Childhood trauma has lasting effect on brain connectivity in patients with depression
April 8, 2019
Science Daily/University of Pennsylvania School of Medicine
A study lead by Penn Medicine researchers found that childhood trauma is linked to abnormal connectivity in the brain in adults with major depressive disorder (MDD). The paper, published this week in Proceedings of the National Academy of Sciences (PNAS), is the first data-driven study to show symptom-specific, system-level changes in brain network connectivity in MDD.
"With estimates of approximately 10 percent of all children in the United States having been subjected to child abuse, the significance of child maltreatment on brain development and function is an important consideration," said Yvette I. Sheline, MD, McLure professor of Psychiatry, Radiology, and Neurology, and director of the Center for Neuromodulation in Depression and Stress (CNDS) in the Perelman School of Medicine at the University of Pennsylvania. "This study not only confirms the important relationship between childhood trauma and major depression, but also links patients' experiences of childhood trauma with specific functional brain network abnormalities. This suggests a possible environmental contributor to neurobiological symptoms."
MDD is a common mental disorder characterized by a variety of symptoms -- including persistently depressed mood, loss of interest, low energy, insomnia or hypersomnia, and more. These symptoms impair daily life and increase the risk of suicide. In addition, experiences of childhood trauma, including physical, sexual, or emotional abuse, as well as physical or emotional neglect, have been associated with the emergence and persistence of depressive and anxiety disorders. However, the neurobiological mechanisms underlying MDD are still largely unknown.
To address this challenge, a team led by Sheline utilized functional magnetic resonance imaging (fMRI) to investigate the brain networks and patterns that underlie the disorder. Researchers compared brain activity in 189 participants with MDD to activity of 39 healthy controls. First author Meichen Yu, a post-doctoral fellow in the CNDS, conducted statistical analyses to determine the associations between temporal correlations in connectivity within and between 10 well-established, large-scale resting state networks (RSNs) and clinical measures, including both past history of trauma and current clinical symptoms, such as depression, anxiety, suicidality. These symptoms were measured by 213 item-level survey questions.
The authors found that in patients with MDD, while the strongest correlations were with childhood trauma, abnormal network connectivity was also associated with current symptoms of depression. Even though participants in this study were not selected as participants based on a history of trauma, and the brain imaging took place decades after trauma occurred, prior trauma was evident in abnormal functional connectivity.
"These results suggest that resting-state network connectivity may point to some of the brain mechanisms underlying the symptoms of major depressive disorder," Sheline explains. "It may have the potential to serve as an effective biomarker, aiding in the development of depression biotypes and opening up the possibility of targeted diagnosis."
https://www.sciencedaily.com/releases/2019/04/190408161610.htm
How to treat depression in prison -- and why it matters
February 21, 2019
Science Daily/Michigan State University
The first randomized study of its kind reveals effective treatment for prisoners suffering from mental illness.
Of the 4 million prisoners released each year, 23 percent have suffered from major depressive disorder. Due to resource shortages, many go without adequate treatment while in prison. Oftentimes they rejoin society in worse mental shape than before their incarceration -- which could be prevented with the right care. A team led by Michigan State University has found a cost-effective way to improve mental health in prisons.
The research, published in Journal of Consulting and Clinical Psychology, tested the effectiveness of interpersonal psychotherapy for inmates battling major depressive disorder, or MDD, as a strategy to bring affordable treatment into a prison setting. It is the first large randomized trial of any treatment for MDD, including therapy or medications, in any incarcerated population.
About 15 million people touch the criminal justice system each year in the United States," said Jennifer Johnson, lead author and professor of public health in MSU's College of Human Medicine. "Most of us have friends, family or neighbors who have been through this system. The fact we've waited until 2019 to conduct a trial like this means we've understudied and underserved a huge population."
About 2.3 million people are incarcerated every day, and if they too suffer from depression, addiction or other disorders, they often do not get the help they need. Prison funding for mental health care is determined by state legislatures, which often leaves them understaffed and under-resourced, Johnson explained. Voters may be unsympathetic, which creates a deficit for mental health treatment in the prison system -- which houses many people with untreated mental illnesses.
To address the issues of care and cost, Johnson and colleagues trained a team to treat 181 inmates through interpersonal psychotherapy, or IPT. The team included master's level health therapists working in the prisons and bachelor's level re-entry counselors. This allowed the researchers to keep costs down by extending the reach of counselors and care without having to hire new mental health professionals.
Johnson explained that IPT is one of the most-effective forms of therapy because it addresses difficult life events, which consistently burden prison populations. She explained that traumatic and challenging experiences -- such as assault, abuse, poverty, death of loved ones and loss of family members, children and friends -- are overwhelmingly present with those incarcerated.
"When practicing IPT, you go back to when someone's depressed mood began and talk about what was going on in their life at that time," Johnson said. "IPT deals with relationships, feelings, conflicts with others, life changes and grief. Using this therapy, you're helping people feel and express emotions, and problem-solve with them in ways to improve communications or improve relationships that address the original problem."
Counselors worked in a group-setting with inmates twice a week for 10 weeks, which reduced the cost of treatment. Inmates were individually assessed at the beginning of the trial, after the trial ended and then three months later to see if the therapy had a lasting impact.
"As compared to the usual treatment prisons offer, IPT reduced depressive symptoms, hopelessness and PTSD symptoms and was better at ending cases of major depression," Johnson said.
Using IPT proved a low-cost intervention as well. Once counselors are trained and supervision is no longer needed, the cost per patient would be $575 -- significantly less than treatment options outside of prison, she said.
"This is the first large randomized study for major depression ever conducted for an incarcerated population, one that found an effective and cost-effective solution," Johnson said. "This method could drastically improve the mental well-being of people while in prison -- and when they re-enter the world."
Moving forward, Johnson will continue researching ways to treat inmates by conducting the first large randomized suicide prevention trial for people leaving the criminal justice system.
https://www.sciencedaily.com/releases/2019/02/190221115909.htm
Half of Those Diagnosed with PTSD Also Suffer from Depression
June 4, 2013 —
Science Daily/Case Western Reserve University
About one of every two people diagnosed with posttraumatic stress disorder (PTSD) also suffer symptoms of depression, according to new research by Case Western Reserve University's Department of Psychological Sciences.
The analysis also concludes that both genders diagnosed with PTSD equally suffer from depression. Since women tend to report more symptoms of depression than men, this contradicts a general belief that women are more inclined to struggle with both.
The findings were based on an analysis of 57 peer-reviewed studies, representing data on 6,670 people (civilians and military personnel) who suffered from PTSD. Researchers conclude that 52 percent of the PTSD cases also reported symptoms of depression.
Before the study, estimates for individuals having both major depression disorder (MDD) and PTSD had ranged anywhere from 20 to 80 percent.
The research represents the first comprehensive analysis of peer-reviewed literature on people with PTSD and MDD.
PTSD is an anxiety disorder resulting from a traumatic incident in which flashbacks or unshakable thoughts about the trauma are common. MDD is characterized by an overwhelming and lingering sense of sadness and hopelessness. Symptoms can range from "feeling the blues" to thoughts of suicide.
"If individuals do not get a comprehensive assessment of what's bothering them, one or the other can be missed," said Case Western Reserve research associate Nina Rytwinski, the study's lead investigator and a researcher with the National Institute of Mental Health-funded PTSD project directed by Norah Feeny, PhD, from Case Western Reserve University and Lori Zoellner, PhD, from the University of Washington. "This high co-occurrence rate accentuates the importance of routinely assessing for both disorders."
The findings also suggest important implications for improving how men with PTSD are treated. Health-care providers tend to identify depression more frequently in women, while men can exhibit symptoms of depression that are misattributed to PTSD, Rytwinski said.
"The biases against men with PTSD symptoms put them at risk for under diagnosis and under treatment of a major depressive disorder," she said.
Researchers narrowed about 1,500 studies on PTSD and MDD to the 57 published peer-reviewed studies. They focused on research about individuals who had experienced some physical or sexual assault trauma.
By recognizing how frequently people experience both disorders, clinicians may better address barriers to completing therapy, personalized treatment and overall care, the researchers report.
http://www.sciencedaily.com/releases/2013/06/130604153515.htm