December/January 2003
Volume 4, Issue 17
Editors: Betty Spinner, Liz Sklar, Barbara Z. and Steven Goodman.

Kadima's New Clinical Director
Thanksgiving and Hanukkah Dinner
Patch Raises New Hope For Beating Depression
Bubbi Knows Best

Kadima's New Clinical Director
By Liz Sklar

I spent some time talking with Kadima's new Clinical Director, Nancy Stein. Here are some highlights of our conversation.

Kadima Voice: First of all, how did you become aware of Kadima?
Nancy Stein: I have known Kadima for a long time. I've been acquainted with Janette Shallal for several years. We met while working in the social work field.

KV: Are you planning on making changes at Kadima?
NS: We are waiting to see what funding changes Easter Seals and Community Mental Health are going to make. We are hiring a new case coordinator for the Supported Independent Program (SIP) and for the independent living program.

KV: How were you welcomed at Kadima?
NS: Everyone's been very helpful.

KV: Have you read the Kadima Voice?
NS: I've been very impressed with the Kadima Voice.

KV: What positions have you held in the mental health field?
NS: I have been a social worker for Catholic Social Services and a Family Service District manager downriver in Southgate. In addition, I ran a program for sexually abused adults, teens, and children.

KV: What do you look forward to at Kadima?
NS: I feel that this will be a very challenging position and I look forward to working with the clients and the staff.

Kadima Thanksgiving and Hanukkah Dinner
By Steve Goodman

     Have you ever had potato latkes at a Thanksgiving dinner? I never had until Monday night (November 25) at Kadima's combination Thanksgiving and Hanukkah dinner. They were very tasty and went well with turkey.

     Normally, Kadima celebrates these two holidays separately. Because they fell so close together this year, it was decided to combine them. This event was held at the Berkley First United Methodist Church. The church is only about a mile and a half from Kadima's offices, so it was very convenient. 

     Of course, there was plenty of food. Geta Richman, our retired clinical director, brought a turkey to share with us. Many Kadima clients contributed to the dinner. There were the standard items: Turkey, stuffing, vegetables, various side dishes, soft drinks, etc, and those potato latkes. It was finished up with dessert, including the requisite pumpkin pie and cookies and cake.

     During our dinner, we were entertained by Michael Krieger on the piano. He sang many popular songs from the 1960's and the 1970's. Some people requested songs that he played as well. A few people had him accompany them on piano while they sang. They were Michael Basel, Joel Kraus, and our very own Kadima Voice editor, Betty Spinner. She sang "Take Me Out To The Ballgame." Betty is a very big Tigers fan. No one else was thinking about baseball, but she was.

     Besides potato latkes to remind us of Hanukkah, there were also gifts. We each received a grab bag full of useful and fun items. There were also hats and gloves available to keep us warm this winter. These gifts and a donation for the dinner were given by the Zager-Stone / Tucker-Grant Lodge of the B'nai B'rith.

     We would like to thank the Kadima staff and other volunteers who helped out at this event. Thanks to the Berkley First United Methodist Church for providing their facilities. Also, special appreciation to the B'nai B'rith. It was a very nice evening seeing old friends and celebrating the holidays. 

Patch Raises New Hope For Beating Depression
By Mary Duffy, New York Times

It was the first type of antidepressant, and for many people the monamine oxidase inhibitor remains the best hope for relief from major depression.

The trouble is, the side effects can be so serious that MAO inhibitors are rarely prescribed. When taken with certain foods, for example, they may bring on sudden and severe hypertension.

The problems, however, may soon be resolved.

A study reported in the November issue of the American Journal of Psychiatry suggests that by administering the MAO inhibitor selegiline in patch form, patients can receive the antidepressant benefits of the drug without the usual side effects.

In research conducted at six sites, 42 percent of the subjects treated with the patch recovered from major depression within six weeks, and many showed great improvement much sooner. In the study, neither subjects nor researchers knew who had received the dummy medication.

One subject, requesting anonymity, told how his mood changed after a few weeks on the patch, saying, "It was like a switch had gone on. Before I had the patch, I couldn't function. Suddenly, I had a dramatic change in outlook. I could look forward to things."

Monamine oxidase is an enzyme found in the brain and digestive system. By inhibiting MAO in the brain, the antidepressant is believed to give patients a better supply of neurotransmitters to fight the symptoms of depression. Taken orally, however, the medication also blocks MAO in the digestive system, and that interferes with the detoxification of tyramine, a harmful byproduct of many aged foods.

Patients receiving MAO inhibitors are instructed to follow a tyramine-restrictive diet, which means no aged cheeses, no red wine, no soy sauce, no fermented foods and little or no alcohol. Eating tyramine-rich food while taking an MAO inhibitor can cause sudden and severe hypertension.

Delivering selegiline through the skin, however, changes the way the medication is absorbed. Rather than first being filtered through the intestines and liver, in patch form, the drug is targeted to the central nervous system.

"With this study we've demonstrated a way of getting an MAO inhibitor to the brain without interfering with the MAO in the digestive system," said the study's lead author, Dr. Alexander Bodkin of the clinical psychopharmacology research program of McLean Hospital in Belmont, Mass. The study was supported by the developers of the selegiline patch, Somerset Pharmaceuticals of Tampa, Fla.

While subjects in this study were instructed to follow a tyramine-restricted diet, in subsequent studies they were not.

Dr. Beverly McCabe, a professor of dietetics and nutrition at the University of Arkansas at Little Rock and a co-author of the "Handbook of Food and Drug Interaction," to be published in January, believes this form of drug delivery offers great promise. "I would think the risk of a tyramine reaction would be very low with transdermal selegiline," McCabe said. "The drug would be absorbed into the bloodstream more evenly, which would also be beneficial."

Dr. Frederic Quitkin, director of the depression evaluation service at the New York State Psychiatric Institute in Manhattan, said, "MAO inhibitors are really great drugs: complicated to use but extremely effective." As for the selegiline patch, he said, the research is encouraging. But, he cautioned, "It will require further study to see how effective it is."

Another notable finding in the study of 177 patients was the 94 percent compliance rate for those on the selegiline patch. That is significant, said Bodkin, because compliance rates with oral antidepressants are typically much lower.

One side effect, in 36 percent of subjects, was a reaction, like redness or irritation, at the site of the patch. For most patients, Bodkin said, the irritation is minor compared with the side effects of most antidepressants.

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