Chapter 16. Psychopathology: Biological Basis of Behavior Disorders

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Sarah Boseley Antidepressants can save lives. At best, they work. At worst, they are a sticking plaster, hopefully enabling people to hold it all together until they get other help in the form of talking therapies. Either way, they are not supposed to be long-term medication. But whether depression is now better diagnosed or we live in sad times, more and more people are taking the pills and the weeks extend into months and years. In some cases, the users find they can’t stop. “I am currently trying to wean myself off,” one told researchers, “which honestly is the most awful thing I have ever done. I have horrible dizzy spells and nausea whenever I lower my dose.” “The withdrawal effects if I forget to take my pill,” another reported, “are severe shakes, suicidal thoughts, a feeling of too much caffeine in my brain, electric shocks, hallucinations, insane mood swings … Kinda stuck on them now cos I’m too scared to come off.” “While there is no doubt I am better on this medication,” said a third, “the adverse effects have been devastating when I have tried to withdraw – with ‘head zaps’, agitation, insomnia and mood changes. This means that I do not have the option of managing the depression any other way.” These anonymised accounts come from scientific studies cited in a report last year to the all-party parliamentary group for prescribed drug dependence and published in the journal Addictive Behaviors. They give a flavour of the reality of dependence on modern antidepressants, the SSRIs (selective serotonin reuptake inhibitors). The most famous is Prozac, AKA fluoxetine, once portrayed as a wonder drug that would make the world rosy and shiny again for all of us, without the dangerous dark side of Valium and the rest of the benzodiazepines. Not only was it harder to overdose on SSRIs than on “benzos”, the experts said; it was also easier to come off them. © 2019 Guardian News & Media Limited

Keyword: Depression
Link ID: 26169 - Posted: 04.24.2019

By Dave Philipps Post-traumatic stress disorder has long been one of the hardest mental health problems to diagnose because some patients try to hide symptoms while others exaggerate them. But a new voice analysis technique may be able to take the guesswork out of identifying the disorder using the same technology now used to dial home hands-free or order pizza on a smart speaker. A team of researchers at New York University School of Medicine, working with SRI International, the nonprofit research institute that developed the smartphone assistant Siri, has created an algorithm that can analyze patient interviews, sort through tens of thousands of variables in their speech and identify minute auditory markers of PTSD that are otherwise imperceptible to the human ear, then make a diagnosis. The results, published online on Monday in the journal Depression and Anxiety, show the algorithm was able to narrow down the 40,500 speech characteristics of a group of patients — like the tension in the larynx and the timing in the flick in the tongue — to just 18 relevant indicators that together could be used to diagnose PTSD. Based on those 18 speech clues, the algorithm was able to correctly identify patients with PTSD 89 percent of the time. “They were not the speech features we thought,” said Dr. Charles Marmar, a psychiatry professor at N.Y.U. and one of the authors of the paper. “We thought the telling features would reflect agitated speech. In point of fact, when we saw the data, the features are flatter, more atonal speech. We were capturing the numbness that is so typical of PTSD patients.” As the process is refined, speech pattern analysis could become a widely used biomarker for objectively identifying the disorder, he said. © 2019 The New York Times Company

Keyword: Stress
Link ID: 26164 - Posted: 04.22.2019

James Hamblin The past two weeks have been frenetic for Bre Hushaw, who is now known to millions of people as the girl in the depression helmet. Hushaw has been hearing from people all around the world who want to try it, or at least want to know how it works. Her life as a meme began when she agreed to an on-camera interview with the local-news site for a story headlined “Helmet Approved by FDA to Treat Depression Available in Arizona.” The feel-good tale of Hushaw’s miraculous recovery from severe depression was tossed into the decontextualizing maw of the internet and distilled down to a screenshot of a young woman looking like a listless Stormtrooper. Jokes poured in. Some of the most popular, each with more than 100,000 likes on Twitter, include: “If u see me with this ugly ass helmet mind ur business.” “Friend: hey everything alright? Me, wearing depression helmet: yeah I’m just tired.” “The depression helmet STAYS ON during sex.” Hushaw has been tracking the virality, sometimes cringing and sometimes laughing. She replies to as many serious inquiries as she can, while finishing up her senior year at Northern Arizona University before starting a job in marketing. A year ago, she didn’t think she was going to live to graduation. When she was 10 years old, her mother died. Her depression symptoms waxed and waned from then on, and they waxed especially when she heard the gunshots on her campus during a shooting at the school in 2015. She’s tried many medications over the years—14, by her count. (c) 2019 by The Atlantic Monthly Group.

Keyword: Depression
Link ID: 26163 - Posted: 04.22.2019

By Sam Rose You’ve probably heard about microdosing, the “productivity hack” popular among Silicon Valley engineers and business leaders. Microdosers take regular small doses of LSD or magic mushrooms. At these doses, they don’t experience mind-bending, hallucinatory trips, but they say they get a jolt in creativity and focus that can elevate work performance, help relationships, and generally improve a stressful and demanding daily life. If its proponents are to be believed, microdosing offers the cure for an era dominated by digital distractions and existential anxiety—a cup of coffee with a little Tony Robbins stirred in. So far, though, it’s been impossible to separate truth from hype. That’s because, until recently, microdoses haven’t been tested in placebo-controlled trials. Late last year, the first placebo-controlled microdose trial was published. The study concluded that microdoses of LSD appreciably altered subjects’ sense of time, allowing them to more accurately reproduce lapsed spans of time. While it doesn’t prove that microdoses act as a novel cognitive enhancer, the study starts to piece together a compelling story on how LSD alters the brain’s perceptive and cognitive systems in a way that could lead to more creativity and focus. The idea behind microdosing traces its roots back decades. In the 1950s, a handful of psychedelic therapists at a mental health facility in Saskatchewan wanted to help alcoholics get clean. They guided the patients through a high dose, ego-dissolving, LSD experience. When they came out the other side, over half of the patients reported complete recovery from alcoholism. The Canadian government was intrigued and ordered more rigorous trials, this time with placebo controls, and without the experienced “trip guides” offering suggestions on what patients should feel. These trials were a bust. In the fall-out, many viewed psychedelic therapy as more shamanism than science. The mindset of the user and suggestion from the therapist (termed “set and setting” to LSD proponents) are just as important as the drug itself. In other words, LSD’s effects had as much to do with goings on outside the brain as inside it. To LSD proponents, though, this was part of how it worked. “Set and setting” guard against a bad trip (with large doses), and give the user an idea of what they should experience. © 2019 Scientific American

Keyword: Depression; Drug Abuse
Link ID: 26148 - Posted: 04.17.2019

Alison Abbott In January 1973, Science published an article called ‘On being sane in insane places’. The author, psychologist David Rosenhan, described how he and seven other healthy people had reported themselves to a dozen psychiatric hospitals, claiming to hear voices uttering odd words such as ‘thud’ or ‘hollow’ — a symptom never reported in the clinical literature. Each person was diagnosed with either schizophrenia or manic-depressive psychosis, and admitted; once inside, they stopped the performance. They were released after an average of 19 days with diagnoses of ‘schizophrenia in remission’ (D. L. Rosenhan Science 179, 250–258; 1973). One research and teaching hospital, hearing about the study, declared that its own staff could never be so deceived. It challenged Rosenhan to send it pseudopatients. He agreed, but never did. Nonetheless, the hospital claimed to have identified 41 of them. Psychiatric hospitals, it seemed, could recognize neither healthy people nor those with mental illnesses. Rosenhan’s study exemplifies much of what went wrong in twentieth-century psychiatry, as biologists, psychoanalysts and sociologists struggled for supremacy. Science historian Anne Harrington takes us through the painful history of that struggle in the enthralling Mind Fixers, which focuses particularly on the United States. © 2019 Springer Nature Publishing AG

Keyword: Schizophrenia; Depression
Link ID: 26145 - Posted: 04.16.2019

by Jesse Noakes In August 2016 I went to New York for the first time. On the second evening, as the sun slipped behind the building across the street, I was sitting on a long couch on the top floor of an old church. All around me instruments were scattered on the floor – singing bowls, tuning forks, rainsticks, Tibetan bells. At the foot of a wall carpeted completely in moss, dripping like the jungle in the baking heat, was a large bronze gong. On the table in front of me two small ceramic bowls contained a capsule of 125mg of pure MDMA and a chilli guacamole with three grams of powdered magic mushrooms stirred through it. I eyed them nervously. I was terrified that I was going to lose my mind but I was more scared that nothing would happen at all, that I was too broken for even this radical treatment. I’d left Australia to take psychedelics with a therapist. Almost a decade of regular talk therapies for depression had done little to explain why I still felt so numb, trapped and terrified. A few months earlier I’d tracked down a guy online who said that, while it wasn’t a magic bullet, he might have something that would help. I can’t name him because it’s still completely illegal. He was sitting across from me and after I’d swallowed the contents of both bowls he handed me a padded eye mask and suggested I lie back on the couch. I heard him move across the room in the steamy darkness as I tried to relax and focus on my breathing. Moments later I heard the first strange notes from the gong. © 2019 Guardian News & Media Limited

Keyword: Depression; Drug Abuse
Link ID: 26141 - Posted: 04.15.2019

/ By Dan Falk It’s been 30 years since Bobby McFerrin urged us, “Don’t Worry, Be Happy.” But it’s not so easy, is it? In the modern world, there’s plenty that you could worry about — but what should you worry about? If you worry about everything, you end up paralyzed with fear; if, on the other hand, you never worry about anything, you’re likely to end up falling victim to circumstances that you could have prevented. We should only worry about things that are likely to happen, and which are likely to cause serious harm if they do happen — and which you can take reasonable measures to prevent from happening. Lise Johnson and Eric Chudler have written a new book to help you navigate the worrysphere. Johnson is a biomedical engineer and a science writer and Chudler is a neuroscientist, and together they lead us on a tour of 58 things that one might potentially worry about, and try to assess how much those things are actually worth worrying about. The authors shine a spotlight on everything from caffeine, fluoride, and the Ebola virus to bees, snakes, public restrooms, and cruise ships. If it were only a list, I suspect they’d have had trouble getting a book deal — but fortunately it’s more than that. The authors have found a nifty way of presenting the variables in graphic form (what they call a “worry index”), displaying each worry-item as a circle on a Cartesian graph: Likelihood is plotted on the x-axis, and preventability on the y-axis; meanwhile, the size of the circle reflects the consequences, or the severity, of the issue. For example, a flesh-eating infection gets a pretty big circle — the disease can be fatal if left untreated. Fortunately, your chances of getting it are very low, so the circle is placed on the far left-hand-side of the graph; and it’s also highly preventable (with good hygiene and prompt medical treatment), so the circle sits high up on the y-axis. In contrast, although “medical errors” get a similar-sized circle, it falls in the lower-right quadrant: Doctors and nurses make mistakes more often than we might imagine, and there’s not much you can do to prevent such errors from happening. Copyright 2019 Undark

Keyword: Stress; Emotions
Link ID: 26140 - Posted: 04.15.2019

Jon Hamilton The anesthetic ketamine can relieve depression in hours and keep it at bay for a week or more. Now scientists have found hints about how ketamine works in the brain. In mice, the drug appears to quickly improve the functioning of certain brain circuits involved in mood, an international team reported Thursday in the journal Science. Then, hours later, it begins to restore faulty connections between cells in these circuits. The finding comes after the Food and Drug Administration in March approved Spravato, a nasal spray that is the first antidepressant based on ketamine. The anesthetic version of ketamine has already been used to treat thousands of people with depression. But scientists have known relatively little about how ketamine and similar drugs affect brain circuits. The study offers "a substantial breakthrough" in scientists' understanding, says Anna Beyeler, a neuroscientist at INSERM, the French equivalent of the National Institutes of Health, who wasn't involved in the research. But there are still many remaining questions, she says. Previous research has found evidence that ketamine was creating new synapses, the connections between brain cells. But the new study appears to add important details about how and when these new synapses affect brain circuits, says Ronald Duman, a professor of psychiatry and neuroscience at Yale University. © 2019 npr

Keyword: Depression; Drug Abuse
Link ID: 26132 - Posted: 04.12.2019

By Emily Mullin About noon most days, the Lieber Institute for Brain Development in East Baltimore gets a case — that is, a brain. It arrives in an inconspicuous red cooler. Almost immediately, resident neuropathologist Rahul Bharadwaj gets to work, carefully inspecting it for any abnormalities, such as tumors or lesions. Often, the brains come from the Maryland Medical Examiner’s Office, just a 15-minute drive across town. On other days, they are flown in — packed on dry ice — from around the country. Since opening in 2011, the institute has amassed more than 3,000 of these post-mortem brains that they are studying to better understand the biological mechanisms behind such neuropsychiatric disorders as schizophrenia, major depression, substance abuse, bipolar disorder and post-traumatic stress disorder. About 100 brain banks exist across the country for all sorts of brain diseases. But Lieber, founded with the support and funding of a wealthy couple whose daughter suffered a psychotic break in her 20s, is the biggest collection dedicated specifically to mental conditions. Current therapies for neuropsychiatric disorders — antipsychotics and antidepressants — treat symptoms rather than the underlying cause of illness, which remains largely unknown. And while they can be lifesaving for certain people, they can cause unpleasant and sometimes serious side effects. In some cases, they won't work at all. Most of these drugs were also discovered by accident. Lieber’s goal is to unravel what happens biologically in the brain to make these conditions occur and then to develop therapies to treat these conditions at their root cause, or even prevent them from happening in the first place. © 1996-2019 The Washington Post

Keyword: Brain imaging; Schizophrenia
Link ID: 26121 - Posted: 04.08.2019

By Darby Saxbe Perinatal depression—depression that occurs during pregnancy or after the birth of a child—is surprisingly common, affecting about 1 in 7 women. And, although depression is debilitating at any time, it may carry a particularly heavy public health burden during the transition to parenthood. Women with depression are less likely to obtain medical care for themselves and their babies, and may struggle to bond with their infants. It’s no wonder that the children of depressed mothers experience heightened long-term risk of emotional and behavioral problems. Despite this grim picture, a new report from the US Preventive Services Task Force offers some hope. The USPSTF, a nonpartisan body of experts, reviews scientific research and makes recommendations for preventing disease. In the past, they’ve issued guidelines for lung cancer detection, aspirin use to prevent heart disease, and blood pressure screening. In a review recently published in the Journal of the American Medical Association (JAMA), the task force shared what they deemed “convincing evidence” that counseling (talk therapy) interventions can not just treat, but actually prevent, perinatal depression. This is exciting news given the high cost of depression during this time and the fact that, unlike other potential treatments for perinatal depression (like the new drug Zulresso), talk therapy is low-tech, relatively low-cost, and brings few side effects. In their report, the USPSTF reviewed 50 studies that they deemed to be at least “good or fair quality.” Almost all were randomized clinical trials, the gold standard for treatment research, in which a treatment is directly compared to a control group condition. About half of the studies focused on pregnant women, and the rest on postpartum women. Some studies targeted women who already had elevated risk for depression, based on risk factors like a personal or family history of depression, low socioeconomic status, and exposure to life stress or intimate partner violence. © 2019 Scientific American

Keyword: Depression; Hormones & Behavior
Link ID: 26109 - Posted: 04.03.2019

By Rachel Aviv Laura Delano recognized that she was “excellent at everything, but it didn’t mean anything,” her doctor wrote. She grew up in Greenwich, Connecticut, one of the wealthiest communities in the country. Her father is related to Franklin Delano Roosevelt, and her mother was introduced to society at a débutante ball at the Waldorf-Astoria. In eighth grade, in 1996, Laura was the class president—she ran on a platform of planting daffodils on the school’s grounds—and among the best squash players in the country. She was one of those rare proportional adolescents with a thriving social life. But she doubted whether she had a “real self underneath.” The oldest of three sisters, Laura felt as if she were living two separate lives, one onstage and the other in the audience, reacting to an exhausting performance. She snapped at her mother, locked herself in her room, and talked about wanting to die. She had friends at school who cut themselves with razors, and she was intrigued by what seemed to be an act of defiance. She tried it, too. “The pain felt so real and raw and mine,” she said. Her parents took her to a family therapist, who, after several months, referred her to a psychiatrist. Laura was given a diagnosis of bipolar disorder, and prescribed Depakote, a mood stabilizer that, the previous year, had been approved for treating bipolar patients. She hid the pills in a jewelry box in her closet and then washed them down the sink. © 2019 Condé Nast

Keyword: Depression
Link ID: 26104 - Posted: 04.02.2019

Almost 71m prescriptions for antidepressants were given out in England last year – not including drugs dispensed in hospitals outside the NHS. This is a vast number of pills – more than twice the number of prescriptions given for antibiotics; 20m more than for cholesterol-lowering statins. In a decade, the number of antidepressant prescriptions has doubled; it has risen by 3m in a year. Around 7 million adults (16% of the English adult population) are now taking this medicine, and around 330,000 children. The new data can’t say whether more people are depressed than previously – only that more are being medicated. The most recent official survey, in 2016, revealed an increase in rates of the most common mental health conditions among women, particularly teenage girls. Recent reports from a commission assembled by the Lancet medical journal, and the World Health Organization, have warned of a growing global mental health crisis, and called on policymakers and professionals worldwide to make this a priority. While people being ill is bad news, reports of people being treated for illness should, so long as the treatment is appropriate, be welcomed. Some researchers believe mental disorders remain under-treated because they are poorly understood, because doctors and patients share doubts about the remedies, and because of the social stigma that makes people reluctant to report symptoms or seek a diagnosis. But even granting that some people may be taking antidepressants who previously went untreated, there is a debate about whether pills are being overprescribed. © 2019 Guardian News & Media Limited

Keyword: Depression
Link ID: 26103 - Posted: 04.02.2019

Alix Spiegel Our thoughts and fears, movements and sensations all arise from the electrical blips of billions of neurons in our brain. Streams of electricity flow through neural circuits to govern these actions of the brain and body, and some scientists think that many neurological and psychiatric disorders may result from dysfunctional circuits. As this understanding has grown, some scientists have asked whether we could locate these faulty circuits, reach deep into the brain and nudge the flow to a more functional state, treating the underlying neurobiological cause of ailments like tremors or depression. The idea of changing the brain for the better with electricity is not new, but deep brain stimulation takes a more targeted approach than the electroconvulsive therapy introduced in the 1930s. DBS seeks to correct a specific dysfunction in the brain by introducing precisely timed electric pulses to specific regions. It works by the action of a very precise electrode that is surgically inserted deep in the brain and typically controlled by a device implanted under the collarbone. Once in place, doctors can externally tailor the pulses to a frequency that they hope will fix the faulty circuit. This week's Invisibilia podcast features the story of a woman with obsessive-compulsive disorder and depression who signed up for a deep brain stimulation trial. The story describes what it's like to be able to adjust her mood by adjusting the settings on her device. Listen to that story here. © 2019 npr

Keyword: Depression; Emotions
Link ID: 26096 - Posted: 03.30.2019

Alix Spiegel We have the story of one woman who is taking part in an experiment on deep brain stimulation. RACHEL MARTIN, HOST: We are about to go deep - deep into your brain. STEVE INSKEEP, HOST: With a story about deep brain stimulation, or DBS, which sounds like a kind of massage, actually. But it means that patients get an implant that delivers small pulses of electricity to their brains. MARTIN: It's often used to treat Parkinson's disease. But for years, researchers have been trying to figure out how to use it to treat psychiatric disorders. INSKEEP: Results and experiments so far have been mixed. Many patients see no benefit. But some with obsessive-compulsive disorder have seen big changes. MARTIN: Like the next woman you're going to meet. For privacy, we are withholding her last name. Alix Spiegel from NPR's INVISIBILIA has her story. ALIX SPIEGEL, BYLINE: During the appointment, Megan didn't have to do that much, just sit in a chair while one of the doctors from the experiment used what looked like an oversized remote control to reprogram her electricity levels. Even after five years of having the implant, getting her electricity adjusted was unpredictable. Sometimes it went fine. But having electrodes in your brain is really complicated. And occasionally, the adjustments didn't go well. UNIDENTIFIED DOCTOR: While you were talking, I slowly ramped it up again. Anything different now? MEGAN: Slightly more aware. UNIDENTIFIED DOCTOR: OK. MEGAN: It's not like in the past, where it was like, oh, I feel good. But it's, like, a different feeling. SPIEGEL: After the doctor turned her up higher, Megan said she felt better. But then he decided to dial it back just a notch. He was worried that too much electricity might make her manic. UNIDENTIFIED DOCTOR: Now, if you notice me turning it down, then maybe I'll change my mind on that. MEGAN: (Crying) I'm sorry; don't do it. UNIDENTIFIED DOCTOR: Did you just feel it? MEGAN: (Crying) I don't feel very good at all right now. © 2019 npr

Keyword: Depression
Link ID: 26095 - Posted: 03.30.2019

By Richard Schiffman The patient, a 48-year-old real estate professional in treatment for anxiety and mild depression, revealed that he had eaten three dozen oysters over the weekend. His psychiatrist, Dr. Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University, was impressed: “You’re the only person I’ve prescribed them to who came back and said he ate 36!” Dr. Ramsey, the author of several books that address food and mental health, is a big fan of oysters. They are rich in vitamin B12, he said, which studies suggest may help to reduce brain shrinkage. They are also well stocked with long chain omega-3 fatty acids, deficiencies of which have been linked to higher risk for suicide and depression. But shellfish are not the only food he is enthusiastic about. Dr. Ramsey is a pioneer in the field of nutritional psychiatry, which attempts to apply what science is learning about the impact of nutrition on the brain and mental health. Dr. Ramsey argues that a poor diet is a major factor contributing to the epidemic of depression, which is the top driver of disability for Americans aged 15 to 44, according to a report by the World Health Organization. Together with Samantha Elkrief, a chef and food coach who sits in on many of his patient sessions, he often counsels patients on how better eating may lead to better mental health. The irony, he says, is that most Americans are overfed in calories yet starved of the vital array of micronutrients that our brains need, many of which are found in common plant foods. A survey published in 2017 by the Centers for Disease Control and Prevention reported that only one in 10 adults meets the minimal daily federal recommendations for fruit and vegetables — at least one-and-a-half to two cups per day of fruit and two to three cups per day of vegetables. © 2019 The New York Times Company

Keyword: Depression
Link ID: 26087 - Posted: 03.28.2019

By Nicholas Bakalar Urban air pollution is associated with an increased risk for psychotic experiences in teenagers, researchers report. A study published in JAMA Psychiatry included 2,063 British teenagers whose health had been followed from birth through age 18. Almost a third of them said they had at least one psychotic experience, ranging from a mild feeling of paranoia to a severe psychotic symptom, since age 12. Researchers linked air pollution data to locations where they spent most of their time — at home, school or work. Compared with teenagers who lived where pollution was lowest, those in the most polluted areas were 27 percent to 72 percent more likely to have psychotic experiences, depending on the type of pollutant; exposure to two pollutants, nitrogen dioxide and nitrogen oxides, accounted for 60 percent of the association. The study controlled for family psychiatric history, maternal psychosis, substance use, socioeconomic status, neighborhood social characteristics and other factors, but it is an observational study that does not prove causation. “From this one study, we can’t say that air pollution causes psychosis,” said the lead author, Helen L. Fisher, a research psychologist at King’s College London. “The study only says that these things commonly occur together.” © 2019 The New York Times Company

Keyword: Schizophrenia; Neurotoxins
Link ID: 26085 - Posted: 03.28.2019

Laura Sanders A few months back, a new storefront appeared in my small Oregon town. Its shelves were packed with tinctures, jars of salve, coffee beans, bath bombs — even beard oil. This motley collection shared a single star ingredient: CBD. Produced by the cannabis plant, CBD is the straitlaced cousin of marijuana’s more famous component — the THC that delivers a mind-swirling high. CBD, or cannabidiol, has no such intoxicating effects on the mind. Yet the molecule has captured people’s attention in a profound way, sold as a remedy for pain, anxiety, insomnia and other ailments — all without the high. That neighborhood shop, CBD Scientific, is far from alone in its efforts to sell people on the benefits of CBD, which is found in both marijuana and hemp, two versions of the Cannabis sativa plant. CBD is popping up in products in pet stores, coffee shops and the health and beauty sections of mainstream grocery stores. It’s even being brewed into beer. I left the shop with a $5 bottle of water infused with “5,000,000 nanograms” of CBD. So far, messages of CBD’s purported health benefits come from people trying to sell CBD products — not from scientists, says Margaret Haney, a neurobiologist who directs the Marijuana Research Laboratory at Columbia University. A gaping chasm separates the surging CBD market and the scientific evidence backing it. While there are reasons to be excited about CBD, the science just isn’t there yet, Haney says. |© Society for Science & the Public 2000 - 2019

Keyword: Drug Abuse; Sleep
Link ID: 26084 - Posted: 03.27.2019

By Laura Parker In the coming adventure video game Sea of Solitude, the main character — a young woman named Kay — navigates a partly submerged city as she faces a multitude of red-eyed scaly creatures. None are as terrifying as her own personal demons. As the game progresses, Kay realizes the creatures she is encountering are humans who turned into monsters when they became too lonely. To save herself, she fights to overcome her own loneliness. Kay was modeled after the game’s creative director, Cornelia Geppert of Jo-Mei Games, an independent game studio, who struggled after a 2013 breakup. “I felt like I was trapped in a cage,” Ms. Geppert, 37, said of her experience. Sea of Solitude, which Electronic Arts will publish this year, is among a growing number of video games that are tackling mental health issues. Last year, a game called Celeste explored depression and anxiety through a protagonist who had to avoid physical and emotional obstacles. In 2017’s fantasy action-adventure video game Hellblade: Senua’s Sacrifice, a young Celtic warrior deals with psychosis. Other games in recent years, including Night in the Woods and Pry, have delved into self-identity, anger issues and post-traumatic stress disorder. All followed the 2013 interactive fiction game Depression Quest, which asked players to step into the shoes of a character living with depression. These games are a far cry from the industry’s better-known story lines of battlefield heroics or the zombie apocalypse. But as a cultural conversation around mental health grows louder, makers of content are responding. According to the National Institute of Mental Health, one in five American adults lives with a mental illness. “Mental health is becoming a more central narrative in our culture, with greater efforts to normalize mental health challenges,” said Eve Crevoshay, executive director of Take This, a nonprofit that educates video game developers on best practices around portraying mental health. “With that trend comes response from creative industries, including games.” (Take This was founded in 2013 after the suicide of a video game journalist prompted a debate about the issue.) © 2019 The New York Times Company

Keyword: Depression
Link ID: 26074 - Posted: 03.25.2019

David Cox Claudia Kieffer remembers the first time she encountered the drug she describes as having “saved my life”. Eight years ago, Kieffer, who had suffered from treatment-resistant depression for decades, was given ketamine as a routine anaesthetic, as part of a post-mastectomy breast reconstruction procedure. But as well as alleviating the pain, Kieffer noticed an instantaneous change in her state of mind. “My head suddenly felt different to any previous time in my entire life,” she says. “I wasn’t high. It wasn’t like I had smoked a joint or had morphine. It was like a spring breeze had blown through my head and just cleaned out all the detritus that had built up over years and years. And when you’ve suffered from depression for as long as I had, it feels like you’re drowning. So when something comes along that makes you feel so very different and healthy, you want to know what that drug is.” Get Society Weekly: our newsletter for public service professionals Read more At the time, Kieffer had tried almost every depression-related treatment available, without success. “I’d had three nervous breakdowns and been hospitalised three times,” she remembers. “I’d had 13 rounds of electric-shock therapy and it didn’t help. When I was in my 20s and 30s, I would self-medicate, just because that’s what you do when you don’t know what else to do. I was thinking about taking my life every single day. I just wanted to fall asleep and not wake up.”

Keyword: Depression; Drug Abuse
Link ID: 26071 - Posted: 03.25.2019

Laura Sanders With great fanfare, a new antidepressant entered the U.S. market in March, the first fundamentally new medicine for depression in decades. Based on the anesthetic ketamine, the drug — called Spravato — is intended to help people with severe depression quickly, taking effect within hours or days instead of the weeks that typical antidepressants take. But for all the hubbub, big questions have gone unanswered about the drug, developed by Janssen Pharmaceuticals, Inc. Some psychiatrists are concerned that the drug was approved by the U.S. Food and Drug Administration based on skimpy data, under standards that were less rigorous than those required for previous antidepressants. It remains unclear, for example, what happens as someone stops taking the drug, as well as whether it has long-term effects. The data on Spravato raise more questions than they answer, says psychiatrist Alan Schatzberg of Stanford University. “And I think that’s unfortunate.” Despite those unknowns, some psychiatrists are relieved to have another drug to try, particularly for people with depression so severe that other drugs have failed to help. Spravato “does something that very few things in psychiatry can do — it works for people who didn’t respond to other treatments, and it works fast,” says psychiatrist Dan Iosifescu of New York University’s School of Medicine. “I really welcome having another powerful tool in my toolbox.” |© Society for Science & the Public 2000 - 2019

Keyword: Depression; Hormones & Behavior
Link ID: 26065 - Posted: 03.23.2019