Has the Drug-Based Approach to Mental Illness Failed?

By John Horgan One of the most impressive, disturbing works of science journalism I’ve encountered is Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, published in 2010. In the book, which I review here, award-winning journalist Robert Whitaker presents evidence that medications for mental illness, over time and in the aggregate, cause net harm. In 2012, I brought Whitaker to my school to give a talk, in part to check him out. He struck me as a smart, sensible, meticulous reporter whose in-depth research had led him to startling conclusions. Since then, far from encountering persuasive rebuttals of Whitaker’s thesis, I keep finding corroborations of it. If Whitaker is right, modern psychiatry, together with the pharmaceutical industry, has inflicted iatrogenic harm on millions of people. Reports of surging mental distress during the pandemic have me thinking once again about Whitaker’s views and wondering how they have evolved. Below he answers some questions. —John Horgan  Horgan: When and why did you start reporting on mental health? Whitaker: It came about in a very roundabout way. In 1994, I had co-founded a publishing company called CenterWatch that covered the business aspects of the “clinical trials industry,” and I soon became interested in writing about how financial interests were corrupting drug trials. Risperdal and Zyprexa had just come to market, and after I used a Freedom of Information request to obtain the FDA’s review of those two drugs, I could see that psychiatric drug trials were a prime example of that corruption. In addition, I had learned of NIMH-funded research that seemed abusive of schizophrenia patients, and in 1998, I co-wrote a series for the Boston Globe on abuses of patients in psychiatric research. My interest was in that broader question of corruption and abuse in research settings, and not specific to psychiatry. © 2020 Scientific American

Related chapters from BN: 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
Link ID: 27531 - Posted: 10.19.2020

50 years ago, an experimental drug hinted at serotonin’s many roles in the brain

By Lisa Grossman Clues from a chemical — Science News, October 3, 1970 An experimental drug’s effects on the sexual behavior of certain animals is arousing interest among investigators.… The drug, para-chlorophenylalanine … reduces the level of a naturally occurring neurochemical, serotonin, in the brain of rats, mice and dogs.… Little is known about how serotonin acts in the brain, and investigators quickly recognized that PCPA could be used to study this brain chemical. Update PCPA helped establish serotonin’s role in regulating sexual desire, as well as sleep, appetite and mood. The chemical messenger has become key to one common class of antidepressant drugs called selective serotonin reuptake inhibitors. Identified in 1974, SSRIs work by increasing the brain’s serotonin levels. But such drugs can hinder sexual desire. One SSRI that failed to relieve depression in humans found a second life as a treatment for sexual dysfunction. Approved by the U.S. Food and Drug Administration in 2015, this “little pink pill,” sold as Addyi, may boost sex drive in women by lowering serotonin in the brain’s reward centers. H.A. Croft. Understanding the role of serotonin in female hypoactive sexual desire disorder and treatment options. Journal of Sexual Medicine. Vol. 14, December 2017, p. 1575. Doi: 10.1016/j.jsxm.2017.10.068. © Society for Science & the Public 2000–2020.

Related chapters from BN: 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: 27497 - Posted: 09.30.2020

Signs of depression and anxiety soar among US graduate students during pandemic

Chris Woolston Signs of depression among graduate students in the United States have apparently doubled during the COVID-19 pandemic, according to a survey that drew responses from more than 15,000 graduate and 30,000 undergraduate students at 9 US research universities. The survey, conducted by the Student Experience in the Research University (SERU) Consortium — a collaboration between the University of California, Berkeley (UC Berkeley), and the University of Minnesota Twin Cities in Minneapolis — found that indications of anxiety among graduate students rose by 50% this year compared with last year. “It’s very alarming that so many students are suffering from mental-health issues,” says Igor Chirikov, director of SERU and a senior researcher in higher education with the Center for Studies in Higher Education at UC Berkeley. “The pandemic has obviously had a big impact.” The survey, which ran from 18 May to 20 July, used simple two-item questionnaires — the Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 — to screen for symptoms of anxiety disorders and major depression. Thirty-nine per cent of graduate students (a group that includes law- and medical-school students) screened positive for anxiety, and 32% screened positive for depression. When the same screening questions were asked in March to July 2019, 26% of graduate students had signs of anxiety and 15% showed depression symptoms. © 2020 Springer Nature Limited

Related chapters from BN: 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: 27427 - Posted: 08.20.2020

Nasal Spray Is A New Antidepressant Option For People At High Risk of Suicide

Jon Hamilton The Food and Drug Administration has approved a variant of the anesthetic and party drug ketamine for suicidal patients with major depression. The drug is a nasal spray called Spravato and it contains esketamine, a chemical cousin of ketamine. In 2019, the FDA approved Spravato for patients with major depressive disorder who hadn't responded to other treatments. Now, the agency is adding patients who are having suicidal thoughts or have recently attempted to harm themselves or take their own lives. "Spravato is the first approved antidepressant medication that's been able to demonstrate a reduction in symptoms of major depressive disorder within 24 hours after the first dose," says Dr. Michelle Kramer, a psychiatrist and vice president of U.S. neuroscience, medical affairs at Janssen Pharmaceuticals, which makes the drug. Janssen is part of Johnson & Johnson. The drug's quick action is potentially important for suicidal patients because "existing drugs typically can take weeks or longer before you really get noticeable clinical benefit," says Dr. Gerard Sanacora, a professor of psychiatry at Yale University and director of Yale's depression research program. He was involved in the studies leading to the FDA approval and has consulted for Janssen. So a dose of esketamine "could potentially get a person out of a difficult, horrible situation when they're feeling so overwhelmed," says Dr. Charles Conway, a professor of psychiatry at Washington University School of Medicine in St. Louis who wasn't involved in the study. "This could be a significant improvement in how we can help people who have intense suicidal thinking." © 2020 npr

Lithium-laced drinking water could curb suicide rates

By Hannah Sparks For communities with a low rate of depression and suicide, there may be something in the water, according to a new study. A comprehensive analysis of findings from previous studies has revealed that regions where the public drinking water contains a high level of naturally occurring lithium — a mineral used most often for the treatment of depression and bipolar disorder — also boast a lower rate of suicide than other areas. The review included all prior research on the effects of lithium, as well as regional water samples and suicide data from 1,286 locales in Austria, Greece, Italy, Lithuania, the UK, Japan and the United States. “Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilization, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water,” the authors concluded in their report. Denoted as “Li” on the periodic table, the element is found in varying concentrations in crops, rocks, soil and ground water — thus how it seeps into our water supply. In a statement on the King’s College London website, lead study author and chairman of epidemiology and public health at Brighton and Sussex Medical School Anjum Memon said, “It is promising that higher levels of trace lithium in drinking water may exert an anti-suicidal effect and have the potential to improve community mental health.” The results, published in the British Journal of Psychiatry, “are also consistent with the finding in clinical trials that lithium reduces suicide and related behaviors in people with a mood disorder,” said Allan Young, a professor at King’s College’s Institute of Psychiatry, Psychology & Neuroscience.

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 27408 - Posted: 08.08.2020

Muddling Through: A Depression Memoir Like No Other

By Matthew Sitman As I read George Scialabba’s new book How To Be Depressed, I recalled that I’d been introduced to his writing almost a decade ago by a schizophrenic, manic-depressive homeless man. R. might have protested that term—technically, he lived in a small garage that a fellow parishioner at the church we all attended let him use. It was shocking to visit him there for the first time; nearly every square inch of the place was filled with musty stacks of the New York Review of Books, assorted newspapers, and books, leaving only a narrow path that led to a mattress. Before adding something to one of these piles, he’d open his latest acquisition and run his finger down its pages, searching for matches or “sparks” that might cause a destructive fire—a phobia caused by a traumatic incident in R.’s childhood. My friends and I tried to look after R., taking him to dinner or paying his phone bill or letting him do laundry in our homes. I was drawn to R. partly because I couldn’t help but see some of myself in him, and had a gnawing fear that his plight would one day be my own. He was, in his way, an intellectual, who actually read at least a few of the periodicals he collected and enjoyed arguing about politics. I’d often see him in the local used bookstore I frequented, and that must have been where he pressed Scialabba’s What Are Intellectuals Good For? into my hands. “This is the good shit,” he solemnly professed, and he was right. R. had been an alcoholic, and I’d gleaned that when he finally kicked booze the withdrawal caused a breakdown from which he’d never quite recovered. I knew I sometimes drank too much, too, and for the wrong reasons—enough to watch myself. We shared both hypochondria and a dread of visiting the doctor. I wasn’t a manic depressive, but for much of the time I knew R. I was in the throes of the worst severe depression of my life. © 2020 Commonweal Magazine.

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 27365 - Posted: 07.15.2020

‘It’s a Superpower’: How Walking Makes Us Healthier, Happier and Brainier

Amy Fleming Taking a stroll with Shane O’Mara is a risky endeavour. The neuroscientist is so passionate about walking, and our collective right to go for walks, that he is determined not to let the slightest unfortunate aspect of urban design break his stride. So much so, that he has a habit of darting across busy roads as the lights change. “One of life’s great horrors as you’re walking is waiting for permission to cross the street,” he tells me, when we are forced to stop for traffic – a rude interruption when, as he says, “the experience of synchrony when walking together is one of life’s great pleasures”. He knows this not only through personal experience, but from cold, hard data – walking makes us healthier, happier and brainier. We are wandering the streets of Dublin discussing O’Mara’s book, In Praise of Walking, a backstage tour of what happens in our brains while we perambulate. Our jaunt begins at the grand old gates of his workplace, Trinity College, and takes in the Irish famine memorial at St Stephen’s Green, the Georgian mile, the birthplace of Francis Bacon, the site of Facebook’s new European mega-HQ and the salubrious seaside dwellings of Sandymount. O’Mara, 53, is in his element striding through urban landscapes – from epic hikes across London’s sprawl to more sedate ambles in Oxford, where he received his DPhil – and waxing lyrical about science, nature, architecture and literature. He favours what he calls a “motor-centric” view of the brain – that it evolved to support movement and, therefore, if we stop moving about, it won’t work as well. © 2020 Read It Later, Inc.

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 11: Motor Control and Plasticity
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 5: The Sensorimotor System
Link ID: 27364 - Posted: 07.15.2020

The Power of Psychedelics

By Erica Rex In 2012, I had my first psychedelic experiences, as a subject in a clinical trial at Johns Hopkins University School of Medicine’s Behavioral Pharmacology Research Unit. I was given two doses of psilocybin spaced a month apart to treat my cancer-related depression. During one session, deep within the world the drug evoked, I found myself inside a steel industrial space. Women were bent over long tables, working. I became aware of my animosity towards my two living siblings. A woman seated at the end of a table wearing a net cap and white clothes, turned and handed me a tall Dixie cup. “You can put that in here,” she said. The cup filled itself with my bilious, sibling-directed feelings. “We’ll put it over there.” She turned and placed the cup matter-of-factly on a table at the back of the room. Then she went back to her tasks. Whenever I speak with her, Mary Cosimano, the director of guide/facilitator services at Johns Hopkins Center for Psychedelic and Consciousness Research, mentions the women in the chamber and the cup. My experience struck a chord. For me, the women in the chamber have become a transcendent metaphor for emotional healing. “I’ve thought about having a necklace made, with the cup, as a momento,” she said the last time I saw her at a conference. “Have you thought about it?” Prior to their 1971 prohibition, psilocybin and LSD were administered to approximately 40,000 patients, among them people with terminal cancer, alcoholics and those suffering from depression and obsessive-compulsive disorder. The results of the early clinical studies were promising, and more recent research has been as well. The treatment certainly helped me. Eight years after my sessions, researchers continue to prove the same point again and again in an ongoing effort to turn psychedelic drug therapy into FDA-sanctioned medical treatment. This can’t happen soon enough. © 2020 Scientific American,

The V.A. Made Me Vomit. And That Was a Good Thing.

By Andrew McCormick The psychiatrist was bald, with kind eyes, a silver goatee and the air of exhaustion that follows a person who works hard in a difficult field. It was March 2019, and having let an old prescription expire months earlier, I had gone to the Veterans Affairs hospital in Manhattan — my first time at a V.A. — hoping to get antidepressants. In a small, sparsely decorated office, the doctor and I faced each other across a wide desk. He told me about various V.A. programs — counseling, group therapy, a veterans’ yoga class, each accompanied by a flier — and described at length the V.A.’s crisis hotline. I appreciated his care, but I wasn’t there to break any new emotional ground; I really just wanted a prescription and to be on my way. I answered briskly as he worked through the questions any mental health worker asks you on a first visit. Did I have a history of anxiety or depression? Yes. Had I had thoughts of hurting myself or of suicide? Not really. Did anyone in my family have a history of mental health issues? Suddenly, my brain went foggy and my thoughts failed to connect. My speech slowed, and I began struggling to form sentences. Weird, I thought. I hadn’t felt sick. I worried the doctor might think he’d hit a nerve, when in fact I had answered questions like these many times before, including in post-deployment health evaluations in the Navy. My vision blurred. Eyes aflutter, I motioned to the doctor to give me a minute. I think I laughed. With the calm dispassion of a man who’s seen it all, the doctor picked up a phone beside him: “I’m going to need some help,” he said. “He’s about to pass out. . . . Yeah, he looks like he might throw up.” I swallowed hard. I tried not to. “Yeah, he just threw up.” © 2020 The New York Times Company

Related chapters from BN: 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: 27319 - Posted: 06.24.2020

Experts Fear Increase in Postpartum Mood and Anxiety Disorders

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 BN: 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

Is the Pandemic Sparking Suicide?

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 BN: 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

Neurosteroids: A Major Step Forward

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 BN: 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

When the Pandemic Leaves Us Alone, Anxious and Depressed

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 BN: 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

Fast-fail trial shows new approach to identifying brain targets for clinical treatments

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 BN: 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

'My anti-depressant withdrawal was worse than depression'

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

Persistent depressive disorder is difficult to diagnose and treat, but I found help

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 BN: 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

Can science cure a broken heart?

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 BN: 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

Will That Antidepressant Work For You? The Answer May Lie In Your Brain Waves

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

What Neurobiology Can Tell Us About Suicide

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 BN: 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

What Is Postpartum Depression? Recognizing The Signs And Getting Help

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 BN: 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

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