Older adults with existing depression show resilience during the pandemic
August 19, 2020
Science Daily/University of California - Los Angeles Health Sciences
A study involving older adults with pre-existing major depressive disorder living in Los Angeles, New York, Pittsburgh, and St Louis found no increase in depression and anxiety during the COVID-19 pandemic.
Researchers from five institutions, including UCLA, found that the older adults, who were already enrolled in ongoing studies of treatment resistant depression, also exhibited resilience to the stress of physical distancing and isolation. The findings were published in peer-reviewed journal, The American Journal of Geriatric Psychiatry.
"We thought they would be more vulnerable to the stress of COVID because they are, by CDC definition, the most vulnerable population," said Helen Lavretsky, MD, a professor-in-residence of psychiatry and biobehavioral sciences at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. "But what we learned is that older adults with depression can be resilient. They told use that coping with chronic depression taught them to be resilient"
For the study, researchers conducted interviews with the participants, all of whom were over the age of 60, with an average age of 69, during the first two months of the pandemic. Using two screening assessments of depression and anxiety, PHQ-9 and PROMIS, researchers found no changes in the participants' depression, anxiety or suicidality scores before and during the pandemic.
Researchers further determined that:
Participants were more concerned about the risk of contracting the virus than the risks of isolation.
While all maintained physical distance, most did not feel socially isolated and were using virtual technology to connect with friends and family.
While they were coping, many participants said their quality of life was lower, and they worry their mental health will suffer with continued physical distancing.
Participants were upset by the inadequate governmental response to the pandemic.
Based on the findings, the study authors wrote that policies and interventions to provide access to medical services and opportunities for social interaction are needed to help older adults maintain mental health and quality of life as the pandemic continues.
Lavretsky said many participants reported their quality of life to be lower, and they worried that their mental health will suffer with continued physical distancing. She said further research is needed to determine the impact of the pandemic over time.
She added that the findings offer takeaways for others while weathering the pandemic. "These older persons living with depression have been under stress for a longer time than many of the rest of us. We could draw upon their resilience and learn from it."
The study identified several self-care and coping strategies used by the participants, which included maintaining regular schedules; distracting themselves from negative emotions with hobbies, chores, work or exercise; and using mindfulness to focus on immediate surroundings and needs without thinking beyond the present.
The authors further emphasized that access to mental health care and support groups, and continued social interaction are needed to help older adults whether the pandemic.
https://www.sciencedaily.com/releases/2020/08/200819170223.htm
A scientific first: How psychedelics bind to key brain cell receptor
September 17, 2020
Science Daily/University of North Carolina Health Care
For the first time, scientists solved the high-resolution structure of these compounds when they are actively bound to the 5-HT2A serotonin receptor on the surface of brain cells. This discovery is already leading to the exploration of more precise compounds that could eliminate hallucinations but still have strong therapeutic effects. Psilocybin - the psychedelic compound in mushrooms - has already been granted breakthrough status by the FDA to treat depression.
Psychedelic drugs such as LSD, psilocybin, and mescaline cause severe and often long-lasting hallucinations, but they show great potential in treating serious psychiatric conditions, such as major depressive disorder. To fully investigate this potential, scientists need to know how these drugs interact with brain cells at the molecular level to cause their dramatic biological effects. Scientists at UNC-Chapel Hill and Stanford have just taken a big step in that direction.
For the first time, scientists in the UNC lab of Bryan L. Roth, MD, PhD, and the Stanford lab of Georgios Skiniotis, PhD, solved the high-resolution structure of these compounds when they are actively bound to the 5-HT2A serotonin receptor (HTR2A) on the surface of brain cells.
This discovery, published in Cell, is already leading to the exploration of more precise compounds that could eliminate hallucinations but still have strong therapeutic effects. Also, scientists could effectively alter the chemical composition of drugs such as LSD and psilocybin -- the psychedelic compound in mushrooms that has been granted breakthrough status by the FDA to treat depression.
"Millions of people have taken these drugs recreationally, and now they are emerging as therapeutic agents," said co-senior author Bryan L. Roth, MD, PhD, the Michael Hooker Distinguished Professor of Pharmacology at the University of North Carolina School of Medicine. "Gaining this first glimpse of how they act at the molecular level is really important, a key to understanding how they work. Given the remarkable efficacy of psilocybin for depression (in Phase II trials), we are confident our findings will accelerate the discovery of fast-acting antidepressants and potentially new drugs to treat other conditions, such as severe anxiety and substance use disorder."
Scientists believe that activation of HTR2A, which is expressed at very high levels in the human cerebral cortex, is key to the effects of hallucinogenic drugs. "When activated, the receptors cause neurons to fire in an asynchronous and disorganized fashion, putting noise into the brain's system," said Roth, who holds a joint faculty appointment at the UNC Eshelman School of Pharmacy. "We think this is the reason these drugs cause a psychedelic experience. But it isn't at all clear how these drugs exert their therapeutic actions."
In the current study, Roth's lab collaborated with Skiniotis, a structural biologist at the Stanford University School of Medicine. "A combination of several different advances allowed us to do this research," Skiniotis said. "One of these is better, more homogeneous preparations of the receptor proteins. Another is the evolution of cryo-electron microscopy technology, which allows us to view very large complexes without having to crystalize them."
Roth credits co-first author Kuglae Kim, PhD, a postdoctoral fellow in his lab, for steadfastly exploring various experimental methods to purify and stabilize the very delicate serotonin receptors.
"Kuglae was amazing," Roth said. "I'm not exaggerating when I say what he accomplished is among the most difficult things to do. Over three years in a deliberate, iterative, creative process, he was able to modify the serotonin protein slightly so that we could get sufficient quantities of a stable protein to study."
The research team used Kim's work to reveal the first X-ray crystallography structure of LSD bound to HTR2A. Importantly, Stanford investigators then used cryo-EM to uncover images of a prototypical hallucinogen, called 25-CN-NBOH, bound together with the entire receptor complex, including the effector protein Gαq. In the brain, this complex controls the release of neurotransmitters and influences many biological and neurological processes.
The cryo-EM image is like a map of the complex, which Kim used to illustrate the exact structure of HTR2A at the level of amino acids -- the basic building blocks of proteins such as serotonin receptors.
Roth, a psychiatrist and biochemist, leads the Psychoactive Drug Screening Program, funded by the National Institute of Mental Health. This gives his lab access to hallucinogenic drugs for research purposes. Normally, these compounds are difficult to study in the lab because they are regulated by the Drug Enforcement Agency as Schedule 1 drugs.
Roth and colleagues are now applying their findings to structure-based drug discovery for new therapeutics. One of the goals is to discover potential candidates that may be able offer therapeutic benefit without the psychedelic effects.
"The more we understand about how these drugs bind to the receptors, the better we'll understand their signaling properties," Skiniotis says. "This work doesn't give us the whole picture yet, but it's a fairly large piece of the puzzle."
https://www.sciencedaily.com/releases/2020/09/200917181259.htm
Early life stress is associated with youth-onset depression for some types of stress but not others
July 15, 2020
Science Daily/Elsevier
A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that individuals exposed to early life stress (ELS) were more likely to develop a major depressive disorder (MDD) in childhood or adolescence than individuals who had not been exposed to ELS.
Examining the association between eight different types of ELS and youth-onset depression, the authors found that while some types of ELS (e.g., poverty) were not associated with MDD, other types of stress, including emotional abuse, were associated more strongly with MDD than a broader assessment of ELS.
"Researchers have documented that early life stress increases the risk for developing depression in adulthood. We wanted to know the degree to which it was associated with depression earlier in life -- specifically during childhood or adolescence," said lead author Joelle LeMoult, PhD, a researcher at the University of British Columbia, Vancouver, Canada. "Given that earlier onsets of depression often mean a more recurrent course across the lifespan. We found that exposure to early life stress more than doubled the likelihood someone will develop youth-onset depression.
"These findings indicate that there is a narrow window between adversity and depression during which we have the opportunity to intervene."
The findings are based on a meta-analysis of data from 62 journal articles and over 44,000 unique participants. Studies that assessed early life stress and the presence or absence of MDD before the age of 18 years were also included.
Compared to youth who were not exposed to ELS, youth who were exposed to ELS were 2.5 times more likely to develop MDD (OR=2.50; 95% CI [2.08, 3.00]).
The authors also conducted eight additional meta-analyses to examine the association between different types of ELS and a diagnosis of MDD during childhood or adolescence. Sexual abuse, physical abuse, death of a family member, domestic violence, and emotional abuse were associated with significantly higher risk for youth-onset MDD; in contrast, poverty, illness/injury, and exposure to a natural disaster were not.
Several variables moderated the association between ELS and youth-onset MDD. For example, studies that used interview-based assessments or included larger sample sizes reported stronger associations between ELS and depression.
Taken together, findings provide evidence that the adverse effects of ELS on risk for MDD manifests early in development, before adulthood, and varies by type of ELS. Further, findings support recommendations to use best-practice methods in early life stress research.
https://www.sciencedaily.com/releases/2020/07/200715142326.htm
Handling traumatic grief reactions in children and adolescents post-9/11
October 1, 2019
Science Daily/Elsevier
In the wake of the World Trade Center attack on September 11, 2001 (9/11), researchers defined the 'traumatically bereaved' as those who experienced the loss of a mother, father, sister, brother, grandmother, grandfather, aunt, uncle, other family member, friend, and/or someone else after 9/11 happened. A new study reports that this disorder warrants separate clinical attention.
Grief reactions in traumatically bereaved youth, particularly in relation to a shared trauma, constitute a unique aspect of psychological distress. A new study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that this disorder warrants separate clinical attention.
In the wake of the World Trade Center attack on September 11, 2001 (9/11), researchers from Columbia University Medical Center (CUMC), New York defined the "traumatically bereaved" as those who experienced the loss of a mother, father, sister, brother, grandmother, grandfather, aunt, uncle, other family member, friend, and/or someone else after 9/11 happened.
"Study findings support the potential clinical relevance of a new bereavement disorder during sensitive developmental periods spanning from middle childhood to late-adolescence," said lead author Lupo Geronazzo-Alman, PhD, Assistant Professor of Clinical Medical Psychology, Division of Child and Adolescent Psychiatry at the New York State Psychiatric Institute, CUMC. "Grief reactions have added clinical value and merit clinical attention, because they describe maladaptive reactions after 9/11 that are not adequately captured by other disorders such as posttraumatic stress and major depression."
The findings, based on The World Trade Center (WTC) Board of Education (WTC-BOE) Study, are comprised of responses taken from a sample of 8,236 youth in grades 4 to 12, who answered a questionnaire six months after 9/11. It is representative of 715,966 New York City (NYC) public school students at the time of assessment.
The 277 youth (3.36 percent of the sample) experienced death of a family member; 576 (6.99 percent) and 1,003 (12.18 percent) youth experienced the death of a friend and of someone else they knew, respectively. In total, 1,696 youth were traumatically bereaved on 9/11, representing 133,446 (18.71 percent) 4th- through 12th-graders attending NYC public schools 6 months after 9/11.
The following five items selected from the UCLA Grief Screening Scale queried bereaved youth about the intensity of grief reactions during the previous month: missing the deceased person; continuing to feel connected to them; avoiding conversations; avoiding activities; and unhelpful rumination about the deceased person.
Symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were assessed with the Diagnostic Interview Schedule for Children (DISC-IV) Predictive Scales (DPS), a screening measure derived from the DISC-IV.
To establish whether a new bereavement disorder warrants a place in psychiatric nosology, the researchers provided four types of convergent evidence showing that the (1) predictors (i.e., non-loss-related trauma versus traumatic bereavement); (2) clinical correlates (new health problems since 9/11, functional impairment); (3) factorial structure; and (4) phenomenology of grief reactions are independent of, and distinct from, other common types of post-disaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress.
Grief reactions, PTSD, and MDD all have different predictors; traumatic bereavement was associated with grief independently of PTSD and MDD but was not associated with PTSD and MDD after adjusting for grief reactions.
After controlling for PTSD and MDD, grief reactions were significantly associated with functional impairment. Furthermore, a factor analysis showed that grief reactions loaded on one factor, which was distinct from factors underlying PTSD and MDD symptoms. Finally, youth with severe grief reactions could be grouped into two classes characterized by (i) negligible and (ii) only moderate probability of co-occurring PTSD and MDD symptoms, respectively.
"A primary benefit of including a new definition of bereavement disorder into the main text of the DSM-V will fill in a current gap in how clinicians are able to describe and explain reactions to traumatic bereavement, allowing us to better predict and prescribe the most appropriate treatment," concluded Dr. Geronazzo-Alman.
https://www.sciencedaily.com/releases/2019/10/191001084005.htm
Just what the doctor ordered: Take a yoga class and depression, anxiety improve
November 13, 2019
Science Daily/Boston University School of Medicine
Scientific studies already support yoga practice as a means to reduce symptoms of depression and anxiety. Now a new study out of Boston University School of Medicine (BUSM) provides evidence that yoga and breathing exercises can improve symptoms of depression and anxiety in both the short term -- with each session as well as cumulatively in the longer term, over three months.
Published online in the Journal of Psychiatric Practice, these findings suggest yoga can be a helpful complementary treatment for clinical depression or major depressive disorder.
A group of 30 clinically depressed patients were randomly divided into two groups. Both groups engaged in lyengar yoga and coherent breathing with the only difference being the number of instructional and home sessions in which each group participated. Over three months, the high-dose group (HDG) spent 123 hours in sessions while the low-dose group (LDG) spent 87 hours.
Results showed that within a month, both groups' sleep quality significantly improved. Tranquility, positivity, physical exhaustion and symptoms of anxiety and depression significantly improved in both groups, as measured by several validated clinical scales
"Think of it this way, we give medications in different doses in order to enact their effects on the body to varying degrees. Here, we explored the same concept, but used yoga. We call that a dosing study. Past yoga and depression studies have not really delved deeply into this," explained corresponding author Chris Streeter, MD, associate professor of psychiatry at BUSM.
"Providing evidence-based data is helpful in getting more individuals to try yoga as a strategy for improving their health and well-being. These data are crucial for accompanying investigations of underlying neurobiology that will help elucidate 'how' yoga works," said study collaborator and co-author Marisa M. Silveri, PhD, neuroscientist at McLean Hospital and associate professor of psychiatry at Harvard Medical School.
Depression, a condition that affects one of every seven adults in the U.S. at some point in their lives, is treated with a variety of modalities, including counseling (especially through cognitive-behavioral therapy) and medication. Research has shown combining therapy and medication has greater success than either treatment alone. Although studies with more participants would be helpful in further investigating its benefits, this small study indicates adding yoga to the prescription may be helpful.
https://www.sciencedaily.com/releases/2019/11/191113105729.htm
Anti-inflammatory agents can effectively and safely curb major depressive symptoms
Effects even stronger when added to antidepressant treatment, pooled data analysis shows
October 28, 2019
Science Daily/BMJ
Anti-inflammatory agents, such as aspirin/paracetamol, statins, and antibiotics, can safely and effectively curb the symptoms of major depression, finds a pooled analysis of the available evidence, published online in the Journal of Neurology Neurosurgery & Psychiatry.
And the effects are even stronger when these agents are added on to standard antidepressant treatment, the results show.
Around a third of people who are clinically depressed don't respond well to current drug and talking therapies, and drug side effects are relatively common.
An emerging body of evidence suggests that inflammation contributes to the development of major depression, but the results of clinical trials using various anti-inflammatory agents to treat the condition have proved inconclusive.
The researchers therefore set out to review the available evidence and pool the data to see if anti-inflammatory agents work better than dummy (placebo) treatment either alone or when used as add-on therapy to standard antidepressant treatment.
Anti-inflammatory agents included: non-steroidal anti-inflammatory drugs (NSAIDs); omega 3 fatty acids; drugs that curb production of inflammatory chemicals (cytokine inhibitors); statins; steroids; antibiotics (minocyclines); a drug used to treat sleep disorders (modafinil); and N-acetyl cysteine, known as NAC, and used to loosen the excess phlegm of cystic fibrosis and COPD and also taken as an antioxidant supplement.
The researchers trawled research databases to find suitable studies published up to January 2019. They found 30 relevant randomised controlled trials, involving 1610 people, which reported changes in depression scales. They pooled the data from 26 of these studies.
The pooled data analysis suggested that anti-inflammatory agents were better than placebo and enhanced the effects of standard antidepressant treatment.
These agents were 52% more effective in reducing symptom severity, overall, and 79% more effective in eliminating symptoms than placebo, as measured by an average fall in depression scales of 55.
More detailed analysis indicated that NSAIDs, omega 3 fatty acids, statins, and minocyclines were the most effective at reducing major depressive symptoms compared with placebo.
And the effects were even greater when one or other of these agents was added to standard antidepressant treatment.
But anti inflammatory agents didn't seem to improve quality of life, although this might have been because of the small number of studies which looked at this aspect, say the researchers.
No major side effects were evident, although there were some gut symptoms among those taking statins and NACs, and the trials lasted only 4 to 12 weeks, so it wasn't possible to track side effects over the longer term.
The researchers also point out that not all studies tracked changes in depression scores over the entire study period. The depression scales used in the studies differed, and those involving statins and minocyclines included only small numbers of patients.
Nevertheless, they conclude: "The results of this systematic review suggest that anti-inflammatory agents play an antidepressant role in patients with major depressive disorder and are reasonably safe."
https://www.sciencedaily.com/releases/2019/10/191028213923.htm
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
Stress in early life could make people more likely to develop depression
May 8, 2019
Science Daily/University of Bristol
New research by the University of Bristol has found that early life adversity could make an individual more at risk of developing negative thinking, which could lead to major depressive disorder (MDD). The findings provide biological and psychological evidence to support work first proposed in the 1960s.
The study, published in Neuropsychopharmacology and funded by the MRC and BBSRC, using a rodent model of early life adversity, has shown that offspring are much more sensitive to negative biases in their cognition when treated with the stress hormone, corticosterone.
The research has shown a dose of corticosterone had no effect in normal rats but caused a negative bias in the early life adversity animals. The study also found that the early life adversity rats were less likely to anticipate positive events and failed to properly learn about reward value. These impairments in reward-related cognition are particularly interesting as one of the main features of depression is a loss of interest in previously enjoyable activities.
The findings support the idea that those at risk of developing mood disorders may have impairments in the way they learn about and use their memories about how rewarding an experience has been to then guide and motivate them to repeat the activity. The researchers suggest that these neuropsychological effects might explain why early life adversity can make people more likely to develop depression.
Emma Robinson, Professor of Psychopharmacology, School of Physiology, Pharmacology & Neuroscience and lead author on the paper, said: "This study supports a wider body of literature which suggests that depression may develop from an interesting yet complex interaction between biological and psychological processes. As we start to understand these better we hope that the knowledge we generate can be used to better guide current and future treatments.
"Our larger body of work suggests that the effectiveness of current antidepressant treatments might be linked to how much a person is able to re-engage with their environment and their level of social support.
"The findings also add further evidence to support the validity of this relatively new area of research into mood disorders, particularly studies using animals to understand the neurobiology of affective biases and how they contribute to normal and pathological behaviour."
Studies in patients have shown that depression is linked to changes in how the person processes information particularly emotional information. People with depression have a negative view of the world which can be measured by looking at how they process information such as emotional faces and words. However, whether this causes the illness or are a consequence is not known.
The researchers developed a method to use in rodents where similar neuropsychological processes were measured. One of the tasks, the affective bias test, looked at how simple associations between a specific cue, a bowl with a specific digging substrate in it, and a reward, a food pellet, could be biased by the animal's affective state when they learn about it.
When animals learn the association in a negative affective state they remember it in a more pessimistic way whilst memories formed in a positive affective state are remembered in a more positive way. The biases the study was able to measure in rodents correlated exactly with how these same treatments affect peoples' mood in the long-term, something which no other animal test in psychiatry has been able to achieve.
The next step in the research will be to understand how these processes and the deficits seen in the animals respond to current antidepressant treatments including the recently licensed, rapid onset antidepressant ketamine. The researchers already have some evidence about how ketamine interacts with these neuropsychological processes and this latest work will help them bring these findings together with an important disease model and risk factor for depression.
https://www.sciencedaily.com/releases/2019/05/190508113326.htm
Daily intake of nutritional supplements cannot prevent depression
March 6, 2019
Science Daily/European Association for the Study of Obesity
MooDFOOD, the largest randomized clinical trial to study the effects of nutritional strategies on the prevention of major depressive disorder concludes that daily intake of nutritional supplements cannot prevent depression.
Over 1000 participants who were overweight or had obesity and were identified as being at elevated risk for depression but who were not currently depressed, from four European countries -the Netherlands, the United Kingdom, Germany and Spain, took part in the study. Participants were randomized to either take nutritional supplements containing folic acid, vitamin D, zinc, selenium or to a pill placebo, and half of participants also received a behavioural lifestyle intervention intended to change dietary behaviours and patterns.
Researcher Mariska Bot from Amsterdam UMC reported: "Daily intake of nutritional supplements over a year does not effectively prevent the onset of a major depressive episode in this sample. Nutritional supplements were not better than placebo. Therapeutic sessions aimed at making changes towards a healthy dietary behaviour did also not convincingly prevent depression." Dr. Bot is first author of a paper showing these results in today's issue of the Journal of the American Medical Association (JAMA).
Depression is a common disorder
More than 40 million Europeans experience a major depressive disorder. One in ten men and one in five women suffer from clinical depression at least once during their lifetime. Depression is one of the most prevalent and disabling disorders in the EU.
Given the increasing prevalence of depression, more people are actively searching for ways to decrease their risk through lifestyle modification, but are often overwhelmed by confusing and contradictory information. To help European citizens the MooDFOOD project has developed evidence-based nutritional strategies to help prevent depression.
Prevention of depression through a healthy diet
The MooDFOOD prevention trial formed a crucial part of the five year MooDFOOD project, which investigated the relationship between nutrition and depression. MooDFOOD was funded by the European Commission and led by the Vrije Universiteit Amsterdam.
Although the behavioural therapy to encourage a healthy dietary behavior and improve diet was not effective at preventing depression overall, there was some evidence that it prevented depressive episodes in those participants who attended a recommended number of sessions. This may suggest the food behavioural therapy only works if the participants get sufficient exposure and are able to sufficiently improve their diet and dietary behaviour.
MooDFOOD project coordinators professor Marjolein Visser and professor Ingeborg Brouwer of the Vrije Universiteit Amsterdam said:
"Several studies within, and outside the five year MooDFOOD project show that consuming a healthy dietary pattern is important for European citizens, not only for physical health, but it may also help to prevent depressive symptoms. " Based on a large number of studies and careful analysis, MooDFOOD researchers have come to three important conclusions at the end of their project. First, a healthy dietary pattern, typified by a Mediterranean style diet high in fruit, vegetables, whole grains, fish, pulses and olive oil, and low in red meat and full-fat dairy products, may reduce the risk of developing depression. Second, in people with obesity, weight loss can lead to a reduction in depressive symptoms. Third, current evidence does not support the use of nutritional supplements in order to prevent depression.
Practical tools
These recent results have important implications for all Europeans. The MooDFOOD team has translated these findings into tools for the general population, health professionals (GPs, dieticians and psychologists), researchers and policy makers.
https://www.sciencedaily.com/releases/2019/03/190306100545.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
Mental health disorders common following mild head injury
Risk factors for neuropsychiatric conditions after concussion
January 30, 2019
Science Daily/NIH/National Institute of Neurological Disorders and Stroke
A new study reveals that approximately 1 in 5 individuals may experience mental health symptoms up to six months after mild traumatic brain injury (mTBI), suggesting the importance of follow-up care for these patients. Scientists also identified factors that may increase the risk of developing post-traumatic stress disorder (PTSD) and/or major depressive disorder following mild mTBI or concussion through analysis of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study cohort.
"Mental health disorders after concussion have been studied primarily in military populations, and not much is known about these outcomes in civilians," said Patrick Bellgowan, Ph.D., NINDS program director. "These results may help guide follow-up care and suggest that doctors may need to pay particular attention to the mental state of patients many months after injury."
In the study, Murray B. Stein, M.D., M.P.H., professor at the University of California San Diego, and his colleagues investigated mental health outcomes in 1,155 people who had experienced a mild TBI and were treated in the emergency department. At three, six, and 12 months after injury, study participants completed various questionnaires related to PTSD and major depressive disorder. For a comparison group, the researchers also surveyed individuals who had experienced orthopedic traumatic injuries, such as broken legs, but did not have head injury.
The results showed that at three and six months following injury, people who had experienced mTBI were more likely than orthopedic trauma patients to report symptoms of PTSD and/or major depressive disorder. For example, three months after injury, 20 percent of mTBI patients reported mental health symptoms compared to 8.7 percent of orthopedic trauma patients. At six months after injury, mental health symptoms were reported by 21.2 percent of people who had experienced head injury and 12.1 percent of orthopedic trauma patients.
Dr. Stein and his team also used the data to determine risk factors for PTSD and major depressive disorder after mTBI. The findings revealed that lower levels of education, self-identifying as African-American, and having a history of mental illness increased risk. In addition, if the head injury was caused by an assault or other violent attack, that increased the risk of developing PTSD, but not major depressive disorder. However, risk of mental health symptoms was not associated with other injury-related occurrences such as duration of loss of consciousness or posttraumatic amnesia.
"Contrary to common assumptions, mild head injuries can cause long-term effects. These findings suggest that follow-up care after head injury, even for mild cases, is crucial, especially for patients showing risk factors for PTSD or depression," said Dr. Stein.
This study is part of the NIH-funded TRACK-TBI initiative, which is a large, long-term study of patients treated in the emergency department for mTBI. The goal of the study is to improve understanding of the effects of concussions by establishing a comprehensive database of clinical measures including brain images, blood samples, and outcome data for 3,000 individuals, which may help identify biomarkers of TBI, risk factors for various outcomes, and improve our ability to identify and prevent adverse outcomes of head injury. To date, more than 2,700 individuals have enrolled in TRACK-TBI.
A recent study coming out of TRACK-TBI suggested that many TBI patients were not receiving recommended follow-up care.
"TRACK-TBI is overturning many of our long-held beliefs around mTBI, particularly in what happens with patients after they leave the emergency department. We are seeing more evidence about the need to monitor these individuals for many months after their injury to help them achieve the best recovery possible," said Geoff Manley, M.D., professor at the University of California San Francisco, senior author of the current study and principal investigator of TRACK-TBI.
Future research studies will help identify mental health conditions, other than PTSD and major depressive disorder, that may arise following mTBI. In addition, more research is needed to understand the biological mechanisms that lead from mTBI to mental health problems and other adverse outcomes, such as neurological and cognitive difficulties.
https://www.sciencedaily.com/releases/2019/01/190130112717.htm