Following are the latest news and information resources for the various mental health topics that we cover. We hope you will find the news educational and the links in the resources section useful in helping you to get even more in-depth data.
Abnormalities in the Brain’s immune cells cause major depression, according to a discovery at the Hebrew University of Jerusalem whose researchers think it could revolutionize next-generation medical treatment for psychiatric patients.
Drugs that restore the normal functioning of these cells can be effective as fast-acting anti-depressants, the researchers said.
“Microglia” cells in the brain, acting as the first and main form of active immune defense of the central nervous system, may be a key to causing depression, said psychobiology Prof. Raz Yirmiya, director of the HU psychoneuroimmunology lab. He has just published what has been described as a “groundbreaking theoretical review paper” in the peer-reviewed journal, Trends in Neurosciences.
Microglia, which comprise 10 percent of all brain cells, are the brain’s immune cells that fight bacterial and viral infections. They also promote repairing and healing processes of damages caused by brain injury and trauma.
“Our views on microglia have dramatically changed over the last decade,” he said. “We now know that these cells play a role in the formation and fine-tuning of the connections between neurons (synapses) during brain development, as well as in changes of these connections throughout life. These roles are important for normal brain and behavioral functions, including pain, mood and cognitive abilities.”
Major depression, which afflicts one in six people at some point in their life, is the leading global cause of disability – surpassing cardiovascular and respiratory diseases, cancer and HIV/AIDS combined.
“Progress in the understanding of the biology of depression has been slow,” said Yirmiya, and it requires expanding our knowledge beyond the “abnormalities in the functioning of neurons.” Other brain cells – often neglected by researchers – may be more relevant in causing depression, he said.
Some forms of depression may result from malfunctioning microglia, he said, but this does not mean that all sub-types of depression or other psychiatric diseases are caused by abnormalities in these cells.
Yirmiya’s new research could have a profound impact on the future development of anti-depressant medications; current drugs do not always have the desired effect on patients, so there is an urgent need to discover novel biological mechanisms and drug targets for diagnosing the root cause of depression and for treating such patients appropriately.
“Studies in humans, using postmortem brain tissue or special imaging techniques, as well as studies in animal models of depression, demonstrated that when the structure and function of microglia change, these cells can no longer regulate normal brain and behavior processes and this can lead to depression,” Yirmiya said.
Indeed, changes in microglia occur during many conditions associated with high incidence of depression, including infection, injury, trauma, aging, autoimmune diseases such as multiple sclerosis and neurodegenerative diseases such as Alzheimer’s.
In these conditions, microglia assume an “activated” state in which they become big and round and secrete compounds that orchestrate an inflammatory response in the brain.
The shape and function of microglia can be also changed following exposure to chronic unpredictable psychological stress, which is one of the leading causes of depression in humans. Importantly, the HU research recently discovered that following exposure to stress, some microglia die and the remaining cells appear small and degenerated. According to the new theory, either activation or decline of microglia can lead to depression, so the same class of drugs cannot treat the disease uniformly.
Yirmiya recommends adopting a personalized medical approach in which the status of the microglia in the individual patient is established first. Based on this initial assessment, treatment with drugs that either inhibit the over-active microglia or stimulate the suppressed microglia should be employed.Read article >>
Symptoms of depression are common for kids with diabetes, but they often go undiagnosed or untreated, according to a U.S. study.
There are many reasons that depression is more common for young people with diabetes than for other kids, said lead author Dr. Janet Silverstein of the University of Florida in Gainesville.
"These issues become more obvious in youth who are adolescents, when peers are the most important people in your life," Silverstein told Reuters Health by phone. "You don't want to be different, and diabetes is a difficult disease, you have to check blood sugar, give insulin injections," which can make kids feel "different," she said.
Teens with diabetes can feel like they are the only ones with these problems, and feel isolated, she said.
Depression has also been linked to poorer adherence to a treatment regimens and diabetes management, Silverstein noted.
The researchers, part of a Pediatric Diabetes Consortium that receives funding from Novo Nordisk and other makers of diabetes medications, wanted to see how common depression symptoms are among youth with diabetes and how often kids with signs of depression get diagnosed and treated for it.
They analyzed the results of short depression questionnaires filled out by 261 youth with type 1 diabetes and 339 with type 2 diabetes, all aged 10 to 17.
Based on those responses, 13 percent of kids with type 1 diabetes and 22 percent of those with type 2 had symptoms of depression. But only 4 percent of kids with type 1 and 9 percent of those with type 2 diabetes had been treated by a therapist over the previous year.
Of the kids with depression symptoms, only 15 percent had been formally diagnosed with depression in the previous year.
Neither age, nor sex, ethnicity, duration of diabetes or parent education levels were tied to the risk of depressive symptoms, according to the results in Diabetes Care.
But obesity and lower family income did increase the risk of depressive symptoms for kids with type 1 diabetes, the researchers found.
Almost a quarter of kids with type 2 diabetes had depressive symptoms, a surprisingly high number, Silverstein said.
"In type 2 diabetes you have the added issue that most of the children or adolescents with it are overweight or obese," Silverstein said. "Obesity in and of itself is related to a higher rate of depression, poor self esteem, teasing and bullying."
"There's not an easy way to identify depressive symptoms, it's difficult enough when youth are overtly depressed and if they have subclinical depression it's really difficult," she said.
Both parents and doctors need to be aware of the signs of depression, like deteriorating schoolwork, diminishing friend groups or appearing withdrawn, she said.
"Creating more awareness of clinical reality as reported in the article is a first and important step," said Janina Karres of the Pediatrics Office at the European Medicines Agency in London, who was not part of the new study.
The American Diabetes Association recommends annual depression screening of youth age 10 and up with diabetes, Karres noted.
"It would be interesting to understand the reasons why pediatric diabetes centers do not carry out these routine screenings in youth with (diabetes)," she said.Read article >>
Squarely facing one's fears is the best way to deal with discomfort in an unfamiliar social setting. Don't feel strange about social anxiety, because it is perfectly normal. What is strange is when we don't feel any at all.
"People are social animals, and we have a strong desire to be part of a group and to be accepted by the group," Stefan G. Hofmann, the director of the Social Anxiety Program at Boston University, says.
"Social anxiety is a result of the fear of a possibility that we will not be accepted by our peers. It's the fear of negative evaluation by others, and that is [part of] a very fundamental, biological need to be liked. That's why we have social anxiety."
In an interview with The Atlantic, Hofmann says: "It would be very abnormal not to be socially anxious. Social anxiety is a very normal stage that children go through, [along with] separation anxiety and stranger anxiety. These are actually very normal stages, and children who do not go through these stages, doctors do worry about those kids."
Like most emotions, there is a spectrum running from healthy to decidedly not.
Nervousness in unfamiliar social environments is normal, and it is distinct from shyness, which is not defined by a sense of uneasiness. It becomes problematic when it causes a level of distress that starts to affect our lives.
"For people with social phobia (sometimes known as social anxiety disorder), being the focus of other people's attention can lead to intense anxiety," Beyond Blue explains. "They may fear being criticised, embarrassed or humiliated, even in the most ordinary, everyday situations."
Social phobia affects about 10 per cent of Australians in their lifetime, and treatment often involves helping sufferers face their fears in order to desensitise them.
Hofmann, who says he has a 75 per cent success rate, suggests matching the fear measure for measure.
By putting people in situations where they face their deepest fears, they learn they will be OK and the phobia loses its suffocating grip.
If someone is terrified of dating, for instance, Hofmann will expose them to a worst-case scenario.
"If someone is not engaging in any dating behaviours because they are concerned about being rejected, we would ask them to go to a restaurant and ask every woman at the table for her number," he says. "And, obviously, he would get rejected a lot, and that's the purpose of it.
"We script it very clearly," Hofmann explains. "We say, you're going to go in there now, and say the following: 'Hi, I like your face. Would you like to go out with me? Would you like to give me your number?' And she would obviously say, 'No, go away, you freak,' or something, and that would be desirable. That would be perfect.
"Or other examples might be, inconveniencing people, so let's say go to a coffee shop and you spill your coffee and you say, 'I'd like to have a new one.' Or you go to a book store and ask for a book on the joy of sex.
"You do something that is over the top that nobody likes to do, that violates their personal social norms and engages them in re-evaluating their maladaptive beliefs. And it's very effective. It's very successful. People speak to this treatment; they love it."Read article >>
Owning a cat is known to have positive health effects, such as reducing stress and improving mood. But it can have downsides, too.
Allergy UK estimates that half of all asthmatic children are allergic to cats, for example.
Now scientists are looking at whether Britain's ten million cats are putting their owners at risk of another condition: anxiety.
The focus of their investigation is Toxoplasma gondii, a tiny, single-cell parasite commonly found in cat droppings, which causes the disease toxoplasmosis.
Pregnant women have long been advised to avoid emptying cat litter trays, as ingesting the parasite accidentally from unwashed hands in early pregnancy can cause miscarriage or stillbirth. In adults, more rarely it can also lead to blindness by causing scarring at the back of the eye. Other sources of infection include undercooked meat and unwashed fruit and vegetables.
Now scientists think exposure to Toxoplasma gondii could be to blame for many cases of anxiety.
It's a theory backed by some of Britain's leading experts on parasitic diseases.
In a study at the University of Michigan, blood samples from 450 adults were checked for antibodies to Toxoplasma gondii.
The presence of these antibodies is a sign the person has been infected. Researchers then identified the study participants who had been diagnosed with generalized anxiety disorder, or GAD.
Anxiety is a normal but temporary response to stress or danger. But with GAD, the anxiety is excessive - a constant worrying when there is no danger present. Up to 7 per cent of the population - nearly five million people in Britain - are thought to be affected with symptoms, ranging from a racing heartbeat and shortness of breath to agitation and constant dread. The University of Michigan research, published in the journal Brain, Behavior and Immunity, found that people with antibodies to the parasite were twice as likely to have been diagnosed with GAD.
And those with the highest levels of antibodies, suggesting greater exposure to the parasite, were three times more likely to be affected by GAD. It's thought that while antibodies might destroy some parasites, others evade detection and head for the brain.
The researchers said: 'Our study is the first to examine the association between T. Gondii infection and diagnosed anxiety disorder.'
This is not the first time the parasite has been linked to brain-related problems. Previous research has linked infection with this parasite to an increased risk of schizophrenia and learning disabilities in children.
'There are even some fascinating studies showing Toxoplasma can cause decreased reaction times and a greater chance of being involved in road accidents,' says Professor Joanne Webster, from the Centre for Emerging, Endemic and Exotic Diseases at the Royal Veterinary College in London, whose research in the Nineties led to an extraordinary discovery about the effect Toxoplasma had on rats' behavior.
The parasite exits the body via droppings - and, if these are then eaten by a rat, the parasite heads straight for the brain, where it somehow switches off the innate fear the rodent has of cats, and makes it crave the smell of feline urine.
All the rat's survival instincts disappear and it effectively serves itself up as dinner for a cat. 'It's basically manipulating the rat's mind,' says Professor Webster.
It's this same 'manipulation' which scientists think might trigger anxiety in humans.
To be on the safe side, wear gloves when cleaning a litter tray
Studies suggest Toxoplasma produces its own supply of dopamine, a brain chemical that sends signals between cells.
The parasite's dopamine might disrupt the normal chemical balance in the human brain.
Although too little dopamine has been linked with anxiety, so has too much, and research suggests that the parasite can trigger over-activity in the amygdala, the area of the brain that is involved in expressing anxiety.
But should cat owners be worried? There are only 350 confirmed human cases of toxoplasmosis in England and Wales a year.
But according to NHS Choices, up to a third of us will be infected at some point, yet not even notice any symptoms (typically it causes flu-like symptoms that last for a couple of weeks).
Maggie Roberts, director of veterinary services at Cats Protection, says: 'I have lots of friends who are vets and have handled hundreds of cats and were tested during pregnancy for Toxoplasma - and I don't know one who has tested positive.'
She says cats are infectious for only about ten days in their whole life. Afterwards, they are resistant. 'To be on the safe side, wear gloves when cleaning a litter tray and wash your hands thoroughly afterwards.'Read article >>
Being anxious may be beneficial to academic motivation, according to a new study coauthored by Yale researchers.
The study, which will be published in the Journal of Adolescence in December, found that anxiety symptoms were positively correlated with higher academic motivation, whereas symptoms of depression showed no correlation.
The study analyzed data from the Social and Health Assessment, a standard survey that assesses risk and protective factors for adolescent adjustment in the United States by asking adolescents about their attitudes toward school, family and emotional and behavioral problems. The data, analyzed through multiple linear regressions, predominantly came from 13- to 15-year-old New Haven youths from economically disadvantaged backgrounds. Additionally, higher levels of teacher support, parent support and attachment to school were all positively correlated to high levels of academic motivation, even in the presence of depressive or anxiety symptoms.
The researchers spent a year looking at the effects of anxiety and depression symptoms on 643 students’ academic motivation over time. The study had two time points used for analysis, beginning in 2003 and ending in 2004. The study focused on academic motivation rather than academic performance, so students’ grades were not taken into account. Academic motivation was measured by students’ positive or negative attitudes toward learning and school. Symptoms of anxiety and depression were measured by student self-reported responses to questions such as “I worry about other people liking me” or “I felt I could not shake off my sad feelings even with help from my family or friends.”
“[That] the general measure of anxiety is positively associated with academic motivation over time is new,” said Chris Henrich, professor of psychology at Georgia State University and an author of the study. Henrich noted that the longitudinal nature of the study was one of its more novel aspects.
But the study’s findings, though new, may seem intuitive.
“It is well established in the literature that anxiety and depression are pretty well correlated,” said Eli Feldman ’16, a board member of the Coalition for Mental Health and Wellbeing at Yale, an undergraduate organization that facilitates collaboration and communication among student groups working on mental health issues.
Feldman added that while the population studied was primarily adolescents from an urban, economically disadvantaged background, he could see clinical anxiety and depression possibly having opposite effects on motivation, with anxiety acting as a discouraging force. He noted, for example, that some level of anxiety is necessary for everyday function while high levels could be problematic.
“If you have no anxiety about the future or your job, you won’t work hard on the application, and you won’t get the job,” Feldman said.
While the study focused primarily on non-clinical anxiety and depressive symptoms, anxiety on a larger scale may have opposite effects, said Eli Lebowitz, an assistant professor at the Yale Child Study Center who specializes in anxiety disorders. He added that anxiety on a clinical scale may hinder students, particularly those who are college-age, from even attending school, particularly schools that require on-campus residence.
“There are many stressors that college students deal with,” said Lebowitz, who works with anxiety-driven young adults and their families.
Lebowitz cited academic demands, social demands, distance from family and competitive environment as several of the factors that cause stress and anxiety in college-age students.
According to the Center for Disease Control and Prevention, anxiety disorders are characterized by excessive and unrealistic worry about everyday tasks or events, or may be specific to certain objects or rituals.Read article >>
Almost one in five young people lives with high levels of anxiety, according to figures on wellbeing published by the Office for National Statistics.
The study looked at the wellbeing and mental health of 7.5 million young people in the UK aged 16 to 24.
The figures also show a rising proportion of young people who felt dissatisfied with their health.
But at the more positive end of the scale, almost three-quarters said they were "happy" or "very happy".
The figures from the ONS show a picture of a growing number of young people who are satisfied with their lives - but with a persistent minority reporting unhappiness or suffering from anxiety.
Almost 83% of young people report high or very high levels of satisfaction - a slight improvement on previous years.
But in terms of anxiety, 18% report high levels of anxiety and almost 16% have "medium" levels of anxiety.
In a separate measure, there are almost 21% of young people with "evidence indicating depression or anxiety".
And young people's perceptions of their own physical health seemed to be progressively more negative, with more expressing dissatisfaction and fewer feeling satisfied.
The ONS also published figures for the wellbeing of younger children which showed about one in eight youngsters between the ages of 10 and 15 reported symptoms of mental ill-health.
At the beginning of the university term there were particular warnings about the need to respond to mental health problems on campus.
Sir Anthony Seldon, University of Buckingham vice-chancellor, has been calling for universities to take a more active role in promoting students' wellbeing.
"We have a crisis, which is growing each year, in student mental health in our universities. I am not blaming the universities, but things must now change quickly before more avoidable misery is spread, and more lives lost.
"There is excellent practice in some areas in some universities, but the sector overall needs to rise quickly to their example."
Sir Anthony has set out ideas for how universities could take responsibility and intervene to help students, including better use of personal tutors, buddy schemes for support between students, tackling "lad culture" and the promotion of healthy living and diet.
Anxiety UK, a charity which helps people with stress and anxiety, is publishing a support guide to help students.
The charity says that overstretched health and counselling services could mean that students do not always get access to the help they need.Read article >>
Sometime around 1907, well before the modern randomized clinical trial was routine, American psychiatrist Henry Cotton began removing decaying teeth from his patients in hopes of curing their mental disorders. If that didn't work, he moved on to more invasive excisions: tonsils, testicles, ovaries and, in some cases, colons.
Cotton was the newly appointed director of the New Jersey State Hospital for the Insane and was acting on a theory proposed by influential Johns Hopkins psychiatrist Adolf Meyer, under whom Cotton had studied, that psychiatric illness is the result of chronic infection. Meyer's idea was based on observations that patients with high fevers sometimes experience delusions and hallucinations.
Cotton ran with the idea, scalpel in hand.
In 1921 he published a well-received book on the theory called The Defective Delinquent and Insane: the Relation of Focal Infections to Their Causation, Treatment and Prevention. A few years later The New York Times wrote, "eminent physicians and surgeons testified that the New Jersey State Hospital for the Insane was the most progressive institution in the world for the care of the insane, and that the newer method of treating the insane by the removal of focal infection placed the institution in a unique position with respect to hospitals for the mentally ill." Eventually Cotton opened a hugely successful private practice, catering to the infected molars of Trenton, N.J., high society.
Following his death in 1933, interest in Cotton's cures waned. His mortality rates hovered at a troubling 45 percent, and in all likelihood his treatments didn't work. But though his rogue surgeries were dreadfully misguided and disfiguring, a growing body of research suggests that there might be something to his belief that infection — and with it inflammation — is involved in some forms of mental illness.
Symptoms Of Mental And Physical Illness Can Overlap
Late last year, Turhan Canli, an associate professor of psychology and radiology at Stony Brook University, published a paper in the journal Biology of Mood and Anxiety Disorders asserting that depression should be thought of as an infectious disease. "Depressed patients act physically sick," says Canli. "They're tired, they lose their appetite, they don't want to get out of bed." He notes that while Western medicine practitioners tend to focus on the psychological symptoms of depression, in many non-Western cultures, patients who would qualify for a depression diagnosis report primarily physical symptoms, in part because of the stigmatization of mental illness.
"The idea that depression is caused simply by changes in serotonin is not panning out. We need to think about other possible causes and treatments for psychiatric disorders," says Canli.
His assertion that depression results from infection might seem far-fetched, or at least premature, but there are some data to bolster his claim.
Harkening back to Adolf Meyer's early 20th century theory, Canli notes how certain infections of the brain — perhaps most notablyToxoplasma gondii — can result in emotional disturbances that mimic psychiatric conditions. He also notes that numerous pathogens have been associated with mental illnesses, including Borna disease virus, Epstein-Barr and certain strains of herpes, including varicella zoster, the virus that causes chickenpox and shingles.
A Danish study published in JAMA Psychiatry in 2013 looked at the medical records of over 3 million people and found that any history of hospitalization for infection was associated with a 62 percent increased risk of later developing a mood disorder, including depression and bipolar disorder.
Canli believes that pathogens acting directly on the brain may result in psychiatric symptoms, but also that autoimmune activity — or the body's immune system attacking itself — triggered by infection may also contribute. The Danish study also reported that a past history of an autoimmune disorder increases the risk of a future mood disorder by 45 percent.
Antibodies Provide A Clue
The idea that there could be a relationship between the immune system and brain disease isn't new. Autoantibodies were reported in schizophrenia patients in the 1930s. Subsequent work has detected antibodies to various neurotransmitter receptors in the brains of psychiatric patients, while a number of brain disorders, including multiple sclerosis, are known to involve abnormal immune system activity. Researchers at the University of Virginia recently identified a previously undiscovered network of vessels directly connecting the brain with the immune system; the authors concluded that an interplay between the two could significantly contribute to certain neurological and psychiatric conditions.
Both infection and autoimmune activity result in inflammation, our body's response to harmful stimuli, which in part involves a surge in immune system activity. And it's thought by many in the psychiatric research community that inflammation is somehow involved in depression and perhaps other mental illnesses.
Multiple studies have linked depression with elevated markers of inflammation, including two analyses from 2010 and 2012 that collectively reviewed data from 53 studies, as well as several postmortem studies. A large body of related research confirms that autoimmune and inflammatory activity in the brain is linked with psychiatric symptoms.
Still, for the most part the research so far finds associations but doesn't prove cause and effect between inflammation and mental health issues. The apparent links could be a matter of chance, or there might be some other factor that hasn't been identified.
Dr. Roger McIntyre, a professor of psychiatry and pharmacology at the University of Toronto, tells Shots that he believes an upset in the "immune-inflammatory system" is at the core of mental illness and that psychiatric disorders might be an unfortunate cost of our powerful immune defenses. "Throughout evolution our enemy up until vaccines and antibiotics were developed was infection," he says. "Our immune system evolved to fight infections so we could survive and pass our genes to the next generation. However, our immune-inflammatory system doesn't distinguish between what's provoking it." McIntyre explains how stressors of any kind — physical or sexual abuse, sleep deprivation, grief — can activate our immune alarms. "For reasons other than fighting infection, our immune-inflammatory response can stay activated for weeks, months or years and result in collateral damage," he says.
Unlike Canli, McIntyre implicates inflammation in general, not exclusively inflammation caused by infection or direct effects of infection itself, as a major contributor to mental maladies. "It's unlikely that most people with a mental illness have it as a result of infection," he says, "but it would be reasonable to hypothesize that a subpopulation of people with depression or bipolar disorder or schizophrenia ended up that way because an infection activated their immune-inflammatory system." McIntyre says that infection, particularly in the womb, could work in concert with genetics, psychosocial factors and our diet and microbiome to influence immune and inflammatory activity and, in turn, our risk of psychiatric disease.
Trying Drugs Against Inflammation For Mental Illness
The idea that inflammation — whether stirred up by infection or by other factors — contributes to or causes mental illness comes with caveats, at least in terms of potential treatments. Trials testing anti-inflammatory drugs have been overall mixed or underwhelming.
A recent meta-analysis reported that supplementing SSRIs like Prozac with regular low-dose aspirin use is associated with a reduced risk of depression, and ibuprofen supplementation is linked with lower chances of obtaining psychiatric care. However, concomitant treatment with SSRIs and diclofenac or celecoxib — two other anti-inflammatories often used to treat arthritis — was associated with increased risk of needing hospital care due to psychiatric symptoms.
A 2013 study explored the antidepressant potential of Remicade, a drug used in rheumatoid arthritis. Overall, three infusions of the medication were found to be no more effective than a placebo, but patients whose blood had higher levels of an inflammatory marker called C-reactive protein did experience modest benefit.
"The truth of the matter is that there is probably a subset of people who get depressed in response to inflammation," says lead author Dr. Charles Raison, a psychiatry professor at the University of Arizona. "Maybe their bodies generate more inflammation, or maybe they're more sensitive to it."
How infection and other causes of inflammation and overly aggressive immune activity may contribute to depression and other mental illnesses — and whether or not it's actually depression driving the inflammation — is still being investigated, and likely will be for some time. But plenty of leading psychiatrists agree that the search for alternative pathologic explanations and treatments for psychiatric disorders could help jump-start the field.
"I'm not convinced that anti-inflammatory strategies are going to turn out to be the most powerful treatments around," cautions Raison. "But I think if we really want to understand depression, we definitely have to understand how the immune system talks to the brain. I just don't think we've identified immune-based or anti-inflammatory treatments yet that are going to have big effects in depression."
But the University of Toronto's McIntyre has a slightly brighter outlook. "Is depression due to infection, or is it due to something else?" he asks. "The answer is yes and yes. The bottom line is inflammation appears to contribute to depression, and we have interventions to address this."
McIntyre notes that while the science of psychiatry has a long way to go, and that these interventions haven't been proved effective, numerous approaches with minimal side effects exist that appear to be generally anti-inflammatory, including exercise, meditation and healthy sleep habits.
He also finds promise in the work of his colleague: "Like most cases in medicine, Charles Raison showed that anti-inflammatory approaches may benefit some people with depression, but not everybody. If you try on your friend's eyeglasses, chances are they won't help your vision very much."Read article >>
New research suggests that a high-fat diet may trigger anxiety and depression.
A new study in mice suggests that increased body weight and high blood sugar as a result of consuming a high-fat diet may cause anxiety and depressive symptoms and measurable changes in the brain. They also found that the beneficial effects of an antidepressant were diminished in mice fed a high-fat diet.
"When treating depression, in general there is no predictor of treatment resistance," Dr. Bruno Guiard, senior author of the study, said in a statement. "If we consider metabolic disorders as a putative treatment resistance predictor, this should encourage psychiatrists to put in place a personalized treatment with antidepressant drugs that do not further destabilize metabolism."
On the other hand, taking mice off a high-fat diet completely reversed the animals' metabolic impairments and lessened their anxious symptoms. "This finding reinforcing the idea that the normalization of metabolic parameters may give a better chance of achieving remission, particularly in depressed patients with type 2 diabetes," Guiard said.
The results set the tone for future investigations on potential mechanisms that may link metabolic and psychiatric disorders.
The findings, detailed in "High fat diet-induced metabolic disorders impairs serotonergic function and anxiety-like behaviors in mice," are published in the British Journal of Pharmacology.Read article >>
More than two million people in the United States have a diagnosis of schizophrenia, and the treatment for most of them mainly involves strong doses of antipsychotic drugs that blunt hallucinations and delusions but can come with unbearable side effects, like severe weight gain or debilitating tremors.
Now, results of a landmark government-funded study call that approach into question. The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.
The report, to be published on Tuesday in The American Journal of Psychiatry and funded by the National Institute of Mental Health, comes as Congress debates mental health reform and as interest in the effectiveness of treatments grows amid a debate over the possible role of mental illness in mass shootings.
Its findings have already trickled out to government agencies: On Friday, the Centers for Medicare & Medicaid Services published in its influential guidelines a strong endorsement of the combined-therapy approach. Mental health reform bills now being circulated in Congress “mention the study by name,” said Dr. Robert K. Heinssen, the director of services and intervention research at the centers, who oversaw the research.
In 2014, Congress awarded $25 million in block grants to the states to be set aside for early-intervention mental health programs. So far, 32 states have begun using those grants to fund combined-treatment services, Dr. Heinssen said.
Experts said the findings could help set a new standard of care in an area of medicine that many consider woefully inadequate: the management of so-called first episode psychosis, that first break with reality in which patients (usually people in their late teens or early 20s) become afraid and deeply suspicious. The sooner people started the combined treatment after that first episode, the better they did, the study found. The average time between the first episode and receiving medical care — for those who do get it — is currently about a year and half.
The more holistic approach that the study tested is based in part on programs in Australia, Scandinavia and elsewhere that have improved patients’ lives in those countries for decades. This study is the first test of the approach in this country — in the “real world” as researchers described it, meaning delivered through the existing infrastructure, by community mental health centers.
The drugs used to treat schizophrenia, called antipsychotics, work extremely well for some people, eliminating psychosis with few side effects; but most who take them find that their bad effects, whether weight gain, extreme drowsiness, or emotional numbing, are hard to live with. Nearly three quarters of people prescribed medications for the disorder stop taking them within a year and a half, studies find.
“As for medications, I have had every side effect out there, from chills and shakes to lockjaw and lactation,” said a participant in the trial, Maggie, 20, who asked that her last name be omitted. She did well in the trial and is now attending nursing school.
Doctors praised the study results.
“I’m very favorably impressed they were able to pull this study off so successfully, and it clearly shows the importance of early intervention,” said Dr. William T. Carpenter, a professor of psychiatry at the University of Maryland, who was not involved in the study.
Dr. Mary E. Olson, an assistant professor of psychiatry at the University of Massachusetts Medical School, who has worked to promote approaches to psychosis that are less reliant on drugs, said the combined treatment had a lot in common with Open Dialogue, a Finnish program developed in the 1980s. “These are zeitgeist ideas, and I think it’s thrilling that this trial got such good results,” Dr. Olson said.
In the new study, doctors used the medications as part of a package of treatments and worked to keep the doses as low as possible — in some cases 50 percent lower — minimizing their bad effects. The sprawling research team, led by Dr. John M. Kane, chairman of the psychiatry department at Hofstra North Shore-LIJ School of Medicine, randomly assigned 34 community care clinics in 21 states to provide either treatment as usual, or the combined package.
The team trained staff members at the selected clinics to deliver that package, and it included three elements in addition to the medication. First, help with work or school such as assistance in deciding which classes or opportunities are most appropriate, given a person’s symptoms. Second, education for family members to increase their understanding of the disorder. And finally, one-on-one talk therapy in which the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions.
For example, some patients can learn to defuse the voices in their head — depending on the severity of the episode — by ignoring them or talking back. The team recruited 404 people with first-episode psychosis, mostly diagnosed in their late teens or 20s. About half got the combined approach and half received treatment as usual. Clinicians monitored both groups using standardized checklists that rate symptom severity and quality of life, like whether a person is working, and how well he or she is getting along with family members.
The group that started on the combined treatment scored, on average, more poorly on both measures at the beginning of the trial. Over two years, both groups showed steady improvement. But by the end, those who had been in the combined program had more symptom relief, and were functioning better as well. They had also been on drug doses that were 20 percent to 50 percent lower, Dr. Kane said.
“One way to think about it is, if you look at the people who did the best — those we caught earliest after their first episode — their improvement by the end was easily noticeable by friends and family,” Dr. Kane said. The gains for those in typical treatment were apparent to doctors, but much less obvious.
The study, begun in 2009, almost collapsed under the weight of its ambition. The original proposal called for two parallel trials, each including hundreds of first-episode patients. But recruiting was so slow for one of the trials that it was abandoned, said Dr. Heinssen.
“It’s been a long haul,” Dr. Heinssen added, “but it’s worth noting that it usually takes about 17 years for a new discovery to make it into clinical practice; or that’s the number people throw around. But this process only took seven years.”Read article >>
A daily capsule of probiotic bacteria may help people cope with mild anxiety and memory problems, according to a small study of healthy men.
Those who took the bug-bearing capsules for a month reported less stress and anxiety, and had lower levels of the stress hormone cortisol in the morning, than when they took a placebo instead.
Those on probiotics also fared better on memory tests that required them to pair objects together, such as a colour and a number, said Ted Dinan, head of psychiatry at University College Cork.
The findings are preliminary and need to be confirmed in more people, but suggest that a harmless strain of live bacteria called Bifidobacterium longum 1714 may have a beneficial effect on brain function.
In the study, healthy men took a daily capsule of a billion probiotic bacteria for a month, and then switched over to a placebo for a month, or vice versa. None of the 22 men knew which pill they were getting. At the start, and after the first and second months, their stress levels and memories were tested, along with brain activity via an EEG machine.
“When they were given these bacteria they were less anxious and their capacity to memorise material seemed to be enhanced,” said Dinan, who led the study. The findings were released at the Society for Neuroscience meeting in Chicago on Sunday.
The effects of the probiotic were small, but enough to help some people, Dinan said. “The effect was large enough for them to perceive less stress.”
Previous research from the Cork team has found that giving the same probiotic to mice seemed to improve their memories and have an antidepressant effect. “This study is one of the few examples where someone has taken a probiotic from preclinical studies and put it into humans and found pretty much the same thing as in rodents.”
Bifidobacterium longum is one of hundreds of bacterial species that live in the gut. Many live there symbiotically, gaining energy from substances absorbed in the intestine. But they do useful jobs for their hosts, such as helping digestion, training the immune system, and keeping harmful bacteria at bay.
Dinan said more studies are needed to learn how B longum might have an effect on the brain, but one possibility is that the bacteria release substances that activate the vagus nerve, which connects the gut to the brain. Alternatively, the chemicals they release may leach into the blood supply and reach the brain that way.
The relationship between humans and their gut microbes has been cemented over millennia of evolution, to the point that each – at least in part – now relies on the other. “Bacteria produce chemicals and some of those are neuroactive. Our bodies clearly require them, but we don’t have the capacity to produce them ourselves,” Dinan said.
“By their very nature, probiotics are safe bacteria, and if we can delineate those that have benefits for mental health, that would be a major advance for neuroscience and psychiatry. My hope is that within the next five years we’ll have a probiotic or two on the market that will be effective for treating mild forms of anxiety and depression,” he added.Read article >>
Untreated young people at clinical high risk for psychosis have increased salivary cortisol levels compared with treated high-risk patients and mentally healthy individuals, study results show.