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By Pooja Lakshmin After going through a harrowing bout of postpartum depression with her first child, my patient, Emily, had done everything possible to prepare for the postpartum period with her second. She stayed in treatment with me, her perinatal psychiatrist, and together we made the decision for her to continue Zoloft during her pregnancy. With the combination of medication, psychotherapy and a significant amount of planning, she was feeling confident about her delivery in April. And then, the coronavirus hit. Emily, whose name has been changed for privacy reasons, called me in late-March because she was having trouble sleeping. She was up half the night ruminating about whether she’d be able to have her husband with her for delivery and how to manage taking care of a toddler and a newborn without help. The cloud that we staved off for so long was returning, and Emily felt powerless to stop it. Postpartum depression and the larger group of maternal mental health conditions called perinatal mood and anxiety disorders are caused by neurobiological factors and environmental stressors. Pregnancy and the postpartum period are already vulnerable times for women due in part to the hormonal fluctuations accompanying pregnancy and delivery, as well as the sleep deprivation of the early postpartum period. Now, fears about the health of an unborn child or an infant and the consequences of preventive measures, like social distancing, have added more stress. As a psychiatrist who specializes in taking care of pregnant and postpartum women, I’ve seen an increase in intrusive worry, obsessions, compulsions, feelings of hopelessness and insomnia in my patients during the coronavirus pandemic. And I’m not alone in my observations: Worldwide, mental health professionals are concerned. A special editorial in a Scandinavian gynecological journal called attention to the psychological distress that pregnant women and new mothers will experience in a prolonged global pandemic. A report from Zhejiang University in China detailed the case of a woman who contracted Covid-19 late in her pregnancy and developed depressive symptoms. In the United States, maternal mental health experts have also described an increase in patients with clinical anxiety. © 2020 The New York Times Company

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 27263 - Posted: 05.28.2020

By Benedict Carey The mental health toll of the coronavirus pandemic is only beginning to show itself, and it is too early to predict the scale of the impact. The coronavirus pandemic is an altogether different kind of cataclysm — an ongoing, wavelike, poorly understood threat that seems to be both everywhere and nowhere, a contagion nearly as psychological as it is physical. Death feels closer, even well away from the front lines of emergency rooms, and social isolation — which in pre-Covid times was often a sign of a mind turning in on itself — is the new normal for tens of millions of people around the world. The ultimate marker of the virus’s mental toll, some experts say, will show up in the nation’s suicide rate, in this and coming years. The immediate effect is not at all clear, despite President Trump’s recent claim that lockdown conditions were causing deaths. “Just look at what’s happening with drug addiction, look at what’s happening with suicides,” he said in a press briefing in the White House Rose Garden on Monday. In fact, doctors won’t know for many months if suicide is spiking in 2020; each death must be carefully investigated to determine its cause. The rolling impact of Covid-19 on these rates give scientists a sense of how extended uncertainty and repeating undercurrents of anxiety affect people’s will to live. “It’s a natural experiment, in a way,” said Matthew Nock, a psychology professor at Harvard. “There’s not only an increase in anxiety, but the more important piece is social isolation.” He added, “We’ve never had anything like this — and we know social isolation is related to suicide.” The earliest signs of whether the pandemic is driving up suicides will likely emerge among those who have had a history of managing persistent waves of self-destructive distress. Many of these people, who number in the millions worldwide, go through each day compulsively tuned to the world’s casual cruelties — its suspicious glances and rude remarks — and are prone to isolate themselves, at times contemplating a final exit plan. © 2020 The New York Times Company

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 27258 - Posted: 05.20.2020

Carl Sherman The world of neuroscience and psychiatry sat up and took notice last March when the Food and Drug Administration (FDA) approved brexanolone (Zulresso) for postpartum depression. It was the first drug specifically approved for the condition, which afflicts some 15 percent of women just before or shortly after childbirth. The event was a pivotal chapter in a neuroscience story that began three-quarters of a century ago with the 1941 discovery by Hans Selye (best known for his pioneering research into the nature of stress) that hormones including progesterone could affect the brain to induce deep anesthesia. Fast-forward 40 years to the discovery that a number of hormones—termed “neurosteroids” by the neuroscientist/endocrinologist Étienne-Émile Baulieu, a key figure in this work—are synthesized within the nervous system itself. In their National Institutes of Mental Health (NIMH) lab, Steven Paul and colleagues showed that several of these compounds work by binding to receptors on brain cells that are activated by GABA, the most plentiful inhibitory neurotransmitter in the brain. The GABA-A receptor is the site of action of several sedating central nervous system (CNS) drugs, including benzodiazepines (Valium, Librium), barbiturates, and many anesthetics. Neurosteroids can also bind to receptors for glutamate, the brain’s principal excitatory neurotransmitter. Paul and Robert Purdy proposed that, with its effect on both GABAergic and glutaminergic systems, neuroactive steroids (a term they coined to include synthetic analogues as well as the naturally-occurring hormones themselves) help regulate excitation throughout the brain. Excitation is a major factor in conditions such as epilepsy. Although there are many neuroactive steroids, the lion’s share of research has focused on allopregnanolone, a progesterone derivative. © 2020 The Dana Foundation.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 27197 - Posted: 04.16.2020

By Andrew Solomon For nearly 30 years — most of my adult life — I have struggled with depression and anxiety. While I’ve never felt alone in such commonplace afflictions — the family secret everyone shares — I now find I have more fellow sufferers than I could have ever imagined. Within weeks, the familiar symptoms of mental illness have become universal reality. A new poll from the Kaiser Family Foundation found nearly half of respondents said their mental health was being harmed by the coronavirus pandemic. Nearly everyone I know has been thrust in varying degrees into grief, panic, hopelessness and paralyzing fear. If you say, “I’m so terrified I can barely sleep,” people may reply, “What sensible person isn’t?” But that response can cause us to lose sight of the dangerous secondary crisis unfolding alongside the more obvious one: an escalation in both short-term and long-term clinical mental illness that may endure for decades after the pandemic recedes. When everyone else is experiencing depression and anxiety, real, clinical mental illness can get erased. While both the federal and local governments (some alarmingly slower than others) have responded to the spread of the coronavirus in critical ways, acknowledgment of the mental illness vulnerabilities has been cursory. Gov. Andrew Cuomo, who has so far enlisted more than 8,000 mental health providers to help New Yorkers in distress, is a fortunate exception. The Chinese government moved psychologists and psychiatrists to Wuhan during the first stage of self-quarantine. No comparable measures have been initiated by our federal government. The unequal treatment of the two kinds of health — physical over mental — is consonant with our society’s ongoing disregard for psychological stability. Insurance does not offer real parity of coverage, and treatment for mood disorders is generally deemed a luxury. But we are in a dual crisis of physical and mental health, and those facing psychiatric challenges deserve both acknowledgment and treatment. © 2020 The New York Times Company

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 27183 - Posted: 04.13.2020

A first-of-its-kind trial has demonstrated that a receptor involved in the brain’s reward system may be a viable target for treating anhedonia (or lack of pleasure), a key symptom of several mood and anxiety disorders. This innovative fast-fail trial was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, and the results of the trial are published in Nature Medicine. Mood and anxiety disorders are some of the most commonly diagnosed mental disorders, affecting millions of people each year. Despite this, available medications are not always effective in treating these disorders. The need for new treatments is clear, but developing psychiatric medications is often a resource-intensive process with a low success rate. To address this, NIMH established the Fast-Fail Trials program with the goal of enhancing the early phases of drug development. “The fast-fail approach aims to help researchers determine — quickly and efficiently — whether targeting a specific neurobiological mechanism has the hypothesized effect and is a potential candidate for further clinical trials,” explained Joshua A. Gordon, M.D., Ph.D., director of NIMH. “Positive results suggest that targeting a neurobiological mechanism affects brain function as expected, while negative results allow researchers to eliminate that target from further consideration. We hope this approach will pave the way towards the development of new and better treatments for individuals with mental illnesses.” In this study, researcher Andrew D. Krystal, M.D., who began the research while at the Duke University School of Medicine, Durham, North Carolina, and is now at the University of California, San Francisco, and colleagues report the first comprehensive application of this fast-fail approach. The researchers examined the kappa opioid receptor (KOR) as a possible neurobiological target for the treatment of anhedonia. Previous findings suggest that drugs that block the KOR, known as KOR antagonists, can affect reward-related brain circuits in ways that could improve reward processing and reverse anhedonia and associated symptoms.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 27152 - Posted: 03.31.2020

By Alex Gatenby Victoria Derbyshire programme The mental health charity Mind says it is signposting people to street drug charities to help them withdraw from antidepressants because of the lack of alternatives available. Those affected can experience debilitating symptoms. "Within a couple of days of coming off, it was overwhelming - agitation, anxiety, akathisia [restlessness], just restlessness, can't sleep, suicidal ideations, all that stuff going on very quickly," Stuart Bryan tells the BBC's Victoria Derbyshire programme. The 48-year-old has been taking anti-depressants on and off for more than two decades. "The withdrawals are far worse than the original depression, for me and so many other people." Stuart has tried to stop more than 10 times, but has struggled with what he calls his withdrawal "hell" - and has now had to stop working. He says doctors have advised him to take anything between "a few weeks" to three months to slowly stop using the drugs. But he believes people coming off anti-depressants are being "abandoned by the system". Image caption Mind's Stephen Buckley says it is not fully understood how difficult a process coming off anti-depressants can be While antidepressants are not addictive, just over half of those who stop or reduce their dosage experience withdrawal symptoms, according to one review of 24 studies last year. The mental health charity Mind's head of information Stephen Buckley says it is having to signpost patients to street-drug charities, even though they have been prescribed the drugs on the NHS. Street-drug charities usually help those misusing alcohol and illegally-obtained drugs. © 2020 BBC

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 27112 - Posted: 03.12.2020

By Heather Jones I knew early on that my normal didn’t feel like everyone else’s. Even as early as kindergarten, I could tell that my brain worked differently than others, and that I seemed more listless than other children my age. Other kids felt sadness when they experienced a loss or something upsetting. I always felt sad. I didn’t question the cloudy lens through which I viewed the world, because I had never seen clearly. When I was 16, my family doctor asked me the questions that would change my worldview. Having treated me since childhood, she had noticed patterns. She asked me whether I was experiencing the list of symptoms associated with persistent depressive disorder. I had all of them — feeling down, feeling hopeless, sleep problems, avoidance of social activities, low self-esteem and the rest of the laundry list of warning signs. My doctor explained to me that persistent depressive disorder, also called dysthymia, was a type of “functional depression” that lasts for years and often for a lifetime. I had probably had it since early childhood. I burst into tears, finally knowing there was a reason I felt this way. Knowing what I had didn’t take away my depression — more than 20 years later, I am still living with this condition — but getting a proper diagnosis started me on a path to better management of my symptoms. I am not alone. According to the National Institute of Mental Health, 1.3 percent of American adults will experience persistent depressive disorder at some time in their lives.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 27104 - Posted: 03.09.2020

Dominique Sisley Nothing is quite as shattering as a broken heart. A bad breakup has been known to trigger a range of psychological and physical symptoms, from nausea and insomnia to clinical depression. In more extreme scenarios, broken heart syndrome – when a person’s heart stops pumping blood properly after an emotional shock – can lead to death. Fortunately, recent breakthroughs suggest we may soon be able to beat it. In March, a Spanish study found propofol, a sedative used for anaesthesia, may also be able to mute the painful memories that come with heartbreak. Participants were injected with the drug immediately after recalling a distressing story and, when asked to recount it again 24 hours later, they found the memory to be less vivid. Advertisement The principal goal of the research was to relieve the symptoms of post-traumatic stress disorder (PTSD), but it seems there may be scope for the drug to be used to suppress other upsetting memories. An unexpected loss such as heartbreak can also be traumatic, and some people report similar symptoms. Dr Bryan Strange, who led the study, says: “Combining anaesthesia with evoking an emotionally charged memory impairs its subsequent recall. We will need to derive a set of criteria that identify people for whom it works well, and where the benefit justifies the risk of anaesthesia. There may well be those for whom heartbreak is so distressing that the criteria is fulfilled.” In the past year, a wave of apps such as Mend, Rx Breakup and Break-Up Boss have been released, promising guidance, advice and distracting activities to help soothe the pain of heartbreak. It is a lofty promise, but one that appears to be rooted in logic: a study in 2017 found similar brain-training style exercises could help curb embarrassing or impulsive post-breakup behaviour and strengthen self-control. © 2020 Guardian News & Media Limited

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 27066 - Posted: 02.24.2020

Jon Hamilton Scientists have taken a small step toward personalizing treatment for depression. A study of more than 300 people with major depression found that brain wave patterns predicted which ones were most likely to respond to the drug sertraline (Zoloft), a team reported Monday in the journal Nature Biotechnology. If the approach pans out, it could offer better care for the millions of people in the U.S. with major depression. "This is definitely a step forward," says Michele Ferrante, who directs the computational psychiatry and computational neuroscience programs at the National Institute of Mental Health. He was not a part of the study. Right now, "one of our great frustrations is that when a patient comes in with depression we have very little idea what the right treatment for them is," says Dr. Amit Etkin, an author of the study and a professor of psychiatry at Stanford University. "Essentially, the medications are chosen by trial and error." Etkin is also the CEO of Alto Neuroscience, a Stanford-backed start-up developing computer-based approaches to diagnosing mental illness and selecting treatments. In the study, researchers used artificial intelligence to analyze the brainwave patterns in more than 300 patients who'd been diagnosed with major depression. Then they looked to see what happened when these same patients started treatment with sertraline. And one pattern of electrical activity seemed to predict how well a patient would do. "If the person scores particularly high on that, the recommendation would be to get sertraline," Etkin says. © 2020 npr

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 3: Neurophysiology: The Generation, Transmission, and Integration of Neural Signals
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 3: Neurophysiology: The Generation, Transmission, and Integration of Neural Signals
Link ID: 27034 - Posted: 02.11.2020

Catherine Offord The first time Kees van Heeringen met Valerie, the 16-year-old girl had just jumped from a bridge. It was the 1980s and van Heeringen was working as a trainee psychiatrist at the physical rehabilitation unit at Ghent University Hospital in Belgium. As he got to know Valerie, who’d lost both legs in the jump and spent several months at the hospital, he pieced together the events leading up to the moment the teenager tried to end her life, including stressful interactions with people around her and a steady accumulation of depression symptoms. Van Heeringen, who would later describe the experience in his 2018 book The Neuroscience of Suicidal Behavior, says Valerie’s story left a permanent impression on him. “I found it very difficult to understand,” he tells The Scientist. He asked himself why anyone would do “such a horrible thing,” he recalls. “It was the first stimulus for me to start studying suicidal behavior.” In 1996, van Heeringen founded the Ghent University Unit for Suicide Research. He’s been its director ever since, helping to drive scientific research into the many questions he and others have about suicide. Many of the answers remain as elusive as they seemed that day in the rehabilitation unit. Suicide rates are currently climbing in the US and many other countries, and suicide is now the second leading cause of death among young people globally, after traffic accidents. The World Health Organization recently estimated that, worldwide, one person ends their own life every 40 seconds. © 1986–2020 The Scientist.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 27032 - Posted: 02.11.2020

Rhitu Chatterjee One in seven women experiences depression during or after pregnancy. The good news is that perinatal depression is treatable. Here are five things to know about perinatal depression, its symptoms and treatment options. Loveis Wise for NPR Shortly after she gave birth to her son last May, Meghan Reddick, 36, began to struggle with depression. "The second I had a chance where I wasn't holding [my son], I would go to my room and cry," says Reddick, who lives with her son and husband. "And I probably couldn't count how many hours a day I cried." Reddick is among the many women who suffer from depression during pregnancy and after childbirth. "There's this kind of myth that women couldn't possibly be depressed during pregnancy, [that] this is such a happy time," says Jennifer Payne, a psychiatrist and the director of the Women's Mood Disorders Center at Johns Hopkins University. "The reality is that a lot of women struggle with anxiety and depression during pregnancy as well as during the postpartum period." An estimated one in seven women experiences depression during or after pregnancy. Among some groups, such as teenage moms and women with a history of trauma, the rate can be even higher. Left untreated, depression during this time can have serious consequences on the health of the mother, the baby and the entire family. © 2020 npr

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 27005 - Posted: 01.29.2020

A fast acting ketamine-like anti-depressant spray that can lift mood within hours has been rejected by the NHS healthcare watchdog. The National Institute for Health and Care and Excellence (NICE) says there are too many uncertainties about the correlation between the price and clinical benefits of esketamine. It is licensed as a therapy for people with hard-to-treat depression. But it costs about £10,000 per patient for a single course of treatment. Mixed reactions Some people already prescribed it - as part of a trial, for example - will be able to continue on the treatment if their doctor says it is appropriate to do so, the NICE's draft recommendation for England and Wales says. Scotland is yet to issue guidance. Experts have expressed mixed reactions to NICE's decision. Dr Sameer Jauhar, at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, said NICE had made the call because there was not yet enough long-term evidence to support the use of nasal esketamine alongside another anti-depressant. Consultant psychiatrist Dr Paul Keedwell, at Cardiff University, said patients would be disappointed by a decision based largely on cost rather than lack of effectiveness. Marjorie Wallace, chief executive of mental health charity Sane, said: "People with depression are currently relying on medications that are 30 years old. "Although these drugs can be life-saving for some people, they can have unpleasant side-effects and do not work for everyone. "It is therefore deeply disappointing that the first new compound that works in a fundamentally different way on the brain should not have passed this hurdle. "This is especially so because people can take as much as six to eight weeks to feel the full effects of most anti-depressants. "We hope this setback will serve only to inspire pharmaceutical companies, researchers and others to discover new ways of treating serious depression." Recreational misuse Ketamine is used in medicine to numb the body or induce sleep and sometimes prescribed for depression. © 2020 BBC.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 27004 - Posted: 01.29.2020

By Laura Sanders After taking a compound found in magic mushrooms, people with cancer had less anxiety and depression, even years later, a new study suggests. The evidence isn’t strong enough yet to pin these lasting improvements on the hallucinatory episode itself, as opposed to other life changes. But the findings leave open the possibility that the compound, called psilocybin, may be able to profoundly reshape how people handle distress and fear (SN: 9/26/06). Research published in 2016 suggested that a dose of psilocybin in combination with therapy could quickly ease anxiety and depression in people with cancer. But scientists wanted to know whether these effects lasted. Surveys conducted about three and 4½ years after the psilocybin dose showed that a majority of the 15 people still had fewer signs of anxiety and depression compared with before they took the compound, the team reports January 28 in the Journal of Psychopharmacology. (By the second follow-up, about a third of the participants still had active cancer; the rest were in partial or complete remission.) All the participants said they had “moderate,” “strong” or “extreme” positive changes in their behavior that they attribute to their experience, which many described as one of the most personally meaningful events of their lives. © Society for Science & the Public 2000–2020

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 27003 - Posted: 01.29.2020

By Nicholas Bakalar People with depression are at increased risk for dementia, researchers report, and the risk may persist for decades. Using the Swedish National Patient Register, scientists identified 119,386 people over 50 with depression and matched them with an equal number of people without that diagnosis. Dementia developed in 5.7 percent of those with depression, compared to only 2.6 percent of those without depression, over an average follow-up of more than 10 years. Those with depression were more than 15 times as likely to develop dementia in the first six months after their depression diagnosis as their peers who were not depressed. That rate decreased rapidly but was still evident after 20 years. The researchers also studied 25,322 sibling pairs older than 50 in which one sibling had depression and the other did not. A sibling with a depression diagnosis was more than 20 times as likely as his brother or sister without depression to be diagnosed with dementia in the first six months after the diagnosis. Again, the risk declined over time, but persisted for more than 20 years. The study is in PLOS Medicine. “This is an observational study that does not prove causation,” said the lead author, Peter Nordstrom, a professor of geriatrics at Umea University in Sweden. “If you are diagnosed with depression, that doesn’t mean that you are bound to have dementia.” © 2020 The New York Times Company

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 26988 - Posted: 01.24.2020

By Brooke Siem The prescriptions began in the wake of my father’s sudden death when I was 15: Wellbutrin XL and Effexor XR for anxiety and depression, two separate doses of Synthroid to right a low-functioning thyroid, a morning and nighttime dose of tetracycline for acne, birth control to regulate the unpleasant side effects of womanhood, and four doses of Sucralfate to be taken at each meal and before bedtime — all given to me by the time I was old enough to vote. My general practitioner asked what Sucralfate was after I’d finished rattling off my prescriptive party mix during our first appointment. I was 22 and a recent Manhattan transplant. I had an apartment in Murray Hill and a job waiting tables at a local Italian restaurant. “It’s for something called bile reflux disease,” I said. “I used to randomly puke up bile all the time.” “Huh. Never heard of it.” He ripped off a completed prescription slip and scribbled across the new blank page. “You should really get the prescription for antidepressants from a psychiatrist, but I’ll give it to you along with all the rest since you’ve been on it for so long. And whenever you come back, maybe we should do a physical.” At the time, it never occurred to me that my medication needed monitoring or that perhaps my doctor should do a physical before sending me to the pharmacy. Not only was this five-minute exchange routine, but at no point during my years in the American mental health system did a psychiatrist, psychologist, doctor or pharmacist suggest that I consider reevaluating the decision to take antidepressants. Therefore, I believed that my only choices were to cope with depression or cope with antidepressants, and that depression would always thump inside me with the regularity of my own pulse.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 26939 - Posted: 01.07.2020

By Laura Sanders “Does the pill cause depression?” the news headline asked. Prompted by a recent study that described a link between taking birth control pills as a teenager and depression in adulthood, the news got some doctors hopping mad. Early research hints that there are reasons to look more closely at hormonal birth control’s side effects. But so far, the link is less than certain. “This is a premature connection,” says pediatrician Cora Breuner of Seattle Children’s Hospital. Putting too much stock in preliminary evidence may lead to fewer teenagers getting birth control and, in turn, more unwanted pregnancies among teens — a situation that can upend young lives, Breuner says. Headlines that frighten teens, their families and doctors are “yet another barrier in place for accessing a completely effective way to prevent unplanned pregnancies.” Ob-gyn and contraception researcher Katharine O’Connell White agrees. “Birth control gets all of the worry and concern,” says White, of Boston University School of Medicine. “But we know that other things are much more dangerous.” Teen pregnancy, for instance. Access to effective birth control is vital for sexually active teenagers, the doctors say. “I don’t think the evidence is there right now to say that this is a threat,” adds epidemiologist and public health researcher Sarah McKetta of Columbia University, who has studied birth control use in teens. Still, she sees value in more research on the issue. “Women deserve good medication … that’s not giving them problems.” If there are risks that come with the pill, then scientists ought to get a handle on them. © Society for Science & the Public 2000–2019

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 26864 - Posted: 12.02.2019

National Institutes of Health researchers found that a single, low-dose ketamine infusion was relatively free of side effects for patients with treatment-resistant depression. Elia Acevedo-Diaz, M.D., Carlos Zarate, M.D., and colleagues at the NIH’s National Institute of Mental Health (NIMH) report their findings in the Journal of Affective Disorders. Studies have shown that a single, subanesthetic-dose (a lower dose than would cause anesthesia) ketamine infusion can often rapidly relieve depressive symptoms within hours in people who have not responded to conventional antidepressants, which typically take weeks or months to work. However, widespread off-label use of intravenous subanesthetic-dose ketamine for treatment-resistant depression has raised concerns about side effects, especially given its history as a drug of abuse. “The most common short-term side effect was feeling strange or loopy,” said Acevedo-Diaz, of the Section on the Neurobiology and Treatment of Mood Disorders, part of the NIMH Intramural Research Program (IRP) in Bethesda, Maryland. “Most side effects peaked within an hour of ketamine administration and were gone within two hours. We did not see any serious, drug-related adverse events or increased ketamine cravings with a single-administration.” The researchers compiled data on side effects from 163 patients with major depressive disorder or bipolar disorder and 25 healthy controls who participated in one of five placebo-controlled clinical trials conducted at the NIH Clinical Center over 13 years. While past studies have been based mostly on passive monitoring, the NIMH IRP assessment involved active and structured surveillance of emerging side effects in an inpatient setting and used both a standard rating scale and clinician interviews. In addition to dissociative (disconnected, unreal) symptoms, the NIMH IRP assessment examined other potential side effects — including headaches, dizziness, and sleepiness. The study did not address the side effects associated with repeated infusions or long-term use.

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 26822 - Posted: 11.16.2019

Ricardo F. Muñoz I have been convinced of the importance of prevention in addressing mental-health problems since the early 1970s, when I began my doctorate in clinical psychology. But only now is there sufficient evidence from clinical trials of the effectiveness of preventive interventions, using approaches derived from interpersonal and cognitive behavioural therapy, to justify deploying them. And only now are the tools available to make such interventions available to people worldwide. Two recent reports underline this conclusion. In February, the US Preventive Services Task Force, an independent panel of experts in evidence-based medicine, urged clinicians to “provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions”1. And last month, the US National Academies of Sciences, Engineering, and Medicine (NASEM) released a report2 calling on various stakeholders, from educators to policymakers, to prevent mental-health disorders and to promote healthy mental, emotional and behavioural development in the under 25s. (I was a member of the committees that prepared this document and two previous NASEM reports in 1994 and 2009 on preventive interventions3,4.) The latest NASEM call to action2 is so all-encompassing, it is hard to know where to begin. I propose that initial efforts focus on preventing depression in pregnant women or in women who have recently given birth (perinatal depression). There is substantial evidence for the effectiveness of providing such women with basic skills in mood management5. These interventions could have an impact across generations, because better maternal mental health is linked to babies’ healthier development2. And if researchers and health-care systems were to monitor and compare the epidemiology of depression in thousands of mothers and their children in areas that have or have not deployed preventive interventions, stakeholders could measure their effect on entire communities. © 2019 Springer Nature Limited

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 26778 - Posted: 11.01.2019

By Nicholas Bakalar A healthy diet may help relieve the symptoms of depression. There is good evidence from observational studies that diet can affect mood, and now a randomized controlled trial suggests that healthy eating can modestly improve clinical levels of depression. The study, in PLOS One, randomized 76 college students with poor diet and depression symptoms to two groups. One group was put on a Mediterranean-style diet high in fruits, vegetables, fish, olive oil, nuts and seeds, and low in refined carbohydrates, sugar and saturated fat. The other continued their usual eating habits. At the beginning and end of the three-week trial, all participants were assessed with well-validated scales measuring depression, anxiety, current mood, memory and self-efficacy (confidence in one’s ability to exert control over behavior). Symptoms of depression improved, on average, in the diet group, shifting from the moderate severity range to the normal range. Depressive symptoms among the controls, meanwhile, remained stable, staying within the moderate severity range. On tests of anxiety and stress, the diet group had significantly lower scores than the controls, after controlling for levels of anxiety and stress at the start of the study. There were no differences between the two groups in memory or self-efficacy scores. The study controlled for smoking, physical activity, B.M.I. and other factors. © 2019 The New York Times Company

Related chapters from BN8e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 26772 - Posted: 10.31.2019

Dean Burnett It’s a damp, midweek afternoon. Even so, Cardiff’s walk-in stress management course has pulled in more than 50 people. There are teenagers, white-haired older people with walking aids, people from Caucasian, Asian and Middle Eastern backgrounds. There is at least one pair who look like a parent and child – I’m unsure who is there to support whom. The course instructor makes it clear that she is not going to ask people to speak out about their own stress levels in this first class: “We know speaking in public is stressful in itself.” She tells us a bit about previous attendees: a police officer whose inexplicable and constant worrying prevented him from functioning; a retired 71-year-old unable to shake the incomprehensible but constant fatigue and sadness that blighted his life; a single mother unable to attend her daughter’s school concert, despite the disappointment it would cause. What is the common theme that links these people – and the varied group sitting there this afternoon and listening? Stress may once just have been a kind of executive trophy – “I’m so stressed!” – but recent research suggests it is a key element in developing mental health problems such as depression and anxiety. The constant, stress-induced stimulation of key brain regions seems to be a major contributor to anxiety. And, in turn, vital brain regions becoming unresponsive and inflexible is believed to be a fundamental element of depressive disorders. Why do these regions become unresponsive? Possibly because they’re overworked, exhausted, by the effects of stress. This would explain why anxiety and depression regularly occur together. © 2019 Guardian News & Media Limited

Related chapters from BN8e: Chapter 15: Emotions, Aggression, and Stress; Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 11: Emotions, Aggression, and Stress; Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 26701 - Posted: 10.15.2019