Tag: antidepressants

Weekly Neuroscience Update

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Researchers have created a new technique that can rapidly “print’ two-dimensional arrays of cells and proteins that mimic a variety of cellular environments in the body.
 

People who develop Parkinson’s disease before age 50 may have been born with disordered brain cells that went undetected for decades, according to new research. The research points to a drug that potentially might help correct these disease processes.

A new substance named Lu AF60097 may help reduce side effects from tricyclic antidepressants in those with severe depression.

Researchers have uncovered a key role of medial prefrontal cortex corticotropin-releasing factor interneurons for bidirectionally controlling motivated behavioral styles under stress. The findings could help in the development of new treatments for PTSD.

MIT researchers have identified a protein fragment that may inhibit COVID-19’s ability to enter human lung cells. 

Researchers have developed a new method to record brain activity at scale. The new technique could help in the development of new neuroprosthetic devices to help amputees and those with movement restricting neurological conditions.

New research suggests that eye movements may come before hand movements in actions that require a two-step decision-making process. 

A new method to accurately record brain activity at scale has been developed by researchers. The technique could lead to new medical devices to help amputees, people with paralysis or people with neurological conditions such as motor neuron disease.

Stress, loneliness, and sleep loss can weaken the immune system, leaving people more susceptible to COVID-19.

Finally this week. using robotics, researchers have uncovered mechanisms in the cerebellum and spinal cord that determine how the nervous system responds to induced changes in step length. The findings could have implications for physical rehabilitation programs for people with movement disorders.

 

 

 

 

 

 

Weekly Neuroscience Update

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MIT engineers have developed a technique that allows them to rapidly image many different proteins within a synapse.

A new rapid imaging technique allows researchers to view synaptic proteins at high resolution.

There may be some good news for people with vestibular migraine, a type of migraine that causes vertigo and dizziness with or without headache pain. A small, preliminary study suggests that non-invasive nerve stimulation may show promise as a treatment for vestibular migraine attacks, a condition for which there are currently no approved treatments.

New research uses artificial intelligence to identify patterns of brain activity that make people less responsive to certain antidepressants.

A new study challenges the belief that epileptic seizures can be predicted by brain wave patterns. Researchers report they have found no evidence that specific brain wave patterns can be a predictive indicator of seizure onset.

New research shows prepartum and postpartum physical and mental health was associated with persistent severe sleep problems in their babies.

In a first-of-its-kind study, researchers have pieced together a road map of typical brain development in children during a critical window of maturation. The study shows how a “wave of brain maturation” directly underlies important social and behavioral changes children develop during the transition from childhood to adolescence.

Finally, this week, a new study highlights the role estrogen plays in the differences in the progression of Parkinson’s disease between men and women.

Is depression and anxiety best treated with medication or psychotherapy?

What is the best treatment for depression?

I attended a lecture last week by leading clinical psychologist and head of the counselling service in the University of Limerick, Dr. Declan Aherne, entitled

“Medication or psychotherapy in the treatment of depression and anxiety.”

The lecture discussed research results – from 1995 to 2011 – which examined the effects of medication and psychotherapy – given alone and in combination – on depression and anxiety. I was impressed by the lecture and by the question from the audience – many of whom were Psychiatrists, GPs, sufferers themselves and others working the area of depression and anxiety.

Let me explain some definitions and summarize a few points raised in this excellent lecture.

Some definitions:

Psychotherapy: The treatment of a behaviour disorder, mental illness, or any other condition by psychological means.

Medication (psychopharmacology): The scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior.

Some interesting points I took from the lecture include:

  1. Incidence – anxiety affects 66 million and depression affects 31 million each year in Europe alone.
  2. Treatment – medication is only beneficial in severe but not moderate or mild depression while up to 30% of patients take both psychotherapy and medication.
  3. Delivery – in Europe, psychotherapy is delivered mainly by non-psychiatrists (mostly psychotherapists) however there is a lack of communication between the psychotherapist and medical doctor in 22% of patients taking both psychotherapy and medication.
  4. Trends – between 1998 and 2007 – the use of psychotherapy decreased from 16% to 10% and combined treatment from 40% to 32%, while the use of medication actually increased from 44% to 57% – possibly reflecting a shift in away from psychotherapy and toward medication.
  5. Cost – it is estimated that the same therapeutic effect can be achieved with €70 for psychotherapy compared with €100 with medication (Prozac) over a 24 month period.
  6. What actually works – the efficacy of psychotherapy is best seen using practice based evidence – while the effects of medication are seen using evidence based practice. Psychotherapy therefore, cannot be reduced to a product resembling a drug.

Neuropsychotherapy

Having been involved in this research area since I earned a Ph.D. on the psychopharmacology of depression over 25 years ago I am convinced that far from there being a debate over which of the two treatments are best – psychotherapy and medication are in fact two sides of the same coin. The recent discovery that what we experience changes the shape of the brain – allowing discrete areas in the brain to grow or change – by adding a tiny fraction of the brain’s neural circuitry and eliminating old ones. As more findings from the neurosciences inform best practices in psychotherapy a new field of neuropsychotherapy will help develop better, more effective therapies to improve brain function and mental health.

What we already know

Nerve cells or neurons are notoriously bad at dividing. Rather than divide, a neuron survives by making up to 10,000 connections to neighbouring neurons – and this is the key to how we learn and recall as memories are created and strengthened.  This compromise works well most of the time however in depression and anxiety a gradual loss in the strength of previous healthy connections in the emotional centres of the brain  – often triggered by a loss – starts to take it toll resulting in a noticeable reduction in mood as we find it harder to remain positive. As the illness progresses a vicious cycle develops whereby maladaptive thoughts and behaviours such as persistent negative thinking, phobias and apathy take hold  – driven by a new set of this time ‘faulty’ connections.

Brain wiring – making healthy connections – is the key to recovery  

Studies in animals show that medication (e.g. an antidepressant drug) not only makes the previously healthy connections in the brain work better but it also triggers the brain to grow new nerve cells. Psychotherapy on the other hand helps to rewire the faulty connections as well as wiring-up new healthy connections from the newly generated neurons. If depression and anxiety resembled a broken down car then medication is the petrol that revives the engine while psychotherapy is the tweaking of any faulty electronic wiring – allowing the car to hum along without a hitch.

Psychotherapy and medication – vive la différence

I predict that in the future – treatments for depression and anxiety will not only involve psychotherapy and medication but will also include a combination of other therapies such as social support, self-help techniques, nutrition, sleep hygiene and exercise. Furthermore, these therapies may be prescribed alone and in combination at key stages to promote the growth of new neurons, strengthen healthy connections and rewire the faulty ones. This combined approach will treat the person as a whole, and will mark the beginning of the journey back to wellness and a normal life.

Weekly Round Up

How does cigarette addiction affect the brain?

The effects of nicotine upon brain regions involved in addiction mirror those of cocaine, according to new neuroscience research.

Aspirin and other anti-inflammatory drugs taken for pain relief may reduce the effectiveness of anti-depressants such as Prozac, say US researchers.

Moments of absent mindedness such as losing your keys could be the result of tiny parts of the brain taking “naps” to recharge, a study finds.Researchers discovered that contrary to popular opinion the brain is not always entirely asleep or awake but parts of it can go “offline”.

Neuroscientists at the California Institute of Technology and their colleagues have tied the human aversion to losing money to a specific structure in the brain-the amygdala.

Music is not only able to affect your mood — listening to particularly happy or sad music can even change the way we perceive the world, according to researchers from the University of Groningen.

The positive effects of mindfulness meditation on pain and working memory may result from an improved ability to regulate a crucial brain wave called the alpha rhythm. This rhythm is thought to “turn down the volume” on distracting information, which suggests that a key value of meditation may be helping the brain deal with an often-overstimulating world. And in other  mindfulness research – fMRI shows how mindfulness meditation changes the decision making process

 

Weekly Round Up

Research shows that our brains understand music not only as emotional diversion, but also as a form of motion and activity.

Research shows that our brains understand music not only as emotional diversion, but also as a form of motion and activity. The same areas of the brain that activate when we swing a golf club or sign our name also engage when we hear expressive moments in music. Brain regions associated with empathy are activated, too, even for listeners who are not musicians.

And still on the theme of music and the brain, a recent study of seventy healthy adults ages sixty to eighty-three with various levels of music education starting around the age of ten showed impressive differences in brain functioning far later in life than any other research has previously shown.

A new study has suggested that sustained training in mindfulness meditation may impact distinct domains of human decision-making, enabling them to make decisions rationally.

Older bilingual adults compensate for age-related declines in brainpower by developing new strategies to process language, according to a recent study published in the journal Aging, Neuropsychology, and Cognition.

Emerging research suggest antidepressant medications may aid creation and survival of new brain cells after a brain injury.

New study examines brain processes behind facial recognition 

Finally, here is an interesting post from Chris Mooney on the science of why we don’t believe science.

What’s going on with Charlie Sheen?

Is Charlie Sheen suffering from bipolar disorder?

As actor Charlie Sheen’s bizarre media blitz continues, viewers are left to ponder if Sheen’s interviews are some kind of brilliant performance art or evidence of an epic meltdown, or some combination of the two. Or is his current behaviour evidence of a more worrying mental illness.

Some psychologists have stated that Charlie Sheen appears to have bipolar disorder. Dr. Drew Pinsky has said that Charlie Sheen appears to be having a “manic episode.”

Another psychologist says that Charlie Sheen is showing classic symptoms of bipolar disorder. “The symptom I see is the pressured speech.” he says. “[Sheen is] really pushing to get those words out; he’s really on a roll. He’s getting everything coming out pretty fast, almost faster than his brain can think and that’s very common with people who have bipolar disorder.” 1

What is bipolar disorder?

Over 300,000 people in Ireland suffer from depression, however a less common form of depression is manic depression also known as bipolar disorder which affects about 20,000 Irish people. Bipolar disorder is a mood disorder characterised by extreme lows with feelings of hopelessness and sadness followed by elated manic highs where in your mind anything becomes possible. 

Vicious cycles

These extremes of mood often follow each other in regular cycles that may be days, months or even years apart although on average there are twice as many episodes of depression then for mania. Like any other mental illness bipolar disorder is related to genetic background and personality type but can also be triggered by stressful events. However in a lot of cases bipolar disorder can arise ‘out of the blue’ when people’s lives’ are going quite well. 

Similarities to classic depression

The depressive symptoms experienced by people with bipolar disorder are similar to those people who experience classic depression.  One minute you are working away in your garden and the next you can be overtaken by profound feelings of despair – a sense of being totally worthless – that can take you down into the depths of depression. In this situation the mood is very low and daily life can become so overwhelming that it can be difficult to endure. As the feelings deepen – thoughts of suicide and a preoccupation with suicide often emerges. 

Manic depression

The German psychiatrist Emil Krapelin coined the term ‘manic depression’ after examining many patients with this condition back in the 1800’s. Even then Krapelin believed that this condition was caused by a specific abnormality in the brain. 

Where in the brain does depression occur?

Depression is associated with a disturbance in the prefrontal lobe of the brain – found just behind the eyes. This region of the brain is involved in judging things to be good or bad. It is also involved in social behaviour and interpreting social situations so it is not surprising that the low mood, reduced motivation and social withdrawal are key symptoms of depression. For this reason, people who are depressed often feel rejected or cut off from the world and blame themselves for wars in distant lands – even though they may have never visited that country. 

The role of amines in depression

Neuroscientists still don’t know for certain why people develop bipolar disorder but they do know that it is related to imbalances in brain chemicals called neurotransmitters which are involved in communication. However, research over the past 40 years has the confirmed that depression is associated with low levels of family of chemicals called amines. Amines are neurotransmitters that help nerve cells to stay in touch with each other. A lack of these amines particularly dopamine and serotonin which are carried by nerve pathways into the frontal lobe leads to a kind of starvation of nerve cells in the frontal lobe – giving rise to the symptoms of depression. 

Reserpine and depression

The link between low amine levels and depression was made when reserpine a drug to lower blood pressure also lowered brain amine levels and caused very profound depression. Also, addictive drugs such as cocaine, amphetamine and alcohol which inappropriately increase amine levels in the brain can trigger depression upon withdrawal. So the message is simple – in order to avoid depression you need healthy levels of these amines in our brain and you need healthy mental health habits to keep them there. 

Medication for depression

Over the past 25 years neuroscientists been working hard to develop drugs that can safely raise amine levels in the brain – the so-called antidepressant drugs – and better, more effective antidepressants come on the market every decade. 

The manic phase of bipolar disorder

In contrast to the depressive phase, the manic phase of bipolar disorder is the ‘polar’ opposite of depression. Feelings of boundless energy and that anything is possible are often felt. Many people are often creative in this phase.  The German composer Robert Schuman experienced bipolar disorder throughout his life. He completed four works in 1829 when in a depressed phase and twenty-five works a year later when in a manic phase. 

The secret of our success…

If bipolar disorder were due to a bad gene then why has it not been weeded out over the generations? One answer is that despite the truly awful cost to the life of the individual the gene for bipolar depression continues to exist because it confers an advantage on our species such as the creative insights leading to discoveries, inventions and exceptional performances in science, the arts, drama, music, sport and business – contributing to the great advances in our civilization – from which we all benefit. Ironically then, bipolar disorder may be the secret of our success as a species.  

…comes at a very high cost

Very tragically the rate of suicide in bipolar disorder is very high. The cycle of depression and mania lead the German composer Robert Schuman to an attempted suicide in 1854. Almost a quarter (22%) of people with this condition will commit suicide.  This is higher than that observed in schizophrenia. 

Recognizing the manic phase

In severe mania an individual will behave in an uncharacteristic way. They will become very talkative, loud, verbal, very expressive, extremely confident even uncharacteristically confident. Some people will start-up companies in this phase. They will go out and direct traffic, invest unwisely. They don’t see things as being limited by their circumstances or by their personal capacities. In the manic phase literally anything is possible! 

The manic phase can come on quickly or gradually. The person may not be fully aware what is happening to them. They may find themselves drinking more, wanting to be with people, going to pubs and nightclubs and dancing all night despite the fact that they may be too old for it. There is a tremendous pressure to ‘do things’ such as going out to dig the garden at 4am in the morning – for the stay-at-home types. 

The brain, stress and bipolar disorder

Whenever you encounter a stressful situation the pituitary gland in your brain sends a signal to your adrenal glands (just above your kidneys) to release cortisol which in turn gets your body ready for action. However blood cortisol levels are much higher than normal in depression and bipolar disorder causing a general state of high alert including early morning wakening which contributes to mental exhaustion.

Neuroscientists believe that the manic phase is an over activity of the dopamine and serotonin pathways in the frontal lobe.  In this way a dysfunction in the serotonin pathway in the brain has a ‘knock-on’ affect in the regulation the pituitary gland which in turn inappropriately over-activates the adrenals to release too much cortisol. However neuroscientists still don’t know for certain why people develop bipolar disorder.

Lithium and treatment of bipolar disorder

Mania is very resistant to treatment – benzodiazepines, major tranquilizers and antidepressants don’t work adequately. Fortunately there is lithium – an element found as a salt in soil and rocks and thus very cheap to make. Because it is element lithium cannot be patented (owned) by the drug industry. It was for this reason that lithium was largely ignored for years by the pharmaceutical industry. However, even in ancient times lithium was known to be a mild sedative. The mood stabilising effect of lithium was rediscovered by accident by an Australian psychiatrist John Cade in 1949 when working with guinea pigs. After ingesting lithium himself to ensure its safety in humans, Cade published an article “Lithium salts in the treatment of psychotic excitement” – which is still the number one most cited article in the Medical Journal of Australia. Lithium was eventually accepted as a treatment for mania in the 1970s.

Lithium – a truly life saving drug

Initially investigated as a treatment for gout, lithium has the effect of calming nerve cells. While lithium is the conventional treatment for the manic phase of bipolar disorder and reaches the brain within hours it can take up to six weeks to show an effect. Lithium is also very toxic particularly to the thyroid and kidneys. The required dosage 400–600 mg (15–20 mg per kg of body weight) is slightly less than the toxic level, requiring blood levels of lithium to be monitored closely during treatment. Within four to five days of stopping lithium a person can begin to get high again. Despite its limitations lithium is truly is a life saving drug – the only one to have an anti-suicide effect – allowing people to manage their moods and get on with their lives.  

The cup that cheers

Hundreds of soft drinks once included lithium salts or lithia water (naturally occurring mineral waters with higher lithium amounts). An early version of Coca Cola available in pharmacies’ soda fountains was called Lithia Coke and was a mixture of Coca Cola syrup and lithia water. The soft drink 7 Up, originally named “Bib-Label Lithiated Lemon-Lime Soda”, contained lithium citrate until it was reformulated in 1950. Lithia light beer was brewed at the West Bend Lithia Company in Wisconsin.

In 2009, Japanese researchers at Oita University reported that low levels of naturally-occurring lithium in drinking water supplies reduced suicide rates. A previous report had found similar data in the American state of Texas. In response, psychiatrist Peter Kramer raised the hypothetical possibility of adding lithium to drinking water.

A possible future treatment?

Research shows that manic depression seems to run in families so genetics also plays a role. Nobel Prize winner Paul Greengard of Rockefeller University, New York believes that a low-level of expression in a gene called P11 – which regulates serotonin levels in the brain – may underlie bipolar disorder. Gene therapy whereby healthy P11 genes are injected into the brain may be a future treatment.    

1 Source: kfor.com

Stroke recovery boosted by Prozac

Stroke is the third biggest killer disease in Ireland – over 2,000 people die per year – causing more deaths than breast cancer, prostate cancer and bowel cancer combined. Up to 10,000 people will suffer a stroke in Ireland this year and one in five people will have a stroke at some time in their life.

An unexpected new finding for antidepressant drugs and a very important one.

Findings from the largest study of selective serotonin re-uptake inhibitors (SSRIs) and stroke report that giving stroke patients the antidepressant drug Prozac soon after the event helps their recovery from paralysis. A total of 118 French patients were involved in the study. The beneficial effects of the drug – more improvement in movement and greater independence – were seen after three months – helping patients gain independence. This finding suggests that this already licensed drug – also known as fluoxetine – could have a dual benefit in the treatment of acute ischemic stroke – that’s where blood flow and oxygen supply to the brain are impaired.

Antidepressant drugs can help neurons to grow

One theory about how antidepressants may help brains recover more quickly from stroke is that they encourage neurogenesis – the creation of new neurons – in particular in the hippocampus – a brain region implicated in emotion especially anxiety – an emotion which can wear down even the most resilient person.

The ability of antidepressant drugs to increase neuron growth and connections – brain plasticity – is a promising pathway for treatment of patients with ischemic stroke and moderate to severe motor deficit. It’s a controversial theory and so far it only appears to hold true in young mice. In middle-aged and older mice, no such neurogenesis was observed – so there may be another mechanisms operating. 

One thing is for sure – it’s an important finding and I hope we’ll see more work on this.