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Clinical Trials of Therapy versus Medication: Even in a Tie, Medication wins | The BMJ

However, disclosure of the relationship would not have changed the troubling end result: A researcher with a history of being funded by SSRI makers completes a 'gold-standard' federally-funded study of post stroke SSRI use, which is published in one of the most prestigious medical journals in the world, and is given a forum in the national media to tell the general public that anyone who has had a stroke, whether or not they have been diagnosed with depression, should start a prophylactic regimen of Lexapro ...even though non-medical approaches perform just as well.

Exercise: Psych patients' new primary prescription -- ScienceDaily

Tomasi, in collaboration with UVMMC's Sheri Gates and Emily Reyns, built a gym exclusively for roughly 100 patients in the medical center's inpatient psychiatry unit, and led and introduced 60-minute structured exercise and nutrition education programs into their treatment plans. The psychotherapists surveyed patients on their mood, self-esteem and self-image both before and after the exercise sessions to gauge the effects of exercise on psychiatric symptoms. Patients reported lower levels of anger, anxiety and depression, higher self-esteem, and overall improved moods. Tomasi, Gates and Reyns found an average of 95 percent of patients reported that their moods improved after doing the structured exercises, while 63 percent of the patients reported being happy or very happy, as opposed to neutral, sad or very sad, after the exercises. An average of 91.8 of patients also reported that they were pleased with the way their bodies felt after doing the structured exercises.

Multiple brain regions moderate and link depressive mood and pain -- ScienceDaily

"We were very surprised about the expansive roles of these regions," said Zeidan. "Brain regions involved in facilitating pain were also associated with lower pain and depression. Brain regions involved in regulating pain where also associated with increasing depression. Perhaps it's not surprising after seeing the results. Why shouldn't specific aspects of the brain perform multiple roles?"

Perseverance toward life goals can fend off depression, anxiety, panic disorders: Looking on the bright side also acts as a safeguard, according to 18-year study -- ScienceDaily

At each interval, participants were asked to rate their goal persistence (e.g., "When I encounter problems, I don't give up until I solve them"), self-mastery (e.g., "I can do just anything I really set my mind to") and positive reappraisal (e.g., "I can find something positive, even in the worst situations"). Diagnoses for major depressive, anxiety and panic disorders were also collected at each interval. People who showed more goal persistence and optimism during the first assessment in the mid-1990s had greater reductions in depression, anxiety and panic disorders across the 18 years, according to the authors.

Train your brain, change your brain - ScienceBlog.com

With this technique, the magnetic resonance equipment helps individuals to have access to their own brain activity in real time and quickly gain control over it. Thirty-six healthy subjects participated in the study in which the goal was to increase the activity of brain regions involved in hand movements. However, instead of actually move their hand, participants were asked to only imagine the movement, in total rest. Nineteen of them received the real brain training and the remaining seventeen were trained with placebo neurofeedback, for comparisons purposes. Immediately before and after the brain training, which lasted around 30 minutes, their neural networks were scanned in order to investigate the impact of the neurofeedback (or placebo) on brain wiring and communication, also known as structural and functional connectivity, respectively. The results show that the corpus callosum – the major cerebral bridge that connects the right and left hemispheres – exhibited increased integrity, and the neural network controlling the movements of the body became strengthened. It seems that the whole system became more robust. Likewise, the training also had a positive impact on the default mode network, a brain network which is impaired after stroke, Parkinson’s and depression, for example. These changes were not observed in the control group.

Note 'average' number of treatments?!

The 16 participants in the FORSEE-II study had suffered from severe depression for 8 to 22 years and had previously undergone an average of 18 drug therapies, 20 electroconvulsive therapies, and 70 hours of psychotherapy -- without success. Prof. Dr. Volker A. Coenen, first author of the study and director of the Stereotactic and Functional Neurosurgery Unit at the Department of Neurosurgery of the Medical Center -- University of Freiburg, and his team implanted the deep brain stimulation systems in the patients medial forebrain bundle of the brain and used them to stimulate the medial forebrain bundle. This brain region is involved in the perception and regulation of pleasure and reward and is thus also significant for motivation and the perceived quality of life. Clear Relief Often within Days The doctors evaluated the success of the therapy monthly with the help of the established Montgomery-Asberg Depression Rating Scale (MADRS). The MADRS scores of ten study participants already decreased significantly within the first week and remained at a low level. All study participants reacted to the stimulation in the course of the study. Eight of the 16 patients had a MADRS score of under 10 points at the end of the study and thus were regarded as non-depressive. "Our patients had struggled with severe depression for years with no signs of improvement. Deep brain stimulation brought most of them significant relief within days, which lasted throughout the course of the therapy. Other forms of treatment like medication and psychotherapy often lose their effectiveness over the course of time. Absolutely sensational about the study data is that the effect seems to be long lasting, with the positive effects continuing for years," says Prof. Schläpfer. "We know from a pilot study that the stimulation of this brain region is very promising and we are delighted about the replication of these significant effects," says Prof. Coenen.

Fast-acting psychedelic associated with improvements in depression/anxiety -- ScienceDaily

One of the unique properties of 5-MeO-DMT is the fast action and short duration of the psychedelic effects when compared to other psychedelics. "Research has shown that psychedelics given alongside psychotherapy help people with depression and anxiety. However, psychedelic sessions usually require 7 -- 8 hours per session because psychedelics typically have a long duration of action," says Alan K. Davis, Ph.D., a postdoctoral research fellow in the Behavioral Research Unit, at the Johns Hopkins University School of Medicine. "Because 5-MeO-DMT is short-acting and lasts approximately 30-90 minutes, it could be much easier to use as an adjunct to therapy because current therapies usually involve a 60 -- 90 minute session."

Inflammation links heart disease and depression -- ScienceDaily

This finding was given further support by the next stage of the team's research. They used a technique known as Mendelian randomisation to investigate 15 biomarkers -- biological 'red flags' -- associated with increased risk of coronary heart disease. Mendelian randomisation is a statistical technique that allows researchers to rule out the influence of factors that otherwise confuse, or confound, a study, such as social status. Of these common biomarkers, they found that triglycerides (a type of fat found in the blood) and the inflammation-related proteins IL-6 and CRP were also risk factors for depression. Both IL-6 and CRP are inflammatory markers that are produced in response to damaging stimuli, such as infection, stress or smoking. Studies by Dr Khandaker and others have previously shown that people with elevated levels of IL-6 and CRP in the blood are more prone to develop depression, and that levels of these biomarkers are high in some patients during acute depressive episode. Elevated markers of inflammation are also seen in people with treatment resistant depression. This has raised the prospect that anti-inflammatory drugs might be used to treat some patients with depression. Dr Khandaker is currently involved in a clinical trial to test tocilizumab, an anti-inflammatory drug used for the treatment of rheumatoid arthritis that inhibits IL-6, to see if reducing inflammation leads to improvement in mood and cognitive function in patients with depression. While the link between triglycerides and coronary heart disease is well documented, it is not clear why they, too, should contribute to depression. The link is unlikely to be related by obesity, for example, as this study has found no evidence for a causal link between body mass index (BMI) and depression.

Serotonin can regulate gene expression inside neurons -- ScienceDaily

The study revolves around DNA and how it works to form each person's individual biological map. Each cell in the body contains two meters of DNA, the blueprint for all functions of all cells in the body. This DNA is wound around spools of histone proteins (proteins that package DNA in the nucleus of cells, and are heavily prone to chemical modifications that aid in the regulation of gene expression) into structures referred to as nucleosomes. When DNA encoding a specific gene is wound tightly within the spool, that gene is less likely to be expressed. When the gene is not wound as tightly, it is more likely to be expressed. This can affect many functions of a given cell. Serotonin is a chemical that can transmit signals between neurons in the brain and is involved in the regulation of mood. Selective serotonin reuptake inhibitors, known as SSRIs, alter the amounts of serotonin in the brain, which enables mood changes. When small packages of serotonin are released from a neuron, the resulting signals set up a chain reaction of communication between different parts of the brain. The research team discovered that a protein called tissue transglutaminase 2 can directly attach serotonin molecules to histone proteins (a process called histone serotonylation), which in turn loosens the spool to enable more robust gene expression. Specifically, they found that in developing rodent brains and human neurons, genes near the part of the spool loosened by the serotonin are more likely to be expressed. They also showed that a specific binding complex enables this process.

Drug Companies and Doctors Battle Over the Future of Fecal Transplants - The New York Times

Mark Smith, a microbiologist at M.I.T., was halfway through his pitch with a group of pharmaceutical executives when one of them interrupted to ask if the meeting was a prank. “I can’t believe you wasted my time with this crazy idea,” the man said, Dr. Smith later recalled. That was 2012. Later that year he helped found OpenBiome, the nonprofit stool bank that now supplies most of the fecal matter for transplants in the United States. Three years ago, he started his own drug company, Finch Therapeutics, which has raised $77 million. Over the past decade, tens of thousands of Americans with C. diff have been cured through fecal transplants, often with a single dose that can bring patients back from the brink of death. The treatment has more than an 80 percent success rate, according to several studies, and many patients feel better within hours of receiving the procedure, which is usually administered through colonoscopy or capsules containing desiccated fecal matter. The F.D.A. has not formally approved the therapy but it has suspended enforcement of its rules for patients who have failed on antibiotics while it figures out the best way to regulate a regimen that, until recently, was sometimes performed at home by desperate patients using an enema, saline and a relative’s stool. Ms. Duff, the head of the C. diff patients group, credits her own recovery from the disease to a homemade concoction her husband created with his own stool in the kitchen blender.

The neuroactive potential of the human gut microbiota in quality of life and depression | Nature Microbiology

Butyrate-producing Faecalibacterium and Coprococcus bacteria were consistently associated with higher quality of life indicators. Together with Dialister, Coprococcus spp. were also depleted in depression, even after correcting for the confounding effects of antidepressants. Using a module-based analytical framework, we assembled a catalogue of neuroactive potential of sequenced gut prokaryotes. Gut–brain module analysis of faecal metagenomes identified the microbial synthesis potential of the dopamine metabolite 3,4-dihydroxyphenylacetic acid as correlating positively with mental quality of life and indicated a potential role of microbial γ-aminobutyric acid production in depression.

Honnold climbs to avoid the dips and flatlands

“Yes. I think I gravitate towards being a somewhat depressed person. Or—I don’t know actually. I’m sort of just flat…I feel like I don’t have any of the highs. I kind of go from level, to slightly below level, to back. It’s all pretty flat…Sometimes you just feel useless, you know? But in some ways I embrace that as part of the process because you kind of have to feel like a worthless piece of poop in order to get motivated enough to go do something that makes you feel less useless. But then ultimately that still doesn’t make you feel any less useless, so you just have to keep doing more.”

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. | Traumatic Brain Injury | JAMA Psychiatry | JAMA Network

Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54).

Newly isolated human gut bacterium reveals possible connection to depression -- ScienceDaily

The research team from the U.S. Department of Energy's (DOE) Argonne National Laboratory, Northeastern University and elsewhere made the connection by first isolating the KLE1738, a bacterium that has a surprising dependency upon a brain chemical called gamma-aminobutyric acid (GABA). "The association of microbial GABAmetabolism with mental health is highly compelling," said Jack Gilbert, group leader for microbial ecology at Argonne who also holds new faculty appointments at the University of California, San Diego, in the Department of Pediatrics and at Scripps Institution of Oceanography. "The general ability of the microbiome to produce and/or consume GABA has not been as broadly described before, and a bacterium dependent on GABAhas never been reported."

Stimulating the vagus nerve in the neck might help ease pain associated with PTSD -- ScienceDaily

Lerman especially wants to know how the emotional pain experience may be influenced by the vagus nerve, which runs down both sides of our necks from the brainstem to the abdomen. The vagus nerve also plays a critical role in maintaining heart rate, breathing rate, digestive tract movement and many other basic body functions. In a study published February 13, 2019 in PLOS ONE, Lerman and colleagues tested noninvasive vagus nerve stimulation as a method for dampening the sensation of pain. "It's thought that people with certain differences in how their bodies -- their autonomic and sympathetic nervous systems -- process pain may be more susceptible to PTSD," Lerman said. "And so we wanted to know if we might be able to re-write this 'mis-firing' as a means to manage pain, especially for people with PTSD." Lerman led the study with Alan N. Simmons, PhD, director of the fMRI Research Laboratory at Veterans Affairs San Diego Healthcare System and associate professor of psychiatry at UC San Diego School of Medicine.

Cannabis use in teens linked to risk of depression in young adults: Cannabis use among adolescents is found to be associated with increased risk of depression and anxiety in adulthood -- ScienceDaily

'Regular use during adolescence is associated with lower achievement at school, addiction, psychosis and neuropsychological decline, increased risk of motor vehicle crashes, as well as the respiratory problems that are associated with smoking.' The active ingredient in cannabis,THC, mediates most of psychoactive and mood-related effects of cannabis and also has addictive properties. Preclinical studies in laboratory animals reported an association between pubertal exposure to cannabinoids and adult-onset depressive symptoms. It is thought that cannabis may alter the physiological neurodevelopment (frontal cortex and limbic system) of adolescent brains.

Do differences in gait predict the risk of developing depression in later life? -- ScienceDaily

Gait parameters and mental health both have significant impacts on functional status in later life. The study's findings suggest that gait problems may represent a potentially modifiable risk factor for depression.

Healthy diet can ease symptoms of depression -- ScienceDaily

The study found that all types of dietary improvement appeared to have equal effects on mental health, with weight-loss, fat reduction or nutrient-improving diets all having similar benefits for depressive symptoms. "This is actually good news" said Dr Firth; "The similar effects from any type of dietary improvement suggests that highly-specific or specialised diets are unnecessary for the average individual. "Instead, just making simple changes is equally beneficial for mental health. In particular, eating more nutrient-dense meals which are high in fibre and vegetables, while cutting back on fast-foods and refined sugars appears to be sufficient for avoiding the potentially negative psychological effects of a 'junk food' diet.

Gut Bacteria Linked to Depression Identified – Neuroscience News

Mireia Valles-Colomer (VIB-KU Leuven): ‘Many neuroactive compounds are produced in the human gut. We wanted to see which gut microbes could participate in producing, degrading, or modifying these molecules. Our toolbox not only allows to identify the different bacteria that could play a role in mental health conditions, but also the mechanisms potentially involved in this interaction with the host. For example, we found that the ability of microorganisms to produce DOPAC, a metabolite of the human neurotransmitter dopamine, was associated with better mental quality of life.’

Lasting impact of concussions on young adults -- ScienceDaily

In their study, recently published in the European Journal of Neuroscience, researchers looked at young adults ranging in age from 18 to 24 who had sustained at least two concussions with the most recent one being at least a month before the testing. The participants were asked to switch between two tasks which included telling the difference between colors and shapes, like red and green and circle or square. Cognitive changes, like working memory and processing speed, were noted and oscillatory activity, or brainwaves, were monitored with an electroencephalogram (EEG), which tests for changes in the brainwaves. In both the concussion group and the control group, researchers looked for differences in three different types of brainwaves and their effects on executive function, which is the ability to control cognitive functions like attention, inhibition, performance, flexibility, stability, working memory, and planning. They found an overall lower performance rate from those in the concussion group during the task-switching exercise. They were less accurate and processing performance was low.

Pot withdrawal eased for dependent users | YaleNews

Withdrawal symptoms are marked by craving for marijuana, irritability, anger, depression, insomnia, and decrease in appetite and weight. In 2015, about 4 million people in the United States met the diagnostic criteria for a cannabis use disorder, and almost 150,000 voluntarily sought treatment for their cannabis use. According to recent national data, approximately one-third of all current cannabis users meet diagnostic criteria for CUD.

Effective new target for mood-boosting brain stimulation found -- ScienceDaily

"Stimulation induced a pattern of activity in brain regions connected to OFC that was similar to patterns seen when patients naturally experienced positive mood states," says Vikram Rao, of the University of California, San Francisco. "Our findings suggest that OFC is a promising new stimulation target for treatment of mood disorders." The team led by Rao and Kristin Sellers in the lab of Edward Chang studied 25 patients with epilepsy who had electrodes placed in the brain for medical reasons to pinpoint the origin of their seizures. Many of those patients also suffered from depression, which is often seen in people with epilepsy. With the patients' consent, Chang's team took advantage of those electrodes to deliver small electrical pulses to areas of the brain thought to be involved in regulating mood. Previous studies have explored deep brain stimulation (DBS) for mood disorders, but its success depends critically on target selection. Targets in other mood-related areas deep in the brain hadn't always led to reliable improvements. In the new study, the researchers focused their attention and the electrical stimulation on the OFC. The OFC is a key hub for mood-related circuitry. But it's also widely regarded as one of the least well-understood brain regions. "Although OFC is a more superficial target, it shares rich interconnections with several brain regions implicated in emotion processing," Sellers says. That made this relatively small brain area an attractive target for therapeutic stimulation. The researchers used the implanted electrodes to stimulate OFC and other brain regions while collecting verbal mood reports and questionnaire scores. Those studies found that unilateral stimulation of the lateral OFC produced acute, dose-dependent mood-state improvement in subjects with moderate-to-severe baseline depression. The changes in brain activity the researchers observed after stimulation closely resembled those seen when people are in a good mood.

Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis | Depressive Disorders | JAMA Psychiatry | JAMA Network

Random-effects meta-analysis of 27 RCTs including 1890 men suggested that testosterone treatment is associated with a significant reduction in depressive symptoms compared with placebo (Hedges g, 0.21; 95% CI, 0.10-0.32), showing an efficacy of odds ratio (OR), 2.30 (95% CI, 1.30-4.06). There was no significant difference between acceptability of testosterone treatment and placebo (OR, 0.79; 95% CI, 0.61-1.01). Meta-regression models suggested significant interactions for testosterone treatment with dosage and symptom variability at baseline. In the most conservative bias scenario, testosterone treatment remained significant whenever dosages greater than 0.5 g/wk were administered and symptom variability was kept low.

May A.I. Help You? - The New York Times

In a study with 70 young adults, Darcy found that after two weeks of interacting with the bot, the test subjects had lower incidences of depression and anxiety. […]Last spring, when Darcy put Woebot online, free to all, its use immediately exploded; in the first week, more than 50,000 people talked to it. (“Do you realize,” Ng told Darcy, “that Woebot spoke to more people today than a human therapist could in a lifetime?”) Nowadays, Woebot exchanges between one and two million messages a week with users, ranging from divorcées to the bereaved to young men, a population that rarely seeks treatment. Many tell Darcy that it’s easier to talk to a bot than a human; they don’t feel judged.

Brain signature of depressed mood unveiled in new study: Direct recordings of human brain activity link memory, emotion, and anxiety during bouts of low mood -- ScienceDaily

Then, to compare results across the unique brains and distinct electrode placements of all 21 research participants, the researchers mapped each subject's ICNs onto neural connectivity diagrams. Comparing these standardized records of network activity across subjects revealed several "cliques" -- groups of brain regions that repeatedly became synchronized at specific frequencies, and were therefore likely to represent functional brain networks. One such clique was highly active and coordinated in 13 research participants, all of whom had also scored high on a psychological assessment of baseline anxiety conducted prior to the start of the study. In these same individuals, changes in the activity of this brain network were also highly correlated with day-to-day bouts of low or depressed mood. This mood-related network was characterized by so-called beta waves -- synchronized oscillations between 13 and 30 cycles per second -- in the hippocampus and amygdala, two deep brain regions which have long been linked, respectively, to memory and to negative emotion. Sohal said the research team was at first taken aback by the clarity of the finding. "We were quite surprised to identify a single signal that almost completely accounted for bouts of depressed mood in such a large set of people," said Sohal. "Finding such a powerfully informative biomarker was more than what we'd expected at this stage of the project." Surprisingly, this powerful link between of mood-associated beta waves in the amygdala and hippocampus was entirely absent from eight other research participants, all of whom had comparatively low preexisting anxiety, suggesting new questions about how the brains of people prone to anxiety may differ from others in how they process emotional situations.

Gut branches of vagus nerve essential components of brain's reward and motivation system -- ScienceDaily

"Our study reveals, for the first time, the existence of a neuronal population of 'reward neurons' amid the sensory cells of the right branch of the vagus nerve," says Ivan de Araujo, DPhil, Senior Faculty in the Department of Neuroscience at the Icahn School of Medicine at Mount Sinai and senior author of the paper. "We focused on challenging the traditional view that the vagus nerve is unrelated to motivation and pleasure and we found that stimulation of the nerve, specifically its upper gut branch, is sufficient to strongly excite reward neurons lying deep inside the brain." The branches of the vagus nerve are intricately intermingled, making it extremely difficult to manipulate each organ separately. To address this challenge, the research team employed a combination of virally delivered molecular tools that allowed them to exclusively target the vagal sensory neurons connected to the stomach and upper intestine. Specifically, researchers combined different viruses carrying molecular tools in a way that allowed them to optically activate vagal neurons connected to the gut while vagal neurons leading to other organs remained mute. The approach, a state-of-the-art technique known as "optogenetics," allows investigators to use light to manipulate the activity of a prespecified set of neurons. The study revealed that the newly identified reward neurons of the right vagus nerve operate under the same constraints attributed to reward neurons of the central nervous system, meaning they link peripheral sensory cells to the previously mapped populations of reward neurons in the brain. Strikingly, neurons of the left vagus were associated with satiety, but not with reward. The research team's anatomical studies also revealed, for the first time, that the right and left vagal branches ascend asymmetrically into the central nervous system.