Is there a link between metabolic deficiencies and treatment resistant depression? New research shows that this could be the case. The research shows that diagnosing and treating many metabolic disorders in patients with treatment resistant depression could lead to improved outcomes, or even complete remission from the depression in some cases. According to professor and University of Pittsburgh School of Medicine’s Department of Psychiatry chair David Lewis, M.D., “What’s really promising about these new findings is that they indicate that there may be physiological mechanisms underlying depression that we can use to improve the quality of life in patients with this disabling illness.” Approximately 15 million adults in the USA alone suffer from depression and the global numbers are much larger.
Treatment resistant depression is a big problem, and more than 65% of suicides are caused by major depressive disorder or what is commonly called depression. This is one of the most common mental disorders but many patients do not respond well to typical treatments. Pitt School of Medicine professor of psychiatry, and clinical and translational science Lisa Pan, M.D., was the lead study investigator. According to Dr. Pan “Major depressive disorder, usually referred to simply as depression, affects nearly 15 million American adults and is one of the most common mental disorders. Unfortunately, at least 15 percent of patients don’t find relief from conventional treatments, such as antidepressant medications and psychotherapy.” Pan explained that “Over a period of years, we tried every treatment available to help this patient, and yet he still found no relief from his depression symptoms. It’s really exciting that we now have another avenue to pursue for patients for whom our currently available treatments have failed, This is a potentially transformative finding for certain groups of people with depression.”
According to researchers the risk of developing PTSD increases after a mild traumatic brain injury. Researchers from a variety of organizations which included Washington University in St. Louis, the U.S. Centers for Disease Control and Prevention, San Francisco General Hospital, and the University of California, San Francisco performed evaluations on various factors that were related to mental health and functioning issues. The hope is that understanding how this type of injury affects mental health and contributes to PTSD and other mental disorders will lead to better screening, more accurate detection and diagnosis, and earlier treatment for post traumatic stress disorder. The impact that mTBI had was explored in emergency services providers who were civilians rather than evaluating the impact on military personnel. In the study roughly 27% of patients who had suffered mTBI screened positive for PTSD at a follow up screening 6 months after their injury.
The study on PTSD and mild traumatic brain injury was published in the Journal of Neurotrauma and the findings show the importance of following up after a mTBI. Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, professor and Journal of Neurotrauma editor in chief John T. Povlishock, Ph.D. explained “This study represents yet another important communication originating from the CDC and the TRACK-TBI study group that now reframes PTSD within the context of civilian TBI. The finding of a relatively significant proportion of civilian patients experiencing PTSD following mild TBI calls for its more routine evaluation, particularly in those patients with the added comorbid factors identified in this report.”
A recent research study shows that grandkids who have a multi generational history of MDD, or major depressive disorder, will have higher risks of developing depression as well. The study investigators determined that when an individual has both a parent and a grandparent with MDD the risk for the individual to develop depression is much higher. Knowing the increase in risk could help with identification so that grandkids who face these higher risks may benefit from early intervention. The full study details were published in the online journal JAMA Psychiatry. This is the first study published that looks at depression over 3 generations, and that uses direct interviews with all three generations of family members. The study looked at 251 grandkids, with an average age of 18, as well as the parents and grandparents of the grandchildren.
The study conclusion for the research on grandkids, generational history, and depression stated “In this study, biological offspring with two previous generations affected with major depression were at highest risk for major depression, suggesting the potential value of determining family history of depression in children and adolescents beyond two generations. Early intervention in offspring of two generations affected with moderate to severely impairing MDD seems warranted.” A well established fact is that parental depression raises the psychiatric disorder risks that the child faces. The latest research also shows how important it is to look further into the generational history than just the parents of a child because the risk is impacted by more than a single generation.
Recent research has suggested that specific neurological circuits in the brain that are associated with dopamine production may be able to inhibit binge eating in lab mice. At the current time the cause of binge eating is not known, and the neurological basis behind this disorder is unclear. The newest research brings some much needed clarity. Researchers at Texas Children’s Hospital and Baylor College of Medicine in Houston determined that some of the neural circuits in the brain may be able to inhibit binge eating although the how and why of this inhibition is still not completely clear. Senior paper author, Baylor College of Medicine associate professor of pediatrics Dr. Yong Xu, explained that “Human literature suggests that dysfunction of the serotonin system or dopamine system in the brain may be associated with developing binge-like eating behavior. However, mechanistically, there’s no direct evidence to show how this system affects behavior.”
Binge eating is a big problem, and the dopamine system in the brain is associated with this disorder but the processes involved are not yet clear. The research study was published in the Biological Psychiatry journal, and researchers managed to identify a neural circuit which involves serotonin neurons which project to dopamine neurons and cause these receptors to become activated. In the research study the mice experienced inhibition in binge eating when this circuit was activated. Identifying the specific receptors and circuits involved is an important first step to determining the causes of binge eating and developing effective treatments. The serotonin 2C receptor plays a role in preventing binge eating, that much researchers have identified, but there are also a number of other variables involved that need to be examined as well.
Treatment options for ADHD can run the gauntlet from behavioral modification to heavy medications that are basically pharmaceutical grade speed, and more people than ever before have been diagnosed with this mental disorder. Those diagnosed include a large number of children, some who may be as young as 4-5 or even younger. Some research has suggested that medicating ADHD symptoms with strong amphetamine drugs could be occurring far too often. Many parents, adults, and even mental health experts believe that treating ADHD with a combination of effective treatments that do not involve these dangerous medications may be the best route. When it comes to children many of the drugs being prescribed have not been approved for use in those under 18 years of age, but thousands of prescriptions are written for this age group every month by misguided but well meaning mental health professionals.
There are non drug treatment options for ADHD that can be used, and these treatments do not carry the same risks that the drugs designed to treat this condition can have. According to Los Angeles Semel Institute for Neuroscience and Human Behavior, University of California researcher Dr. James McCracken “ADHD is the most commonly diagnosed neuropsychiatric disorder in children, and we know full well the risks it poses for children’s future success in every area of functioning. Our current treatments clearly benefit most children in the short-term, but we’ve yet to find ways to protect those with ADHD from suffering many of the long-term risks.” Many adults are now being diagnosed with ADHD as well, and in many cases non drug therapy can be effective.
A new genome study for the very first time has identifies genome regions which seem to have an association with depression in people with European ancestry. The study researchers used an innovative way of enrolling people by analyzing data which people had already shared when they purchased their own individual DNA profile using an online service. These individuals then chose to participate in the research option. This method provided researchers with an enormous sample of DNA material to work with. According to co-corresponding study report author and Harvard Medical School associate professor of psychiatry Roy Perlis “Identifying genes that affect risk for a disease is a first step towards understanding the disease biology itself, which gives us targets to aim for in developing new treatments. More generally, finding genes associated with depression should help make clear that this is a brain disease, which we hope will decrease the stigma still associated with these kinds of illnesses.”
The genome study results could play a vital role in developing medical and genetic tests for depression. Perlis explained that “The neurotransmitter-based models we are currently using to treat depression are more than 40 years old, and we really need new treatment targets. We hope that finding these genes will point us toward novel treatment strategies. Another key takeaway from our study is that the traditional way of doing genetic studies is not the only way that works. Using existing large datasets or biobanks may be far more efficient and may be helpful for other psychiatric disorders, such as anxiety disorders, where traditional approaches also have not been successful.”
Treatment for mental disorders come in a variety of shapes and sizes, and the treatment recommended will depend on the specific mental illness and symptoms that need to be addressed. In the USA mental institutions were common until a few decades ago, but today many with one or more mental disorders face stigma as well as substandard care. The mentally ill often end up homeless through no fault of their own, or they end up falling through the cracks so that they do not get access to the help and treatment that they deserve. The stigma associated with mental disorders can cause some not to even seek treatment in the first place. There are a number of private programs which can offer confidentiality along with the latest innovative treatments but few insurances and government programs will pay for the higher cost of these effective programs.
If you or a loved one needs treatment for mental disorders you can try to work within the system, waiting weeks or even months in order to try and qualify for a government or social agency program. Another option is to seek out private treatment for any mental illness that you have. If you can afford it this is normally the best choice because the right programs can make a big difference. Government and charity run facilities are typically crowded, and they often offer only the most basic treatment options because they must work within a smaller budget. It is no secret that more needs to be done to address mental illness, and to provide treatment for mental disorders to everyone who needs it.
Is there a link between mental illness and workplace violence? Mentally ill individuals are no more likely to become violent than someone in the general population, whether this is domestic violence, workplace violence, or other violent acts. People who suffer from a mental disorder may be high functioning or low functioning, and around 20% of the population will experience at least one mental disorder in any given year. To put this in perspective in the USA alone this means that in 2016 more than 42.5 million people will have to deal with mental illness on some level. Since there is nowhere near this rate of workplace violence in America the false association of mental illness with violence is disproved. Some studies show that those with a mild mental disorder may even be less likely than an individual in the general population to commit workplace violence.
One problem is that as soon as an episode of workplace violence becomes news people start looking for mental illness in the belief that no sane person could do something so extreme. Unfortunately history has shown that there are evil people who do not suffer from any mental disorders yet these individuals have performed monstrous acts of violence and sadism. Until the stigma is removed from any form of mental illness and these conditions are treated the same as physical ailments there will be instances where workplace violence and mental illness are linked. In many more cases mental illness will play no role at all though, and the person who becomes violent will do so because they are angry, they feel unappreciated, they are jealous, they have been rejected, or some other superficial motive.
The new CDC guidelines on pain and opioid use have been released, and these guidelines have left many patients wondering what these rules and recommendations mean for patients who have cancer, those who are dying, and individuals who deal with chronic pain. Millions of Americans struggle with opioid use disorder and the number of overdose deaths has continued to rise when opioids are abused. Studies have shown that using this class of drugs for chronic pain may be ineffective. Even worse, some studies show that when chronic long term pain is treated with these narcotic drugs this treatment may actually make the pain worse, leading to a vicious cycle where the patient never gets better in spite of being on the pain medications.
It is estimated that around 70% of people who have pain and opioid use is prescribed for have chronic pain, and the CDC guidelines list the various alternative treatments that should be tried before a doctor prescribed this class of medication. There are non narcotic medications which may provide relief, and exercise, physical therapy, and other non drug treatments may also be effective at helping to relieve chronic pain. The CDC is not calling for cancer patients or end of life patients to be refused proper pain management though. According to the report “these medications have a legitimate and important role in the treatment of severe acute pain and some severe chronic pain conditions but they are also overprescribed or prescribed without adequate safeguards and monitoring. According to the CDC opioids for patients who have non cancer pain should never be the first line of treatment or the only treatment used.
A National Institute on Drug Abuse funded research study shows that when states implement prescription drug monitoring programs the rate of opioid overdose deaths is reduced. The research study has been published in the Health Affairs journal, and it also found that when these programs monitored more drugs which had abuse potential and made more frequent database updates the rate of deaths from opioid overdoses were even lower than the reduction seen when the programs did not have these characteristics. Monroe Carell Jr. Children’s Hospital at Vanderbilt, Division of Neonatology, assistant professor of Pediatrics and Health Policy, and lead author of the study Stephen Patrick, M.D., MPH, M.S., explained that “Today, opioid overdose deaths are more common than deaths from car crashes. Our study provides support that prescription drug monitoring programs are part of what needs to be a comprehensive approach to the prescription opioid epidemic.”
The senior study author of the research study on the effect that prescription drug monitoring programs have on opioid overdose deaths was professor and chair of the Department of Health Policy at Vanderbilt Melinda Buntin, Ph.D. According to Buntin “This work is important not only because it demonstrates that prescription drug monitoring programs can save lives, but also because it shows that there are specific actions that states can take to strengthen their programs.” The opioid abuse epidemic in the USA and Canada is a growing problem. If these programs can reduce the number of people who die from abusing these drugs then they should be implemented everywhere.
Noninvasive electrical brain stimulation is an effective treatment for symptom reduction for a number of mental health and physical disorders according to emerging research, but neuroscientists are warning that this is not a DIY treatment that anyone should attempt at home. Close to 40 scientists signed an open letter that the Annals of Neurology published which warns against trying to self administer this type of treatment outside of a medical setting. Deep Brain Stimulation Program associate director and Harvard Medical School neurology professor Michael D. Fox, M.D., Ph.D., explains “There is much about noninvasive brain stimulation that remains unknown. Some risks, such as burns to the skin, are well recognized. However, other potential problems may not be immediately apparent. As neuroscientists we perceive an ethical obligation to draw the attention of both professionals and DIY users to some of these issues.”
University of Pennsylvania Laboratory for Cognition and Neural Stimulation postdoctoral research fellow Rachel Wurzman, Ph.D., first author for the study, also weighed in on noninvasive electrical brain stimulation as a DIY treatment. “Published results of these studies might lead DIY users to believe that they can achieve the same results if they mimic the research studies. However, there are many reasons why this simply isn’t true Outcomes of tDCS can be unpredictable, and we know that in some cases tDCS use can actually make brain function worse.” The open letter authors also wrote that “We know that stimulation from a few sessions can be quite lasting, but we do not yet know whether such changes are reversible, and the possible risks of a larger cumulative dose over several years or a lifetime have not been studied.”
A recent study on sleep disorders, military veterans, and PTSD shows that these disorders have increased considerably in the last decade. The study involved over 9.7 million United States military veterans and the results showed that in 2010 vets had a risk of developing sleep disorders which was more than 6 times what the rate was in 2000. Because patients with PTSD, or those who had combat experience or another mental disorder, had the greatest rate increase the connection between these conditions is hard to ignore. During the study period the PTSD prevalence among vets also tripled. Study participants with chronic diseases such as cancer, cardiovascular disease, and others also had higher rates of sleep disorders as well.
University of South Carolina Arnold School of Public Health Department of Epidemiology and Biostatistics associate professor, senior study author, and principal investigator James Burch, Ph.D., discussed the study on sleep disorders, military veterans, and PTSD. Burch explained that “Veterans with PTSD had a very high sleep disorder prevalence of 16 percent, the highest among the various health conditions or other population characteristics that we examined. Because of the way this study was designed, this does not prove that PTSD caused the increase in sleep disorder diagnoses. However, we recently completed a follow-up study, soon to be submitted for publication, that examined this issue in detail. In that study, a pre-existing history of PTSD was associated with an increased odds of sleep disorder onset.” The study results must be viewed with the fact that 93% of the study participants were men while only 7% were women.