(MadInAmerica.com) – A new rigorous study, published in the American Journal of Psychiatry, closely examined 18 candidate genes hypothesized to be genetic underpinnings of depression. Despite recent claims that these genetic polymorphisms may serve as reliable biomarkers suitable for identifying later development of “Major Depressive Disorder,” the results from this study found no support for this association. Based on these findings, the research team, led by Richard Border and Dr. Matthew Keller in Colorado, call on the field to abandon the idea that depression is genetic.
“In agreement with the recent recommendations of the National Institute of Mental Health Council Workgroup on Genomics, we conclude that it is time for depression research to abandon historical candidate gene and candidate gene-by-environment interaction hypotheses.”Read More
Standardized clinical treatment guidelines recommend that individuals with psychosis be treated with antipsychotic medication in the acute phase as well as throughout the protracted phases of maintenance and recovery (APA, 2006; NICE, 2014). Antipsychotic medication has unequivocally proven effective in acute and short-term treatment (Bola, Kao, & Soydan, 2012; Lally et al., 2017; Leucht et al., 2017; Mackin & Thomas, 2011). Over the longer term, there are significant challenges related to this type of treatment.
First, a sizable share of those remitting after a first episode psychosis may be able to achieve a good long-term outcome with a very low dose or without antipsychotic drugs at all. Robust predictors for the early identification of these patients are still lacking, which may result in excessive use of antipsychotic medicine (Harrow, Jobe, Faull, & Yang, 2017; Moilanen et al., 2013; Murray et al., 2016; Wunderink, Nieboer, Wiersma, Sytema, & Nienhuis, 2013).
Second, severe side effects, particularly associated with long-term use, include grey matter volume decrease and lateral ventricular volume increase (Fusar-Poli et al., 2013; Moncrieff& Leo, 2010), diabetes (Rajkumar et al., 2017), metabolic syndrome (Vancampfort et al., 2015), and reduced subjective quality of life and functioning (Wunderink et al., 2013; Wykes et al., 2017).
Third, shared decision-making has become a stated priority in medical treatment in an attempt to reduce the use of compulsory treatment and increase subjective empowerment and adherence to treatments that are actively chosen (Leng, Clark, Brian, & Partridge, 2017). Hence, shared decision-making is a central part of the recovery paradigm (Alguera-Lara, Dowsey, Ride, Kinder, & Castle, 2017).
This perspective has emerged resulting from a growing body of evidence showing a gap between the realities of those who use, refuse, or are forced to take antipsychotic medication and professionals and researchers (Faulkner, 2015; Moncrieff, 2013). Nevertheless, and despite non-adherence to treatment recommendations continuing to be considered a sizeable public health problem (Kane, Kishimoto, & Correll, 2013), few studies have investigated the effects of shared decision-making in mental healthcare settings (Boychuk, Lysaght, & Stuart, 2018; Schauer, Everett, del Vecchio, & Anderson, 2007; Slade, 2017; Stovell, Morrison, Panayiotou, & Hutton, 2016).
Large scale, prospective long-term, double-blind, controlled studies using clearly defined samples in terms of illness type, severity, and duration evaluating treatment effect are lacking (Sohler et al., 2016). These types of studies are essential to reveal how antipsychotic treatment affects critical functioning throughout the course of illness (Rhee, Mohamed, & Rosenheck, 2018; Zipursky & Agid, 2015). Also, meta-analyses of qualitative studies are needed to systematically describe and summarize the growing empirical qualitative knowledge base on service users’ subjective perspectives on using antipsychotic drugs. Such studies are essential to inform large-scale trials with clinically relevant hypotheses, as well as to illuminate clinical implications for different sub-groups of individuals.
Source: Journal of Mental HealthRead More
For over 2 decades, there have been debates, sometimes contentious, about the efficacy and safety of antidepressants. Growing awareness of the difficulty some patients have when discontinuing these medications has intensified these debates. Recently, Cipriani and colleagues published the largest meta-analysis to date that assessed the efficacy and tolerability of antidepressants. They concluded that all were more efficacious than placebo, and they also synthesized the trial results from head-to-head studies in an effort to guide pharmacologic treatment for major depressive disorder in adults. Although the researchers acknowledged many limitations in their analysis, including the fact that effect sizes were modest at best, the media overstated the results of the study. Both the meta-analysis and the news stories reinvigorated the debates about whether or not antidepressants “work.” Unfortunately, however, the key question—how can this meta-analysis help physicians in assisting their patients with a difficult decision about depression treatment options?—was lost in the controversy. In this commentary, we identify the questions and challenges that were not addressed in the current debate and offer specific suggestions for enhancing shared decision making for physicians working in primary care settings.Read More
(MadInAmerica.com) – This week, MIA Radio presents the fifth in a series of interviews on the topic of the global “mental health” movement.” This series is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team.
I was fortunate to interview Dr. Gail Hornstein, a Professor of Psychology at Mount Holyoke College in South Hadley, Massachusetts. She is the author of To Redeem One Person is to Redeem the World: The Life of Frieda Fromm-Reichmann and, most recently, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. In her work, she chronicles both the personal narratives of people with lived experience of being treated as “mad,” and also the growing movement of survivor and service-user activism. Her Bibliography of First-Person Narratives of Madness in English (now in its 5th edition) lists more than 1,000 books by people who have written about madness from their own experience; it is used by researchers, clinicians, educators, and peer groups around the world.
She is now director of a major research and training project investigating how hearing voices peer-support groups work, supported by a grant from the Foundation for Excellence in Mental Health Care. This project is training dozens of new hearing voices group facilitators across the US and sponsors research to identify the key mechanisms by which this approach works.
What follows is a transcript of our conversation, edited for clarity.Read More
This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals.
The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration.
A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults.
Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches.Read More
(MadInAmerica.com) – The journal Behavioral and Brain Sciences features several prominent researchers in its latest issue debunking the notion that mental health concerns are “brain disorders.” It begins with a paper by researchers in the Netherlands arguing that neurobiology will never convincingly explain any mental health concerns. The rest of the issue includes dozens of commentaries by influential researchers, some supporting the initial premise, and others attempting to argue against it. In response, the initial study authors point out that none of the responses can provide any convincing evidence that neurobiological reductionism has succeeded in a meaningful way.Read More
Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first hand experience of recipients.
Objectives: To ascertain the experiences and opinions of users of an international sample of antipsychotic drugs regarding positive and negative effects.
Method: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date.
Results: Over half (56%) thought the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘Helpful’ (41%) than found them ‘Unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects.
Conclusions: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.
Keywords: Antipsychotic drugs, psychosis, side effects, suicidality, quality of life, sedation, informed consent
Affiliation: School of Psychology, University of East London, London, Department of Psychological Sciences, Swinburne University of Technology, Melbourne
(Medscape) – The popular and expensive spice saffron (Crocus sativus L), appears to be as effective as the stimulant methylphenidate (MPH) in treating symptoms in youngsters with attention deficit hyperactivity disorder (ADHD), new research suggests.
In a randomized 6-week trial, a team of investigators from Tehran University of Medical Sciences in Iran, found there were no significant differences in efficacy or adverse events in the saffron vs MPH group.
“From this preliminary study, the main point is that we can consider saffron as an alternative [to stimulants] in patients with ADHD,” senior author Shahin Akhondzadeh, PhD, FBPhS, DSc, professor of clinical psychopharmacology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran, told Medscape Medical News.
“Short-term efficacy of saffron demonstrated the same efficacy as methylphenidate, although larger, controlled studies with longer treatment periods are necessary to verify the findings,” he said.
The study was published online February 11 in the Journal of Child and Adolescent Psychopharmacology.Read More
Background and Aims: Some patients with the diagnosis of a psychotic disorder wish to minimize or avoid medications. They are seeking a recovery model with the aim of maximizing independence and healing.
Methods: We report qualitative and quantitative data on a group of 69 motivated adult patients with psychosis as a proof of concept study — that management with minimal or no medication is possible for some.Read More
EVANSVILLE, Ind. — As the health of U.S. population continues to rise to the forefront of discussion, increasing evidence is finding that paying attention to what we eat is not just important for how our bodies function but also for our minds.
More and more, research is indicating the food we consume affects how we feel, think, pay attention and even regulate our behaviors. This is especially important for youth and young adults, whose brains continue to undergo maturation that affects the rest of their lives.
Given this, I sat down with one of the world’s foremost experts on nutrition and mental health, Dr. Bonnie Kaplan, to discuss this critical topic. Dr. Kaplan is an Emeritus Professor at the University of Calgary and has an appointment at the Alberta Children’s Hospital Research Institute. She has published countless articles on this topic and has spoken to audiences all over the world.Read More