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Mental Health News

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.

Anxious Students Strain College Mental Health Centers

One morning recently, a dozen college students stepped out of the bright sunshine into a dimly lit room at the counseling center here at the University of Central Florida. They appeared to have little in common: undergraduates in flip-flops and nose rings, graduate students in interview-ready attire.

But all were drawn to this drop-in workshop: “Anxiety 101.”

As they sat in a circle, a therapist, Nicole Archer, asked: “When you’re anxious, how does it feel?”

“I have a faster heart rate,” whispered one young woman. “I feel panicky,” said another. Sweating. Ragged breathing. Insomnia.

Causes? Schoolwork, they all replied. Money. Relationships. The more they thought about what they had to do, the students said, the more paralyzed they became.

Anxiety has now surpassed depression as the most common mental health diagnosis among college students, though depression, too, is on the rise. More than half of students visiting campus clinics cite anxiety as a health concern, according to a recent study of more than 100,000 students nationwide by the Center for Collegiate Mental Health at Penn State.

Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association.

The causes range widely, experts say, from mounting academic pressure at earlier ages to overprotective parents to compulsive engagement with social media. Anxiety has always played a role in the developmental drama of a student’s life, but now more students experience anxiety so intense and overwhelming that they are seeking professional counseling.

As students finish a college year during which these cases continued to spike, the consensus among therapists is that treating anxiety has become an enormous challenge for campus mental health centers.

Like many college clinics, the Center for Counseling and Psychological Services at the University of Central Florida — one of the country’s largest and fastest-growing universities, with roughly 60,000 students — has seen sharp increases in the number of clients: 15.2 percent over last year alone. The center has grown so rapidly that some supply closets have been converted to therapists’ offices.

More students are seeking help partly because the stigma around mental health issues is lessening, noted Stephanie Preston, a counselor at U.C.F.

Ms. Preston has seen the uptick in anxiety among her student clients. One gets panic attacks merely at the thought of being called upon in class. And anxiety was among a constellation of diagnoses that became life-threatening for another client, Nicholas Graves.

Two years ago, Mr. Graves, a stocky cinema studies major in jeans, a T-shirt and Converse sneakers, could scarcely get to class. That involved walking past groups of people and riding a bus — and Mr. Graves felt that everyone was staring at him.

He started cutting himself. He was hospitalized twice for psychiatric observation.

After some sessions with Ms. Preston, group therapy and medication, Mr. Graves, 21, who sat in an office at the center recently describing his harrowing journey, said he has made great progress.

“I’m more focused in school, and I’ve made more friends in my film courses — I found my tribe,” he said, smiling. “I’ve been open about my anxiety and depression. I’m not ashamed anymore.”

Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C.

Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.

“A lot are coming to school who don’t have the resilience of previous generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying, and they don’t have the ability to soothe themselves.”

Social media is a gnawing, roiling constant. As students see posts about everyone else’s fabulous experiences, the inevitable comparisons erode their self-esteem. The popular term is “FOMO” — fear of missing out.

And so personal setbacks that might once have become “teachable moments” turn into triggers for a mental health diagnosis.

“Students are seeking treatment, saying, ‘I just got the first C in my life, my whole life just got shattered, I wanted to go to medical school and I can’t cope,’” said Micky M. Sharma, president of the Association for University and College Counseling Center Directors and head of Ohio State University’s counseling center.

Anxiety is an umbrella term for several disorders, including social anxiety disorder and agoraphobia. It can accompany many other diagnoses, such as depression, and it can be persistent and incapacitating.

Students who suffer from this acute manifestation can feel their very real struggles are shrugged off, because anxiety has become so ubiquitous, almost a cliché, on campus.

Alexa, 18, has been treated for an anxiety disorder since middle school, when she was still feeling terrorized by monsters under the bed. She has just finished her freshman year at Queens College in New York.

If she had a severe episode during a test, afterward she would try to explain to her professors what had happened but they would dismiss her. “They’d say, ‘Your mind isn’t focused,’ or ‘That’s just an excuse,’ ” said Alexa, who wrote her college application essay about grappling with the disorder. She asked not to be fully identified for privacy reasons.

More often, anxiety is mild, intermittent or temporary, the manifestation of a student in the grip of a normal developmental issue — learning time management, for example, or how to handle rejection from a sorority.

Mild anxiety is often treatable with early, modest interventions. But to care for rising numbers of severely troubled students, many counseling centers have moved to triage protocols. That means that students with less urgent needs may wait several weeks for first appointments.

“A month into the semester, a student is having panic attacks about coming to class, but the wait list at the counseling center is two to five weeks out. So something the student could recover from quickly might only get worse,” said Ben Locke, associate director of clinical services at Penn State University and the lead author of the Penn State report.

By necessity, most centers can only offer individual therapy on a short-term basis. Ms. Preston estimates that about 80 percent of clients at U.C.F. need only limited therapy.

“Students are busting their butts academically, they’re financially strapped, working three jobs,” she said. “There’s nothing diagnosable, but sometimes they just need a place to express their distress.”

Even with 30 therapists, the center at U.C.F. must find other ways to reach more students — especially the ones who suffer, smoldering, but don’t seek help.

Like many college counseling centers, U.C.F. has designed a variety of daily workshops and therapy groups that implicitly and explicitly address anxiety, depression and their triggers. Next fall the center will test a new app for treating anxiety with a seven-module cognitive behavioral program, accessible through a student’s phone and augmented with brief videoconferences with a therapist.

It also offers semester-long, 90-minute weekly therapy groups, such as “Keeping Calm and in Control,” “Mindfulness for Depression” and “Building Social Confidence” — for students struggling with social anxiety.

The therapists have to be prepared to manage students who present a wide array of challenges. “You never know who is going to walk in,” said Karen Hofmann, the center’s director. “Someone going through a divorce. Mourning the death of a parent. Managing a bipolar disorder. Or they’re transgender and need a letter for hormone therapy.”

Indeed, Dr. Locke and his colleagues at Penn State, who have tracked campus counseling centers nationwide for six years, have documented a trend that other studies have noted: Students are arriving with ever more severe mental-health issues.

Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication. One quarter have self-injured.

The fundamental goal of campus counseling centers is to help students complete their education. According to federal statistics, just 59 percent of students who matriculated at four year colleges in 2006 graduated within six years.

Studies have repeatedly emphasized the nexus between mental health and academic success. In a survey this year at Ohio State’s center, just over half of the student clients said that counseling was instrumental in helping them remain in school.

Anxiety-ridden students list schoolwork as their chief stressor. U.C.F.’s center and after-hours hotline are busiest when midterm and final exams loom. That’s when the center runs what has become its most popular event: “Paws-a-tively Stress Free.”

The other afternoon, just before finals week, students, tired and apprehensive, trickled into the center. The majority were not clients.

At a tent outside, their greeter was the center’s mascot and irresistible magnet: a 14-pound Havanese, a certified therapy dog whom many clients ask to hold during individual sessions, stroking his silky white coat to alleviate anxiety.

“Bodhi!” they called, as he trotted over, welcoming them to his turf with a friendly sniff.

For the next two hours, some 75 students visited the center, sitting on floors for a heavy petting session with therapy dogs.

They laughed at the dogs’ antics and rubbed their bellies. They remarked on how nice it was to get a study break.

On the way out, the students were handed a smoothie and a “stress kit,” which included a mandala, crayons, markers, stress balls and “Smarties” candy.

Also tucked into the kit was a card with information about how to contact the center, should they ever need something more.

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We Project Our Goals On Others

Whether we’re buying a ticket to a movie, catching a train, or shopping for groceries, the more committed we are to achieving that goal, the more likely we are to assume others have exactly the same objective, a study by New York University psychology researcher Janet Ahn shows.

The findings, which appear in the European Journal of Social Psychology, point to the types of assumptions we make about others’ behavior, which may have an impact on social interaction.

“If we’re fixated on seeing that blockbuster film or purchasing those fresh strawberries, we’re more likely to see others wanting to do the same,” explains Ahn, an NYU doctoral candidate. “These assumptions may unnecessarily spur a competitive spirit and, with it, more aggressive behavior.”

The study, co-authored with NYU psychology professors Gabriele Oettingen and Peter Gollwitzer, centers on a well-established psychological phenomenon, “goal projection,” which is an egocentric way of understanding other people’s goals by projecting your goals onto them—or, put another way, assuming that others share the same goal as you.

To determine how goal projection applies in certain real-life situations, Ahn conducted surveys in three different New York City environments: a multiplex movie theater near Union Square, Penn Station, and outside a Whole Foods Market.

In the movie-theater study, Ahn and her colleagues randomly approached people preparing to buy tickets, asking them to identify both the movie they came to see and then, to gauge their goal commitment, “How badly do you want to watch this movie?” Responses were on a 1- (not at all) to 5-point (extremely) scale. The researchers then pointed out the first person waiting in line to purchase a ticket at the multiplex and asked the test subjects which movie they thought the individual was going to see.

The researchers controlled for the frequency at which the subjects attended the movies and the popularity of the movies playing the multiplex—two variables that may increase the likelihood of making informed guesses rather than ones driven by goal projection.

The results showed that among these subjects, the stronger participants’ goal commitment, the higher the probability of inferring that the target person had the goal to watch the same movie.

In the second study—of commuters at Penn Station from which dozens of trains depart every hour—the researchers approached people waiting for the track number of their train to appear. Test subjects were asked their destination; their goal commitment was ascertained through two questions: “How frustrated would you be if you missed your train?” and “How rushed are you to get to your destination?”

At this point, experimenters singled out a target person who was waiting in closest vicinity to them and was easily observable. Here, they also wanted to determine if perceived similarity to the target could influence goal projection, so the researchers asked test subjects how similar to themselves they perceived the target person. The study measured goal projection by asking subjects how likely the target was headed to the same destination they were.

The results showed that participants with strong goal commitment were more likely to believe the target person would go to the same destination the more that person was perceived to be similar—but this was not true of participants with weak goal commitment. In other words, perceived similarity can dampen goal projection.

In the final study, conducted outside a Whole Foods Market, the researchers examined whether differences in goal attainment affect the relationship between goal commitment and the perceived similarity of the target person.

The researchers studied two types of individuals: those surveyed before shopping, and who had yet to attain their goal, and those surveyed after shopping and had reached their goal. Participants were asked to name the main item they came to purchase, or just purchased, then indicated their goal commitment to purchase that item: 1 (not at all) to 7 (extremely).

The researchers then chose a target person who was just about to enter the supermarket at that given moment for both types of shoppers—those who were going to shop and shoppers who just shopped. Participants indicated how similar to themselves they viewed the target person using a 7-point scale: “How similar do you think that person is to you?” Then, as an indication of goal projection, participants answered the following item: “Please indicate the probability (from 1-100%) that the other shopper is committed to purchasing the same item.”

The study’s subjects projected their goal onto another shopper when goal commitment was strong and the target person was viewed to be similar, as long as the goal had not been attained yet—a finding consistent with the train study.

However, when the subjects had already achieved their goals—that is, they’d completed their shopping—there was no relationship between goal commitment and perceived similarity with another.

“After purchasing their groceries, these shoppers, compared to those who were about to shop, were less likely to think others wanted the same products,” explains Ahn. “This suggests there is a competitive aspect to goal projection—we think others are after the same things if we have yet to obtain them.”

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Towards A Better Understanding Of Depression

A new study published by the team of Naguib Mechawar, Ph.D., a researcher at the Douglas Institute (CIUSSS de l’Ouest-de-l’île-de-Montréal) and Associate Professor in the Department of Psychiatry at McGill University, suggests that the integration of new neurons in the adult brain is a phenomenon more generally compromised in the brains of depressed patients. This new work confirms that neurogenesis in the human olfactory bulb is a marginal phenomenon in adults. These findings shed light on the special features of the human brain.

We already knew about the existence of neurogenesis in the adult brain, the process through which new neurons are produced and integrated throughout the course of life, mainly in two brain regions, the hippocampus and the olfactory bulb (OB). So far, however, this knowledge has relied mainly on studies in rodents. In humans, although neurogenesis in the adult hippocampus is no longer a matter of debate, the presence of neurogenesis in the OB has remained controversial.

The Douglas-Bell Canada Brain Bank

The work of the doctoral candidate Marissa Maheu on Naguib Mechawar’s team breaks new ground.  Based on post-mortem brain samples from the Douglas-Bell Canada Brain Bank, it shows the presence of only a few immature cells within each olfactory tract, which is the migration path to the OB. However, the comparison of brain tissue from healthy people with samples from depressed, suicidal individuals, suggests that migration and maturation of these cells is affected in depressed patients.

“While previous evidence from animals and humans has suggested that neuronal proliferation or survival might be altered in depression, this is the first evidence implicating changes in neuronal maturation and migration in the disorder,” explains Dr. Mechawar.

Given that the phenomenon of neurogenesis in the adult hippocampus has already been implicated in depression, these new data, published in the journal Frontiers in Neuroanatomy, is an important step towards understanding depression.

This work was funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de recherche du Québec-Santé (FRQS).

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Study: Millennials Get Help For Workplace Depression The Most

Millennials are more likely to seek help for workplace depression than any other generation in the workforce today, says a new study.

Twenty percent of workers below 37 years old — aka the “millennial generation” — report being depressed on the job, compared to 16% of workers in Generation X and the Baby Boom, according to the report from Bensinger, DuPont & Associates, which provides counseling for employees of companies, governments, and nonprofits.

It’s unclear if millenial workers are more depressed or simply more likely to seek counseling from their employers, who may be providing it for free. But the finding does jibe with earlier studies saying millennials are the most stressed-out, competitive and attention-seeking generation — and the least-skilled.

Depressed employees were most likely to phone in a day’s work, a concept known as presenteeism. Seventy percent of Millennials said their performance declined as a result, as did 68% of Generation X and 63% of Baby Boomers.

"Regardless of age, presenteeism is the most common impact of depression in the workplace," the report read.

Generation X workers — ages 38-50 — were slightly more likely than Millennials to take a sick day when down in the dumps. Baby Boomers — ages 51-69 — were most apt to work through their depression, but faced more issues when they got to the office, like trouble with colleagues and punishment for their behaviors.

Depression doesn’t only bum out workers — it depresses their bosses. Previous studies have shown that depression-related declines in productivity or outright absenses cost businesses $23 billion a year.

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Emotion Regulation Distinguishes Unipolar And Bipolar Depression

Patients with bipolar disorder regulate their emotions differently from those with major depressive disorder (MDD) in both depressed and remitted states, a study shows.

Bipolar disorder patients had impaired emotion regulation even in the remitted state; however, in the depressed state they had “unexpectedly normal” regulation of happy emotions, whereas MDD patients had impaired regulation of both happy and sad emotions, report researcher Maria Rive (University of Amsterdam, the Netherlands) and co-workers.

The patients observed pictures depicting different emotions and either viewed them passively or attempted to distance themselves from the emotion. The 26 remitted bipolar disorder patients were significantly less successful at emotion regulation than the 21 remitted MDD patients and 36 mentally healthy controls, irrespective of whether the emotion was happy or sad.

The patients underwent functional magnetic resonance imaging while attempting emotion regulation, revealing significantly increased activity in the dorsolateral prefrontal cortex of the bipolar patients relative to MDD patients, which the team believes “reflects increased, but still insufficient, regulation attempts” in the bipolar patients.

Among currently depressed patients, the 21 MDD patients had impaired regulation of both sad and happy emotions, relative to controls, whereas the nine bipolar patients had impaired regulation of sad emotions but could successfully distance themselves from happy emotions.

The researchers speculate that the happy pictures provoked happy emotions in the bipolar patients, which were contrary to their mood and thus easy to distance themselves from, whereas they triggered sad emotions in the MDD patients.

“These state-specific emotion regulation differences may represent different underlying pathophysiological mechanisms”, writes the team in JAMA Psychiatry. They suggest that these differences, in combination with clinical features and imaging biomarkers, may help to “resolve remaining diagnostic uncertainty” between bipolar disorder and MDD.

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Thinking Alike Changes How We Speak

As social creatures, we tend to mimic each other’s posture, laughter, and other behaviors, including how we speak. Now a new study shows that people with similar views tend to more closely mirror, or align, each other’s speech patterns. In addition, people who are better at compromising align more closely.

“Few people are aware that they alter their word pronunciation, speech rate, and even the structure of their sentences during conversation,” explained Florian Jaeger, associate professor of brain and cognitive sciences at the University of Rochester and coauthor of the study recently published in Language Variation and Change. “What we have found is that the degree to which speakers align is socially mediated.”

“Our social judgments about others and our general attitude toward conflict are affecting even the most automatic and subconscious aspects of how we express ourselves with language,” said lead-author Kodi Weatherholtz, a post-doctoral researcher in Jaeger’s lab.

To test the social effects of how greatly we mimic each other’s speech patterns, the researchers devised an experiment in which participants first listened to ideologically charged messages with a set sentence structure. After listening to the diatribes they were asked to describe some simple illustrations showing characters performing simple actions, such as a waitress giving a banana to a monk.

Most participants subconsciously aligned their descriptions with the sentence structure presented in the listening phase of the experiment. But, how closely the participants aligned with the speaker varied based on how much they agreed with the speaker’s views (as assessed in a post-experimental interview). Those who shared views with the speaker altered their speech to more closely match the sentence pattern used by the speaker.

During the experiment, participants heard phrases like “Congress is giving too much money to welfare moochers.” Others heard the same ideologically loaded sentiment expressed with a different sentence structure: “Congress is giving welfare moochers too much money.” (Notice the order of the phrases “too much money”—which refers to the thing being given—and “welfare moochers”—the recipient.)

Those who heard the first version, “Congress is giving too much money to welfare moochers” (the recipient is mentioned after the thing being given), for example, were more likely to describe a picture as “The waitress is giving a banana to the monk” rather than “The waitress is giving the monk a banana” when they agreed with the speaker’s views.

When participants disagreed with the opinion expressed by the speaker, they aligned less or not at all. Additionally, participants who described themselves as compromising in conflict situations, showed more linguistic alignment with the speaker.

One of the researchers, Kathryn Campbell-Kibler, an associate professor of linguistics at Ohio State University, pointed out that testing for political influences on syntactic alignment might be interesting in its own right, but the purpose in this experiment was to influence social similarity and establish a situation in which participants were ideologically invested.

One reason people tend to align certain speech patterns is because it facilitates communication, Jaeger said. When we align how we talk, then sounds, words, and sentence structures become more predictable,

In addition to this well-known psychological function, the study’s findings provide evidence that speech alignment serves a social function. Similarity is a powerful social force, Jaeger explained. In short, we tend to like people who share certain characteristics with us. Thus, speaking in a way that is more or less similar to others can be a subtle means of influencing liking, trust, and other interpersonal emotions.

The findings shed new light on the relationship between human psychology and social behavior, Jaeger said. They suggest that social factors “piggy back” on the subconscious process—which is primary—and can boost the degree of alignment. “The extent to which we align is moderated by the attitudes we have towards our conversation partner,” added Weatherholtz.

These two traditions—the psychological and the social—”are not necessarily competing; they can be complementary,” said Jaeger. “What’s been lacking in the research is a way to talk to both communities and bring them together.”

A National Science Foundation Graduate Research Fellowship to Westherholtz, an Alfred P. Sloan Research Fellowship to Jaeger, and the National Science Foundation supported the study.

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Depression May Be Linked To Parkinson's Disease

Depression may be an early indicator or a risk factor of Parkinson’s disease, a long-term new Swedish study has found.

Researchers discovered 1.1% of people suffering from depression developed Parkinson’s, while 0.4% of those who did not have depression developed the progressive nervous system disorder.

The 26-year study of more than 400,000 Swedes over 50 was published Wednesday in the medical journal Neurology.

Those with more serious cases of depression were more likely to develop Parkinson’s — people who were hospitalized five or more times were 40% more likely to develop the disease than those who had been hospitalized only once.

While the vast majority — 98.9% — of people with depression did not develop Parkinson’s, the study showed a strong link between the two conditions, experts said.

“This observation has been made before, but it has never been made so powerfully. This is really an important study,” said Dr. Alessandro Di Rocco, director of the NYU Langone Parkinson's & Movement Disorders Center.

Di Rocco said that along with the physical impact of Parkinson’s — such as tremors and loss of motor control — the disease causes changes in hormones and neurotransmitters in the brain, like dopamine and serotonin, which can trigger depression.

“This is part of the disease, it’s a manifestation of the chemical imbalance and can develop early on,” he said.

Actor Robin Williams, who committed suicide last summer, was privately dealing with the early stages of Parkinson’s as well as depression and anxiety.

Williams’ conditions may have been linked — and gone beyond a depressive reaction spurred by his upsetting diagnosis, Di Rocco said.

“The story may be a little different. The story may be that the depression was part of the Parkinson’s, biologically,” Di Rocco said.

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Anxiety 'Linked To Liver Disease'

Suffering from anxiety or depression could carry an increased risk of death from liver disease, a new study suggests.

The study is said to be the first to identify a possible link between high levels of psychological distress and deaths resulting from a variety of liver diseases.

But researchers say reasons for this are unclear as the biological links between psychological distress and liver disease are not well understood.

Researchers at the University of Edinburgh investigated responses to a questionnaire capturing psychological distress in more than 165,000 people.

They then tracked participants' progress over a 10-year period, examining who died and the causes of death.

The team found that individuals who scored highly for symptoms of psychological distress were more likely to die later from liver disease than those with lower scores.

The study took into account factors such as alcohol consumption, obesity, diabetes and socioeconomic status.

Dr Tom Russ, of the University of Edinburgh's Centre for Clinical Brain Sciences, who led the research, said: "This study provides further evidence for the important links between mind and body, and of the damaging effects psychological distress can have on physical well-being.

"While we are not able to confirm direct cause and effect, this study does provide evidence that requires further consideration in future studies."

Previous research suggests that mental distress can put people at increased risk of cardiovascular disease.

At the same time, risk factors for cardiovascular disease - such as obesity and raised blood pressure - have been linked to a common form of liver disease, known as non-alcoholic fatty liver disease.

The team suggested that, in a similar way, suffering from anxiety and depression may be indirectly linked to an increased risk of death from liver disease.

The study is published in the journal Gastroenterology.

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Non-Pharmaceutical Treatments For Depression

Mood disorders such as depression are devastating to sufferers, and hugely costly to treat. The most severe form of depression, often called clinical depression or major depressive disorder (MDD), increases the person’s likelihood of suicide and contributes significantly to a person’s disability-adjusted life years (DALYs), a measure of quality of life taking into account periods of incapacity. The healthcare burden of MDD is large in most countries, especially when the person requires a stay in hospital. Putting these factors together, it’s clear we need to develop effective treatments to combat depression.

The mechanisms of depressive disorders are not well understood, and it seems likely that there is no single cause. Most modern therapies use drugs that target neurotransmitters – the chemicals that carry signals between neurons. For example, the class of drugs known as SSRIs, or selective serotonin reuptake inhibitors, prevent the neurotransmitter serotonin from being reabsorbed by a neuron; this means that more serotonin is available to wash around between the nerve cells, and is more likely to activate cells in the brain networks that area affected in MDD.

But SSRIs and other drugs are not a pharmacological ‘free lunch’. Drug treatments for depression are ineffective for many people, cause side-effects, and may lose their therapeutic effect over time. For these reasons, many researchers are searching for alternative treatments for MDD that overcome these problems, and are more effective or less unpleasant. One potential treatment involves the use of pulses of magnetic energy over the head to target the brain’s mood circuits. This technique, called transcranial magnetic stimulation (TMS), may potentially address some of the problems of pharmaceutical treatments, but we still don’t know exactly how it works, or how effective it will be in treating MDD.

Some of these mysteries may be close to a solution however, with last week’s news that a company based in West Wales was granted approval by the US Food and Drug Administration to enter the USA market for device-based treatment of MDD. The approval of the Magstim Company’s Rapid2 stimulator means that the stimulator can be used as a treatment option in adult sufferers of MDD who have not responded to other therapy- or drug-based treatments. Magstim’s products have long been used in universities and research centres to probe and modulate brain function, and approval of these devices for clinical use marks an important milestone in translational neuroscience - the idea of taking academic findings into the clinic.

TMS works by sending pulses of magnetic energy across the skull. These magnetic fields induce electric currents to flow in small patches of the brain of around one square centimetre, which in turn causes the neurons in that area to activate - these events take place over fractions of a second. For reasons that are not well understood, spacing out trains of these magnetic pulses leads to more durable effects, lasting for an hour or more after the stimulation - this is known as repetitive TMS, or rTMS. Repeated sessions of rTMS, given every day for several days, exploit the brain’s plasticity to change brain activity for many months. This gives neuroscientists a way to reorganise (never ‘rewire’) small brain circuits.

rTMS treatment for MDD targets the prefrontal cortex, usually in a spot a few centimetres above the corner of the left eye, called the dorsolateral prefrontal cortex (or DLPFC). The cells in this area connect to networks that project throughout the brain, and rTMS has both enhancing and inhibiting effects on distant brain regions. The full extent of these hubs and networks are poorly understood, but it seems clear that modulating the activity of the prefrontal cortex releases neurotransmitters deep in the ancient structures of the midbrain, in particular the caudate nucleus. In turn, these structures regulate our basic motivations and emotions. So by indirectly stimulating these regions, rTMS seems to correct the low mood and listlessness of MDD in some people.

Is rTMS the future of depression treatment? The treatment certainly looks promising, with increased remittance rates and seemingly few side-effects. Baseline depression scores may be reduced by up to a third according to some studies, although other studies are more cautious. It seems that longer courses of treatment, lasting several weeks, have greater effects - this suggests an additive effect of rTMS on the brain over time. However the uncertainties over the mechanisms of rTMS in MDD mean that neurologists will find it difficult to personalise treatment for an individual patient. The number of parameters involved in rTMS, such as the number of pulses to deliver, or the intensity of each pulse, make it difficult to specify precisely the dose required for a patient. Precision is also a problem in locating the exact target in prefrontal cortex for stimulation - each person’s brain folds in its own way, and missing the DLPFC even by a centimetre can mean the difference between a person being a ‘responder’ or a ‘non-responder’, in the stark language of psychiatry. Moreover, the physical sensation of rTMS, which can feel like a woodpecker tapping the head, makes it difficult to create a placebo condition for use in clinical trials.

rTMS is currently approved for use only in the USA, and only in a restricted group of patients. However it is likely that, with further research into improvements in efficacy and in understanding the mechanisms of the technique, we will see increasing use of rTMS as a treatment for this burdensome disorder. The entry of Magstim into this market offers clinicians a new avenue for people who may be running out of drug-based options, and marks an important milestone in taking knowledge gained in research and making use of it for the benefit of many.

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Unexpected Reasons Why You May Be Stressed

You're probably all too aware of the major sources of stress in your life—money, your terrible commute, the construction workers who start jackhammering at 5 a.m. But stress and anxiety don't have to just come from obvious or even negative sources. "There are plenty of chronic strains and low-grade challenges that don't necessarily overwhelm you in the moment, but almost take more of a toll in the long run," says Scott Schieman, PhD, professor of sociology at the University of Toronto. These are some of unexpected reasons why you might feel anxious or agitated. By recognizing them for what they are, says Schieman, you can better prepare to cope.

Your significant other

Even if you have a blissfully happy relationship with your live-in partner or spouse, you're both bound to do things that get on each other's nerves. "Early in the relationship, it's usually about space and habits—like whether you squeeze the toothpaste from the middle or the bottom of the tube," says Ken Yeager, PhD, associate professor of psychiatry at the Ohio State University Wexner Medical Center. "Later on, you might clash over parenting style or financial issues, and finding a unified front to face these issues together." So what's the key to surviving and thriving in your life together? Finding balance, says Yeager: spending the right amount of time together (not too much and not too little), making compromises, keeping communication open and honest, and remembering to acknowledge what you love about each other on a daily basis.

Everyday annoyances

We're told not to sweat the small stuff, but sometimes it's the little things that have the biggest impact on our mood: the never-ending phone calls with your insurance company, the rude cashier at the grocery store, the 20 minutes you lose looking for a parking space. "We let these things bother us because they trigger unconscious fears," says Yeager—fears of being seen as irresponsible, of being bullied or embarrassed, or of being late all the time, for example. "Sometimes you need to take a step back and realize that you're doing the best you can given the circumstances."

Other people's stress

Stress is contagious, according to a 2014 German study: In a series of experiments, most participants who simply observed others completinga stressful task experienced an increase themselves in production of the stress hormone cortisol—a phenomenon known as empathic stress. You can also experience stress when someone you know is affected by a traumatic event, like a car crash or a chronic illness. "You start to worry, 'Oh my gosh, could that happen to me?'," says Yeager. "We tend not to think about these things until they hit close to home."

Social media

It may seem like Facebook is the only way you keep up with the friends you don't see regularly—which, during particularly busy times, can be just about all of them. The social network also has a downside, according to a 2015 study from the Pew Research Center: It can make you aware of stressful situations in your friends' lives, which in turn can add more stress to your life. The Pew report didn't find that social media users, overall, had higher levels of stress, but previous studies have suggested that frequent social-media use can be associated with negative body image and prolonged breakup pain.

Distraction

A distraction can be a good thing then when it takes your mind off of a stressful situation or difficult decision, like when you take a break from work to meet a friend for lunch. But it works the other way, as well: When you're so busy thinking about something else that you can't enjoy what's going on around you, that kind of distraction can be a recipe for stress. Practicing mindfulness gives you brain the refresh it needs, says Richard Lenox, director of the Student Counseling Center at Texas Tech University. Paying full attention to your surroundings when you're walking and driving can help, he adds. "Stress and anxiety tend to melt away when our mind is focused on the present."

Your childhood

Traumatic events that happened when you were a kid can continue to affect your stress levels and overall health into adulthood. A 2014 University of Wisconsin-Madison study found that these childhood experiences may actually change parts of the brain responsible for processing stress and emotion. The way you were raised can also have a lasting impact on your everyday angst, suggests a 2014 Johns Hopkins University study. Researchers found that children of parents with social anxiety disorders are more likely to develop "trickle-down anxiety"—not simply because of their genes, but because of their parents' behaviors toward them such as a lack of warmth and emotion, or high levels of criticism and doubt.

Tea and chocolate

You probably know to take it easy on the coffee when you're already feeling on edge. "Caffeine is always going to make stress worse," says Yeager. But you may not think as much about drinking several cups of tea at once, or chowing down on a bar of dark chocolate—both of which can contain nearly as much caffeine as a cup of joe. "Chocolate is a huge caffeine source," says Yeager. "I know people who don't drink coffee but they'll eat six little candy bars in a two-hour period because they want the same kind of jolt." Too much caffeine, in any form, can cause problems with sleep, digestion, and irritability.

Your expectations

When things don't go the way you've planned, do you tend to get upset and act defensively, or do you roll with the punches and set off on a new plan? If it's the former, you could be contributing to a mindset of pessimism and victimization that will slowly wear you down, even when things may not be as bad as they seem. "Your level of serenity is inversely proportionate to your expectations," says Yeager. That doesn't mean you shouldn't set ambitious goals for yourself or settle for less than what you want, of course, but being realistic about what's truly possible is important, as well.

Your reaction to stress

If you tend to deal with stressful situations by working long hours, skipping your workouts, and bingeing on junk food, we've got some bad news: You're only making it worse. "We know that physical activity and healthy foods will help your body better deal with stress, and yet we often avoid them when we need them the most," says Yeager. "People really need to think about this downward spiral we get into and work harder to counteract it."

Multitasking

Think you're being super efficient by tackling four tasks at once? Chances are you're not —and it's only decreasing your productivity while increasing your stress. A 2012 University of Irvine study, for example, found that people who responded to emails all day long while also trying to get their work done experienced more heart-rate variability (an indicator of mental stress) than those who waited to respond to all of their emails at one time. Focusing on one task at a time can ensure that you're doing that job to the best of your abilities and getting the most out of it, so you won't have to worry about or go back and fix it later, says Schieman. And don't worry: You'll have enough time to do it all. In fact, you may discover you have more time than you thought.

Your favorite sport

Watching a tight game of college hoops can stress you out—even if your alma mater wins. "The body doesn't distinguish between 'bad' stress from life or work and 'good' stress caused by game-day excitement," says Jody Gilchrist, a nurse practitioner at the University of Alabama at Birmingham's Heart and Vascular Clinic. Watching sports can even trigger the body's sympathetic nervous system, releasing adrenaline and reducing blood flow to the heart. Those temporary consequences aren't usually anything to be concerned about, but over time, chronic stress can lead to high blood pressure and increased disease risk. And, of course, it doesn't help if you're adding alcohol and binge-eating to a situation that's already stressful on your body. You may not be able to control the outcome of the game, says Gilchrist, but you can limit its effects on your own body.

Digital devices

Whether you're using it for work or play, technology may play a large role in your mental health, says Yeager. Using computers or e-readers too close to bedtime could lead to sleep problems, he says, and spending too much time virtually socializing can make real-life interactions seem extra stressful. (Plus, texting doesn't trigger the same feel-good hormones as face-to-face talk does.) Then there's the dreaded "work creep," says Schieman, when smartphones allow employees to be tethered to their jobs, even during off-hours. "People say they're only going to check email for an hour while they're on vacation, but the problem with email is that they're filled with responsibilities, new tasks, and dilemmas that are going to be hard to compartmentalize and put out of your head once that hour is up."

Your (good) health

While it may not be as stressful as having a chronic illness or getting bad news at the doctor's office, even people in the best shape of their lives worry about their bodies, their diets, and their fitness levels. In fact, people who take healthy living to an extreme may experience some rather unhealthy side effects. People who follow low-carb diets, for example, are more likely to report being sad or stressed out, while those on any kind of restrictive meal plan may feel more tired than usual. And it's not unheard of for someone to become obsessed with healthy eating (known as orthorexia) or working out (gymorexia). Like any form of perfectionism, these problems can be stressful at best, and extremely dangerous at worst.

Housework

Does folding laundry help you feel calm, or does it make your blood boil? If you're in a living situation where you feel you're responsible for an unfair share of work, even chores you once enjoyed may start to feel like torture. "Dividing up housework and parenting responsibilities can be tricky, especially if both partners work outside the home," says Schieman. "And whether you define that division of labor as equal or unequal can really change your attitude toward it."

Uncertainty

Stress can be defined as any perceived or actual threat, says Yeager, so any type of doubt that's looming over you can contribute to your anxiety levels on a daily basis. "When you know something could change at any minute, you always have your guard up and it's hard to just relax and enjoy anything." Financial uncertainty may be the most obvious stressor—not being sure if you'll keep your job during a round of layoffs, or not knowing how you'll pay your credit card bill. Insecurities in other areas of life, like your relationship or your housing status, can eat away at you too.

Your pet

No matter how much you love your furry friends, there's no question that they add extra responsibility to your already full plate. Even healthy animals need to be fed, exercised, cleaned up after, and given plenty of attention on a regular basis—and unhealthy ones can be a whole other story. "Pets can be the most positive source of unconditional love, but at the same time they require an extreme amount of energy," says Yeager. People also tend to underestimate the stress they'll experience when they lose a pet. "I've had people in my office tell me they cried more when their dog died than when their parent died. It's a very emotional connection."

Your education

Having a college degree boosts your odds of landing a well-paying job, so although you're less likely to suffer from money-related anxiety, your education can bring on other types of stress, according to a 2014 study by Schieman and his University of Toronto colleagues. His research found that highly educated people were more likely to be stressed out thanks to job pressures, being overworked, and conflicts between work and family. "Higher levels of authority come with a lot more interpersonal baggage, such as supervising people or deciding whether they get promotions," says Schieman. "With that type of responsibility, you start to take things like incompetency and people not doing their jobs more personally, and it bothers you more."

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Did You Know?

More than 350 million people worldwide suffer from depression. Fewer than half receive any treatment; even fewer have access to psychotherapy.

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