Tag Archives: depression

Playing Mahjong could boost mental health at old age

Mahjong, a game of skill and luck played by four people using domino-like engraved tiles, is often referred to as China’s “national pastime”. Unlike many other popular leisure games, mahjong requires cooperation and strategy between players, which fosters the ideal forum for interaction between people. And according to a new study conducted at the University of Georgia, this engaging social interaction may boost mental health among Chinese elderly people, who are some of the most vulnerable people to depression in the world.

Credit: Pixabay.

The history of mahjong is somewhat contested, but the current consensus seems to be that it first appeared around Shanghai in the mid- to late-1800s. It quickly became popular in Shanghai and Beijing, then the entire country, and eventually among American expatriates that brought the game back to the United States, where it spread like wildfire in the 1920s.

It’s common for fans of the game to play mahjong with the same group of people for a long time, routinely meeting for game sessions. Some older Chinese people have had the same mahjong partners for decades. Even during the pandemic, the most dedicated players kept in touch by playing mahjong online.

The benefits of engaging in social activities for mental health have been widely reported, but such research has been mainly done in developed nations, such as the U.S. and Japan. To fill the gap, researchers led by Adam Chen, an associate professor of health policy and management at the University of Georgia, wanted to investigate the mental health impact of playing mahjong among elderly Chinese people.

The researchers analyzed survey data from nearly 11,000 Chinese people aged 40 years and older from the nationally representative China Health and Retirement Longitudinal Study. Depression symptoms were assessed for each participant and compared to the type and frequency of social participation, including visiting with friends, playing mahjong, participating in a sport or social club, and volunteering in the community.

As a whole, engaging in frequent social activities was associated with better mental health outcomes, playing mahjong was particularly associated with a positive effect. That’s not surprising. Studies looking at brain connectivity during social interaction have found that our brains react strongly to social cues, suggesting that our social networks and interactions also help shape the brain. Besides, talking to people can make you feel better, whereas loneliness can increase the level of cortisol and the level of stress, which can hamper brain activity.

Another 2019 study in England found cultural engagement — i.e. going to plays, movies, concerts, and museum exhibits — lowers the risk of developing depression. Studies also suggest that playing brain games can help in sharpening certain cognitive abilities such as planning, processing speed, and decision making.

“What is more surprising is that mahjong playing does not associate with better mental health among rural elderly respondents,” Chen said in a statement. “One hypothesis is that mahjong playing tends to be more competitive and at times become a means of gambling in rural China.”

Poor mental health is a huge burden on China, accounting for 17% of the global disease burden of mental disorders. These findings may offer a guide for policymakers looking to design interventions to improve mental health among older Chinese, which could also translate to Asian American communities.

“Social participation manifests itself in different formats within different cultural contexts,” said Chen.

“Older Asian Americans have a much higher proportion of suicidal thoughts than whites and African Americans,” he said. “Improving social participation among older Asian Americans may help to address this burden to the U.S. population health that has not received due attention.”

The findings appeared in the journal Social Science & Medicine.

People who sat down more during the pandemic were more likely to become depressed

Spending more time sitting is associated with more signs of depression, according to a new study.

Image credits Cheryl Holt.

With the pandemic and the lockdowns it caused, more people than ever have been working their jobs from home, while self-isolating. Due to this shift many parts of our day that used to involve physical movement, such as our commutes or hours spent in the gym, have turned into sedentary hours. While unfortunate, this gave a team of researchers at Iowa State University a unique opportunity to study the effects of widespread, sustained sedentarism on public and personal health.

According to the findings, people who maintained a higher proportion of sitting time in their daily lives between April and June 2020 were more likely to have symptoms of depression compared to those who engaged in a more dynamic lifestyle. While the study can’t establish a direct causal link between sitting and depression, it does uncover a link that’s worth a deeper examination in the future.

Sitting down, feeling down

“Sitting is a sneaky behavior. It’s something we do all the time without thinking about it,” said Jacob Meyer, assistant professor of kinesiology at Iowa State University and lead author of the paper.

“In March 2020, we knew COVID was going to affect our behavior and what we could do in lots of weird, funky ways that we couldn’t predict,” he adds.

Meyer and his colleagues at the Wellbeing and Exercise Laboratory at ISU, Trinity College Dublin, University of Dublin, and the University of Limerick examined how physical activity and sedentary behaviors impact mental health. They were also interested in quantifying how changes in these behaviors can influence the way our minds work, our emotional states, and our perceptions of the world around us.

For the study, they surveyed a sample of over 3,000 participants from all 50 U.S. states and the District of Columbia. As part of these surveys, the participants self-reported how much time they spent daily on certain activities including sitting, looking at screens, and exercising. They were also asked to detail how the time spent engaged with each activity and their general behavior revolving around them changed after the onset of the pandemic. Standard clinical scales were included in the surveys through which the participants could indicate changes they observed in their mental wellbeing since the onset of the pandemic.

These activities and the particular mental health markers used in this survey were chosen based on previous research regarding factors affecting mental health.

“We know when people’s physical activity and screen time changes, that’s related to their mental health in general, but we haven’t really seen large population data like this in response to an abrupt change before,” Meyer said.

According to the results, participants who met the criteria set out in the U.S. Physical Activity Guidelines before the pandemic, which call for 2.5 to 5 hours of moderate to vigorous physical activity per week, decreased their levels of physical activity by 32% on average after lockdown measures came into effect. These participants further reported feeling more depressed, anxious, and lonely following the change.

A follow-up study from the same team tracked how the participants’ behaviors and mental health changed over time by asking them to fill out the same survey once per week between April and June. This study uncovered that people who continued to spend a large part of their time sitting maintained a higher level of depressive symptoms on average compared to everyone else.

“In the second study, we found that on average, people saw their mental health improve over the eight-week period,” Meyer said. “People adjusted to life in the pandemic. But for people whose sitting times stayed high, their depressive symptoms, on average, didn’t recover in the same way as everyone else’s.”

Still, the authors underline that an “association” between sitting and depressive symptoms is not the same as saying that one causes the other. It’s possible that people who were more depressed simply sat down for longer periods of time, or the people who sat more became depressed from other causes. There could be other factors at play here that the surveys can’t account for, as well. But the results warrant further research into the topic, says Meyer.

Changing our habits is very difficult even when we want to do it, the team explains. However, they hope that the current papers will help bring awareness to just how important it is to move, even a little, every day. If you’re stuck at home, you can try forming a habit of taking a short walk before and after your workday, for example. This will help alleviate the negative effects of sedetarism and help impart some structure to your day, both of which will be beneficial for your mental health.

The paper “High Sitting Time Is a Behavioral Risk Factor for Blunted Improvement in Depression Across 8 Weeks of the COVID-19 Pandemic in April–May 2020” has been published in the journal Frontiers in Psychiatry.

New brain stimulation technique cured 80% of major depression cases during trial run

We might soon have a reliable treatment for severe depression. New research at the Stanford University School of Medicine reports that a new type of magnetic brain stimulation was successful in treating almost 80% of participants with this condition.

Image via Pixabay.

The treatment approach is known as the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), or Stanford neuromodulation therapy for short. It is an intensive, individualized transcranial magnetic stimulation therapy, and it shows great promise against severe depression — so far, in controlled trials. While effective, there are some side effects to this treatment: temporary fatigue and headaches.

All in all, the authors are confident that the benefits far outweigh the risks with SAINT, and they hope their work will pave the way towards new treatment options for many patients around the world.

A promising approach

“It works well, it works quickly and it’s noninvasive,” said Nolan Williams, MD, an assistant professor of psychiatry and behavioral sciences, and senior author of the study. “It could be a game changer.”

The study included 29 participants with treatment-resistant depression. They ranged in age from 22 to 80, and had suffered from depression for an average of nine years at the time of the study. All of these cases have proven to be resistant to medication. Participants who were on medication during the study maintained their regular dosage, but those who weren’t did not start any course during the treatment period.

They were split into two groups, one of which received the SAINT treatment, with the other receiving a placebo procedure that mimicked it. Five days into the treatment, 78.6% of the participants in the SAINT group no longer qualified for depression as judged using several evaluation efforts. The effects were sustained over time after the treatment had ceased, the authors note.

Current transcranial magnetic stimulation options that carry the approval of the Food and Drug Administration require six weeks of daily sessions, the authors explain. It’s effective in about half the patients who undergo such treatments, and only about a third show remission from depression following the treatment.

SAINT builds on these approaches by first targeting the pulses in different areas tailored after each patient’s neurocircuitry, and by delivering a greater number of magnetic pulses at a higher frequency.

In order to determine the particularities of each patient’s dorsolateral prefrontal cortex — an area of the brain involved in regulating executive functions –, the authors performed an MRI analysis on each participant before the start of the study. Their goal was to find the exact subregion in the brain that had the strongest functional link to the subgenual cingulate. This structure has been documented to exhibit heightened levels of activity in people experiencing depression. The goal of the magnetic stimulation treatment is to strengthen the link between the two areas in order to allow the dorsolateral prefrontal cortex to better control the activity in the subgenual cingulate.

The density of the pulses delivered in this trial was three times greater than that of currently-approved treatments: 1,800 per session compared to the regular number of 600. Finally, instead of providing one treatment session per day, the team gave their participants 10 10-minute treatments, with 50-minute breaks in between. The control group underwent ‘treatment’ with a magnetic coil that mimics the experience of the magnetic pulses.

Both groups wore noise-canceling earphones and received a topical ointment to dull sensation before each session.

Four weeks after the trial, 12 of the 14 participants in the experimental group showed improvements in their symptoms. According to FDA criteria for remission, 11 of them were officially cured of depression. In the control group, only 2 out of 15 patients met the criteria for remission.

The team is particularly interested in using SAINT to treat patients who are at a crisis point. Their study revealed that participants felt better and had attenuated symptoms within days of starting SAINT; this timeframe is much shorter than what is seen with medication, where improvements can take up to a month or more.

“We want to get this into emergency departments and psychiatric wards where we can treat people who are in a psychiatric emergency,” Williams said. “The period right after hospitalization is when there’s the highest risk of suicide.”

The paper “Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial” has been published in the American Journal of Psychiatry.

Scientists solve ‘untreatable’ depression with personalized brain implant, in world first

Schematic of deep brain stimulation, which involves implanting electrodes in the brain.

For some people diagnosed with depression, their condition is so severe that neither therapy nor drugs make a dent in it. Such was the case of Sarah, a 38-year-old patient, who agreed to undergo an experimental procedure that involved treating her depression using a brain implant that interrupts patterns of neural activity linked to the condition. It actually worked, putting a smile on Sarah’s face for the first time in five years.

Although the therapy involved a single patient, experts in the field have praised the study, pointing out that this form of personalized therapy may be the future — not just for treating depression but also a score of other psychiatric illnesses.

The success of the therapy also validates prior research, showing that certain patterns of brain activity underlie symptoms of mental illness and tweaking them towards a pattern seen in healthy people can improve the mental health of patients.

Katherine Scangos, an assistant professor of clinical psychiatry at the University of California, San Francisco (UCSF) and lead author of the new study describing the breakthrough psychiatric treatment, said the therapy “is an incredible advancement in our knowledge of the brain function that underlies mental illness.”

Before volunteering for the therapy, Sarah, a Northern California native, often had sudden bouts of crying. At the peak of her depression, she had to quit her job at a health tech company and moved in with her parents at the request of her doctor. She was on more than 20 different medications and spent months in the hospital. She had also tried various experimental techniques that previously worked on some hard cases like herself, including transcranial magnetic stimulation and electroconvulsive therapy. However, her symptoms didn’t improve.

But weeks later, scientists at the University of California, San Francisco surgically implanted a matchbook-sized device in her brain, Sarah’s persistent suicidal thoughts disappeared.

The device is calibrated specifically to Sarah’s brain activity. It detects neural patterns that occur when she is depressed then delivers pulses of electrical stimulation that rewire these patterns into a healthy state.

Sarah’s score on a standard depression scale was 33 in August 2020, before her surgery. A score between 20 and 27 reflects ‘severe’ depression. Two weeks after the “brain pacemaker” was successfully implanted, her scores quickly dropped to 14. A few months later she scored 10, the range where doctors consider a patient is in remission.

Previous deep brain stimulation implants for depression were found to produce no better improvements than a “sham” implant meant to induce a placebo effect. But, those implants were designed to be”one size fits all”, whereas the present implant is personalized to Sarah’s depression neural activity.

According to Scangos and colleagues, who presented their findings in the journal Nature Medicine, one person’s depression might look very different from another. Before they performed the surgery, the researchers spent ten days analyzing Sarah’s brain while she was interviewed about her feelings. They also applied stimulation to different locations in varying doses.

Using this training data, the deep brain stimulation was automated with the help of a machine learning algorithm after the implant was inserted in Sarah’s right brain hemisphere. The implant fires electrical impulses about 300 times each day with bursts lasting a couple of seconds. There is no obvious sensation when the implant is firing, aside from a feeling of alertness and positivity, Sarah said.

Electrodes were implanted in two key brain regions: the ventral striatum, which is involved in emotion, motivation, and reward, and the amygdala, primarily associated with emotional processes.

The implant hasn’t eliminated depression-causing activity in Sarah’s brain; it just corrects it. Furthermore, the patient is still taking psychiatric medication. Nevertheless, her condition has improved dramatically — a night and day difference. Even now, a year after her surgery, Sarah’s depresion is kept at bay.

Nearly a third of patients with depression don’t respond to standard treatment. Deep brain stimulation may be the therapy some of these patients have been waiting for to live a normal life. However, the invasive procedure and high cost (at least tens of thousands of dollars) will act as an entry barrier for many.

“Future work is required to determine if the results and approach of this n-of-1 study generalize to a broader population,” the scientists concluded in their paper’s abstract.

Mice can develop neural signs of depression when forced to watch other mice experiencing stress

Depression is a global problem, affecting an ever-growing number of individuals. In a bid to better understand its physiological underpinnings, a team from the Tokyo University of Science has explored how neural deterioration in areas of the brain such as the hippocampus, as well as physical and psychological stress, is tied to depression.

Image credits Tibor Janosi Mozes.

There are several theories regarding why and how depression emerges, both from psychological and physiological factors. In regards to the latter, the “neurogenic hypothesis of depression” has garnered a lot of scientific interest. It states that depression can stem from physical degradation in areas of the brain such as the hippocampus, degradation which can be incurred by stress.

While the link between physical stress and depression has been investigated in the past, much less is known about the effects of psychological stress. A new study aims to give us a better understanding of this topic, using mice as a model organism.

A grinding toll

“The number of individuals suffering from depression has been on the rise the world over. However, the detailed pathophysiology of depression still remains to be elucidated. So, we decided to focus on the possible mechanism of psychological stress in adult hippocampal neurogenesis, to understand its role in depressive disorders,” says Prof. Akiyoshi Saitoh from Tokyo University of Science, co-lead author of the study.

“We have found out that chronic mental stress affects the neurogenesis of the hippocampal dentate gyrus. Also, we believe that this animal model will play an important role in elucidating the pathophysiology of depression, and in the development of corresponding novel drug.”

For the study, the team exposed mice to “repeated psychological stress” in order to test how this impacts hippocampus degeneration in their brains. The experiment consisted of making the mice experience chronic social defeat stress (cSDS) via their peers — a source of psychological stress for the animals, as they are a highly social species. Chronic social defeat stress is an experimental tool through which stress is induced in a subject (such as a mouse), the ‘naive mouse’ to ‘aggressor’ mice. As part of this research, the mice were made to witness the naive mice, who were participating in the stressful situation.

After this exposure, the team analyzed their brains to measure the level of degradation it produced in key brain areas, as well as noting changes in behavior.

First off, they report that the mice exposed to this repeated source of stress started exhibiting behavioral issues such as social withdrawal, indicative of depression. In their brains, more specifically the dentate gyrus area of the hippocampus, the team recorded a decreased survival rate of new-born neurons compared to those of controls. This area is heavily involved in memory and sensory perception.

Lower new-born neuron survival rates persisted for up to four weeks after the animals were exposed to the stress-inducing scenarios. Chronic treatment with antidepressant fluoxetine was efficient in restoring neuronal survival rates for these mice. Other characteristics, such as cell growth, differentiation, and maturation rates were not impacted by stress in the experimental mice (as compared to controls), the team adds.

The authors link neural degradation in the hippocampus to the emergence of depression through the fact that avoidance behaviors in the experimental mice was “significantly enhanced” 4 weeks after the last stress-inducing exercise, compared to the first day after it. This behavior, they explain, is likely produced by degradation mounting in neurons of the hippocampus following the experience.

Although these findings have not yet been validated in humans, the authors believe that they can form an important part of understanding how depression emerges in the brain even among us. Further work is needed to validate the results and see whether they translate well to humans, however.

The paper “Chronic vicarious social defeat stress attenuates new-born neuronal cell survival in mouse hippocampus” has been published in the journal Behavioural Brain Research.

Potential new treatment for drug-resistant depression identified in mice — blocking histamines in the brain

Inflammation could have a direct impact on our mood through a molecule known as histamine, according to new research. Histamines are produced when white blood cells encounter a potential allergen, but their release in the blood also seems to interfere with serotonin, a mood-regulating neurotransmitter.

Histamine molecule. Image via Wikimedia.

Nobody likes allergies, but science has found a new reason to dislike them even more. Histamines, the molecules that mediate allergic responses, also seem to sour the mood of lab mice. New research from Imperial College London and the University of South Carolina reports that inflammation, and the release of histamines that accompanies it, interferes with serotonin in the brain. It also seems to affect how effective antidepressants can be at improving our mood, since these compounds also work by regulating serotonin production in the brain.

If these findings are replicated in humans, the team explains, we could open up new avenues of treatment for depression and treatment-resistant depression, which together form the most common mental health problem worldwide.

Unfortunate interaction

“Inflammation could play a huge role in depression, and there is already strong evidence that patients with both depression and severe inflammation are the ones most likely not to respond to antidepressants,” explains Dr. Parastoo Hashemi from Imperial’s Department of Bioengineering, lead author of the paper.

“Our work shines a spotlight on histamine as a potential key player in depression. This, and its interactions with the ‘feel-good molecule’ serotonin, may thus be a crucial new avenue in improving serotonin-based treatments for depression.”

While histamines are best known for the part they play in allergic reactions, they’re actually involved in basically every episode of inflammation in our bodies. Inflammation is an expansive term that refers to the process through which immune cells fight off pathogens and other threats. Swelling is one of the most obvious symptoms of inflammation, so the two terms are colloquially used to mean the same thing.

Inflammation is generally a response to infections, but can also be caused by stress, chronic diseases, obesity, neurodegenerative diseases, and allergic responses. Histamines mediate this process by increasing blood flow to affected areas and drawing immune cells to it.

Serotonin, colloquially known as the “happiness molecule”, is a key mood-regulating neurotransmitter. It is the chemical that makes you feel pleasure, and underpins our brains’ reward pathways. It’s also one of the main targets for today’s antidepressants. One of the most commonly prescribed classes of antidepressants today, selective serotonin reuptake inhibitors (SSRIs), helps to alleviate this condition by preventing our bodies from scrubbing serotonin from the brain — essentially, it doesn’t touch the happiness tap, but it does block the drain.

However, many patients are resistant to SSRIs. The team set out to determine whether specific interactions between serotonin and other neurotransmitters could explain this resistance. They applied serotonin-measuring microelectrodes to the brains of live mice, especially on the hippocampus area, as it’s known to play a part in regulating mood. The technique is known as fast scan cyclic voltammetry (FSCV) and allows for live measurements of serotonin levels without harming the brain.

After placing the microelectrodes, they injected half the mice with lipopolysaccharide (LPS), an inflammation-causing toxin found in some bacteria, and half the mice with a saline solution as a control.

Brain serotonin levels dropped sharply within minutes of the LPS injection, but remained constant in the control group. This shows how quickly inflammation can affect serotonin levels in the brain, the team explains, as LPS is unable to cross the blood-brain barrier — and therefore cannot be the cause of the drop.

Further investigation revealed that histamines released in response to the LPS in the brain inhibitied the release of serotonin by attaching to inhibitory receptors on the serotonin neurons. Humans also have these inhibitors, the team explains. SSRIs administered to these mice had very modest results in regards to boosting their brain serotonin levels.

However, when administered alongside histamine-reducing drugs, the SSRIs countered the observed drop, and serotonin levels rose to the same levels as seen in the control group. According to the authors, these drugs lower histamine levels throughout the body and are distinct from antihistamines taken for allergies, which block histamine’s effects on neurons — so don’t try to self-medicate with anti-allergy pills for depression.

That being said, if these findings can be replicated in humans, we’d gain access to a new and powerful avenue of treatment, especially for cases that do not respond to our current options. However, because the current findings are based solely on work with lab animals, there’s no guarantee that they will be replicated in humans.

The paper “Inflammation-Induced Histamine Impairs the Capacity of Escitalopram to Increase Hippocampal Extracellular Serotonin” has been published in the Journal of Neuroscience.

Toxic workplaces make depression three times more likely — and that’s just the start

It’s no secret that working in a toxic environment can affect our mental health. Having an impossible boss, working long hours, and not taking a proper vacation, among many other things, not only affects our performance but can also make us depressed. To what extent? That’s what a group of Australian researchers set to find out. 

Image credit: The researchers

Depression is one of the most common mental illness worldwide. An estimated 300 million people are affected by major depression, which has become a pervasive global burden across cultures. It’s a recurrent problem and it can lead to functional impairment, elevated morbidity, and destructive social consequences. 

The International Labour Organization (ILO) estimates that 22% of the global working population, or 614 million workers, are working long hours — more than 48 hours per week. This has become an especially severe problem amid the COVID-19 pandemic, with a growing number of people working extra hours as they don’t go to the office. 

“Evidence shows that companies who fail to reward or acknowledge their employees for hard work, impose unreasonable demands on workers, and do not give them autonomy, are placing their staff at a much greater risk of depression,” Amy Zadow, lead author and member of the Psychosocial Safety Climate Observatory, said in a statement

Zadow and a team of researchers from the University of South Australia carried out a year-long study among full-time workers in Australia. Their premise was simple: follow a group of workers to see who among them is diagnosed with serious depression and then check to see what factors from the workplace can be correlated with that. 

After they crunched the numbers, the results were clear. The workers employed by organizations that don’t prioritize their employees’ mental health have a threefold increased risk of being diagnosed with depression. And while working long hours was a key factor of depression, poor management practices represented an even greater risk. 

Mental health challenges

The researchers randomly selected employees from the Australian population, who were contacted through a computer-assisted telephone interviewing system. They were also sent a letter providing details of the study. Data were collected only from workers over the age of 18 from South Wales, South Australia, and Western Australia. 

The sample size was 1,000 people, only including full-time workers. The researchers defined toxicity by how well companies communicate to their employees about mental health issues and how to treat them, as well as how actively companies encouraged workers to be nice to each other and look out for each other’s mental health. 

They used a standard scale that asked workers to agree or disagree with a set of statements, including “senior management considers employee psychological health to be as important as productivity” and “senior management acts decisively when a concern of an employee’s psychological status is raised”. This helped to get an idea on mental health issues around the workplace. 

The findings showed that a toxic work environment was associated with a 300% increase in major depressive symptoms. This means that in jobs where there’s a lack of consideration, knowledge, and community empathy around mental health issues, the employees are not just getting sadder — but they’re three times more likely to develop significant depressive symptoms. 

“Overly engaged workers might tend to become workaholics ignoring early signals of depressed mood, continue working and develop major depressive disorders,” the researchers wrote in the study. “These findings suggest that policymakers and clinicians should focus the efforts on improving the climate for psychological health.”

While the study is relatively small, it still makes an important point. Even before the pandemic, the world had a problem with toxic workplaces, but after it, with all the uncertainty around offices and working in general, things are unlikely to get better. Unfortunately, mental health is still not often considered a priority for many employers.

The study was published in the British Medical Journal. 

Ayahuasca relieves depression and anxiety, finds study on nearly 12,000 users

Ayahuasca brewing in Peru. Credit: Wikimedia Commons.

Ayahuasca is a powerful hallucinogenic tea that has been brewed in the Amazon rainforest for thousands of years. Although the brew’s main active ingredient, dimethyltryptamine (DMT), is illegal in most countries, recent research suggests the drug may have significant therapeutic properties in the context of improving depression and anxiety symptoms. A new study published this week — the largest thus far on ayahuasca — adds weight to this body of evidence.

The Global Ayahuasca Project was conducted between 2017 and 2020 and involved more than 11,000 individuals, 7,785 of whom suffered from symptoms of depression or anxiety at the time they took the drug. The participants had to fill an online self-reported questionnaire designed to measure mental health outcomes among Ayahuasca users.

The results were impressive, to say the least. Nearly 94% of the respondents experienced at least some sort of improvement in their depression symptoms, ranging from “a bit” and “great” to the complete resolution of their depression. The same was reported in 90% of cases for anxiety symptoms.

Users who reported profound mystical experiences tended to report the greatest improvements in their depression or anxiety symptoms. Similarly, insights into one’s personal relationships following Ayahuasca use were also correlated with improved mental health outcomes.

However, a small fraction actually saw their mental health deteriorate following Ayahuasca use. About 2.7% of respondents reported worsened depression symptoms and 4.4% reported worsened anxiety symptoms. The researchers found that feeling lonely, nervous, anxious or on edge, as well as depressed or hopeless in the weeks immediately following Ayahuasca consumption were predictors of worsened symptoms.

“Drinkers of Ayahuasca in naturalistic settings perceived remarkable benefits for their affective symptoms in this survey assessment. There is no obvious evidence of negative mental health effects being associated with long-term consumption. Additional randomized controlled trial evidence is required to establish the efficacy of Ayahuasca in affective disorders, and to understand the worsened symptoms reported by a small percentage of drinkers,” the authors of the study wrote in the Journal of Affective Disorders Reports.

The fact that this cross-sectional study relied on self-reported data is an important limitation. Also, the study relied on reaching out to Ayahuasca users on niche forums and websites, where individuals with positive experiences are more likely to be online and respond, thus contributing to selection bias to some degree. However, the very large sample size makes it a valuable study. It’s not alone either.

Ayahuasca and mental health

Traditionally, ayahuasca is made by brewing the Banisteriopsis caapi vine and the Psychotria viridis shrub, along with other native plants, in a specific manner. When ingested, the brew delivers a powerful dose of DMT to the body. Typically, a DMT trip shouldn’t last more than a couple of minutes but thanks to the presence of at least one monoamine oxidase-inhibiting plant, the DMT can bind to receptors in the brain for hours. The experience has been described as anything between enlightening to downright distressing.

The brew contains several substances that alter brain chemistry. Among them, some regulate the neurotransmitters serotonin and MAO-A. It was also previously shown that ayahuasca directly affects activity in the hippocampus and amygdala, areas of the brain responsible for memory and emotions, respectively.

A 2013 study carried out by researchers led by Gerald Thomas from the University of Victoria in Canada, found that ayahuasca therapy causes significant improvements “for scales assessing hopefulness, empowerment, mindfulness, and quality of life meaning and outlook subscales.” Thomas argues that ayahuasca therapy is particularly helpful for those suffering from psychological trauma, which puts them at risk of developing alcohol and other drug addictions.

A study published in 2020 by neuroscientists at the University of California, San Francisco, scanned the brains of 50 healthy participants the day before and after they received either a single low dose of Ayahuasca or a placebo. According to the researchers, “the psychedelic experience induced by ayahuasca has a long-lasting effect on the functional organization of brain networks supporting higher-order cognitive and affective functions.”

Changes in these neural networks are associated with introspection, altered levels of affect, and motivation, which may explain both the altered states of consciousness during the high of the drug and the long-lasting brain changes elicited by ayahuasca.

As Ayahuasca’s potential medical benefits surface, scientists will hopefully be allowed to perform clinical trials with the drug. Decades after it was banned from research by governments, studies may show that Ayahuasca’s benefits far-outweigh its risks in a controlled medical context.

Laughing gas could be the key against treatment-resistant depression

Nitrous oxide, also known as laughing gas, could help patients with treatment-resistant depression, according to a new study.

Image from Public Domain.

An estimated 15% of depression patients around the world don’t respond to treatment the way they should. Very often, alternative treatment options aren’t available to these individuals, and they’re left to handle their condition without any help from medication. We know from previous research that a single inhalation session using a relatively thin mix of (50%) nitrous oxide can help relieve the symptoms of treatment-resistant depression. However, it can also cause some unpleasant side-effects.

New research reports that a similar clinical outcome can be achieved even with a much lower dose of laughing gas (a 25% mix). Participants who underwent this process saw improvements in their condition for upwards of two weeks while having fewer and less intense side effects.

Laughing it away

“This investigation was motivated by observations from research on ketamine and depression,” said Peter Nagele, MD, Chair of Anesthesia and Critical Care at UChicago Medicine. “Like nitrous oxide, ketamine is an anesthetic, and there has been promising work using ketamine at a sub-anesthetic dose for treating depression.”

“We wondered if our past concentration of 50% had been too high. Maybe by lowering the dose, we could find the ‘Goldilocks spot’ that would maximize clinical benefit and minimize negative side effects.”

Nitrous oxide is widely employed as a short-term anesthetic, mostly used in dentistry and surgery. But, as previous research has found, a one-hour inhalation session with 50% nitrous oxide gas led to rapid improvements in depressive symptoms for 20 patients. These improvements lasted for at least 24 hours and were compared to a placebo. However, several of the participants in that initial study experienced side effects such as nausea, vomiting, and headaches.

This study repeated the experiment, again with 20 patients, but this time the inhalation session used only 25% nitrous oxide — half of the original concentration. This produced similar clinical effects as the 50% concentration trial but reduced the incidence of reported negative side effects to only one-quarter.

Each participant’s clinical depression scores were monitored for over two weeks, while the initial study only followed their state for up to 24 hours after treatment. The authors report that, after a single inhaling session, some patients saw improvements in their symptoms for the entire evaluation period.

“The reduction in side effects was unexpected and quite drastic, but even more excitingly, the effects after a single administration lasted for a whole two weeks,” said Nagele. “This has never been shown before. It’s a very cool finding.”

Overall, the results are quite encouraging, suggesting that nitrous oxide could become a fast-acting treatment option for patients with severe depression that doesn’t respond to typical treatments such as SSRIs

“A significant percentage—we think around 15%—of people who suffer from depression don’t respond to standard antidepressant treatment,” said Charles Conway, MD, Professor of Psychiatry and Director of the Treatment Resistant Depression and Neurostimulation Clinic at Washington University School of Medicine.

“These ‘treatment-resistant depression’ patients often suffer for years, even decades, with life-debilitating depression. We don’t really know why standard treatments don’t work for them, though we suspect that they may have different brain network disruptions than non-resistant depressed patients. Identifying novel treatments, such as nitrous oxide, that target alternative pathways is critical to treating these individuals.”

For now, however, these are just very early studies. The authors hope that the data they provide will help the medical community accept nitrous oxide as a possible treatment avenue and spark further research into its use. Psychiatrists in particular, they explain, are not familiar with nitrous oxide or how it can be administered. Hopefully, the results will help spark their interest. Public acceptance is also an issue, the team adds, that could slow down the implementation of this procedure. Despite the name, Nagele says, patients who undergo treatment with laughing gas are “not getting high or euphoric”, but “sedated”.

If our estimates are correct, there are millions of individuals living with depression who cannot be helped using traditional methods. If nitrous oxide proves itself to be a reliable option for these individuals, it could end up saving a lot of lives.

The paper “A phase 2 trial of inhaled nitrous oxide for treatment-resistant major depression,” has been published in the journal Science Translational Medicine.

If you don’t align your sleeping patterns to your body clock, you risk depression, lower wellbeing

If you like to skip on sleep, we have some bad news: a new study reports that people whose sleeping patterns go against their natural body clock are more likely to be depressed, and experience lower levels of wellbeing.

Image via Pixabay.

Early bird gets the worm and all that, but we now have evidence to show that some people really are naturally early risers. Even worse, going against this, or being a night owl by nature, seems to promote issues such as depression and lower perceived quality of life. But you can rest easy, there’s nothing wrong with you. Most likely, these effects are caused by the way our societies are ordered, as they are generally tailored more for early risers, through the standard 9-5 working pattern.

The right time for sleep

The research was built on previous work that mapped 351 genes linked to being either an early riser or a night owl. A statistical process known as Mendelian Randomisation was employed to see whether these genes had a causal association with seven mental health and wellbeing outcomes (major depression was one of these seven). Data for the study was supplied from the UK Biobank’s biomedical database and research resource and pertained to over 450,000 UK adults.

Apart from genetic information, participants also supplied information regarding their sleeping habits (i.e. whether they were a morning or evening person) through a questionnaire.

Alongside this data, the authors also developed a new indicator of “social jetlag”, a measurement of the variations in sleeping patterns one experiences between workdays and free days. This was measured in around 85,000 UK Biobank participants (for whom sleep data was available) via wrist-worn activity monitors.

The first important finding of the study was that participants whose natural and actual sleeping patterns were more misaligned were more likely to report depression, anxiety, and lower wellbeing.

“We found that people who were misaligned from their natural body clock were more likely to report depression, anxiety, and have lower wellbeing. We also found the most robust evidence yet that being a morning person is protective of depression and improves wellbeing,” says lead author Jessica O’Loughlin, of the University of Exeter.

“We think this could be explained by the fact that the demands of society mean night owls are more likely to defy their natural body clocks, by having to wake up early for work.”

Morning people had the highest likelihood of their sleeping patterns being aligned with their natural body clock. When looking at shift workers alone, the team found that being a morning person doesn’t seem to protect them from depression. This is likely indicative that morning people who work shifts don’t get any benefits from their natural sleeping patterns, but this remained inconclusive overall.

“The COVID-19 pandemic has introduced a new flexibility in working patterns for many people. Our research indicates that aligning working schedules to an individual’s natural body clock may improve mental health and wellbeing in night owls,” said senior author Dr Jessica Tyrrell, of the University of Exeter.

The paper “Using Mendelian Randomization methods to understand whether diurnal preference is causally related to mental health” has been published in the journal Molecular Psychiatry.

Why ketamine is so good against depression

Credit: Wikimedia Commons.

Ketamine was initially developed as an anesthetic for the battlefield, operating rooms, and veterinary practices. In rave culture, it is a popular recreational drug. But, somewhat recently, scientists have found that it can be used as a very potent therapeutic drug for treating depression — often easing symptoms when no other therapy works.

Ketamine: our secret weapon against depression?

Though ketamine users may actually incur depression if abused, in the right dosage and taken in moderation the drug is a proven remedy for depression. It’s so effective that the positive effects can be felt in a matter of hours and can last weeks, whereas conventional antidepressants take weeks to start working.

For the chronically depressed pondering suicide, those weeks of waiting could mean the difference between life and death. “It blew the doors off what we thought we knew about depression treatment,” says psychiatrist James Murrough at Mount Sinai Hospital in New York City.

Colleen Loo, a professor at the University of New South Wales in Australia, led a team that studied the drug’s effect on people over 60, concluding that depression symptoms were relieved in 43% of the patients. These effects lingered for six months after therapy, the authors reported in the American Journal of Geriatric Psychiatry.

The largest trial on ketamine’s antidepressant effects was conducted in 2013 with 73 participants. Mere 24 hours after the first treatment, ketamine proved to reduce depression symptoms in 64% of patients who had tried three or more other medications with unsuccessful results. Oth\er studies have confirmed the findings. “Feeling better faster, getting the mood to improve faster — that’s why ketamine is very promising,” said Alan Manevitz, MD.

Ketamine is considered by many psychiatrists as the only treatment for rapid relief of suicidal thoughts in depressed patients. In 2017, Michael Grunebaum, a psychiatrist at Columbia University Medical Center, performed a study involving 80 patients who were diagnosed with “clinically significant suicidal thoughts.”

The researchers administered the patients either a low dose of ketamine or a sedative called midazolam. Compared to the midazolam group, the patients who were given the ketamine showed a marked reduction in suicidal thoughts only 24 hours after the drug was administered — and this effect lingered on for six weeks after the single low-dose treatment. The ketamine group also reported an improvement in mood, as well as depression and fatigue symptoms, indicating that ketamine has a broad effect on psychiatric well-being.

How ketamine works to treat depression

There are two main types of ketamine used to treat depression in a clinical setting. One is racemic ketamine, which is a mixture of two mirror ketamine molecules (“R” and “S” ketamine). Most studies that investigate the therapeutic effects of ketamine for depression use the racemic variety, which is usually administered intravenously. The other type is esketamine, also known as Spravato — it was recently approved by the FDA in the United States and is given as a nasal spray. Esketamine only employs the “S” molecule.

The two forms of ketamine interact slightly differently with receptors in the brain and may cause different side effects. The rest of this article will focus on the effects of racemic ketamine, since it is more widely established in research.

Scientists are still figuring out how ketamine molecules interact with receptors in the brain to ease clinical depression symptoms. Studies suggest that ketamine binds to NMDA receptors in the brain, thereby increasing the amount of the neurotransmitter glutamate in between neurons. Glutamate increases the connections in another receptor, known as the AMPA receptor. This cascade effect ultimately causes the brain to release other molecules that help neurons communicate with each other along new pathways, affecting mood and cognition.

Dr. Conor Liston, a neuroscientist and psychiatrist at Weill Cornell Medicine in New York, published a 2019 study that showed ketamine triggers brain circuitry repair in a two-step process. In the study, the researchers used a virus activated by a laser microscope to destroy synapses in the brains of mice, mimicking the effect of chronic stress. The findings showed that in only six hours after a dose of ketamine, brain circuits damaged by depression started firing together again in sync. The mice also started exhibiting normal behavior in this time period. 

This study might also explain why ketamine’s antidepressant effects wear off eventually — if the synaptic changes cannot be maintained, there will be a relapse.

A study led by Hailan Hu, a neuroscientist at Zhejiang University School of Medicine in Hangzhou, China, found that ketamine may interact with the lateral habenula, a small region of the brain known as the “anti-reward center.” Neurons in the lateral habenula are activated by stimuli associated with unpleasant events, like the absence of the reward or punishment, especially when these are unpredictable.

In rodents with depression, neurons in the lateral habenula fire several times in quick bursts, rather than firing once at regular intervals in the case of healthy rats. An analysis of brain slices of healthy rats showed that they only had about 7% of these bursting type of neurons, in comparison to the depressed rodents that had almost 23% bursting neurons. But after the mice and rats were given ketamine, the number of bursting neurons became similar to those found in healthy animals. Even when the scientists directed the neurons to fire in bursts, animals that had been administered ketamine no longer exhibited symptoms of depression.

Daniel Lodge, Ph.D., of The University of Texas Health Science Center at San Antonio, found that ketamine activates the ventral hippocampus (vHipp)-medial prefrontal cortex (mPFC) pathway in rats. Artificially stimulating this pathway mimics the anti-depressant effects of ketamine, whereas preventing activation of the circuit eliminates the antidepressant-like effects of ketamine.

Ketamine side effects

Whether administered orally, intravenously or nasally, ketamine produces several side effects. Some include headache, dizziness, dissociation, elevated blood pressure and blurred vision.

Previously, studies have linked the long-term use of ketamine to bladder inflammation, liver damage, cognitive changes like memory loss, and craving or addiction.

Regarding addiction to ketamine, only 15 cases have been officially described in the scientific literature over the last 20 years. Does this mean that ketamine isn’t addictive? That’s the problem: we don’t know that much yet, which is why researchers in the field claim that more studies specifically geared towards assessing the safety of dosing regimes for ketamine are urgently needed. Scientists can’t seem to cause ketamine addiction in rodents, which is one of the other reasons why it’s so challenging to study.

But by understanding how ketamine interacts with the brain — which we are only beginning to comprehend — is that it’s possible to design a new molecule that only has ketamine’s antidepressive effects without its potentially addictive side effects. Some researchers, like Lodge’s group at the University of Texas Health Science Center at San Antonio, are already working on finding a drug that interacts selectively with the ketamine-brain pathways.

“The idea is, if one part of the brain contributes to the beneficial effects of ketamine, and another part contributes to its abuse and effects such as hallucinations, now we can come up with medications to target the good part and not the bad,” Flavia R. Carreno, an assistant professor at University of Texas San Antonio, said in a statement.

“We’re working on testing compounds that more selectively target the hippocampus and we and others actually found and published that such compounds recapitulate the beneficial effects of ketamine without the abuse liability, without the psychotomimetic effects,” Carreno told ZME Science.

Is ketamine a miracle drug that can promise to ease even the worst depression? It’s difficult to draw any conclusion at this point, and research still has a long way to go. And while results so far are promising, ketamine’s side effects and its potential for abuse are poorly understood — and this is very problematic considering that there are now many people who are seeking ketamine treatments on their own.

In the United States, particularly in California, a number of clinics are already offering ketamine infusions. Anecdotal reports suggest they succeed in reducing depression symptoms among hard-case patients, who pay top dollar for an otherwise generic and cheaply sourced substance. For depression, the price per infusion ranges from $400 to $1000.

A number of clinicians and medical organizations, however, have raised serious concerns about the lack of regulatory or legislative oversight. “It scares the hell out of me that this is still unregulated,” said Steve Levine, MD, a psychiatrist who also is the founder of a clinic that offers ketamine infusions.

In an article published online in Lancet Psychiatry, researchers called for better oversight.

“We find that, based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles,” they write.

“However, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, that all experimental and trial data are made available through national registries, and that the risk potential of ketamine treatment continues to be monitored and modeled.”

Rap music lyrics referencing suicide and depression double since 1998

Emerging from the dark corners of the Internet’s underground rap scene, Long Island rapper Lil Peep quickly garnered a cult following thanks to his blend of rock and hip-hop, but also due to his lyrics about depression and other mental health struggles. Lil Peep died on 15 November 2017 from a drug overdose.

Hip hop culture is often considered as a mirror of current negative issues faced by society, whether it’s poverty, abuse, or corruption. As such, contemporary rap lyrics may provide a unique glimpse not only into the personal lives of the artists but also into today’s most pressing social issues.

In a new study, researchers at the University of North Carolina (UNC) at Chapel Hill analyzed the lyrics of top rap songs released from 1998 to 2018, finding that the proportion of songs that referenced mental health more than doubled in the two decades.

“These artists are considered the ‘coolest’ people on earth right now,” said Alex Kresovich, a doctoral student studying health communication at UNC Hussman School of Journalism and Media. “The fact that they are talking about mental health could have huge implications for how young people perceive mental health or how they look at themselves if they struggle with mental health, which we know millions and millions of young people do.”

Kresovich analyzed the lyrics of the 25 most popular rap songs released in the United States in 1998, 2003, 2008, 2013, and 2018. The researchers found that the lead artists, most of whom were black, referenced anxiety in nearly one-third of their songs, whereas depression and suicide were mentioned in 22% and 6%, respectively, of their songs.

According to Kresovich, who has a background as a music producer, rap artists generally use music as an outlet to reflect the distress felt by themselves but also those around them. The most common mental health stressors were love and life issues, the authors wrote in their study published in the journal JAMA Pediatrics.

Of course, rappers have always reflected on the difficulties of their lives from the very beginnings of hip-hop. For instance, some might remember the 1982 classic The Message, in which Grandmaster Flash says: “Don’t push me ‘cause I’m close to the edge, I’m trying not to lose my head/ It’s like a jungle sometimes, it makes me wonder how I keep from goin’ under”.

However, lyrics describing mental health problems have ballooned in recent years. Sometimes depression and anxiety are laid bare and explicitly referenced, but most of the time metaphors are preferred.

“Using metaphors may be a safe way to avoid being judged,” Kresovich says. “For men, especially men of color, mental health is still stigmatized.

“Artists are treading lightly and aren’t going to say, ‘I’m depressed.’ But what they will do is describe feelings in a way that others with depression can understand and relate to,” he says, adding. “It also just may be really hard to rhyme the word ‘depression’ in a song.”

On one hand, the increasing number of references to mental health problems in rap music suggests that artists are more open to sharing their emotional struggles. On the other hand, the lyrics may also reflect a pattern of growing cases of mental illness and emotional distress among the American population, particularly among those 18 to 25 years old and the black youth, who also represent one of the most significant groups of listeners.

According to a Pew Research Center analysis of data from the 2017 National Survey on Drug Use and Health, the total number of teenagers who recently experienced depression increased 59% between 2007 and 2017.

This generation-wide angst may have fueled a new genre of hip-hop music, known as ‘SoundCloud rap’ or ’emo rap’, whose themes lean heavily towards suicide, depression, anxiety, and prescription drugs. Lil Peep, 21, and Mac Miller, 26, two of the scene’s biggest stars, both died of accidental overdoses in 2017 and 2018.

For now, hip-hop seems to be going through a very sad moment. But that’s only because art imitates life and life imitates art — and life right now seems to be really depressing for Americans.

Researchers identify a protein that may be the link between anxiety and depression

Researchers at Karolinska Institutet in Sweden report on a new protein that could tie stress to depression and anxiety.

A 3D-printed human brain. Image via Flickr / NIH Image Gallery.

The team has identified a protein in the brains of mice that regulates the release of both serotonin and cortisol, which are the feel-good hormone and stress hormone, respectively. This protein, p11, was previously discovered by the same team, who showed that it plays a key role in the functioning of serotonin. The present study showed that mice lacking p11 show depression- and anxiety-like behaviour, which was treatable in part with antidepressants.

The findings could help us better understand the biochemical mechanisms behind depression and anxiety, and to develop new medicine to treat them.

P11 giveth, p11 taketh away

“We know that an abnormal stress response can precipitate or worsen a depression and cause anxiety disorder and cardiovascular disease,” says first author Vasco Sousa, researcher at the Department of Clinical Neuroscience, Karolinska Institutet. “Therefore, it is important to find out whether the link between p11 deficiency and stress response that we see in mice can also be seen in patients.”

Individuals that have experienced trauma or episodes of very severe stress are known to sometimes develop an abnormal (i.e. excessive) response to stress in the future. Those who also suffer from anxiety or depression are more likely to show such responses. However, in order to find out how to help them, we must first understand how our bodies create and regulate stress.

The authors report previously observing that depressed patients and suicide victims tend to have lower-than-average levels of the p11 protein in their brains. In order to find if there’s a link there, they engineered lab mice to produce low levels of p11. Further testing confirmed that these animals showed behavior consistent with depression and anxiety.

Mice with p11 deficiency also showed a stronger reaction to stress, exhibiting higher heart rates and more anxiety-related behavior when presented with a stressful situation, than unaltered mice.

The protein is directly involved in the initial release of cortisol in mice, the team explains, as it dictates the activity of neurons in the hypothalamus, an area of the brain heavily involved in controlling hormone levels in the body. It also — through its activity in a completely separate pathway in the brainstem — dictates the release of adrenaline and noradrenaline (also known as epinephrine and norepinephrine), two other hormones involved in the stress response.

Keeping p11 levels in the brain in check could thus be a promising avenue to treat patients suffering from depression, anxiety, and those who are struggling with chronic anxiety and stress from past experiences. This is especially heartening news as many such patients report that currently-available antidepressants are not effective in managing or treating their conditions.

“One promising approach involves administration of agents that enhance localised p11 expression, and several experiments are already being conducted in animal models of depression,” says Per Svenningsson, professor at the Department of Clinical Neuroscience, Karolinska Institutet, who led the study.

“Another interesting approach which needs further investigation involves developing drugs that block the initiation of the stress hormone response in the brain.”

The paper “P11 deficiency increases stress reactivity along with HPA axis and autonomic hyperresponsiveness” has been published in the journal Molecular Psychiatry.

Trauma may cause cognitive decline in adults

Credit: Pixabay.

Trauma suffered both in childhood and adulthood may lead to significant cognitive decline later in life, according to a new study that highlights the importance of therapy and other interventions in order to stave off mental health problems.

“We found that the more adverse events experienced, such as your parents’ divorce or a parent dying, the greater the cognitive decline,” said Margie Lachman, professor of psychology at Brandeis University and co-author of the new study.

It’s no secret that traumatic stress can provoke long-lasting changes in key brain areas involved in stress response, such as the amygdala, hippocampus, and prefrontal cortex.

Previously, neuroscientists found that patients with post-traumatic stress disorder (PTSD) had smaller hippocampal and anterior cingulate volumes, increased amygdala function, and decreased medial prefrontal/anterior cingulate function. In addition, patients with PTSD show increased cortisol and norepinephrine responses to stress.

In terms of behavior and symptoms, PTSD is strongly associated with disruptions in one’s ability to have healthy, satisfying relationships and a low tolerance for uncertainty and adversity.

In their new study, Lachman and graduate student Kristin Lynch investigated potential associations between trauma and cognition.

The researchers combed through the Midlife Development in the U.S. (MIDUS) study, a national longitudinal study of health and well-being in adulthood, which involved 2,500 adults, ages 28 to 84.

The participants had to complete a questionnaire that listed 12 potentially traumatic events and investigated how these events negatively affected them. Examples of potentially traumatic events include divorce or death of a parent during childhood, emotional or physical abuse, parental alcohol or drug addiction, military combat experience, and losing a home to fire, flood, or natural disaster.

Each subject also had to complete tests that assessed their cognitive abilities in two key areas: executive functioning (focusing attention, planning, problem-solving, and multitasking) and episodic memory (remembering recently learned information).

The cognitive test results were compared to those from participants who claimed they hadn’t experienced traumatic events.

Not surprisingly, those who said they experienced trauma in the past exhibited a greater decline in both executive functioning and episodic memory.

The researchers also found that exposure to trauma later in life led to a greater decline in executive functioning than those who suffered from childhood trauma. There were no significant differences in episodic memory decline between those who experienced trauma earlier or later in life.

According to the researchers, trauma may lead to impaired cognitive performance due to the effects of stress and depression. Trauma is also linked to metabolic disease, inflammation, and disruption of the body’s immune system, which are also known to harm the brain’s performance.

The researchers stress that the effects of trauma on the brain vary on a person-to-person basis and for some they can be quite subtle. “It might not feel like there’s an effect on your day-to-day functioning,” Lynch said.

The findings appeared in the Journal of Traumatic Stress.

New magnetic brain stimulation technique relieved depression in 90% of the participants in a small-scale study

Researchers at the Stanford University School of Medicine have developed a form of magnetic brain stimulation that could ‘rapidly’ relieve symptoms of severe depression in 90% of participants in a small study.

Image via Pxhere.

Although the findings are limited by the small sample size so far, the team is working on a larger, double-blind trial to test the approach; in this trial, half of the patients will receive similar electromagnetic stimulation, while the other half will receive fake treatment. In this second trial, the team hopes to prove that their approach will be effective in treating people whose conditions are resistant to medication, talk therapy, or other forms of electromagnetic stimulation.

The real positive vibes

“There’s never been a therapy for treatment-resistant depression that’s broken 55% remission rates in open-label testing,” said Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences and a senior author of the study. “Electroconvulsive therapy is thought to be the gold standard, but it has only an average 48% remission rate in treatment-resistant depression. No one expected these kinds of results.”

The method was christened Stanford Accelerated Intelligent Neuromodulation Therapy, or SAINT, and is a form of transcranial magnetic stimulation, an approach currently approved by the Food and Drug Administration for treatment for depression. Transcranial magnetic stimulation involves the use of a magnetic coil placed on the scalp to excite a region of the brain — in this case, those involved in depression.

Compared to other similar approaches, the SAINT method uses more magnetic pulses (1,800 pulses per session instead of the traditional 600), which helps speed up the pace of treatment, and focuses them depending on each patient’s particular neural architecture. Study participants underwent an accelerated treatment program compared to similar treatment approaches, 10 sessions per day of 10-minute treatments, with 50-minute breaks in between.

In their trial study, the team worked with 21 participants with severe depression — as determined by several diagnostic tests — which proved resistant to medication, FDA-approved transcranial magnetic stimulation, or electroconvulsive therapy. After receiving treatment, 19 of them scored within the nondepressed range, the team explains. All of the participants reported having suicidal thoughts before treatment, but none of them reported such thoughts afterward.

“There was a constant chattering in my brain: It was my own voice talking about depression, agony, hopelessness,” explains Deirdre Lehman, 60, one of the participants of the study. “I told my husband, ‘I’m going down and I’m heading toward suicide.’ There seemed to be no other option.”

There were some side effects of this treatment, but they were relatively minor: fatigue and some physical discomfort during treatment.

“By the third round, the chatter started to ease,” she said. “By lunch, I could look my husband in the eye. With each session, the chatter got less and less until it was completely quiet.”

“That was the most peace there’s been in my brain since I was 16 and started down the path to bipolar disorder.”

Although Lehman’s scores indicated that she was no longer depressed after a single day of therapy, it took up to five days for other participants to see the same results. Postdoctoral researcher Eleanor Cole, Ph.D., a lead author of the study, says that the “less treatment-resistant participants are, the longer the treatment lasts”.

The team evaluated each participant’s cognitive functions before and after treatment to ensure safety, and found no negative effects. One month after the therapy, 60% of participants were still in remission from depression. Follow-up studies are underway to determine the duration of the antidepressant effects, the team adds.

The researchers plan to study the effectiveness of SAINT on other conditions, such as obsessive-compulsive disorder, addiction, and autism spectrum disorders.

The paper “Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression” has been published in the American Journal of Psychiatry.

Teen girls on birth-control pills show more symptoms of depression

Life as a teenage girl can be emotionally draining as it is, but taking oral contraceptives could make it even more gloomy. According to a new study, 16-year-old girls who took birth control pills showed more depressive symptoms than their counterparts who were not on the pill.

Credit: Pixabay.

The pill is perhaps the most efficient birth control method. Today, more than 100 million women around the world use hormonal birth control pills, and they are particularly popular among teens. The pill is so widely used that some women who are not sexually active take it in order to reduce menstrual pain or treat acne. But, although the pill has been around for decades, there is still a lot we don’t know about its effects, especially among younger users.

In the new study, psychiatrists at the University Medical Center Groningen in the Netherlands analyzed data from the Tracking Adolescents’ Individual Lives Survey. This longitudinal study of teens and young adults included the contraceptive practices and mental health assessment of 1,010 female participants ages 16 to 25, from 2005 to 2016.

The results suggest that 16-year-old girls using oral contraceptives reported 21.1% more depressive symptoms, on average, than 16-year-old girls who weren’t using the pill. This group experienced more episodes of crying, hypersomnia, and eating problems than their counterparts. However, this difference in depressive symptoms wasn’t recorded at ages 19, 22, and 25.

Researchers note that the magnitude of the association is small and the depressive symptoms are rather mild — or at least not strong enough to constitute clinical or major depression. This was an observational study, hence the researchers couldn’t infer any cause-effect relationship, i.e. if the pill causes depression. For instance, it could be that teens who are prone to depression may be more likely to start using oral contraceptives.

That being said, these are evident mood changes seen in the oral contraceptive-using adolescents, who constitute an emotionally vulnerable population.

As such, teenage girls and their parents should bear in mind the risk of enhancing depressive episodes and symptoms when contemplating the best contraceptive method to use. Puberty is not only marked by rapid growth and changes in the body, but also in the brain. Sex hormones such as estrogen and progesterone, for instance, are known to affect the brain during puberty. It is therefore reasonable to consider that synthetic estrogen and progesterone — both core ingredients in most birth control pills — could trigger consequences to mental health during this sensitive period.

“Although oral contraceptive use showed no association with depressive symptoms when all age groups were combined, 16-year-old girls reported higher depressive symptom scores when using oral contraceptives. Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence,” the authors concluded in the journal JAMA Psychiatry

Previously, researchers at the University of British Columbia published a study in the Journal of Child Psychology and Psychiatry, in which they examined data on 1,236 women between the ages of 20 and 39 enrolled in the National Health and Nutrition Examination Survey who had provided information about their history of contraceptive pill use. Almost half of the women in the sample had first used contraceptive pills as teenagers; these women were at a higher risk for being clinically depressed (16%) years later, compared to women who had never used contraceptive pills (6%), and also compared to women who had only started taking contraceptive pills as adults (9%).

New studies in the future might shed light on why 16-year-old girls on the pill report more depressive symptoms but not older age groups.

A healthy diet can help with depression, new study shows

Deppression is a common mental disorder, affecting more than 300 million people worldwide. The symptoms can vary in intensity, but it is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Although treatments for depression exist and they are usually safe and effective, less than half of people suffering from depression (and in many countries, less than 10%) seek any help with the condition.

However, it’s not just medical treatment that can have an impact on depression. There is strong epidemiological evidence that poor diet (rich in red meat and processed foods) is associated with depression. The reverse has also been shown: eating a healthy diet rich in fruit, vegetables, fish, and lean meat, is associated with reduced risk of depression. There has only been one randomized controlled trial to test this hypothesis, however — until now.

Food vs depression

The new study assessed the potential of a healthy diet to reduce depression symptoms in young adults — one of the most at-risk groups when it comes to depression. Heather Francis from Macquarie University, Australia, and colleagues studied 76 university students (17-35 years old) exhibiting moderate-to-high depression symptoms. All the students had poor diets — rich in sugars, saturated fats, and processed foods.

The participants were randomly placed in one of two groups: a ‘business as usual’ group, and a ‘diet change’ group. The diet change group was given brief instructions on how to improve their diet, as well as a $60 voucher to spend on groceries. They also received two subsequent check-in phone calls. Meanwhile, the control group received nothing whatsoever and was told to return in three weeks.

The researchers assessed the participants for depression, anxiety, and overall mood, both before and after the intervention. They found that only 21% of the group stuck to the healthy diet changes, but all of those who did reported significant improvements in depression symptoms and overall mood.

There are several significant limitations to this study which should be mentioned. For starters, it’s a small sample size, and university students might not be representative of the entire young adult segment. Second, as most studies of this type, it relies on self-reported information — which may not be accurate (people are notoriously bad at recalling their diets). Lastly, in an ideal scenario, the control group would have also received an intervention, just one that didn’t really change their diet. This would help eliminate the possibility that it’s a change in the diet itself that’s accountable for the improvement — but the changes towards a healthier diet. In other words, there is a chance the mere fact that people were working on changing something might account for some of the improvement.

Nevertheless, the results seem to support previous findings, that a healthy diet can be a simple intervention to tackle depression. The researchers add:

“Modifying diet to reduce processed food intake and increase consumption of fruit, vegetables, fish and olive oil improved depression symptoms in young adults. These findings add to a growing literature showing a modest change to diet is a useful adjunct therapy to reduce symptoms of depression.”

However, this should not be interpreted as ‘all you need to get rid of depression is good food’ — depression is a serious mental condition and while a healthy diet can help, it is definitely not a panacea.

So what was the healthy food?

If you or someone else is struggling with depression, switching to healthier diets is one of the best things you can do. Here’s a rundown of what the healthy intervention in this study consisted of.

Medierranean food has been associated with significant health benefits.

The biggest shift is eating more servings of fruits and vegetables; on average, participants ate six more servings of fruit and vegetable per week, which is essentially just one serving per day. Researchers note that participants “who had a greater increase in fruit and vegetable intake showed the greatest improvement in depression symptoms” .

Eating more whole grains (and replacing white grains) was also an important shift. Protein from lean meats, poultry, eggs, tofu, and beans was also encouraged. In addition, they were also told to eat three servings of fish per week.

Regarding dairy, the recommendation was three small servings per day — but only unsweetened dairy. Participants were also instructed to consume three tablespoons of nuts and seeds per day and were advised to add spices in their food (such as turmeric and cinnamon).

This is pretty much the cookie-cutter Mediterranean diet: low in fats and meats, high in fruits, vegetables, whole grains, and nuts. This makes a lot of sense, particularly since a meta-analysis of 22 previously published studies showed that the Mediterranean diet was associated with a lower risk of depression — but also because the Mediterranean diet seems to be associated with an improvement in overall health.

This can be adapted with relative ease (for instance, to a vegetarian diet) and is not really strict. You can tweak it to your heart’s content, while sticking to the core principles.

The study was published in the journal PLoS.

Exercising with a coach might be good for fighting depression

Credit: Pixabay.

Study after study has shown that exercising is a fantastic way to improve one’s mood and depression symptoms. When you’re already depressed, however, it can be a challenge to leave the house, let alone clock 5k on a treadmill. Here’s an idea, though: a new study suggests that hiring a coach renders better results than training alone in terms of improving depression outcomes.

You don’t have to do this alone

For their study, researchers at Iowa State University, the University of Wisconsin-Madison, the Medical College of Wisconsin, and William S. Middleton Memorial Veterans Hospital, enlisted 17 women with major depressive disorder (MDD).

Each participant had to complete two, 30-minute exercise sessions on a stationary bike. One session was performed at the participants’ own preferred intensity, while the other session was supervised by a coach which gave directions when to push harder and when take it more easy.

The researchers led by Jacob Meyer, an assistant professor of kinesiology at Iowa State University, drew blood samples immediately after each exercise session. They also measured mood and anxiety at 10 minutes and 30 minutes after the workouts.

The blood tests enabled the researchers to analyze changes in endocannabinoid levels — self-produced psychoactive compounds typically found in marijuana. It’s endocannabinoids like anandamide, which is present at high levels in people’s blood after vigorous exercise, that is thought to be responsible for the “runner’s high”: a feeling of euphoria coupled with reduced anxiety and a lessened ability to feel pain.

These tests showed that endocannabinoids spiked particularly high in the participants who were coached on how far to push themselves, as opposed to those who pedaled at their own pace. Both groups self-reported improved mood, however, the coached women felt better than those who had no guidance.

“Finding alternatives to medication is important for the treatment of depression,” Meyer said. “If we can figure out how exercise works with the endocannabinoid system, we could then design optimal exercise interventions.”

For Meyer, the results, which were published in the journal Medicine & Science in Sports & Exercise, were somewhat surprising. These differences, he explains, may arise from variations in the preferred session.

In 2016, he and colleagues studied the association between exercise and brain-derived neurotrophic factor (BDNF), a protein that regulates neuron growth and survival. In people with depression, BDNF levels are lower. The study found that when women with MDD were asked to perform a different exercise routine of the same intensity with the one they previously selected, they had higher BDNF levels following the prescribed session.

“Having someone else prescribe the exercise could be involved in both the psychological and biological response to exercise,” Meyer said.

Pictured: Jacob Meyer. Credit: Christopher Gannon.

Having a coach or personal trainer facilitate your exercise routine is thus something worth considering for those battling depression. Not only is the coach able to push you harder, he or she can also keep you accountable so you’re less likely to skip the gym.

If these findings inspire you to seek out a personal trainer, here are some tips:

  • Interview thoroughly. You’re paying someone for their services, so you might as well pick a person who is the best fit to help you with your goals. Ask them about how they helped previous clients who were in the same situation as you or what’s their strategy for customized training giving your mental health goals.
  • Choose a certified trainer. The world is full of so-called coaches and personal trainers. If you’ve never set foot in a gym, it can be difficult to ascertain a person’s skills. This is why it’s a good idea to look for someone who’s a certified trainer or coach, such as a person who’s prepared for the NASM CPT exam.
  • Don’t be afraid to say ‘No!’. Depression can a harrowing experience in and of itself, nevermind having some person scream at you ‘Just one more!’ It’s okay to say ‘not this time’ and set clear boundaries if you feel you’ve had enough. Your goal is to improve your mood after a workout and look forward to going to the gym, not graduate bootcamp.
  • Don’t book too many sessions upfront. You’ll be spending quite some time with your trainer, and just like any relationship it may or may not work well. Like in dating, it’s wise not to invest too much time and energy in a person if the investment is not reciprocated. Book just a couple of sessions with a trainer to feel the waters, then continue if all goes well or find a different trainer who’s more suited to your needs and personality.

Remember, even if you don’t have someone to supervise your training, exercising by yourself at any intensity can still improve the depressed mood state.

Facebook posts can be used to predict anxiety, depression, and even diabetes

A new study finds that Facebook posts are better than demographic information when it comes to predicting a number of mental health conditions, as well as diabetes. This suggests that one day, our social media history might play an important role in the doctor’s office.

You can tell a lot of things by a person’s social media history, but medical information isn’t exactly one of them, but this is exactly what was presented in a new study. In the research, the team analyzed the entire Facebook post history of around 1,000 patients (who had given their consent for this study), building three analysis models: one that looked at post language, one that looked at demographics, and one that combined the two.

They then looked at 21 different medical conditions, assessing whether the Facebook history could be used to predict these conditions — all 21 were. Actually, 10 of them were predictable from post history alone, without even looking at the demographic information. It’s still early, but the results were impressive.

“This work is early, but our hope is that the insights gleaned from these posts could be used to better inform patients and providers about their health,” said lead author Raina Merchant, MD, MS, the director of Penn Medicine’s Center for Digital Health and an associate professor of Emergency Medicine. “As social media posts are often about someone’s lifestyle choices and experiences or how they’re feeling, this information could provide additional information about disease management and exacerbation.”

The language we use carries many unconscious biases which can be linked to our behaviors and habits. In turn, these behaviors can also be indicative of other underlying problems. Some connections were clear: people who tended to use words like “bottle” or “drink” more often were more likely to suffer from alcohol abuse. Others, however, were much less intuitive.

For instance, the people that most often used religious language (with words such as “God” or “pray”) were 15 times more likely to have diabetes than those who used these terms the least. When fed into the models, this information could be used and extrapolated to predict serious conditions.

“Our digital language captures powerful aspects of our lives that are likely quite different from what is captured through traditional medical data,” said study author Andrew Schwartz, PhD, visiting assistant professor at Penn in Computer and Information Science, and an assistant professor of Computer Science at Stony Brook University. “Many studies have now shown a link between language patterns and specific disease, such as language predictive of depression or language that gives insights into whether someone is living with cancer. However, by looking across many medical conditions, we get a view of how conditions relate to each other, which can enable new applications of AI for medicine.”

The thing is, because the content we publish on Facebook is not in a medical context, it can contain information that’s usually not mentioned in a medical or clinical context, including potential markers for specific diseases. For depression, words like “pain,” “crying,” or “tears” were good indicators, but also less obvious words such as “stomach,” “head,” or “hurt”.

It’s not the first time this idea was suggested. Previous research has found that Facebook history can be indicative of mental health conditions such as depression. The fact that this approach can be further extended to conditions such as diabetes is even more encouraging.

Now, the team is carrying a larger trial where they will ask participants to share social media history with their doctor to see how this data can be best used in a practical setting. This is the one big caveat to this study: the sample size. Not only was it fairly small, but it was also largely female (76%) and African American (71%) — not representative for the entire population.

Journal Reference: Merchant et al. Evaluating the predictability of medical conditions from social media posts. PLOS ONE. DOI:10.1371/journal.pone.0215476

Why depressed people listen to more sad music

It’s not because they want to maintain their low mood, as some have claimed, but rather because they find it calming, or even uplifting.

Image via DoD.

We all know just how much of an impact music can have on our mood. We put a jumpy playlist to go with our workout, a soothing song when we have a cup of tea, and sadder tunes when we’re feeling down. We also use music to purge ourselves of negative emotions — Thank you next, anyone? The ancient Greeks had a word for this: catharsis. Catharsis is the process of releasing, and thereby providing relief from, strong or repressed emotions. Something similar might be happening when depressed people listen to sad music: counterintuitively, it might give them relief from feelings of sadness and help them purge some of their negative emotions.

A few years ago, a provocative study found that people suffering from depression are much more likely to listen to sad music — which was interpreted by some as a way of seeking to maintain negative feelings. However, a new study challenges that idea, suggesting that depressed people are not seeking to perpetuate negativity, but rather feel better after listening to sad music.

The study had 38 female undergrads diagnosed with depression and 38 non-depressed female undergrad controls listen to music. The first part was consistent with previous findings — depressed people being more likely to opt for sad music. But unlike previous works, researchers also asked the volunteers why they made the choices they did. The majority of people with depression said that the music makes them feel more calm and relaxed. Lastly, researchers asked participants to listen to their choice of songs a second time, and asked participants how it made them feel. Critically, when they listened to the songs a second time, participants reported feeling more happiness and less sadness.

“In the replication music task, major depressive disorder (MDD) people were more likely to choose sad music,” researchers write. “However, inconsistent with any motivation to upregulate sadness, people with MDD reported that they chose sad music because it was low in energy levels (e.g., relaxing). The strong appeal of sad music to people with MDD may be related to its calming effects rather than any desire to increase or maintain sad feelings.”

The study was unable to explain why exactly people find sad music more relaxing and why it makes them happier. Intuitively, it makes sense to listen to something that’s in tune with your feelings — kind of like having a comforting friend that empathizes with you — but the exact mechanism remains unknown for now. At any rate, the idea that depressed people are trying to maintain negative feelings just took a serious blow.

The study “Why do depressed people prefer sad music?” has been published in APA Psych.