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

Anti-depressant spray not recommended on NHS

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.

Psilocybin may help cancer patients with depression and anxiety for years

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

Depression May Elevate Dementia Risk

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 BN: 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 4: Development of the Brain
Link ID: 26988 - Posted: 01.24.2020

I spent half my life on antidepressants. Today, I’m off the medication and feel all right.

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.

Is taking birth control as a teen linked to depression? It’s complicated

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 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: 26864 - Posted: 12.02.2019

Side effects mild, brief with single antidepressant dose of intravenous ketamine

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 BN: 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

Prevent depression in pregnancy to boost all mental health

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 BN: 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

Mediterranean Diet May Help Ease Some Symptoms of Depression

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

The link between stress and depression … and the 10 simple words that could help

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 BN: 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

Changing Your Diet Can Help Tamp Down Depression, Boost Mood

Allison Aubrey There's fresh evidence that eating a healthy diet, one that includes plenty of fruits and vegetables and limits highly processed foods, can help reduce symptoms of depression. A randomized controlled trial published in the journal PLOS ONE finds that symptoms of depression dropped significantly among a group of young adults after they followed a Mediterranean-style pattern of eating for three weeks. Participants saw their depression "score" fall from the "moderate" range down to the "normal" range, and they reported lower levels of anxiety and stress too. Alternatively, the depression scores among the control group of participants — who didn't change their diets — didn't budge. These participants continued to eat a diet higher in refined carbohydrates, processed foods and sugary foods and beverages. Their depression scores remained in the "moderate severity" range. "We were quite surprised by the findings," researcher Heather Francis, a lecturer in clinical neuropsychology at Macquarie University in Sydney, Australia, told NPR via email. "I think the next step is to demonstrate the physiological mechanism underlying how diet can improve depression symptoms," Francis said. In this study, participants in the "healthy eating" arm of the study ate about six more servings of fruits and vegetables per week, compared with the control group. Participants "who had a greater increase in fruit and vegetable intake showed the greatest improvement in depression symptoms," Francis said. © 2019 npr

Antidepressant Approvals Could Herald New Era in Psychiatric Drugs

Bianca Nogrady As droughts go, the one plaguing the antidepressant drug development landscape for the past few decades has been noteworthy. Since the advent of serotonin and norepinephrine reuptake inhibitors in the 1980s and 1990s, there has been a dearth of new pharmacological therapies for mood disorders, says psychiatrist Samantha Meltzer-Brody, director of the University of North Carolina’s Perinatal Psychiatry Program. “The same medications largely that were there when I went to medical school a long time ago were still the ones we’ve been using.” Given this state of affairs, Meltzer-Brody says she had the “most modest” of expectations a few years ago when she got involved in the first clinical trial testing a new drug, SAGE-547, for postpartum depression. Developed by Massachusetts-based Sage Therapeutics, SAGE-547 is a solution of allopregnanolone, a neuroactive metabolite of the sex hormone progesterone, which plays key roles in the female reproductive system. Progesterone and allopregnanolone levels peak during the third trimester of pregnancy, then crash immediately after delivery. Preclinical data suggested the drop in allopregnanolone could be a trigger for postpartum depression in some women. The company-funded trial involved administering SAGE-547 to a handful of patients with postpartum depression as an intravenous infusion over 48 hours. The response in the first patient treated with SAGE-547 was dramatic. From being withdrawn and depressed with no appetite before treatment, she began smiling, talking, eating, and interacting, Meltzer-Brody says. “After that first patient, we thought either that’s one heck of a placebo or maybe there’s a signal.” Three more patients were treated, with similar results. Known by the generic name brexanolone, the drug sped through Phase 2 and Phase 3 trials before being approved by the US Food and Drug Administration (FDA) on March 19. © 1986–2019 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: 26689 - Posted: 10.10.2019

When Depression Is Like a Cancer

By Jill Halper, M.D. Depression is not cancer. It’s a completely different disease. Yet when I look back on my husband’s depression and death by suicide three years ago, it sure looks a lot like cancer to me. As an adolescent medicine physician in Los Angeles, I have cared for many patients with depression and mental illness, and as a pediatric resident in training, I also cared for many children with cancer. But the difference in how people view these illnesses is astounding. Before we met, my husband’s first marriage had ended, and his ex-wife told him that he did not deserve love. Primed by genetics and an abusive childhood, he was convinced he would always be alone. He attempted suicide with an overdose of pills. When he unexpectedly woke up in the morning, he drove to U.C.L.A. and was checked into the psychiatric unit. He was treated, started on medication and improved. Six months later we met, and soon felt that we were soul mates. He realized he did deserve love. We never took the suicide attempt lightly and always had professional support and treatment. We were married for nearly 20 years. We had two children, purchased a home and negotiated our marriage as best we could. We communicated well, and had the support of a couples’ therapist. It seemed his horrible disease was cured — until it wasn’t. He wasn’t cured; as with some cancers, his disease was simply in remission. And while his first suicide attempt was about the fear of never finding love, his second fear, equally unwarranted, was that he was a complete failure as a provider. My husband’s father was not trained in any skill or profession. He was laid off in his 50s, and never worked again. When he died in his 60s, he left behind a financial mess. © 2019 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: 26650 - Posted: 09.27.2019

Suicide Data Reveal New Intervention Spots, Such as Motels and Animal Shelters

By Maureen O'Hagan, Kaiser Health News Hanging on Kimberly Repp’s office wall in Hillsboro, Ore., is a sign in Latin: “Hic locus est ubi mors gaudet succurrere vitae,” meaning “This is a place where the dead delight in helping the living.” For medical examiners, it is a mission. Their job is to investigate deaths and learn from them, for the benefit of us all. Repp, however, is not a medical examiner; she is a microbiologist. She is also an epidemiologist for Oregon’s Washington County, where she had been accustomed to studying infectious diseases such as flu or norovirus outbreaks among the living. But in 2012 she was asked by county officials to look at suicide. The request introduced her to the world of death investigations and also appears to have led to something remarkable: in this suburban county of 600,000, just west of Portland, the suicide rate now is going down. That result is remarkable because national suicide rates have risen, despite decades-long efforts to reverse the deadly trend. Advertisement While many factors contribute to suicide, officials here believe they have chipped away at this problem through Repp’s initiative to use data—very localized data that any jurisdiction could collect. Now her mission is to help others learn how to gather and use them. New York State has just begun testing a system like Repp’s. Humboldt County in California is implementing it. She has gotten inquiries from Utah and Kentucky. Colorado, meanwhile, is using its own brand of data collection to try to achieve the same kind of turnaround. © 2019 Scientific American

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: 26630 - Posted: 09.21.2019

Out of the darkness

By Ioanna Roumeliotis On any day, at any moment, Toronto’s subway can transform into a tragic stage. It's a place where every year people try to end their lives. Those acts of private despair become public spectacles that force transit workers and commuters to bear horrible witness, a collective trauma that for decades was shrouded in silence. A silence the Toronto Transit Commission is breaking. Talking openly about suicide is incredibly difficult and some consider it nothing short of dangerous. The Toronto Transit Commission (TTC) has a different perspective — that acknowledging what's going on is a crucial part of preventing people from taking their own lives, and showing how simple things can head off tragedy. "We are worried," says John O’Grady, who's been in charge of safety at the TTC for the past 21 years, referring to the fear of a contagion effect if people talk about suicide. "But not talking about it hasn’t worked." It was the death of 27-year-old Michael Padbury three years ago that marked a cautious turning point for the TTC. In a series of tweets, a spokesperson told frustrated commuters the delays were the result of someone’s mental health anguish. It was a nod to the fact Padbury’s death was a deliberate act. And for his mother, it was an acknowledgement that her son existed. ©2019 CBC/Radio-Canada

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: 26615 - Posted: 09.16.2019

Can a New Diagnosis Help Prevent Suicide?

By Temma Ehrenfeld One night in her Nashville apartment, Bre Banks read a comment from her boyfriend on Facebook. They were in a shaky spell, and his words seemed proof she would lose him. She put her laptop down on the couch and headed to the bedroom to cry. “My legs seized up, and I fell,” she recalled. With her knees and forehead pressing into the carpet, she heard a voice that said, “Slit your wrists, slit your wrists.” She saw herself in the bathtub with the blood flowing. She was terrified that if she moved she would die. In one study, about a quarter of the suicide attempts were made by people who reported zero suicidal thoughts. Banks, then 25, was a disciplined graduate student with a job and close friends and had no psychiatric history. “I had never considered suicide an option,” she says. But for the next three days, she couldn’t sleep while the voice and disturbing images persisted. After seeing a therapist, she decided to teach herself techniques from dialectical behavior therapy, one of the few treatments shown to reduce suicidality. The voices and images came back over the next few months, but eventually faded. Eight years later, Banks now evaluates suicide prevention programs across Tennessee as a manager at the large mental health provider Centerstone’s research institute, and she and the same boyfriend just celebrated their 10th anniversary. Copyright 2019 Undark

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: 26605 - Posted: 09.12.2019

Esketamine Nasal Spray Eases Depression Symptoms In Suicidal Patients

Jon Hamilton The depression drug esketamine, marketed as Spravato, appears to offer quick relief to people who are actively considering suicide. Esketamine, a chemical cousin of the anesthetic and party drug ketamine, reduced depression symptoms within hours in two large studies of suicidal patients, the drug's maker announced Monday. The studies, which included 456 patients who were suicidal, found that after 24 hours, patients who got the drug along with standard treatment were less depressed than people who got standard treatment alone. Surprisingly, though, patients who got esketamine were not significantly less suicidal, even though they had fewer symptoms of depression. The finding came from two studies sponsored by the drug's maker, Johnson & Johnson, and presented at the 32nd European College of Neuropsychopharmacology meeting in Copenhagen. Esketamine "showed a benefit in a very high-risk patient population, which is usually excluded from most clinical trials," says Dr. David Hough, a psychiatrist and esketamine compound development team leader at Janssen Research and Development LLC, a part of Johnson & Johnson. © 2019 npr

Johns Hopkins Opens New Center for Psychedelic Research

By Benedict Carey Since childhood, Rachael Petersen had lived with an unexplainable sense of grief that no drug or talk therapy could entirely ease. So in 2017 she volunteered for a small clinical trial at Johns Hopkins University that was testing psilocybin, the active ingredient in magic mushrooms, for chronic depression. “I was so depressed,” Ms. Petersen, 29, said recently. “I felt that the world had abandoned me, that I’d lost the right to exist on this planet. Really, it was like my thoughts were so stuck, I felt isolated.” The prospect of tripping for hours on a heavy dose of psychedelics was scary, she said, but the reality was profoundly different: “I experienced this kind of unity, of resonant love, the sense that I’m not alone anymore, that there was this thing holding me that was bigger than my grief. I felt welcomed back to the world.” On Wednesday, Johns Hopkins Medicine announced the launch of the Center for Psychedelic and Consciousness Research, to study compounds like LSD and psilocybin for a range of mental health problems, including anorexia, addiction and depression. The center is the first of its kind in the country, established with $17 million in commitments from wealthy private donors and a foundation. Imperial College London launched what is thought to be the world’s first such center in April, with some $3.5 million from private sources. “This is an exciting initiative that brings new focus to efforts to learn about mind, brain and psychiatric disorders by studying the effects of psychedelic drugs,” Dr. John Krystal, chair of psychiatry at Yale University, said in an email about the Johns Hopkins center. The centers at Johns Hopkins and Imperial College give “psychedelic medicine,” as some call it, a long-sought foothold in the scientific establishment. Since the early 2000s, several scientists have been exploring the potential of psychedelics and other recreational drugs for psychiatric problems, and their early reports have been tantalizing enough to generate a stream of positive headlines and at least two popular books. The emergence of depression treatment with the anesthetic and club drug ketamine and related compounds, which cause out-of-body sensations, also has piqued interest in mind-altering agents as aids to therapy. © 2019 The New York Times Company

Three suicide prevention strategies show real promise. How can they reach more people?

By Greg Miller Can a three-digit phone number avert suicides on a grand scale? Last week, the Federal Communications Commission recommended designating 988 as a nationwide suicide prevention hotline number. Currently, the National Suicide Prevention Lifeline can be reached around the clock through the more cumbersome 1-800-273-TALK (8255). Many paths in life can bring someone to the brink of suicide, and a shorter phone number might seem to be a naïvely simple solution. But researchers have repeatedly found that simple works: Callers routinely credit the existing hotline, which is on track to take 2.5 million calls this year, with keeping them safe. "It's one of the most basic human realities," says Lifeline Director John Draper, a counseling psychologist with Vibrant Emotional Health, the New York City nonprofit that administers the hotline. "Helping people feel understood and cared about saves lives." More than 47,000 people died by suicide in the United States in 2017. Although the global suicide rate has dropped, in the United States it has increased 33% since 1999. Beating back that number is challenging. Although suicide is the 10th leading cause of death in the United States, it's still rare enough that designing large studies to probe interventions is difficult—and the high stakes bring ethical worries. "For a long time, the field was just kind of demoralized," says Jane Pearson, a clinical psychologist and researcher who helps strategize suicide prevention research for the National Institute of Mental Health (NIMH) in Bethesda, Maryland. But Pearson and others see glimmers of optimism. NIMH spent $51 million on suicide prevention research in 2018, twice as much as in 2015 though still well below research funding for other conditions that cause similar numbers of deaths. Other government agencies and nonprofits now spend tens of millions more. Suicide has shed some of its stigma and is increasingly viewed as a public health issue. © 2019 American Association for the Advancement of Science.

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: 26527 - Posted: 08.22.2019

Brain scans could help personalize treatment for people who are depressed or suicidal

By Emily Underwood By his late 20s, Moe had attained the young adult dream. A technology job paid for his studio apartment just blocks from the beach in Santa Barbara, California. Leisure time was crowded with close friends and hobbies, such as playing the guitar. He had even earned his pilot's license. "There was nothing I could have complained about," he says. Yet Moe soon began a slide he couldn't control. Insomnia struck, along with panic attacks. As the mild depression he'd experienced since childhood deepened, Moe's life collapsed. He lost his job, abandoned his interests, and withdrew from his friends. "I lost the emotions that made me feel human," Moe says. (He asked that this story not use his full name.) Although many people with depression respond well to treatment, Moe wasn't one of them. Now 37, he has tried antidepressant drugs and cycled through years of therapy. Moe has never attempted suicide, but he falls into a high-risk group: Though most people with depression don't die by suicide, about 30% of those who don't respond to multiple antidepressant drugs or therapy make at least one attempt. Moe was desperate for relief and fearful for his future. So when he heard about a clinical trial testing a new approach to treating depression at Stanford University in Palo Alto, California, near his home, he signed up. People like Moe present a conundrum to doctors but an opportunity for researchers: a group whose health could be transformed by precision psychiatry. Depression is often treated as a single disease, but many researchers agree that it is actually multiple, distinct ailments. Some of those conditions may heighten suicide risk more than others. How many depression subtypes exist—and how they differ—is hotly debated. One way researchers are trying to settle the question is by peering into the brain. They're studying the neural circuits that light up during specific tasks and then correlating those patterns of activation with symptoms. © 2019 American Association for the Advancement of Science

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: 26524 - Posted: 08.21.2019

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