So says this report published this week in the Archives of General Psychiatry.

According to the report, nearly 9% of patients started on antidepressants were also started on antipsychotics - an increase of 40% compared to 1996.

Of all the drugs out there there are perhaps none more uniformly detrimental to weight than the newest generation of antipsychotics where it's not even remotely abnormal to see patients gain 20-60lbs within a year of initiation.

Unfortunately these results don't surprise me at all as in my experience it's not just for depression where antipsychotics are inappropriately prescribed without considering the inevitable weight related consequences as they've also found favour with some physicians as sleep aids.

Bottom line?

Antipsychotics should be used to treat psychosis - and if someone's going to use them to augment therapy with an antidepressant or for another off label use they'd better darn well have exhausted every other possible treatment strategy.

Mark Olfson, MD, MPH; Steven C. Marcus, PhD (2009). National Patterns in Antidepressant Medication Treatment Archives of General Psychiatry, 66 (8), 848-856

Depression is an all too common medical condition and seasonal affective disorder is common too.

Ever wonder how severe your depression or seasonal blues are, or whether or not you should pursue treatment?

I recently found some great net based testing utilizing the very same tests that psychologists and psychiatrists administer to their patients - and like many things net-based, they're free. They can help you determine if you need help or in the event of ongoing therapy, can help to track progress. Now of course they won't take the place of the clinical judgment of a decent doctor, but they may be a good place to start.

Click here and the Centre for Environmental Therapeutics will serve you the option to take a Personal Inventory of Depression and SAD, or a Structured Interview for the Hamilton Depression Rating Scale with Atypical Depression Supplement, or your Morningness-Eveningness Questionnaire (regarding circadian rhythms).

Doctors reading my blog may want to let their patients fill these out in their offices as you can send the results to the printer.

Thank you internets!

A great deal of well designed research has been published demonstrating that exercise is just as good, if not better, than antidepressants for mild to moderate depression.

One of the best papers on the matter was published in 2000 in the journal Psychosomatic Medicine. In it Michael Babyak and his co-authors randomly assigned 156 depressed adults to one of three groups: Zoloft, Exercise, or Zoloft plus exercise. They then looked at depression after 4 months and again after 10 months utilizing the fairly standard Hamilton Rating Scale for Depression.

Exercise involved 10 minutes of warmup followed by 30 minutes of moderate intensity cycling, jogging or brisk walking and finally by 5 minutes of cool down. This was performed 3 times per week.

The results were impressive. After 16 weeks of treatment all groups showed significant reductions in their depressive symptoms. Medication worked faster, but by week 16 exercise had caught up. What was more impressive were the results at 10 months - those exercising had lower remission rates than those on Zoloft or a combination of Zoloft and exercise.

The authors summarized their results with the following statement, "Each 50-minute increment in exercise per week was associated with a 50% decrease in the odds of being classified as depressed"

Bottom line: Don't throw out your pills, but slowly, along with your doctor, it may be reasonable to try to trade your drugs for some great shoes and a minor committment to exercise.

This month the journal Psychosomatic Medicine published a very interesting paper on the effects of stopping exercise on mood.

Their study involved taking 40 regular exercisers (>30mins per time, >3times/week) who were not taking or receiving any psychological or psychiatric treatment, and simply asking 20 of them to stop exercising for two weeks. They then compared symptoms and mood between those who continued exercising versus those who stopped.

Within one week of stopping exercise, compared with folks still exercising the study subjects reported more fatigue and depressive symptoms which then worsened in week number two.

While we probably didn't need a study to prove this (anyone who exercises regularly and has to stop knows this to be true already), here is now proof of yet another reason not to stop exercising!

Today the Canadian Journal of Psychiatry published an article that the media has picked up upon that states that depression is more prevalent in obese patients.

The Montreal Gazette states, "Obesity-depression link is confirmed", CanWest News Service states, "Obesity, depression have same root causes, study suggests".

So what did the study state? It stated that 19% of obese Canadians were depressed compared with "only" 15% of the general population.

To me that sure doesn't seem like a slam-dunk difference.

There are many co-morbdities associated for obesity that apparently were not controlled that almost certainly could contribute to the development of depression. Things like pain from increased incidences of osteoarthritis, worry from cardiovascular disease and diabetes, bias and discrimination in the workplace, frustration with weight loss difficulties.

As well, the majority of medications used in the treatment of depression themselves directly lead to weight gain and while the medication induced weight gain is not always dramatic, it can be.

Bottom line for me is that there are a lot of realities commonly associated with obesity that are in and of themselves depressing and there are a lot of realities associated with the treatment of depression that are in and of themselves obesogenic.