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March 18, 2019 by Zenobia Morrill | MadInAmerica.com

It is Time to Abandon the Search for the Genetic Underpinnings of Depression

Claims for genetic underpinnings of depression go unsupported and are likely based on bad science, new research finds.

(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.”

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March 14, 2019 by Lisa Cosgrove, Deborah Erlich and Allen F. Shaughnessy | J Am Board Fam Med

No Magic Pill: A Prescription for Enhanced Shared Decision-Making for Depression Treatment

 Journal of the American Board Family Medicine

Abstract

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.

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March 8, 2019 by Lisa Rapaport | Reuters Health

Aerobic Exercise Eases Depression, Even in Chronically Ill

(Reuters Health) – People with chronic health problems who suffer from depression may find their mood improve when they do aerobic exercise, a research review suggests.

Patients with long-term medical issues are two to three times more likely to develop depression than the general population, researchers noted in the British Journal of Sports Medicine, online February 6. When these patients do become depressed, their chronic illnesses often worsen and their risk of dying goes up.

For the current study, researchers examined data from 24 studies with a total of 4,111 patients living with chronic illness and symptoms of depression. All of the smaller studies randomly assigned some patients to do aerobic exercise and others to comparison groups that just got usual medical care.

Patients who exercised at least two to three times a week were more likely to see a reduction in depression symptoms than people who didn’t do aerobic exercise at all, the study found. There was a more pronounced effect when people exercised four to five times a week, but this difference was too small to rule out the possibility that it was due to chance.

“One of the key messages that we see often around aerobic exercise is: something is better than nothing and more is better than less, said senior study author Dr. Simon Bacon of Concordia University in Montreal, Canada.

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March 5, 2019 by Mark Abie Horowitz, PhD & Prof David Taylor, PhD | The Lancet

Tapering of SSRI treatment to mitigate withdrawal symptoms

Summary

All classes of drug that are prescribed to treat depression are associated with withdrawal syndromes. SSRI withdrawal syndrome occurs often and can be severe, and might compel patients to recommence their medication. Although the withdrawal syndrome can be differentiated from recurrence of the underlying disorder, it might also be mistaken for recurrence, leading to long-term unnecessary medication. Guidelines recommend short tapers, of between 2 weeks and 4 weeks, down to therapeutic minimum doses, or half-minimum doses, before complete cessation. Studies have shown that these tapers show minimal benefits over abrupt discontinuation, and are often not tolerated by patients. Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms. Other types of medication associated with withdrawal, such as benzodiazepenes, are tapered to reduce their biological effect at receptors by fixed amounts to minimise withdrawal symptoms. These dose reductions are done with exponential tapering programmes that reach very small doses. This method could have relevance for tapering of SSRIs. We examined the PET imaging data of serotonin transporter occupancy by SSRIs and found that hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums, in line with tapering regimens for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised.

Source: TheLancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext

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March 5, 2019 by Benedict Carey | The New York Times

How to Quit Antidepressants: Very Slowly, Doctors Say

(The New York Times) – Thousands, perhaps millions, of people who try to quit antidepressant drugs experience stinging withdrawal symptoms that last for months to years: insomnia, surges of anxiety, even so-called brain zaps, sensations of electric shock in the brain.

But doctors have dismissed or downplayed such symptoms, often attributing them to the recurrence of underlying mood problems.

The striking contrast between the patients’ experience and their doctors’ judgment has stirred heated debate in Britain, where last year the president of the Royal College of Psychiatrists publicly denied claims of lasting withdrawal in “the vast majority of patients.”

Patient-advocacy groups demanded a public retraction; psychiatrists, in the United States and abroad, came to the defense of the Royal College. Now, a pair of prominent British psychiatric researchers has broken ranks, calling the establishment’s position badly mistaken and the standard advice on withdrawal woefully inadequate.

In a paper published Tuesday in Lancet Psychiatry, the authors argued that any responsible withdrawal regimen should have the patient tapering off medication over months or even years, depending on the individual, and not over four weeks, the boilerplate advice.

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March 1, 2019 by Jo Ann Cook | MadInAmerica.com

How the Mental Health Industry Exploits Schoolchildren

(MadInAmerica.com) – On December 18, 2018, U. S. Surgeon General Jerome Adams issued a public health advisory urging parents, teachers, and health professionals to address an epidemic of childhood e-cigarette use. The advisory emphasized repeatedly that the nicotine in e-cigarettes was addictive; was harmful to the developing brain; affected learning, memory, and attention; and exposed the lungs to harmful chemicals. In a press release, one federal health official claimed that “we have never seen use of any substance by America’s young people [to] rise as rapidly…” To address this crisis, the surgeon general’s office proposed local bans on indoor vaping and recommended retail restrictions to reduce the purchase of e-cigarettes among youth.

While the government chose to single out the rise of e-cigarette use, it has been ignoring the astronomical spread of another type of dangerous drug taken by children and youth: psychiatric medications.

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February 25, 2019 by JONATHAN LAMBERT | NPR.org

Greener Childhood Associated With Happier Adulthood

(NPR.org) – The experience of natural spaces, brimming with greenish light, the smells of soil and the quiet fluttering of leaves in the breeze can calm our frenetic modern lives. It’s as though our very cells can exhale when surrounded by nature, relaxing our bodies and minds.

Some people seek to maximize the purported therapeutic effects of contact with the unbuilt environment by embarking on sessions of forest bathing, slowing down and becoming mindfully immersed in nature.

But in a rapidly urbanizing world, green spaces are shrinking as our cities grow out and up. Scientists are working to understand how green spaces, or lack of them, can affect our mental health.

A study published Monday in the journal PNAS details what the scientists say is the largest investigation of the association between green spaces and mental health.

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February 24, 2019 by James Ponder | Loma Linda University

School of Public Health study links unhealthy diet to mental illness in California adults

(Loma Linda University) – A study has found that poor mental health is linked with poor diet quality — regardless of personal characteristics such as gender, education, age, marital status and income level.

The study, published Feb. 16 in the International Journal of Food Sciences and Nutrition, revealed that California adults who consumed more unhealthy food were also more likely to report symptoms of either moderate or severe psychological distress than their peers who consume a healthier diet.

Jim E. Banta, PhD, MPH, associate professor at Loma Linda University School of Public Health and lead author of the study, said the results are similar to previous studies conducted in other countries that have found a link between mental illness and unhealthy diet choices. Increased sugar consumption has been found to be associated with bipolar disorder, for example, and consumption of foods that have been fried or contain high amounts of sugar and processed grains have been linked with depression.

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February 21, 2019 by Jacob Z. Hess, PhD | Unthinkable.cc

Why Have Suicides Increased (Even More) After Enormous Efforts to Reduce Them?

(Unthinkable.cc) – Like so many, I’ve lost loved ones to suicide. The most obvious question that always comes up is why? What was it that led this individual…to that tragedy?

Although there will always be some uncertainty involved in this heartbreak, thousands of studies documenting various risk factors for suicide make it clear that no single cause is responsible, as much as hundreds of overlapping contributors.

As suicides keep rising, the same basic question comes up in another form:  Why have the numbers been rising?

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February 13, 2019 by Batya Swift Yasgur, MA, LSW

CBT Best for Perinatal Depression Prevention, USPSTF Says

(Medscape) – The US Preventive Services Task Force (USPSTF) has issued a final recommendation statement and evidence summary on interventions to prevent depression in women during pregnancy and/or following childbirth.

Based on “convincing evidence,” the Task Force recommended counseling — specifically, cognitive behavioral therapy (CBT) and interpersonal therapy — as effective for preventing perinatal depression.

These modalities are recommended especially for women with a history of depression, current depressive symptoms, or economic risk factors such as low income or young or single parenthood.

“[Perinatal depression] is a very common problem. Our evidence review suggests that one in seven pregnant women will become depressed and up to 40% will have an episode of depression during the 1-year postpartum period,” Task Force member and coauthor Karina Davidson, PhD, MASc, told Medscape Medical News.

“Effective counseling interventions, in particular CBT and interpersonal therapy, can help prevent perinatal depression before it develops,” she added.

The recommendations were published online February 12 in JAMA.

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