Chapter 16. Psychopathology: Biological Basis of Behavior Disorders
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By Esther Crawley We know almost nothing about chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME). And yet it causes misery and suffering for hundreds of thousands of people, including many children. One in a hundred teenagers in the UK miss a day a week or more of school because of it, and 2 per cent are probably missing out on the normal stuff that teenagers do. Those I see in my clinic are sick with disabling fatigue, memory and concentration problems, and terrible pain. On average, they miss a year of school, on top of which mothers give up work and siblings suffer. Yet progress on this illness is being hampered by controversy, with some people disputing both its cause and treatment. Some still dismiss it as a non-illness; others decry attempts to treat it with psychological therapy. The result is that few patients are offered treatment and there is almost no research on the condition. This illness is more common than leukaemia and more disabling than childhood arthritis, but few specialists treat it. How have we arrived at a position where the biggest reason for teenagers to miss school long-term is rarely studied and society allows so few to receive treatment? Part of the difficulty is that CFS/ME is not a single illness. Both children and adults have different clusters of symptoms that may represent different illnesses with different biology, requiring different treatments. This may explain why treatments only work for some – and is a problem for those trying to develop them and for people who don’t get better. © Copyright Reed Business Information Ltd.
Sarah Boseley Health editor Hundreds of children and young people are to get treatment for chronic fatigue syndrome for the first time, to see whether methods that have proved highly successful in the Netherlands can be adopted by the NHS. Up to 2% of young people are affected by CFS, also known as myalgic encephalopathy (ME). But few get any treatment, and attempts to help have sometimes stoked the row over the causes of the condition. Activists on social media frequently denounce doctors who suggest that psychological issues play any part in the disease. Treatment given to young people in the Netherlands has had remarkable results, helping 63% recover within six months and return to school and a normal life, compared with 8% of those who had other care. The children are given cognitive behavioural therapy to understand and overcome the debilitating exhaustion that neither sleep nor rest can help. The sessions are conducted with a therapist over the internet, using Skype, diaries and questionnaires. This means children will be able to get treatment in their own homes in parts of the country where there is nothing currently available to them. Esther Crawley, a professor of child health at Bristol University, said she would argue that the trial she is leading is not controversial. “Paediatric CFS/ME is really important and common,” she said. “One per cent of children at secondary school are missing a day a week because of CFS/ME. Probably 2% of children are affected. They are teenagers who can’t do the things teenagers are doing.” © 2016 Guardian News and Media Limited
Link ID: 22824 - Posted: 11.03.2016
Mo Costandi Stem cells obtained from patients with schizophrenia carry a genetic mutation that alters the ratio of the different type of nerve cells they produce, according to a new study by researchers in Japan. The findings, published today in the journal Translational Psychiatry, suggest that abnormal neural differentiation may contribute to the disease, such that fewer neurons and more non-neuronal cells are generated during the earliest stages of brain development. Schizophrenia is a debilitating mental illness that affects about 1 in 100 people. It is known to be highly heritable, but is genetically complex: so far, researchers have identified over 100 rare genetic variations and dozens of mutations associated with increased risk of developing the disease. One of the best characterised mutations associated with the disease is a microdeletion on chromosome 22, within a region containing dozens of genes known to be involved in the development, maturation, and function of brain circuits. This deletion is found in 1 in every 2,000 – 4,000 live births; all patients carrying it exhibit various psychiatric symptoms and conditions, with just under a third of them developing schizophrenia in adolescence or early adulthood. Manabu Toyoshima of the RIKEN Brain Science Institute and his colleagues obtained skin cells from two female schizophrenic patients diagnosed with the chromosome 22 deletion and two healthy individuals, then reprogrammed them to generate induced pluripotent stem cells (iPSCs), unspecialised cells which, like embryonic stem cells, retain the ability to differentiate into all the different cell types in the body. They then compared the properties of iPSCs obtained from the schizophrenic patients with those from the healthy controls. © 2016 Guardian News and Media Limited
Link ID: 22822 - Posted: 11.02.2016
Emily Sohn After a mother killed her four young children and then herself last month in rural China, onlookers quickly pointed to life circumstances. The family lived in extreme poverty, and bloggers speculated that her inability to escape adversity pushed her over the edge. Can poverty really cause mental illness? It's a complex question that is fairly new to science. Despite high rates of both poverty and mental disorders around the world, researchers only started probing the possible links about 25 years ago. Since then, evidence has piled up to make the case that, at the very least, there is a connection. People who live in poverty appear to be at higher risk for mental illnesses. They also report lower levels of happiness. That seems to be true all over the globe. In a 2010 review of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes. And there's growing evidence that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the "poor but happy African sitting under a palm tree," says Johannes Haushofer, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University. © 2016 npr
By David Tuller After living in Oklahoma for 40 years, Nita and Doug Thatcher retired in 2009 to the Rust Belt city of Lorain, Ohio, a Cleveland suburb that hugs Lake Erie. When Nita needed to find a new primary care doctor, a friend recommended someone from the Cleveland Clinic. Nita knew the institution’s reputation for cutting-edge research and superior medical services. But as a longtime patient grappling with chronic fatigue syndrome, a debilitating disorder that scientists still don’t fully understand, she was wary when she learned that the clinic was promoting a common but potentially dangerous treatment for the illness: a steady increase in activity known as graded exercise therapy. The notion that people with chronic fatigue syndrome should be able to exercise their way back to health has enjoyed longstanding and widespread support, and “graded exercise” has become the de facto standard of clinical care. This approach has obvious intuitive appeal. Exercise helps all kinds of illnesses, and it’s a great tool for boosting energy. How could it possibly hurt? British psychiatrists and psychologists developed the graded exercise strategy for treating chronic fatigue syndrome during the 1990s. They offered a straightforward rationale: These patients were not medically sick but severely out of shape (“deconditioned”) from prolonged avoidance of activity. And they avoided activity because they wrongly believed they had a biological disease that would get worse if they overexerted themselves. During treatment, patients were encouraged to question this “dysfunctional cognition,” view any resurgent symptoms as transient, and push through the exhaustion and pain to rebuild their strength. Copyright 2016 Undark
Link ID: 22805 - Posted: 10.29.2016
Alison Abbott Psychiatrist Joshua Gordon wants to use mathematics to improve understanding of the brain. The US National Institute of Mental Health (NIMH) has a new director. On 12 September, psychiatrist Joshua Gordon took the reins at the institute, which has a budget of US$1.5 billion. He previously researched how genes predispose people to psychiatric illnesses by acting on neural circuits, at Columbia University in New York. His predecessor, Thomas Insel, left the NIMH to join Verily Life Sciences, a start-up owned by Google’s parent company Alphabet, in 2015. Gordon says that his priorities at the NIMH will include “low-hanging clinical fruit, neural circuits and mathematics — lots of mathematics", and explains to Nature exactly what that means. What do you plan to achieve in your first year in office? I won’t be doing anything radical. I am just going to listen to and learn from all the stakeholders — the scientific community, the public, consumer advocacy groups and other government offices. But I can say two general things. In the past twenty years, my two predecessors, Steve Hyman [now director of the Stanley Center for Psychiatric Research at the Broad Institute in Cambridge, Massachusetts] and Tom Insel, embedded into the NIMH the idea that psychiatric disorders are disorders of the brain, and to make progress in treating them we really have to understand the brain. I will absolutely continue this legacy. This does not mean we are ignoring the important roles of the environment and social interactions in mental health — we know they have a fundamental impact. But that impact is on the brain. Second, I will be thinking about how NIMH research can be structured to give pay-outs in the short-, medium- and long-terms. © 2016 Macmillan Publishers Limited,
Link ID: 22794 - Posted: 10.27.2016
By NICHOLAS BAKALAR Extremely high or low resting heart rates in young men may predict psychiatric illness later in life, a large new study has found. Researchers used heart rate and blood pressure data gathered at Swedish military inductions from 1969 to 2010, and linked them with information from the country’s detailed health records through the end of 2013. The study, in JAMA Psychiatry, included 1,794,361 men whose average age was 18 at induction. The highest heart rates — above 82 beats a minute — were associated with increased risks of obsessive-compulsive disorder, anxiety disorder and schizophrenia. The lowest, below 62 beats, were associated with an increased risk of substance abuse and violent criminality. Extremes in blood pressure followed similar patterns, but the associations were not as strong. The lead author, Antti Latvala, a researcher at the University of Helsinki, said that the reasons for the association remain unknown. But, he added, “These measures are indicators of slightly different reactivity to stimuli. These people might have elevated heart rates because of an elevated stress level that is then predictive of these disorders.” Still, Dr. Latvala said, a high or low heart rate does not mean future psychiatric disease. “These are very complex illnesses,” he said. “People with high or low heart rate have nothing to worry about because of these findings. This is just a tiny piece of the puzzle.” © 2016 The New York Times Company
By Tori Rodriguez Uric acid is almost always mentioned in the context of gout, an inflammatory type of arthritis that results from excessive uric acid in the blood. It may be surprising, then, that it has also been linked with a vastly different type of disease: bipolar disorder. Elevated uric acid has been observed in patients with acute mania, and reducing uric acid improves symptoms. New evidence supports its potential as a treatment target. Uric acid is a by-product of the breakdown of compounds called purines, found in many foods and manufactured by the body. High levels of uric acid can indicate that these compounds, such as the neurotransmitter adenosine, are being broken down too readily in the body. “Adenosine might play a key role in neurotransmission and neuromodulation, having sedative, anticonvulsant and antiaggressive effects,” says physician Francesco Bartoli, a researcher at the University of Milano-Bicocca in Italy. Bartoli's new study, published in May in the Journal of Psychosomatic Research, examined uric acid levels in 176 patients with bipolar disorder or another severe mental illness and 89 healthy controls. The results show that bipolar disorder was the only diagnosis significantly linked with levels of uric acid. Excess uric acid was found to be linked to male gender, metabolic syndrome, waist size and triglyceride levels. Beyond the too rapid breakdown of adenosine, other potential explanations for increased uric acid include the metabolic abnormalities often present in people with bipolar disorder and frequent consumption of purine-rich foods and drinks, such as liver, legumes, anchovies and alcohol. Fructose consumption can also be a problem because the sugar inhibits uric acid excretion. Dietary interventions may reduce levels, but medication is typically required if dietary changes are insufficient. © 2016 Scientific American
Link ID: 22790 - Posted: 10.26.2016
Andrew Solomon A new virtual-reality attraction planned for Knott’s Berry Farm in Buena Park, Calif., was announced last month in advance of the peak haunted-house season. The name, “Fear VR 5150,” was significant. The number 5150 is the California psychiatric involuntary commitment code, used for a mentally ill person who is deemed a danger to himself or others. Upon arrival in an ersatz “psychiatric hospital exam room,” VR 5150 visitors would be strapped into a wheelchair and fitted with headphones. “The VR headset puts you in the middle of the action inside the hospital,” an article in The Orange County Register explained. “One patient seems agitated and attempts to get up from a bed. Security officers try to subdue him. A nurse gives you a shot (which you will feel), knocking you out. When you wake up in the next scene, all hell has broken loose. Look left, right and down, bloody bodies lie on the floor. You hear people whimpering in pain.” Knott’s Berry Farm is operated by Ohio-based Cedar Fair Entertainment Company, and Fear VR 5150 was to be featured at two other Cedar Fair parks as well. Almost simultaneously, two similar attractions were started at Six Flags. A news release for one explained: “Our new haunted house brings you face-to-face with the world’s worst psychiatric patients. Traverse the haunted hallways of Dark Oaks Asylum and try not to bump into any of the grunting inmates around every turn. Maniacal inmates yell out from their bloodstained rooms and deranged guards wander the corridors in search of those who have escaped.” The Orange County branch of the National Alliance on Mental Illness (NAMI) sprang into action, and Doris Schwartz, a Westchester, N.Y.-based mental-health professional, immediately emailed a roster of 130 grass-roots activists, including me, many of whom flooded Cedar Fair and Six Flags with phone calls, petitions and emails. After some heated back-and-forth, Fear VR 5150 was shelved, and Six Flags changed the mental patients in its maze into zombies. © 2016 The New York Times Company
David Brooks We’ve had a tutorial on worry this year. The election campaign isn’t really about policy proposals, issue solutions or even hope. It’s led by two candidates who arouse gargantuan anxieties, fear and hatred in their opponents. As a result, some mental health therapists are reporting that three-quarters of their patients are mentioning significant election-related anxiety. An American Psychological Association study found that more than half of all Americans are very or somewhat stressed by this race. Of course, there are good and bad forms of anxiety — the kind that warns you about legitimate dangers and the kind that spirals into dark and self-destructive thoughts. In his book “Worrying,” Francis O’Gorman notes how quickly the good kind of anxiety can slide into the dark kind. “Worry is circular,” he writes. It may start with a concrete anxiety: Did I lock the back door? Is this headache a stroke? “And it has a nasty habit of taking off on its own, of getting out of hand, of spawning thoughts that are related to the original worry and which make it worse.” That’s what’s happening this year. Anxiety is coursing through American society. It has become its own destructive character on the national stage. Worry alters the atmosphere of the mind. It shrinks your awareness of the present and your ability to enjoy what’s around you right now. It cycles possible bad futures around in your head and forces you to live in dreadful future scenarios, 90 percent of which will never come true. Pretty soon you are seeing the world through a dirty windshield. Worry dims every sunrise and amplifies mistrust. A mounting tide of anxiety makes people angrier about society and more darkly pessimistic about the possibility of changing it. Spiraling worry is the perverted underside of rationality. This being modern polarized America, worry seems to come in two flavors. © 2016 The New York Times Company
Bret Stetka Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor. The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones. But what about a child's future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, "I'm just trying not to drop her!" Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention. In 2013, University of Colorado psychiatrist Robert Freedman and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the B vitamin choline during pregnancy would enhance brain growth in the developing fetus. The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream. © 2016 npr
By Nathaniel P. Morris When meeting new people, I'm often asked what I do for work. Depending on how I phrase my answer, I receive very different reactions."I'm a doctor specializing in mental health" elicits fascination. People's faces brighten and they say, "Very cool!" But If I instead say, "I'm a psychiatrist," the conversation falls quiet. They get uncomfortable and change the subject. Mental health has made great strides in recent years. Every week, people across the country participate in walks to support mental health causes. The White House now designates May as National Mental Health Awareness Month. In the presidential race, Hillary Clinton released a comprehensive plan to invest in mental health care. Yet psychiatry—the medical specialty focused on mental health—remains looked down upon in nearly every corner of our society. The public often doesn’t regard psychiatrists as medical doctors. Many view psychiatric treatments as pseudoscience at best and harmful at worst. Even among health professionals, it’s one of the least respected medical specialties. The field is in serious decline. Academic papers abound with titles like “Is psychiatry dying?” and “Are psychiatrists an endangered species?” Despite growing mental health needs nationwide, fewer medical students are applying into the field, and the number of psychiatrists in the US is falling. Patients too often refuse treatment because of stigma related to the field. © 2016 Scientific American
By Jessica Hamzelou Is depression caused by an inflamed brain? A review of studies looking at inflammation and depression has found that a class of anti-inflammatory drugs can ease the condition’s symptoms. Golam Khandaker at the University of Cambridge and his colleagues analysed 20 clinical studies assessing the effects of anti-cytokine drugs in people with chronic inflammatory conditions. These drugs block the effects of cytokines – proteins that control the actions of the immune system. Anti-cytokines can dampen down inflammation, and are used to treat rheumatoid arthritis. Together, these trials involved over 5,000 volunteers, and provide significant evidence that anti-cytokine drugs can also improve the symptoms of depression, Khandaker’s team found. These drugs work about as well as commonly used antidepressants, they say. The most commonly used anti-depressant drugs, known as SSRIs, act to increase levels of serotonin in the brain, to improve a person’s mood. But depression might not always be linked to a lack of serotonin, and SSRIs don’t work for everyone. Recent research has found that around a third of people with depression appear to have higher levels of cytokines in their brains, while people with “overactive” immune systems seem more likely to develop depression. Khandaker’s team think that inflammation in the brain might be responsible for the fatigue experienced by people with depression. © Copyright Reed Business Information Ltd.
By Meredith Wadman The second century C.E. Greek physician and philosopher Galen advised patients suffering from disorders of the spirit to bathe in and drink hot spring water. Modern day brain scientists have posited that Galen’s prescription delivered more than a placebo effect. Lithium has for decades been recognized as an effective mood stabilizer in bipolar disease, and lithium salts may have been present in the springs Galen knew. Yet exactly how lithium soothes the mind has been less than clear. Now, a team led by Ben Cheyette, a neuroscientist at the University of California in San Francisco (UCSF), has linked its success to influence over dendritic spines, tiny projections where excitatory neurons form connections, or synapses, with other nerve cells. Lithium treatment restored healthy numbers of dendritic spines in mice engineered to carry a genetic mutation that is more common in people with autism, schizophrenia, and bipolar disorder than in unaffected people, they report today in Molecular Psychiatry. The lithium also reversed symptoms in these mutant mice—lack of interest in social interactions, decreased motivation, and increased anxiety—that mimic those in the human diseases. “They showed there’s a correlation between the ability of lithium to reverse not only the behavioral abnormalities in the mice, but also the [dendritic] spine abnormalities,” says Scott Soderling, a neuroscientist at Duke University in Durham, North Carolina, who studies how dysfunctions in signaling at brain synapses and lead to psychiatric disorders. Soderling adds that the work also sheds light on the roots of these diseases. “It gives further credence to this idea that these spine abnormalities are functionally linked to the behavioral disorders.” © 2016 American Association for the Advancement of Science.
Link ID: 22764 - Posted: 10.18.2016
Bruce Bower Scientists, politicians, clinicians, police officers and medical workers agree on one thing: The U.S. mental health system needs a big fix. Too few people get the help they need for mental ailments and emotional turmoil that can destroy livelihoods and lives. A report in the October JAMA Internal Medicine, for instance, concludes that more than 70 percent of U.S. adults who experience depression don’t receive treatment for it. Much attention focuses on developing better psychiatric medications and talk therapies. But those tactics may not be enough. New research suggests that the longstanding but understudied problem of stigma leaves many of those suffering mental ailments feeling alone, often unwilling to seek help and frustrated with treatment when they do. “Stigma about mental illness is widespread,” says sociologist Bernice Pescosolido of Indiana University in Bloomington. And the current emphasis on mental ills as diseases of individuals can unintentionally inflame that sense of shame. An effective mental health care system needs to address stigma’s suffocating social grip, investigators say. “If we want to explain problems such as depression and suicide, we have to see them in a social context, not just as individual issues,” Pescosolido says. |© Society for Science & the Public 2000 - 2016
Link ID: 22758 - Posted: 10.15.2016
By JOHN C. MARKOWITZ The United States government recently announced its new director of the National Institute of Mental Health, Dr. Joshua Gordon. If you think that’s just bureaucracy as usual, think again. Mental health research, under the leadership of the previous director, Dr. Thomas Insel, underwent a quiet crisis, one with worrisome implications for the treatment of mental health. I hope Dr. Gordon will resolve it. For decades, the National Institute of Mental Health provided crucial funding for American clinical research to determine how well psychotherapies worked as treatments (on their own as well as when combined with medications). This research produced empirical evidence supporting the effectiveness of cognitive behavioral therapy, interpersonal psychotherapy and other talking treatments. But over the past 13 years, Dr. Insel increasingly shifted the institute’s focus to neuroscience, strangling its clinical research budget. Dr. Insel wasn’t wrong to be enthusiastic about the possibilities of neuroscientific research. Compared with the psychiatric diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), which can be vague and flawed, brain-based research holds out the promise of a precise and truly scientific understanding of mental illness. Psychiatric diagnoses depend on clusters of signs and symptoms. For major depression, for example, some criteria are low mood; wanting to die; and sleep, appetite and energy changes. These diagnoses lack the specificity of the biological markers that neuroscience seeks to identify. If we could find a genetic, neuroimaging or brain-circuit explanation for a mental illness, it might even yield a cure, rather than just the treatment of what can be recurrent, chronic conditions. But where does that leave patients whom today’s treatments do not help? Can they wait for neuroscience developments that may take decades to appear, or prove illusory? Staking all your money on one bet, as the institute did under Dr. Insel, has consequences. © 2016 The New York Times Company
Link ID: 22757 - Posted: 10.15.2016
By Daisy Yuhas About 350 million people around the world suffer from depression. Therapists can use many different techniques to help, but none has more rigorous scientific evidence behind it than cognitive-behavioral therapy (CBT). This “inside-out” technique focuses primarily on thought patterns, training patients to recognize and reframe problematic thinking. Now, however, mental health professionals have another option: mounting evidence shows that a technique called behavioral-activation (BA) therapy is just as effective as CBT. BA is an outside-in technique in which therapists focus on modifying actions rather than thoughts. “The idea is that what you do and how you feel are linked,” says David Richards, a health services researcher at the University of Exeter in England. If a patient values nature and family, for example, a therapist might encourage him to schedule a daily walk in the park with his grandchildren. Doing so could increase the rewards of engaging more with the outside world, which can be a struggle for depressed people, and could create an alternative to more negative pastimes such as ruminating on loss. BA has existed for decades, and some of its elements are used in CBT, yet until now it had never been tested with the scale and rigor needed to assess its relative strength as a stand-alone approach. In one of the largest studies of its kind, Richards led a collaboration of 18 researchers working at three mental health centers in the U.K. who put BA and CBT head-to-head. They assigned 440 people with depression to about 16 weeks of one of the two approaches, then followed the patients' progress at six, 12 and 18 months after treatment began. As revealed in a paper, published online in July in the Lancet, the team found the treatments to be equally effective. A year on, about two thirds of the patients in both groups reported at least a 50 percent reduction in their symptoms. © 2016 Scientific American
Link ID: 22741 - Posted: 10.11.2016
Alison Abbott Arrival in a foreign, hostile country causes many refugees great stress. On an ice-cold day in January, clinical psychologist Emily Holmes picked up a stack of empty diaries and went down to Stockholm’s central train station in search of refugees. She didn’t have to look hard. Crowds of lost-looking young people were milling around the concourse, in clothes too flimsy for the freezing air. “It struck me hard to see how thin some of the young men were,” she says. Holmes, who works at Stockholm’s Karolinska Institute, was seeking help with her research — a pilot project on post-traumatic stress disorder (PTSD), which is all too common in refugees. She wanted to see whether they would be willing to spend a week noting down any flashbacks — fragmented memories of a trauma that rush unbidden into the mind and torment those with PTSD. She easily found volunteers. And when they returned the diaries, Holmes was shocked to see that they reported an average of two a day — many more than the PTSD sufferers she routinely dealt with. “My heart went out to them,” she says. “They managed to travel thousands of kilometres to find their way to safety with this level of symptoms.” Europe is experiencing the largest movement of people since the Second World War. Last year, more than 1.2 million people applied for asylum in the European Union — and those numbers underestimate the scale of the problem. Germany, which has taken in the lion’s share of people, reckons that it received more than a million refugees in 2015, tens of thousands of whom have yet to officially apply for asylum. Most came from Syria, Afghanistan and Iraq. Many have experienced war, shock, upheaval and terrible journeys, and they often have poor physical health. The crisis has attracted global attention and sparked political tension as countries struggle to accommodate and integrate the influx. © 2016 Macmillan Publishers Limited
By NICHOLAS BAKALAR Hormonal contraceptives are associated with an increased risk for depression, a large study has found. Danish researchers studied more than a million women ages 15 to 34, tracking their contraceptive and antidepressant use from 2000 to 2013. The study excluded women who before 2000 had used antidepressants or had another psychiatric diagnosis. Over all, compared with nonusers, users of hormonal contraception had an 80 percent increased risk of depression. Some types of contraceptives carried even greater risk. Women who used progestin-only pills more than doubled their risk, for example, while those who used those who used the levonorgestrel IUD (brand name Mirena) tripled their risk. The risk persisted after adjusting for age, age of first intercourse, educational level and other factors. The study, in JAMA Psychiatry, also found that the risk was greater in adolescent girls, but this may be because adolescent girls are especially susceptible to depression. “Even though the risk of depression increases substantially with these drugs — an 80 percent increase is not trivial — most women who use them will not get depressed,” said the senior author, Dr. Oejvind Lidegaard, a clinical professor of obstetrics and gynecology at the University of Copenhagen. “Still, it is important that we tell women that there is this possibility. And there are effective nonhormonal methods of birth control.” © 2016 The New York Times Company
Jon Hamilton There's growing evidence that a physical injury to the brain can make people susceptible to post-traumatic stress disorder. Studies of troops deployed to Iraq and Afghanistan have found that service members who suffer a concussion or mild traumatic brain injury are far more likely to develop PTSD, a condition that can cause flashbacks, nightmares and severe anxiety for years after a traumatic event. And research on both people and animals suggest the reason is that a brain injury can disrupt circuits that normally dampen the response to a frightening event. The result is like "driving a car and the brake's not fully functioning," says Minxiong Huang, a biomedical physicist at the University of California, San Diego. Scientists have suspected a link between traumatic brain injury (TBI) and PTSD for many years. But the evidence was murky until researchers began studying troops returning from Iraq and Afghanistan. What they found was a lot of service members like Charles Mayer, an Army sniper from San Diego who developed PTSD after finishing a deployment in Iraq. In 2010, Mayer was on patrol in an Army Humvee near Baghdad when a roadside bomb went off. "I was unconscious for several minutes," he says. So he found out what happened from the people who dragged him out. The blast fractured Mayer's spine. It also affected his memory and thinking. That became painfully clear when Mayer got out of the Army in 2012. © 2016 npr