17
AUDIO:
“I went through the death of someone that was very close to me and we had problems in the family and everything came at once and then the heart gave out.”
VIDEO:
B-ROLL
Edward and Dr. Lesperance walking into office
Sitting in office
GFX/JAMA Cover
Man having ultrasound of heart
AUDIO:
SIXTY-FIVE-YEAR OLD EDWARD PIETRANTONIO (pee-YET-tran-tonio) HAD A HEART ATTACK FIFTEEN YEARS AGO. HE SAYS HIS DEPRESSION AND HEART PROBLEMS COINCIDED. THAT’S VERY COMMON, SO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, EXPLORED THE BEST WAY TO TREAT DEPRESSION IN HEART DISEASE PATIENTS.
VIDEO:
SOT/FULL
@ :36
Super: Francois Lesperance, M.D.
University of Montreal
Runs :08
AUDIO:
“It has been known for many years that depression is highly prevalent in patients with heart disease, so we wanted to evaluate two treatments of depression.”
VIDEO:
B-ROLL
Dr. Lesperance and colleague at computer
Pharmacist filling Citalopram prescription
Psychotherapist with patient in office
AUDIO:
DR. FRANCOIS LESPERANCE (lay-pair-AHN) OF UNIVERSITY OF MONTREAL WAS PART OF A CANADA-WIDE STUDY OF ALMOST THREE-HUNDRED PATIENTS. FOR TWELVE WEEKS, RESEARCHERS COMPARED THE EFFECTS OF AN ANTIDEPRESSANT DRUG, CITALOPRAM (sight-AL-o-pram) TO THE EFFECTS OF WEEKLY PSYCHOTHERAPY – FORTY-FIVE-MINUTE SESSIONS WHERE PATIENTS TALKED ABOUT THEIR DEPRESSION.
VIDEO:
SOT/FULL
Francois Lesperance, M.D.
University of Montreal
Runs :09
AUDIO:
“An antidepressant working on the serotonin system in the brain was helping the patient with depression, improving their depressive symptoms.”
VIDEO:
B-ROLL
More Psychotherapist with patient in office
AUDIO:
BUT INTERPERSONAL PSYCHOTHERAPY, TALKING ABOUT THEIR STRESSES, PROBLEMS AND RELATIONSHIP ISSUES, DID NOT HELP ANY MORE THAN DID BRIEF WEEKLY VISITS JUST TO MONITOR PATIENTS’ HEALTH.
VIDEO:
SOT/FULL
Francois Lesperance, M.D.
University of Montreal
Runs :07
AUDIO:
“Talking about these issues, trying to make changes, seems to have been difficult for patients with heart disease.”
VIDEO:
B-ROLL
Dr. Lesperance and Edward talking in office
AUDIO:
BUT DR. LESPERANCE SAYS PSYCHOTHERAPY CAN WORK FOR SOME PEOPLE, AND THAT HIS MOST IMPORTANT MESSAGE FOR PEOPLE SUFFERING FROM DEPRESSION IS, GET HELP. EDWARD AGREES.
VIDEO:
SOT/FULL
Edward Pietrantonio
Depression/Heart patient
Runs : 11
AUDIO:
“They should go see a doctor. That’s all I have to say. See a doctor, don’t wait. That’s it!”
VIDEO:
B-ROLL
Edward getting onto elevator
Edward walking down hallway
AUDIO:
THAT’S WHAT HE FINALLY DID, AND HIS DEPRESSION AND HEART HEALTH ARE MUCH IMPROVED. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
