R7420_2_DEP2_4_COV_CME_03.qxd 20/7/06 17:23 Page 1 VOLUME 2 NUMBER 4 2006 DEPRESSION: Mind and Body Advances in the Understanding and Treatment of Depression and its Physical Symptoms Editor-in-Chief Alan F Schatzberg, Stanford, CA, USA The Role of Vagus Nerve Stimulation as a Therapy for Treatment-Resistant Depression Mustafa M Husain, Kenneth Trevino, Louis A Whitworth, and Shawn M McClintock Neuropsychiatric Effects of IL-2: Mechanisms and Treatment Implications Stephen E Nicolson, Andrew H Miller, David Lawson, and Dominique L Musselman The Bidirectional Relationship between Diabetes Mellitus and Depression Sanjay J Mathew and Susan Burd www.depressionmindbody.com This activity has been planned and implemented in accordance with the Essential Areas and Policies of the ACCME through the joint sponsorship of the University of Kentucky College of Medicine and Remedica. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The University of Kentucky is an equal opportunity university. R7420_2_DEP2_4_COV_CME_03.qxd 20/7/06 17:23 Page 2 Depression: Mind and Body is supported by an unrestricted educational grant from Wyeth Pharmaceuticals Editor-in-Chief Alan F Schatzberg Kenneth T Norris Jr, Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA Editorial Advisory Board Dwight Evans Kurt Kroenke Professor and Chair, Department of Psychiatry, Professor of Medicine, Department of Medicine University of Pennsylvania, Philadelphia, PA, USA and Regenstrief Institute for Health Care, Indiana Maurizio Fava University School of Medicine, Indianapolis, IN, USA Psychiatrist and Director, Depression Clinical and Yves Lecrubier Research Program, Massachusetts General Hospital, Director of Research, Hôpital de la Salpêtrière, Boston, MA, USA Paris, France John Greden Norman Sartorius Professor and Chair, Department of Psychiatry, Psychiatry Department Director, University Hospital, University of Michigan Depression Center, Geneva, Switzerland Ann Arbor, MI, USA Donna Stewart Wayne Katon Professor and Chair, Women’s Health University Professor and Vice Chair, Department of Psychiatry Health Network and University of Toronto, and Behavioral Sciences, University of Washington, Toronto, ON, Canada Seattle, WA, USA Editors Christos Ballas Po W Wang Assistant Clinical Professor, Department of Psychiatry, Senior Research Scientist, Bipolar Disorders Clinic, University of Pennsylvania Medical Center, Philadelphia, Department of Psychiatry and Behavioral Sciences, PA, USA Stanford University School of Medicine, Stanford, CA, USA Editorial Policy Depression: Mind and Body is an independent journal published by Remedica Medical Education and Publishing. Editorial control is the sole responsibility of the Editor-in-Chief, Editorial Advisory Board, and the Editors. Before publication, all material submitted to the journal is subjected to rigorous review by the Editor-in-Chief, Editorial Advisory Board, Editors, and/or independent reviewers for suitability of scientific content, scientific accuracy, scientific quality, and conflict of interest. Aims and Scope Depression: Mind and Body is designed to bring a critical analysis of the world literature on depression, written by clinicians, for clinicians, to an international, multidisciplinary audience. Our mission is to promote better understanding of the treatment of depression across the global healthcare system by providing an active forum for the discussion of clinical and healthcare issues. Leading Articles - These major review articles are chosen to reflect topical clinical and healthcare policy issues in depression. All contributions undergo a strict editorial review process. Clinical Reviews - The most important papers from the best of the international literature on depression are systematically selected by an internationally recognized panel of experts. The Editors then prepare concise and critical analyses of each paper, and, most importantly, place the findings into clinical context. Meeting Reports - Depression: Mind and Body also provides incisive reportage from the most important international congresses. Publisher’s Statement ©2006 Remedica Medical Education and Publishing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of the copyright owners. While every effort is made by the publishers and editorial board to see that no inaccurate or misleading data, opinions, or statements appear in this journal, they wish to make it clear that the material contained in the publication represents a summary of the independent evaluations and opinions of the authors and contributors. As a consequence, the board, publishers, and any supporting company accept no responsibility for the consequences of any such inaccurate or misleading data or statements. Neither do they endorse the content of the publication or the use of any drug or device in a way that lies outside its current licensed application in any territory. Depression: Mind and Body (ISSN 1479-5035) is published four times a year by Remedica Publishing Ltd and distributed by USA Mail Agent Pronto Mailers Association, 544 Lincoln Boulevard, Middlesex, NJ 08846. Subscription price $170 per year. Periodicals Postage Paid at Middlesex NJ. POSTMASTER: Please send address changes to Remedica Publishing Ltd, 544 Lincoln Boulevard, Middlesex NJ 08846-2439. Remedica Medical Education and Publishing Ltd., Commonwealth House, 1 New Oxford Street, London WC1A 1NU, UK. Telephone: +44 (0)20 7759 2999 Fax: +44 (0)20 7759 2951 Email: [email protected] Editorial Team: Emma Beagley, Scott Millar Editorial Director: Reghu Venkatesan Publishers: Ian Ackland-Snow, Simon Kirsch Design and Artwork: AS&K Skylight Creative Services ISSN 1479-5035 R7420_2_REM_DEP2_4_17.qxd 20/7/06 17:39 Page 113 Dear Colleagues, Contents Welcome to the final issue of the second volume of Depression: Mind and Body. Leading Articles Although great advances have been made in therapies for The Role of Vagus Nerve Stimulation as a the treatment of depression, some patients fail to respond Therapy for Treatment-Resistant Depression to initial treatment courses, and many do not respond to Mustafa M Husain, Kenneth Trevino, multiple medication trials. These patients are described as Louis A Whitworth, and Shawn M McClintock 114 having treatment-resistant depression (TRD) and the prevalence of this disorder calls for new treatment techniques. In this Neuropsychiatric Effects of IL-2: issue, Dr Husain and colleagues (University of Texas Mechanisms and Treatment Implications Southwestern Medical Center at Dallas, Dallas, TX, USA) Stephen E Nicolson, Andrew H Miller, David Lawson, and Dominique L Musselman 120 discuss a novel neurostimulation technique, vagus nerve stimulation (VNS) therapy, and its role as an antidepressant The Bidirectional Relationship between therapy for patients with TRD. Studies have demonstrated Diabetes Mellitus and Depression the safety and efficacy of VNS therapy for patients suffering Sanjay J Mathew and Susan Burd 130 from TRD, and this article expands upon its mechanism of action and the results of recent trials. Our second article examines interleukin-2 (IL-2), a vital Clinical Reviews signaling molecule in immune and inflammatory responses as Epidemiology 134 well as in cell migration and differentiation. IL-2 has been used for the treatment of diseases such as cancer and AIDS; Clinical Practice 137 however, it exhibits strong adverse effects, including a high Comorbidities 140 incidence of depressive symptoms and memory disturbances. The mechanisms for these effects are not well documented Pathogenesis 142 or understood and Dr Nicolson and colleagues (Emory University School of Medicine, Atlanta, GA, USA) provide an insight into the neuropsychiatric effects of IL-2 and their Meeting Reports treatment implications. 14th Annual Meeting of the Association As is well-known, depression is frequently comorbid with a of European Psychiatrists (AEP) number of diseases. Drs Mathew and Burd (Mount Sinai Nice, France, 4–8 March, 2006 146 School of Medicine, New York, NY, USA) elaborate on the association between depression and diabetes, offering 159th Annual Meeting of the American Psychiatric Association (APA) pathophysiological hypotheses regarding this relationship and Toronto, ON, Canada, 20–25 May, 2006 148 reviewing treatment approaches for the depressed patient suffering from comorbid diabetes mellitus. As in all issues, the Clinical Reviews provide concise and critical analyses of the latest depression literature, placing recent developments into a clinical context. These are followed by reports of the most important presentations concerning depression from the Annual Meeting of the Association of European Psychiatrists (Nice, France) and an extended report of the highlights of the American Psychiatric Association Annual Meeting (Toronto, ON, Canada). We are pleased that the comments we have received about Depression: Mind and Body have been overwhelmingly positive and that the journal continues to be regarded as a useful resource by clinicians working in this fast-developing field. We welcome your comments and suggestions and look forward to your feedback and any thoughts to help us provide a relevant review of current topics.