Chapter 16. Psychopathology: Biological Basis of Behavior Disorders

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By Emily Witt In the fall of 1972, a psychiatrist named Salvador Roquet travelled from his home in Mexico City to the Maryland Psychiatric Research Center, an institution largely funded by the United States government, to give a presentation on an ongoing experiment. For several years, Roquet had been running a series of group-therapy sessions: over the course of eight or nine hours, his staff would administer psilocybin mushrooms, morning-glory seeds, peyote cacti, and the herb datura to small groups of patients. He would then orchestrate what he called a “sensory overload show,” with lights, sounds, and images from violent or erotic movies. The idea was to push the patients through an extreme experience to a psycho-spiritual rebirth. One of the participants, an American psychology professor, described the session as a “descent into hell.” But Roquet wanted to give his patients smooth landings, and so, eventually, he added a common hospital anesthetic called ketamine hydrochloride. He found that, given as the other drugs were wearing off, it alleviated the anxiety brought on by these punishing ordeals. Clinicians at the Maryland Psychiatric Research Center had been studying LSD and other psychedelics since the early nineteen-fifties, beginning at a related institution, the Spring Grove Hospital Center. But ketamine was new: it was first synthesized in 1962, by a researcher named Calvin Stevens, who did consulting work for the pharmaceutical company Parke-Davis. (Stevens had been looking for a less volatile alternative to phencyclidine, better known as PCP.) Two years later, a doctor named Edward Domino conducted the first human trials of ketamine, with men incarcerated at Jackson State Prison, in Michigan, serving as his subjects. At higher doses, Domino noticed, ketamine knocked people out, but at lower ones it produced odd psychoactive effects on otherwise lucid patients. Parke-Davis wanted to avoid characterizing the drug as psychedelic, and Domino’s wife suggested the term “dissociative anesthetic” to describe the way it seemed to separate the mind from the body even as the mind retained consciousness. The F.D.A. approved ketamine as an anesthetic in 1970, and Parke-Davis began marketing it under the brand name Ketalar. It was widely used by the U.S. military during the Vietnam War, and remains a standard anesthetic in emergency rooms around the world. © 2021 Condé Nast.

Keyword: Depression; Drug Abuse
Link ID: 28132 - Posted: 12.31.2021

By Vanessa Barbara JUIZ DE FORA, Brazil — My first encounter with ketamine did not go well. A lifelong depressive — I picked up the habit of despairing sadness in early adulthood, and it remained faithfully with me — I’d turned to a more experimental form of treatment: ketamine infusions, in which a kindly anesthesiologist funnels the drug into a sad person’s veins for around 50 minutes and hopes it perks her up. Forty-five minutes into my first session, I rather anxiously asked my partner, who was in the room with me, if our 3-year-old daughter was fine. He decided it was the perfect time for a joke. Our daughter, he answered, was safe at home — and as a matter of fact, he added, she was already a very independent 15-year-old. I panicked. While under the strong, dissociative effect of the drug, patients sometimes enter what’s called a k-hole, in which their sense of time and space is distorted or eliminated. In that state of oblivion, I found it entirely plausible that my daughter was not a toddler anymore, but a strong-willed teenager. I became very distressed. My heartbeat accelerated. The anesthesiologist hurriedly ended the session as my partner said: “I’m kidding! Sorry! She’s still 3!” It was an inauspicious start, but I was determined to make the best of it. Ketamine, long used as an anesthetic but better known as an illegal party drug and, of course, a horse tranquilizer, has in recent years been gaining traction as an antidepressant. People have written enthusiastic accounts of their experiences, and researchers and psychiatrists, in a cascade of studies, have pointed to its possible benefits, not least the speed with which it can alleviate symptoms. Today, hundreds of clinics around the world provide infusions to people who have found little, if any, improvement with other treatments. That’s where I come in. Over the years, apart from the good old psychotropic medications, I have tried several types of talk therapy, meditation, acupuncture, singing lessons, bungee jumping and transcranial magnetic stimulation. (I still have sweet memories of the woodpecker sounds tapped into my brain.) © 2021 The New York Times Company

Keyword: Depression; Drug Abuse
Link ID: 28130 - Posted: 12.29.2021

By Karen Brown For decades, Linda Larson has been trying to distance herself from the diagnosis she was given as a teenager: schizophrenia. She accepts that she has the mental disorder but deeply resents the term’s stigma. People hear it and think, “violent, amoral, unhygienic,” she said. Ms. Larson, 74, is part of a group trying to remove that association — by changing the name of the illness. The idea is that replacing the term “schizophrenia” with something less frightening and more descriptive will not only change how the public perceives people with the diagnosis, but also how these people see themselves. Ms. Larson is a member of the Consumer Advisory Board of the Massachusetts Mental Health Center, which is associated with Beth Israel Deaconess Medical Center in Boston. The group has been working with psychiatrists at Harvard to build momentum for a name change, most recently through a national survey published in the journal Schizophrenia Research. “That term over time has become so associated with hopelessness, with dangerousness, with volatile and erratic behavior, that doctors are afraid to use that term with people and their family members,” said Dr. Raquelle Mesholam-Gately, a Harvard psychologist and the lead author of the new paper. “And people who have the condition don’t want to be associated with that name.” As a result, she said, clinicians often avoid making such a devastating diagnosis and many patients and their families don’t seek treatment until after the illness has wreaked considerable damage. Dr. Mesholam-Gately and her team asked about 1,200 people connected to schizophrenia — including those with the disorder, their family members, mental health providers, researchers and government officials — whether it should be called something else. The survey proposed nine alternative names, based partly on the experience of people diagnosed with schizophrenia. Among them: altered perception disorder, attunement disorder, disconnectivity syndrome, integration disorder and psychosis spectrum disorder. © 2021 The New York Times Company

Keyword: Schizophrenia
Link ID: 28124 - Posted: 12.22.2021

L. Carol Ritchie U.S. Surgeon General Vivek Murthy has a warning about the mental health of young people. Murthy told Morning Edition that children and young adults were already facing a mental health crisis before the coronavirus pandemic began: One in three high school students reported persistent feelings of sadness or hopelessness, a 40% increase from 2009 to 2019, he said. Suicide rates went up during that time by 57% among youth ages 10 to 24. During the pandemic, rates of anxiety and depression have increased, he said. The pandemic has made the issues behind the mental health crisis only worse, he said. "This is a critical issue that we have to do something about now," he said. "We can't wait until after the pandemic is over." Murthy, who issued an advisory called "Protecting Youth Mental Health," also cites gun violence, the specter of climate change, racism and social conflict as sources of stress. "We also have to recognize that kids increasingly are experiencing bullying, not just in school but online, that they're growing up in a popular culture and a media culture that reminds kids often that they aren't good-looking enough, thin enough, popular enough, rich enough, frankly, just not enough," he said. Article continues after sponsor message "Even to this day, even though I have parents who I know unconditionally loved me, I never felt comfortable telling them about it because I thought that this was my fault. I don't want that to be the reality for my children, who are 4 and 5 and growing up, you know, in this very complicated world." © 2021 npr

Keyword: Depression
Link ID: 28101 - Posted: 12.08.2021

By Laura Sanders Kanu Caplash was lying on a futon in a medical center in Connecticut, wearing an eye mask and listening to music. But his mind was far away, tunneling down through layer upon layer of his experiences. As part of a study of MDMA, a psychedelic drug also known as molly or ecstasy, Caplash was on an inner journey to try to ease his symptoms of post-traumatic stress disorder. On this particular trip, Caplash, now 22, returned to the locked bathroom door of his childhood home. As a kid, he used to lock himself in to escape the yelling adults outside. But now, he was both outside the locked door, knocking, and inside, as his younger, frightened self. He started talking to his younger self. “I open the door, and my big version picks up my younger version of myself, and literally carries me out,” he says. “I carried myself out of there and drove away.” That self-rescue brought Caplash peace. “I got out of there. I’m alive. It’s all right. I’m OK.” For years, Caplash had experienced flashbacks, nightmares and insomnia from childhood trauma. He thought constantly about killing himself, he says. His experiences while on MDMA changed his perspective. “I still have the memory, but that anger and pain is not there anymore.” Caplash’s transcendent experiences, spurred by three therapy sessions on MDMA, happened in 2018 as part of a research project on PTSD. Along with a handful of other studies, that research suggests that when coupled with psychotherapy, mind-altering drugs bring some people immediate, powerful and durable relief. © Society for Science & the Public 2000–2021.

Keyword: Depression; Drug Abuse
Link ID: 28099 - Posted: 12.04.2021

By Kelly Servick For patients whose depression resists treatment with drugs and electroconvulsive therapy, surgically implanted wires that stimulate the brain might bring relief. But in recent years, two randomized, controlled trials of this approach, known as deep brain stimulation (DBS), were halted after underwhelming results in interim analyses. “It was like the air was let out of the room,” Sameer Sheth, a neurosurgeon at Baylor College of Medicine, says of those results. “It was a big let-down.” Now, researchers are testing more sophisticated, personalized DBS techniques they hope will yield stronger results. The tests to date have involved just one or a few patients, far from proof of effectiveness. But researchers hope they’ll inform larger studies that finally cement the effectiveness of DBS in depression. “With all these irons in the fire … we will hopefully build up enough understanding and evidence,” says Sheth, an author of a case study published this week. DBS is already approved in the United States to treat epilepsy, obsessive compulsive disorder, and movement disorders such as Parkinson’s disease. Could it also shift patterns of abnormal activity in neural circuits that may drive depression symptoms? Early studies without control groups yielded promising results, but two randomized, controlled trials, sponsored by the medical device companies Medtronic and St. Jude Medical, Inc. (which was later acquired by Abbott Laboratories) did not show significant benefits after several months of DBS, teams reported in 2015 and 2017. Long-term follow-up of participants has revived some optimism. For example, many people in the 30-participant Medtronic trial improved over 1 year or more—beyond the timeline of the initial study, says Stanford University psychiatrist Mahendra Bhati, a co-investigator. Last month, he and colleagues published a follow-up study of eight trial patients, most of whom continue to use their implant about 10 years later. About one-half have had at least a 50% improvement over their pretreatment score on a depression scale. © 2021 American Association for the Advancement of Science.

Keyword: Depression
Link ID: 28089 - Posted: 11.24.2021

Chloe Tenn Depression affects almost 300 million people globally, and is considered a leading cause of disability by the World Health Organization. As with many diseases, studies that have searched for genetic variations associated with depression have been conducted primarily in people of European ancestry, and there is limited data available on genes linked to depression in non-European ancestry groups. Finding such genetic variations can not only help in assessing individuals’ likelihood of developing depression, but potentially provide insight into how to treat the mental illness by pinpointing the genes and proteins that underlie it. See “Our Aching Brains” Researchers have now conducted the largest genomic study to date on depression in a non-European population, focusing on participants with East Asian ancestry. In a study published on September 29 in JAMA Psychiatry, they reveal that not only were a majority of genetic variants associated with depression in European populations not applicable in East Asian ancestral cohorts, but novel indicators emerged in East Asians that had not been discovered in studies on Europeans. The study’s authors caution that the existing knowledge on genetic risk factors for depression is not generalizable to a global population. “I think it’s a strikingly ambitious effort,” says Andrew Ryder, a cultural-clinical psychologist who specializes in East Asian cultures at Concordia University in Montreal who was unaffiliated with the study. “I see this research as establishing that, even in the hard science aspects of studying humanity, you can’t ignore the social world and the potential influence of culture. . . . It’s too easy for people to assume if we’re doing something scientific, it must be true of people everywhere in the world, rather than building culture into their sense of how their science works.” © 1986–2021 The Scientist

Keyword: Depression; Genes & Behavior
Link ID: 28076 - Posted: 11.17.2021

Sarah Marsh and Hannah Devlin A growing number of private clinics are offering ketamine for depression, according to experts who warn of a potential “wild west” of providers with no national register of patients’ treatment being integrated into overall NHS care. At least six private providers in the UK offer the drug for depression. In March the first service that also includes psychotherapy opened in Bristol, charging £6,000 for a course of low-dose treatments and talking therapy. But health experts expressed concern about creating a two-tier system in which the novel treatment is unavailable to NHS patients. They also warned of “doctor shopping”, where patients go to a ketamine clinic one day and another the next without health professionals being able to keep track of who is getting the drug. Scientists said the NHS healthcare watchdog was taking too long to update its guidance informing clinical practice on prescribing antidepressants in the UK. It was last updated in 2009. Ketamine has a reputation as a party drug because of its short-term dissociative effects but is licensed as an anaesthetic. When abused, the drug can cause long-term problems such as ulcers, pain in the bladder and kidney problems. But it has shown potential in depression treatment trials for those who are resistant to other treatments. Because ketamine is licensed to be used by doctors as an anaesthetic it can be prescribed off-licence for depression, which is what is happening in private clinics. To be prescribed on the NHS, it would need to be approved by the National Institute for Health and Care Excellence (Nice) as a cost-effective treatment. Ketamine would also need to be authorised by the Medicines and Healthcare Regulatory Agency to be marketed as a treatment for depression. © 2021 Guardian News & Media Limited

Keyword: Depression; Drug Abuse
Link ID: 28073 - Posted: 11.13.2021

By Andrew Jacobs APPLE VALLEY, Calif. — Jose Martinez, a former Army gunner whose right arm and both legs were blown off by a roadside bomb in Afghanistan, has a new calling: He’s become one of the most effective lobbyists in a campaign to legalize the therapeutic use of psychedelic drugs across the country. On a Zoom call this spring with Connie Leyva, a Democratic legislator in California who has long opposed relaxing drug laws, Mr. Martinez told her how psilocybin, the psychoactive ingredient in “magic” mushrooms, had helped to finally quell the physical pain and suicidal thoughts that had tormented him. Ms. Leyva says she changed her mind even before the call ended, and she later voted yes on the bill, which is expected to become law early next year. “We ask these men and women to go fight for our freedoms,” she said in an interview. “So if this is something that is helping them live a more normal life, I feel like I shouldn’t stand in the way.” In the two years since Oregon, Washington, D.C., and a half-dozen municipalities decriminalized psilocybin, vets have become leading advocates in the drive to legalize psychedelic medicine, which they credit with helping ease the post-traumatic stress, anxiety and depression that are often tied to their experiences in the military. The campaign has been propelled by the epidemic of suicides among veterans of Iraq and Afghanistan, but also by the national reckoning over the mass incarceration of people on drug charges that has softened public attitudes on prohibition. More than 30,000 service members have taken their own lives in the years since Sept. 11 — four times the number of those who died on the battlefield — and the Department of Veterans Affairs has struggled to address the crisis with the traditional repertoire of pharmacological interventions. © 2021 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 28072 - Posted: 11.13.2021

Sirin Kale Claudia*, a sailor from Lichfield in her late 30s, is not Italian. She has never been to Italy. She has no Italian family or friends. And she has no idea why a belligerent Italian couple have taken over her inner voice, duking it out in Claudia’s brain while she sits back and listens. “I have no idea where this has come from,” says Claudia, apologetically. “It’s probably offensive to Italians.” The couple are like the family in the Dolmio pasta sauce adverts: flamboyant, portly, prone to waving their hands and shouting. If Claudia has a big decision to make in her life, the Italians take over. “They passionately argue either side,” Claudia says. “It’s really useful because I let them do the work, so I don’t get stressed out by it.” These disagreements always take place in a kitchen, surrounded by food. Claudia hasn’t given the Italians names – yet. But they did help Claudia make a major life decision, encouraging her to quit her job as a scientist two years ago and fulfil a lifelong dream of running away to sea. “They were chatting non-stop before I handed in my notice,” Claudia sighs. “I’d wake up and they’d be arguing. I’d be driving to work and they’d be arguing. It was exhausting, to be honest.” The woman was in favour of Claudia going, but her husband was wary. “He’d be saying: ‘It’s a stable job!’ And she’d go: ‘Let her enjoy life!’” The woman prevailed, and Claudia left to work on a flotilla in Greece (although she’s now back in the UK temporarily, due to Covid). She’s much happier, even if she did have to have neurolinguistic programming to get the shouting to calm down. “They’re quieter now,” Claudia says with relief. “Less shouting. They just bicker.” Most of us have an inner voice: that constant presence that tells you to “Watch out” or “Buy shampoo” or “Urgh, this guy’s a creep”. For many of us, this voice sounds much like our own, or at least how we think we sound. But for some people, their inner voice isn’t a straightforward monologue that reproaches, counsels and reminds. Their inner voice is a squabbling Italian couple, say, or a calm-faced interviewer with their hands folded on their lap. Or it’s a taste, feeling, sensation or colour. In some cases, there isn’t a voice at all, just silence. © 2021 Guardian News & Media Limited

Keyword: Consciousness; Schizophrenia
Link ID: 28053 - Posted: 10.27.2021

By Brianna Randall Inside the Big Sky Ketamine Care clinic in Missoula, Montana, a woman relaxes in a leather recliner as soothing classical music pipes through the speakers. She watches nature scenes flicker across a TV screen as a low dose of ketamine drips into her arm for 40 minutes. A nurse monitors vitals and sits beside the woman as her mind drifts — and hopefully heals. The Montana business is just one example of the recent boom in ketamine treatment, which uses a sedative also known as an animal tranquilizer or a club drug nicknamed “Special K.” This alternative therapy option for treating mood disorders has grown in popularity as patients and medical providers look to fast-acting options for the 264 million people worldwide who suffer from depression. It’s the only legal psychedelic currently available in the U.S., though psilocybin was recently legalized for therapy in Oregon. Providers and many researchers say ketamine can alleviate anxiety or depression symptoms, including suicidality, in a matter of hours; commonly prescribed oral antidepressants, like Zoloft or Prozac, on the other hand, often take weeks before they kick-in. Still, along with its promise in psychiatric treatment, ketamine faces cultural distrust and lingering questions, especially surrounding its main side effect: feeling high, or a dissociated sense that you are separate from your mind, body and surroundings. Scientists still don’t know the exact pathways by which ketamine alleviates mood disorders, but recent research about how ketamine works in the brain — as well as how best to use it in clinical settings — may help overcome some of the distrust. © 2021 Kalmbach Media Co.

Keyword: Depression; Drug Abuse
Link ID: 28048 - Posted: 10.23.2021

By Jane E. Brody It’s no surprise that when a person gets a diagnosis of heart disease, cancer or some other life-limiting or life-threatening physical ailment, they become anxious or depressed. But the reverse can also be true: Undue anxiety or depression can foster the development of a serious physical disease, and even impede the ability to withstand or recover from one. The potential consequences are particularly timely, as the ongoing stress and disruptions of the pandemic continue to take a toll on mental health. The human organism does not recognize the medical profession’s artificial separation of mental and physical ills. Rather, mind and body form a two-way street. What happens inside a person’s head can have damaging effects throughout the body, as well as the other way around. An untreated mental illness can significantly increase the risk of becoming physically ill, and physical disorders may result in behaviors that make mental conditions worse. In studies that tracked how patients with breast cancer fared, for example, Dr. David Spiegel and his colleagues at Stanford University School of Medicine showed decades ago that women whose depression was easing lived longer than those whose depression was getting worse. His research and other studies have clearly shown that “the brain is intimately connected to the body and the body to the brain,” Dr. Spiegel said in an interview. “The body tends to react to mental stress as if it was a physical stress.” Despite such evidence, he and other experts say, chronic emotional distress is too often overlooked by doctors. Commonly, a physician will prescribe a therapy for physical ailments like heart disease or diabetes, only to wonder why some patients get worse instead of better. © 2021 The New York Times Company

Keyword: Depression
Link ID: 28034 - Posted: 10.13.2021

By Laura Sanders A personalized brain implant eased the crushing symptoms of a woman’s severe depression, allowing her to once again see the beauty of the world. “It’s like my lens on the world changed,” said Sarah, the research volunteer who requested to be identified by her first name only. The technology, described October 4 in Nature Medicine, brings researchers closer to understanding how to detect and change brain activity in ultraprecise ways (SN: 2/10/19). The device was bespoke; it was built specifically for Sarah’s brain. The details of the new system may not work as a treatment for many other people, says Alik Widge, a psychiatrist and neural engineer at the University of Minnesota in Minneapolis. Still, the research is “a really significant piece of work,” he says, because it points out a way to study how brain activity goes awry in depression. Researchers at the University of California, San Francisco implanted temporary thin wire electrodes into Sarah’s brain. The 36-year-old woman had suffered from severe depression for years. These electrodes allowed researchers to monitor the brain activity that corresponded to Sarah’s depression symptoms — a pattern that the researchers could use as a biomarker, a signpost of trouble to come. In Sarah’s case, a particular sign emerged: a fast brain wave called a gamma wave in her amygdala, a brain structure known to be involved in emotions. With this biomarker in hand, the researchers then figured out where to stimulate the brain to interrupt Sarah’s distressing symptoms. A region called the ventral capsule/ventral striatum, or VC/VS, seemed to be the key. That’s not surprising; previous research suggests the region is involved with feeling good and other emotions. When researchers applied tiny jolts of electrical current to this region, Sarah’s mood improved. © Society for Science & the Public 2000–2021.

Keyword: Depression
Link ID: 28022 - Posted: 10.06.2021

By Christina Caron For about 1 in 20 people in the northern half of the United States, cooling temperatures and shorter, darker days may signal the onset of seasonal affective disorder, or SAD, a type of depression that typically arrives in the fall or winter, then goes away in the spring. Unlike mild cases of the “winter blues,” SAD symptoms make it difficult to function. It tends to start with so-called “vegetative symptoms”: an increased appetite and a craving for carbohydrates like french fries or ice cream, the urge to sleep longer hours, difficulty getting up in the morning and feeling wiped out at work. Then, in three to four weeks, “the mood plummets,” said Michael Terman, a professor of clinical psychology at Columbia University and an expert in seasonal affective disorder. Patients with SAD develop major depression, which includes persistent feelings of sadness, withdrawal from friends and family and a loss of interest in activities that were once enjoyable. Researchers don’t yet know why some people develop SAD and others do not, but the disorder is believed to run in families and is more common among women. SAD develops in the fall and winter because shorter daylight hours and less sunlight shift the body’s internal clock, and certain mood-regulating hormones, like serotonin, oscillate with the seasons. The good news is that because SAD is tied to the changing seasons, “you can predict its onset and ward it off,” Dr. Terman said. If you have already started experiencing vegetative symptoms — for example you are sleeping longer and having more difficulty waking up — or if you already know you are susceptible to seasonal affective disorder, experts said it’s best to start implementing preventive measures before major depression sets in. © 2021 The New York Times Company

Keyword: Depression; Biological Rhythms
Link ID: 28018 - Posted: 10.02.2021

by Giorgia Guglielmi About five years ago, when his younger twin brothers reached their thirties, Giacomo Vivanti started to wonder how the pair, who both have autism, would fare in middle and old age. In particular, he wondered if they might be prone to develop age-related neurological conditions. His brothers didn’t show any signs of ill health or cognitive deterioration, but Vivanti, associate professor of early detection and intervention at the A.J. Drexel Autism Institute in Philadelphia, Pennsylvania, knew that the scientific literature provided few clear answers. “I was pretty shocked to learn that we have such limited knowledge of outcomes as children with autism become adults, and as they age,” Vivanti says. It prompted him to scour four years’ worth of data from Medicaid, the largest healthcare program in the United States, to determine the incidence of neurodegenerative conditions among 30- to 64-year-olds with autism. That group, he and his colleagues reported last month, is about 2.5 times as likely to be diagnosed with early-onset Alzheimer’s or other forms of dementia as the general population. The study is one of a handful that have found higher-than-average rates of neurodegenerative conditions in autistic adults. The risk estimates for Parkinson’s disease in autistic people range from 15 to 20 percent, compared with about 1 percent in the general population. Similarly, the prevalence of dementia is less than 1 percent in non-autistic people but about 4 percent in those with autism. None of these studies offer solid evidence, but their results are strong enough to warrant further investigation, researchers say. © 2021 Simons Foundation

Keyword: Autism; Alzheimers
Link ID: 28011 - Posted: 09.29.2021

By Nicholas Bakalar Electroconvulsive therapy, or ECT, can be effective for the treatment of major depression and is just as safe as antidepressant drugs combined with psychotherapy, a large new study concludes. The procedure, once referred to as electroshock therapy, has a controversial and largely unfavorable history. This was partly due to inaccurate portrayals in popular books and films like “One Flew Over the Cuckoo’s Nest,” and partly the result of real problems with the earliest versions of the procedure, which used strong electrical currents and no anesthesia. Today, ECT is performed under general anesthesia, and the doctor, working with an anesthesiologist and a nurse, applies a weak electric current to the brain (usually about 0.8 amperes at 120 volts) for one to six seconds. This causes a seizure inside the brain, but because of the anesthesia, the patient does not experience muscular contractions. The seizure leads to brain changes that relieve symptoms of depression and certain other mental illnesses. Usually, doctors administer a series of ECT treatments over a period of days or weeks. The only painful part of the procedure is the insertion of an intravenous line before anesthesia. There can be side effects afterward, including temporary memory loss, confusion or transitory headaches and muscle aches. Doctors debate whether ECT can cause long-term memory problems distinct from the memory problems that can be caused by depression itself. For this new study, published in Lancet Psychiatry, Canadian researchers used the records of 10,016 adults whose depression was severe enough that they spent three or more days in the hospital. Half of them had received ECT, while the other half were treated with drugs and psychotherapy. Their average age was 57, and about two-thirds were women. The researchers tracked how each group fared in the 30 days after they were discharged from the hospital. © 2021 The New York Times Company

Keyword: Depression
Link ID: 27999 - Posted: 09.18.2021

By Husseini Manji, Joseph Hayes Depression affects more than 264 million people of all ages globally. The World Health Organization ranks depression as one of the most debilitating diseases to society. It is the leading cause of disability worldwide and the psychiatric diagnosis most commonly associated with suicide, which accounts for nearly 800,000 deaths globally each year. Individuals suffering from depression may face an inability to manage life’s demands and maintain social connections, affecting all aspects of their experiences, from school and employment to relationships and overall quality of life. When it comes to treatment, approximately one third of those suffering from depression do not respond to two or more antidepressants and are considered treatment-resistant. Treatment-resistant depression is a chronic condition that places an increased emotional, functional and economic burden on the individual, their loved ones and society. It is also associated with greater morbidity, higher health care costs and various comorbid conditions. While a number of antidepressants exist, they all work through changing the levels of brain-signaling molecules called monoaminergic neurotransmitters. New drug development for depression had stalled for a number of years, and many pharmaceutical companies have withdrawn from neuroscience entirely. But recent scientific advances have led to the development of novel antidepressants working via completely different mechanisms. The brain is the most advanced, adaptive information processing system in existence—in large part because of its tremendous plasticity. Scientists have been building upon these neuroscience advances to develop completely novel, rapid-acting antidepressants. In this regard, considerable evidence has demonstrated that the regulation of two receptors—AMPA and NMDA—on many neurons that respond to the neurotransmitter glutamate control changes in the tiny junctions, or synapses, between neurons. © 2021 Scientific American

Keyword: Depression
Link ID: 27991 - Posted: 09.15.2021

James M. Gaines Young macaques given the popular antidepressant fluoxetine for two years had lower levels of certain fatty acids and other lipids in their brains than ones not given the drug, finds a recent study (July 28) in International Journal of Molecular Sciences. The findings may help explain why younger people sometimes experience adverse side effects when taking the drug. Fluoxetine, often sold under the brand name Prozac, is a prescription medication that can be given to adults as well as children as young as 7 or 8 years old. But there’s not good literature on the long-term impact of fluoxetine and other psychoactive drugs that we use to treat adult symptoms in the young brain, says Bita Moghaddam, a behavioral neuroscientist at Oregon Health & Science University who was not involved in the study, “so [it] was really nice to see that there is this level of focus.” While genes and neurotransmitters may get the lion’s share of the attention in neuroscience research, brains are mostly made of up fats and other lipids. But lipids, it turns out, can be hard to study. So, when University of California Davis brain scientist Mari Golub and her colleagues wanted to know what was going on with the fats in the brains of the monkeys they were studying, they reached out to the brain lab at the Skoltech Institute of Science and Technology in Moscow where Anna Tkachev—the lead author on the new paper—works. “We happen to specialize in lipids in particular,” says Tkachev. For years, Golub and her colleagues had been using macaques to investigate the effects of fluoxetine. The antidepressant can be an effective treatment for maladies such as depression and obsessive-compulsive disorder. However, some studies suggest that the drug can occasionally cause serious, long-term side effects, and perhaps counter-intuitively for an antidepressant, it’s been linked to an increased risk of suicidal thinking and behavior, particularly in young people. © 1986–2021 The Scientist.

Keyword: Depression; Development of the Brain
Link ID: 27988 - Posted: 09.13.2021

By Baland Jalal Obsessive-compulsive disorder (OCD) has puzzled artists and scientists for centuries. Afflicting one in 50 people, OCD can take several forms, such as compulsively putting things in just the right order or checking if the stove is turned off 10 times in a row. One type of OCD that affects nearly half of those with the condition entails irresistible washing urges. People with this type can spend hours scrubbing their hands in agitation after touching something as trivial as a doorknob even though they know this makes no sense. There is currently a shortage of effective therapies for OCD: 40 percent of patients do not benefit from existing treatments. A major issue is that today’s treatments are often too stressful. First-line “nonpharmacological therapies” involve telling patients to repeatedly touch things such as toilet seats and then refrain from washing their hands. But recent work by my colleagues and me has found something surprising: people diagnosed with OCD appear to have a more malleable “sense of self,” or brain-based “self-representation” or “body image”—the feeling of being anchored here and now in one’s body—than those without the disorder. This finding suggests new ways to treat OCD and perhaps unexpected insights into how our brain creates a distinction between “self” and “other.” In our recent experiments, for example, we showed that people with and without OCD responded differently to a well-known illusion. In our first study, a person without OCD watched as an experimenter used a paintbrush to stroke a rubber hand and the subject’s hidden real hand in precise synchrony. This induces the so-called rubber hand illusion: the feeling that a fake hand is your hand. When the experimenter stroked the rubber hand and the real one out of sync, the effect was not induced (or was greatly diminished). This compelling illusion illustrates how your brain creates your body image based on statistical correlations. It’s extremely unlikely for such stroking to be seen on a rubber hand and simultaneously felt on a hidden real one by chance. So your brain concludes, however illogically, that the rubber hand is part of your body. © 2021 Scientific American

Keyword: OCD - Obsessive Compulsive Disorder; Pain & Touch
Link ID: 27980 - Posted: 09.08.2021

by Peter Hess Children born to mothers who take antipsychotic medications during pregnancy do not have elevated odds of autism or attention deficit hyperactivity disorder (ADHD), nor are they more likely to be born preterm or underweight, according to a study released this past Monday in JAMA Internal Medicine. Some women with schizophrenia, Tourette syndrome or bipolar disorder take antipsychotic drugs, such as aripiprazole, haloperidol or risperidone. Clinicians have long debated whether women should discontinue these medications during pregnancy out of concern for the drugs’ effects on the developing fetus. But children born to mothers who take antipsychotics during pregnancy and to those who do not take them have similar outcomes, the new work shows. “Our findings do not support a recommendation for women to discontinue their regular antipsychotic treatment during pregnancy,” says senior investigator Kenneth Man, research fellow at the University College London School of Pharmacy in the United Kingdom. Prescribing antipsychotics during pregnancy can help prevent potentially dangerous psychotic episodes and ensure that an expectant mother can take care of herself, says Mady Hornig, associate professor of epidemiology at Columbia University, who was not involved in the study. “We certainly don’t want to be cavalier about the use of any medication during pregnancy, but one also wants to balance out the implications of not treating.” © 2021 Simons Foundation

Keyword: Schizophrenia; Development of the Brain
Link ID: 27954 - Posted: 08.21.2021