March 25, 2020 Rita Rubin, MA
JAMA. 2020;323(14):1333-1334. doi:10.1001/jama.2020.1836
Recent studies have assessed the relationship
between sedentary behavior and depressive symptoms in adolescents, whether
benzodiazepines or z-hypnotics increase dementia risk, and how opioid
prescribing rates differ among people with certain psychiatric illnesses
compared with the general public.
Less Physically Active Teens Might Have Higher
Depression Risk
Younger adolescents who stay physically active
during their teens might help lower their risk of depressive symptoms at age 18
years, a recent study in The Lancet Psychiatry suggests.
Depression appears to be increasing among
adolescents, the authors wrote. They cited a US study that showed that the
12-month prevalence of major depressive episodes in teens rose from 8.7% in
2005 to 11.3% in 2014.
London researchers distributed hip-worn
accelerometers to measure how physically active a population-based cohort of UK
adolescents were at ages 12, 14, and 16 years and compared those findings with
results from a standardized mental health assessment when they were 18 years
old. The scientists had accelerometer data for 1220 teens at all 3 age points
and for 2486 at 1 or more time points.
To the best of their knowledge, the authors
wrote, theirs was the first study to use repeated objective measures instead of
self-reported data to examine whether physical activity levels and sedentary
behavior were associated with depressive symptoms in adolescents. Self-reported
information about physical activity is subject to biases, such as recall and
mood, the authors noted.
The accelerometer data showed that total
physical activity decreased as the adolescents got older, driven by a decline
in light physical activity and an increase in sedentary behavior.
Depression scores at age 18 years were 8% to
11% lower for every additional 60 minutes per day of light activity at ages 12,
14, and 16 years. Depression scores were 8% to 11% higher for every additional
hour of sedentary behavior per day.
However, total physical activity and moderate
to vigorous physical activity weren’t consistently associated with depressive
symptoms, possibly because the study was underpowered to detect that, the
authors wrote. Only 50 participants at baseline got at least 60 minutes of
moderate to vigorous physical activity per day, as recommended by UK national
guidelines.
Light activity could include standing during
some classes, having to walk distances between classes, or engaging in hobbies
such as playing a musical instrument or painting, the authors wrote. They noted
that a variety of psychosocial and biological mechanisms could explain why
physical activity might influence depressive symptoms. They include stimulating
neuroplasticity in brain regions connected to depression, reducing
inflammation, or promoting self-esteem.
Sleep Medications Linked to Higher Dementia
Risk
Using benzodiazepines (BZDs) or z-hypnotics
may increase the risk of developing dementia, scientists in Taiwan
recently reported in Neurotherapeutics.
The researchers identified 260 502 people aged
65 years or older in Taiwan’s National Health Insurance Research Database who
were newly prescribed oral BZDs or z-hypnotics between 2003 and 2012.
Z-hypnotics are nonbenzodiazepines with
similar clinical effects. They include zaleplon (Sonata), zolpidem (Ambien,
Intermezzo), and zopiclone. (Zopiclone is not approved in the United States,
but eszopiclone, a stereoisomer of zopiclone, is sold under
the brand name Lunesta, among others.)
Compared with nonusers, older people who used
BZDs or z-hypnotics for more than 28 days during each quarter of the year had a
greater risk of dementia during the follow-up period. The risk was even more
pronounced in patients who took both types of drugs at the same time.
Paradoxically, short-acting BZDs were associated with a greater risk of
dementia than long-acting BZDs. People who used a combination of short-acting
and long-acting BZDs as well as a z-hypnotic were nearly 5 times more likely to
be diagnosed with dementia than people who didn’t use any of the drugs.
One limitation of their study, the authors
noted, was that their data set did not include some factors related to
cognitive decline, such as education, smoking, alcohol consumption, family
history, apolipoprotein E4 status, and baseline cognitive function.
Still, in an accompanying editorial,
2 University of Florida cognition scientists called the study’s finding
“alarming” and deserving of “additional scrutiny of prescribing habits and
susceptibility to neurodegenerative changes.”
Opioid Dispensing Among Patients With Serious
Mental Illness
People with serious mental illness, who are
most at risk of developing opioid-related problems, are also more likely to be
prescribed opioids than individuals without mental illness, a recent study in BMC
Psychiatry concluded.
The study’s authors noted that people with
mental illness may also have particularly high rates of chronic noncancer pain.
More frequent complaints of pain, higher pain intensity, and the more chronic
nature of pain reported in some people with mental health disorders can make
them much more likely to be prescribed an opioid than people without mental
health problems, although evidence of the drugs’ effectiveness over the
long-term is lacking, the researchers wrote. To date, however, the authors
said, little is known about opioid prescribing rates among people with mental
illness.
For the BMC Psychiatry study,
the researchers, who were from Georgia State University in Atlanta and several
Kaiser Permanente locations, analyzed electronic medical record data from
the 13 sites that make up the Mental Health
Research Network, funded by the National Institute of Mental Health.
They identified 65 750 people diagnosed with
major depressive disorder (MDD), 38 117 with bipolar disorder, and 12 916 with
schizophrenia or schizoaffective disorder and matched them on age, sex, and
Medicare status to controls with no documented mental illness. All were aged 18
to 70 years and had insurance.
The scientists examined data about chronic
non–cancer pain diagnoses and prescription opioid medication dispensing. After
accounting for age, sex, race, income, medical comorbidities, and health care
utilization, they found that having an MDD or bipolar disorder diagnosis
increased the odds of being diagnosed with chronic noncancer pain by nearly
2-fold. Conversely, having a schizophrenia diagnosis was linked with a 14%
lower chance of having the pain diagnosis.
What’s more, patients with a bipolar disorder
or MDD diagnosis were, respectively, 2 and 2 ½ times more likely to receive an
opioid prescription, even after accounting for potential confounders as well as
a chronic pain diagnosis.
The relationship between depressive symptoms
and opioid use is likely bidirectional, the authors wrote. Although people with
MDD or bipolar disorder might present with more severe pain that results in an
opioid prescription than people without either condition, prior research suggests that chronic opioid use can
increase the risk of depression.
Having a schizophrenia diagnosis was not
associated with receiving opioids. One possible explanation is that people with
schizophrenia might have reduced
sensitivity to pain compared with individuals without
psychiatric illness. And research has shown that antipsychotics
have analgesic qualities. On the other hand, the authors wrote, people with
schizophrenia might experience as much pain as those with other mental
illnesses, but they might be less
likely to express it.
The authors noted that their study had some
limitations: Data about opioid prescriptions might not necessarily represent
patients’ actual medication use. Plus, patients with 2 or more mental health
diagnoses were classified as having only the one the researchers ranked as most
serious, with schizophrenia first, bipolar disorder second, and mood disorder
third. And, because all the patients in their sample had health care coverage,
the findings might not be generalizable to uninsured populations.
Some have called for mental health clinicians to help
manage pain in patients with psychiatric disorders, the authors noted, but
added that more research is needed to evaluate the effectiveness of doing so.
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