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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 6, 2019 by FiercePharma | Eric Sagonowsky

J&J depression spray Spravato, carrying big expectations and restrictions, scores FDA nod

(FiercePharma) – Johnson & Johnson has an FDA green light for its next big drug launch, and it’s a drug sure to command attention as the rollout progresses: Spravato, a tweaked form of ketamine, which is used legally in anesthesia, but illegally as a street drug.

Also known as esketamine, Spravato won agency approval Tuesday, ushering in the first new treatment mechanism for major depressive disorder in decades. The nasal-spray drug is OK’d as an add-on to oral antidepressants in patients who have tried at least two antidepressants without success.

The drug won’t come cheap. For the first month of therapy, when it’s administered more frequently, Spravato’s list price runs to $6,785 for the higher dose, before rebates and discounts. After that, depending on dose and frequency, the list price adds up to $3,450 max.

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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 Johanna Ryan | RxISK.org

Bait and Switch: the Great Ketamine “Breakthrough”

(RxISK.org) – Maybe you heard the exciting news last month about a game-changing new treatment for depression.  It offered new hope to millions who were not helped by existing drugs, the headlines said – the first real breakthrough in depression treatment since Prozac, some thirty years ago.

The product was Janssen’s esketamine nasal inhaler, described as a new variation on an old generic drug.  Ketamine is an anesthetic, given by injection (IV) for invasive or unpleasant medical procedures that don’t require a complete knock-out.  It’s known to cause feelings of “dissociation” (a sense of being outside one’s body or personal identity) and, occasionally, hallucinations.   Some people like this effect, which has led to an illicit market in ketamine or “Special K” for recreational users.  (Esketamine is simply one of the two forms of the ketamine molecule.  It’s not a new drug, exactly, but Janssen can patent it as one, for an obvious economic advantage.)

For at least a decade, both studies and case reports have described severely depressed people getting rapid and robust relief within hours of a ketamine injection.  Now Janssen (a subsidiary of Johnson & Johnson) claimed to have turned this old and rather scary-sounding drug into a new, safe and effective treatment which it dubbed “Spravato.”

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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 4, 2019 by Sara L Johansen et al | The BMJ

Management of perinatal depression with non-drug interventions

(The BMJ)

ABSTRACT

Perinatal depression is a common disorder that has been associated with serious risks to mother and child. Recently, screening for depression in pregnant and postpartum women has increased, as has the development of new psychotherapy and non-drug treatment modalities. Matching patients to treatments can be challenging, and although research into personalized treatment of major depression in the general population has increased, no published guidelines focus on personalized treatment approaches to perinatal depression. In particular, guidelines on non-drug treatments are lacking. This review summarizes the evidence on personalized non-drug treatment of perinatal depression, how to incorporate patients’ preferences, novel treatments under investigation, and the potential role of biomarkers in matching patients to treatment. The review provides recommendations for future research in personalized care of perinatal depression.

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March 1, 2019 by Hannah Emerson | MadInAmerica.com

Researchers Make the Case to Rename Schizophrenia

The authors outline reasons for renaming schizophrenia and the way a change can reform practice.

(MadInAmerica.com) – A recent editorial, published in Epidemiology and Psychiatric Sciences, makes an argument for getting rid of the schizophrenia diagnosis, listing five reasons for the change, five signals of change, five challenges of change, five promises of change, and five steps for change. The authors argue that changing the name for schizophrenia is a necessary step to modernize psychiatry and mental health services worldwide.

“Renaming a particular form of mental suffering should be accompanied by a broader debate of the entire diagnosis-evidence-based-practice (EBP)-symptom-reduction model as the normative factor driving the content and organization of mental health services that may be detached from patients’ needs and reality, overlooks the trans-syndromal structure of mental difficulties, appraises the significance of the technical features over the relational and ritual components of care, and underestimates the lack of EBP group-to-individual generalizability,” write the authors, Sinan Guloksuz and Jim van Os.

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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 26, 2019 by RxISK.org

Could your Stimulant or Antidepressant cause Dementia?

Quixotic Challenge

(RxISK.org) – A few years ago, a friend, Alan Baumeister, embarked on an interesting journey.  Alan had been Head of Psychology in Louisiana State University. He has been actively involved in the history of the mental health field and psychological inputs to it for a  long time.

Louisiana is the state that hosted Robert Heath in Tulane University in the 1970s who it could be argued was the father of Deep Brain Stimulation (DBS). His story is told in a wonderful book by Lone Frank ‘The Pleasure Shock’.

Alan now having a little more time on his hands had turned to a topic that had interested him for a while – a suspicion that chronic use of stimulants could trigger Parkinson’s disease – a prospect more likely with increased rates of supposed Adult ADHD.

He emailed me a copy of an article that he had written asking for my thoughts. It was an excellent article. The idea that stimulants might trigger problems like this was new to me but the case he outlined made sense. It seemed a good idea to put the hypothesis on the radar so that if there was a problem someone might actually look for the data to see how big the problem might be.

I was expecting that Alan might have some difficulties getting his paper published but not that he would have quite the difficulties he had. It took several years before he could find a journal happy to take it.  Several journals that he approached refused even to review it. His paper came back by return of email. This is not the way science is supposed to happen.

Finally nearly two years ago the paper was published – see here.

Since then a further paper by another group has appeared – see here.

This appears to show that exactly what Alan figures is right – people with a history of ADHD it seems are at increased risk of Parkinson’s disease, dementia and other cognitive disorders.  The authors don’t say these problems are caused by the stimulants – they leave open the option that the illness has caused the illness but this is stimulant caused until proven otherwise.

Just Stimulants?

The question is whether cognitive problems are something specific to the effect of stimulants on the dopamine system which is also involved in Parkinson’s disease, some poisoning of the dopamine system, or whether it’s a more general issue of whether the more drugs that people take for longer periods of time the more likely they are to suffer brain failure – to dement.  People with ADHD of course end up taking cocktails of drugs.

In one of those coincidences, in the course of a week, two weeks back, several women (its rarely men) got in touch about problems members of their family were having or had.  One drew my attention to a very common effect on SSRIs that I and most doctors have learned to dismiss – low sodium.

This was something some of us might have noticed when SSRIs turned up first and some people ended up with drastically low sodium levels.  When you see it first as a doctor, you wonder should I get this person to Intensive Care.  But nothing much seemed to happen and the problem seemed more often than not to auto-correct.

Another mentioned Osmotic Demyelination Syndrome (ODS).  I’d never heard of this.

Turns out in the small print of details very enthusiastic nerdy trainee docs or docs in training might have noticed when revising for exams decades back was a condition called Central Pontine Myelinolysis (CPM).  Neurologists know about this the rest of us don’t.  Described decades back, no-one knew what caused it but it was thought it might be a toxin. Myelinolysis was an invented word because no-one wanted to use demyelination.  It was thought the Pons of the brain was somehow uniquely susceptible to injury by something.

Some neurologists have moved on, many haven’t and few other docs know anything about ODS.

Basically myelinolysis is demyelination.  It can happen anywhere in the brain.  Its most commonly triggered by drugs.  Its particularly common when in the course of trying to restore a person’s sodium levels to normal they are either rehydrated too quickly or too slowly or just at the right speed but the patient still ends up the myelin sheaths of some of their nerves being destroyed.

This has been a lightbulb moment for me. I’ve seen many cases over the past decade – usually of women who have had clear cognitive problems following antidepressant intake linked to an atypical neurological picture such as Parkinson’s like syndrome, supranuclear palsy or atypical motor neurone disorder.  Whether caused by their antidepressant or not, these have come on after antidepressant intake. They are all consistent with ODS.

Right from the very start of the SSRI era, there has been a handful of people who have taken an SSRI and had an encephalopathic response to it – they claim something has gone so badly wrong and remained wrong after stopping what might have just been a few days of treatment, they figure they must have brain damage.  In some instances it’s happened on the first course of treatment in other instances it’s happened on re-exposure. Some have been young people. Others have been older women.

Another thing that has been very clear for over a decade is that a strikingly large proportion of those attending dementia services or memory clinics linked to dementia services are on SSRIs and related drugs.  The problem has been trying to work out if the anxiety states or nervousness that led to their SSRI were the first sign of dementia or whether the drug has caused memory and cognitive problems.

There have been several articles lately pointing to increased rates of dementia in people taking antidepressants, especially SSRIs.  The problems are unlikely to be confined to SSRIs in that most anticonvulsants have significant effects on sodium levels and sodium channels also.

Dementia used to be Alzheimer type or multi-infarct – stemming from a series of minor strokes.  Multi-infarct dementia was linked to smoking and with the drop in smoking data suggests it is happening less frequently – perhaps though soon to be replaced by multi-demyelination dementia.

What Now?

Given that even people with considerable expertise on SSRIs or even in brain demyelination syndromes know little or nothing about these issues, and people with no background in healthcare have told me more than I knew up to this week, it looks like a concerted effort by a wider than usual group of people is needed to try and assemble a picture of what might be going on and what people should know about and might do about the situation.

(The little white spot in the image above shows something happening in the Pons).

Source: RxISK.org/could-your-stimulant-or-antidepressant-cause-dementia/

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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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The contents of this Headlines page are provided for informational purposes. Any material, conclusions, or opinions presented in the linked articles are not necessarily endorsed by the Foundation for Excellence in Mental Health Care.