Friday, January 30, 2015

Depression May Be Linked to Inflammation in the Brain

New research in Canada reveals that inflammation deep in the brain may be linked to depression.  Specifically, the Centre for Addiction and Mental Health (CAMH) studied the brain scans of patients with depression and those without.  Results showed 30% more inflammation in the brains of patients with clinical depression.  In addition, symptoms worsened with the degree of inflammation.  Keeping in mind that researchers only studied the scans of 40 patients, concrete conclusions are a tad premature.

Nevertheless, this research does offer new ideas for investigation, which could uncover other possible causes for the illness as well as potential new treatments for depression.  In other words, perhaps reducing inflammation in the brain may alleviate or eliminate the symptoms.  This is exciting news for the individuals that do not respond to medication, which, according to this research, consists of 30 to 50 per cent of patients!

“Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.
[…] The purpose of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and to initiate tissue repair.
[…] Too little inflammation could lead to progressive tissue destruction by the harmful stimulus (eg. bacteria) and compromise the survival of the organism. In contrast, chronic inflammation may lead to a host of diseases, such as hay fever, periodontitis, atherosclerosis, rheumatoid arthritis, and even cancer (e.g., gallbladder carcinoma).”
According to Dr. Jeffrey Meyer of CAMH, it is theorized that the body of patients that have suffered some type of infection or trauma may have healed, however the brain has not had the opportunity to recover.  This may explain why patients with certain types of inflammatory disease, such as lupus, are several times more likely to develop clinical depression.

Of course, it is still unclear whether the inflammation in the brain occurs before depression sets in or as a result of the illness.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depression, major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life isn't worth living.

During these episodes, symptoms occur most of the day, nearly every day and may include:
  • Feelings of sadness, emptiness or unhappiness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in normal activities, such as sex
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so that even small tasks take extra effort
  • Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
  • Anxiety, agitation or restlessness — for example, excessive worrying, pacing, hand-wringing or an inability to sit still
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that are not your responsibility
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches
  • Depression is a common mental disorder. Globally, more than 350 million people of all ages suffer from depression.
  • Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease.
  • More women are affected by depression than men.
  • At its worst, depression can lead to suicide.
  • There are effective treatments for depression.
Study finds link between depression, brain inflammation
Depression (major depressive disorder)


Tuesday, January 27, 2015

Commonly Used Medications Linked to Dementia

A new study reveals that higher doses or prolonged use of medications with anticholinergic effects significantly increases the risk for developing dementia.  Although, this is not the first study to discover such a link, it is the first to suggest that the risk of dementia as a result of taking such medications may not be reversible.
“An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movement of smooth muscles present in the gastrointestinal tract, urinary tract, lungs, etc.”
Anticholinergic agents are used to treat a variety of conditions such as gastrointestinal disorders, respiratory disorders, insomnia, dizziness etc.  Some of these commonly used medications include Diphenhydramine (Benadryl, Advil PM etc.), Bupropion (Zyban, Wellbutrin), Dextromethorphan (cough suppressant) and the list goes on.  In addition, some of these medications can be acquired without a prescription and can have very strong anticholinergic effects.

Moreover, many older patients, already at higher risk of developing dementia, are frequently using these types of medications.  Doctors should be taking a proactive approach and monitoring the use of these drugs, including non-prescription use.
“For instance, the most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). The study estimated that people taking at least 10 mg/day of doxepin, 4 mg/day of chlorpheniramine, or 5 mg/day of oxybutynin for more than three years would be at greater risk for developing dementia.”
Consequently, the study suggests that medical professionals should seek substitutes such as citalopram (Celexa) or fluoxitene (Prozac) for depression or loratadine (Claritin) for allergies or behavioral changes for urinary incontinence.  However, if substitutes are not available, the suggestion is to prescribe the lowest dose possible, monitor its effectiveness closely and cease use if there is no real benefit to the patient.

This study differs from other research as it used more rigorous methods, longer follow-up periods and better assessment of medication use by using pharmacy records of both prescription and non-prescription use.  It is also the first of its kind to link anticholinergic medication dosages to dementia risk.  Results were obtained by tracking nearly 3,500 Group Health seniors participating in the long-running Adult Changes in Thought study (a longitudinal population-based prospective cohort study of brain aging and incident dementia in the Seattle metropolitan area), some of which have also agreed to have their brains autopsied after they die.  Stay tuned.

Quick Facts:

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.

Alzheimer's is the most common type of dementia.

While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:

Communication and language
Ability to focus and pay attention
Reasoning and judgment
Visual perception

Many dementias are progressive, meaning symptoms start out slowly and gradually get worse.
Dementia is caused by damage to brain cells, which interferes with the ability of brain cells to communicate with each other.

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer's and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type.

Some risk factors for dementia, such as age and genetics, cannot be changed, however some of the most active areas of research in risk reduction and prevention include cardiovascular factors, physical fitness, and diet.

The total number of new cases of dementia each year worldwide is nearly 7.7 million, implying one new case every four seconds. The number of people with dementia is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

The costs are estimated at US$ 604 billion per year at present and are set to increase even more quickly than the prevalence.

Caring for dementia patients is overwhelming for caregivers. The stresses include physical, emotional and economic pressures. Care givers require support from the health, social, financial and legal systems.

People with dementia are frequently denied the basic rights and freedoms available to others. For example, physical and chemical restraints are used extensively in aged-care facilities and acute-care settings.

Improving the awareness and understanding of dementia across all levels of society is needed to decrease discrimination and to improve the quality of life for people with dementia and their caregivers.

More research is needed to develop new and more effective treatments and to better understand the causes of dementia. Research that identifies the modifiable risk factors of dementia is still scarce.

Higher dementia risk linked to more use of common drugs
World Health Organization


Friday, May 23, 2014

Mental Illness Can Have More Impact on Life Expectancy Than Smoking

According to researchers at Oxford University, mental illness has an effect on life expectancy that is equivalent or greater than smoking. A great deal of effort and spending has been invested into smoking cessation programs and smoking awareness campaigns. This new research should prompt the government, health care and social services to shift their focus in an effort to increase life expectancy for those living with mental illness.

Researchers reviewed 20 review papers from clinical studies that reported mortality risk among mental health problems, substance and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioral disorders. These studies included over 1.7 million individuals and over 250,000 deaths. They also used studies and reviews that reported life expectancy and risk of dying by suicide. All results were compared to data for heavy smoking.

According to their findings, “one in four people in the UK will experience some kind of mental health problem in the course of a year” while smokers consist of roughly 21% of British men and 19% of women. 

They discovered that all diagnoses studied had an increased mortality risk similar or greater than heavy smoking. Some of the estimated reductions in life expectancy were found to be as follows:
  • Bipolar Disorder: 9 - 20 years
  • Schizophrenia: 10 – 20 years
  • Drug and Alcohol Abuse: 9 - 24 years
  • Recurrent Depression: 7 - 11 years
  • Heavy smoking: 8 - 10 years
Dr. Seena Fazel of the Department of Psychiatry at Oxford University said: "We found that many mental health diagnoses are associated with a drop in life expectancy as great as that associated with smoking 20 or more cigarettes a day."
Despite the fact that this study did not mention the prevalence of smoking among persons with mental illness, the results are still devastating.

There may be many reasons for this phenomenon. For example:
  • Psychiatric patients and those with drug and/or alcohol dependence can be more likely to engage in high-risk behaviours.
  • Physical health problems may not be taken seriously and treated properly due to the stigma attached to their mental illness.
  • Many mental illnesses can create physical health problems and/or worsen pre-existing ones.
  • People with serious mental illness may not access healthcare effectively.
  • The de-medicalization of mental illness may increase the likelihood that physical health problems go untreated or neglected.
Life expectancy may increase if only we could make mental health a priority as we have with smoking. In addition to funding and advancing research on mental illness, we should improve health and social services to ensure that persons with mental illness have better access to health care, suitable employment and supports in their community.

Many mental illnesses reduce life expectancy more than heavy smoking


Friday, January 24, 2014

Late Night Smartphone Use Affects Productivity

Research suggests that you should put away your smartphone at the end of the work day in order to be more productive the following day.

Michigan State University business scholar, Russell Johnson and colleagues discovered that workers that tried to continue working on their smartphone past 9:00 p.m. were more worn out and less engaged during the following work day.
"Smartphones are almost perfectly designed to disrupt sleep," said Johnson, MSU assistant professor of management who acknowledges keeping his smartphone at his bedside at night. "Because they keep us mentally engaged late into the evening, they make it hard to detach from work so we can relax and fall asleep."
According to research, at least 50% of U.S. adults own a smartphone.  Many of them consider their phones to be critical workforce productivity tools; however the National Sleep Foundation indicates that only 40% of Americans get enough sleep on most nights.  Likewise, much of the self-reported data suggests that the lack of sleep can be attributed to smartphone usage for work. 

To study this phenomenon, researchers asked 82 upper-level managers to complete multiple surveys daily for two weeks.  They also surveyed 161 employees daily in a variety of occupations, such as nursing, manufacturing and dentistry etc.

All workers from all occupations indicated in their surveys that smartphone use for business purposes affected their sleep and drained their energy the following work day. The study also noted that smartphones more negatively impacted workers than watching television or using laptops and tablet computers.

“In addition to keeping people mentally engaged at night, smartphones emit "blue light" that seems to be the most disruptive of all colors of light. Blue light is known to hinder melatonin, a chemical in the body that promotes sleep.”

It seems that smartphone use late at night impacts the amount and quality of sleep we get, which affects our attention and abilities the following day.  That being said, this small study may be reason enough to turn that phone off after 9:00 p.m. to see how it might benefit us physiologically and psychologically.

Nighttime Smartphone Use Zaps Workers' Energy


Thursday, January 2, 2014

Dad's Absence Affects Neurobiology of Offspring

Scientists at the Research Institute of the McGill University Health Centre (RI-MUHC) have discovered that an absent father during critical growth periods can lead to social and behavioral impairments in adults. This is the first study of its kind to correlate paternal deprivation and social attributes with physical changes in the brain.
"Although we used mice, the findings are extremely relevant to humans," says senior author Dr. Gabriella Gobbi, a researcher of the Mental Illness and Addiction Axis at the RI-MUHC and an associate professor at the Faculty of Medicine at McGill University. "We used California mice which, like in some human populations, are monogamous and raise their offspring together."
Researchers were able to control the environment in which the mice were raised, including the factors among the different groups.  As a result, mice studies may be clearer than human studies claims Francis Bambico, a former student of Dr. Gobbi at McGill and now a post-doc at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Researchers compared the social behaviour and brain structure of mice in different groups; those raised with both parents and those raised by their mothers. Findings show that mice raised by single mothers experienced abnormal social interactions and were more aggressive than those raised with both parents present. In addition, these findings were more prevalent among female mice.  Furthermore, females also experienced an increased sensitivity to amphetamine.
"The behavioral deficits we observed are consistent with human studies of children raised without a father," says Dr. Gobbi, who is also a psychiatrist at the MUHC. "These children have been shown to have an increased risk for deviant behavior and in particular, girls have been shown to be at risk for substance abuse. This suggests that these mice are a good model for understanding how these effects arise in humans."
Further studies may uncover a clearer reasoning for such findings.  Is it merely the presence of a male role model?  Could it be that two parents, regardless of gender, have more influence than one?  Could male mice be more sensitive to amphetamine if raised by fathers alone?  Many questions remain for future studies to uncover, however this research demonstrates that the role of the father and/or the presence of both parents during critical stages of growth appear to be relatively important in children's mental health development. 

Dads: How Important Are They? New Research Highlights Value of Fathers in Both Neurobiology and Behavior of Offspring