Sleep Helps Improve Memory and Creativity

It is common knowledge that sleep is an important part of healthy living, but just how important is it? We already know that sleep helps to strengthen our memories and store them in some sort of order so that they may be retrieved as needed at a later date.

Recently, the journal, Current Directions in Psychological Science, has published findings that explain how sleep is also important for the reorganization of memories. According to Jessica D. Payne of the University of Notre Dame, who co-wrote the article with Elizabeth A. Kensinger of Boston College, our brain extracts the emotional details from our memories during our slumber, while keeping the most relevant information in tact so that it may reconfigure those memories and use them to create new and creative ideas.

Payne and Kensinger study what happens to memories during sleep, and they have found that a person tends to hang on to the most emotional part of a memory. For example, if someone is shown a scene with an emotional object, such as a wrecked car, in the foreground, they're more likely to remember the emotional object than, say, the palm trees in the background -- particularly if they're tested after a night of sleep. They have also measured brain activity during sleep and found that regions of the brain involved with emotion and memory consolidation are active.

The table below displays our suggested amount of sleep that is needed at various stages in life:


So, the sleeping brain is actually quite busy. We may not realize how beneficial sleep can be for our brains. Payne says: “People who say they'll sleep when they're dead are sacrificing their ability to have good thoughts now […] we can get away with less sleep, but it has a profound effect on our cognitive abilities”.

Sweet dreams.

Sleep Makes Your Memories Stronger, and Helps With Creativity
Sleep

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Concussions Are Quite Common In Canadian Junior Hockey

The November 2010 issue of Neurosurgical Focus illustrates concern for young players in Canadian junior ice hockey as researchers have uncovered alarming data and trends regarding head injuries and concussions.

"The aftermath of a concussion can impact memory, judgment, social conduct, reflexes, speech, balance and coordination. Epidemiological studies have suggested an association between sport concussions and both immediate and later-life cognitive impairment. As such, this is a public health issue that needs to be taken more seriously by players, parents, coaches, and medical professionals," said Dr. Echlin.

Although, the issue of sports-related head injuries has been a growing concern for some time, this new study is the first to document the significance of this concern among junior hockey players.

Specifically, the Hockey Concussion Education Project (HCEP), a cohort study conducted between 2009 and 2010, researched 67 male ice-hockey players between the ages of 16 and 21 among two fourth-tier teams.

Before the hockey season began, the players were assessed with the Sideline Concussion Assessment Test (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Following these tests, players were monitored by one independent physician and one to three independent, non-physician observers, at each regular season game.

The disturbing results…

• 17 players experienced a total of 21 concussions in only 52 games.
  
  
• 5 of those 17 players suffered a second or recurrent concussion during the hockey season.
  
  
• 15 of the same 17 players admitted to having at least one concussion in the past, while 2 admitted to hiding the fact to continue playing.
  
  
• The positions most affected by concussion are: forward position (71%) and defense (29%).
  
  
• No concussions were incurred by goalies.
  
  
• The rate of concussion increases as the game progresses: first period (14%); second period (29%); and third period (57%).
  
  
• 24% of the concussions occurred in players directly involved in a fight.
  
  
• The mean clinical return-to-play duration in 15 players was 12.8 days.

These statistics suggest that more education is needed to convince players, coaches and parents alike that concussion really is a serious problem that should not be ignored. Testing and monitoring after a concussion occurs is extremely important, however more often than not, the extra attention required is more of a burden to most.

In addition, educating players on the dangers should reduce the number of unreported cases and the concealment of concussions to avoid sitting on the bench. Players need to be aware that concussions are quite common in sport and the tough guy act could have devastating results to both physical and mental abilities that could last decades.

Junior Ice Hockey Study Uncovers Alarming Concussion Rates

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Study Suggests That Light Drinking During Pregnancy Is Not Harmful

According to a study published in the Journal of Epidemiology and Community Health, light drinking during pregnancy will not harm your child's behavioural or intellectual development.

A past study found similar findings among 3 year olds, but researchers wanted to study older children in case any symptoms had been delayed in the previous research.

“They used data from the Millennium Cohort Study -- a large study tracking the long term health of children born in the UK -- drawing on a representative sample of 11,513 children born between September 2000 and January 2002.”

As in many studies, researchers relied on the mothers self-reports. When children reached 9 months of age, the mothers were questioned about their drinking habits and other social and economic factors surrounding their lives.

Their alcohol consumption was divided into categories set out by the government's National Alcohol Strategy. “The mothers were classified as teetotal; those who drank but not in pregnancy; light (1 or 2 units a week or at any one time); moderate (3 to 6 units a week or 3 to 5 at any one time); and binge/heavy (7 or more units a week or 6 at one sitting).”

Although the study relied on the mothers’ self-reports of their children’s behavior at the age of 3, a formal assessment on behavioral and intellectual development of these children was completed when they reached 5 years of age.

Results showed that just below 6% of the mothers abstained from drinking and 60% abstained from drinking for the duration of the pregnancy alone. Of the mothers that drank during pregnancy, 26% admitted to light drinking, 5.5% were considered moderate drinkers and 2.5% were classified as heavy or binge drinkers.

Findings among all groups revealed that boys were more likely to have developmental problems, behavioral issues, hyperactivity and peer issues. Girls, on the other hand, were more likely to develop emotional problems. Testing also indicated that girls scored higher in cognitive abilities than boys.

As expected, the children of heavy drinking mothers were more likely to have behavioral and emotional issues as well as problems with hyperactivity. However, the findings did not suggest any behavioral or intellectual deficiencies among children whose mothers were considered light drinkers during pregnancy.

“Children born to light drinkers were 30% less likely to have behavioural problems than children whose mothers did not drink during pregnancy. After taking account of a wide range of influential factors, these children achieved higher cognitive scores than those whose mums had abstained from alcohol while pregnant.”

In today's world, attitudes have hardened and the widespread opinion is to avoid any risks and abstain from drinking alcohol, but this study certainly questions these beliefs. Although the findings may turn our views upside-down, it would be helpful to know if these mothers were light drinkers for the entire duration of pregnancy and/or during breastfeeding before alcohol-dependent mothers are given the green light.

Light Drinking During Pregnancy: Harmful to Child's Behavioral or Intellectual Development?

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Mental Health Blog's Opinion On Technology and Mental Health

The following is an article that mentions Mental Health Blog and outlines my opinion on technology and how it relates to the mental health field.

For those interested in reading the article, please click the following link:

Medical Animation, Technology a Growing Industry

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Estrogen Levels Affect Women's Ability To Learn

Concordia University has published new research in the popular journal, Brain and Cognition, demonstrating that high levels of estrogen, such as those found during the female ovulation period, has an affect on attention and learning.

"Although estrogen is known to play a significant role in learning and memory, there has been no clear consensus on its effect," says senior author Wayne Brake, an associate professor at Concordia's Center for Studies in Behavioural Neurobiology. "Our findings, using a well-established model of learning called latent inhibition, shows conclusively that high estrogen levels inhibit the cognitive ability in female rodents."

Findings in this study resulted from experiments on the latent inhibition of rats. Latent inhibition is a term derived from Classical conditioning. It occurs when a subject takes longer to give meaning to a stimulus that had no previous significance than it would when associated with a new stimulus. It is a natural tendency to disregard or inhibit forming a memory by preventing associative learning of a stimulus with no associated consequence. It is an unconscious response and presumed to prevent sensory overload. “Latent inhibition is observed in many species, and is believed to be an integral part of learning, enabling an organism to interact successfully in an environment.”

The research team discovered that estrogen has a direct effect on the brain. In their experiment, rats were repeatedly exposed to a specific tone that had no consequence linked to it. After some exposure rats began ignoring the tone because they were used to it. The researchers then linked the tone with a different stimulus. Results showed that rats with higher levels of estrogen took much longer to form the association than rats with low levels of estrogen.

"We only observed this effect in adult female rats," says Brake. "This and our other findings indicate that estrogen directly effects the brain, perhaps by interfering with brain signaling molecules. Our study helps clear up the controversy about the effects of estrogen, the next step is to look at how this occurs."

Can't Focus? Maybe It's the Wrong Time of Month, Finds Estrogen Study on Attention and Learning
Latent inhibition

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Lest We Forget...

It estimated that as many as 70,000 people in New York could be suffering from PTSD because of the attacks on the World Trade Centre seven years ago today. Health officials have determined that more than 400,000 people were exposed to the tragedy on September 11, 2001. Recent data suggests that, of those who experienced the atrocity, 35,000 to 70,000 may have developed PTSD and 3,800 to 12,600 may have developed asthma. There are 71,437 people on the health registry who agreed to be monitored for up to 20 years since the disaster. "Half of those surveyed said they were in the dust cloud left by the collapsing towers, 70 per cent witnessed a traumatic sight – such as a plane hitting a tower or falling bodies – and 13 per cent were injured that day". Of the endless list of rescue and recovery workers, commuters, area workers, Lower Manhattan residents, and passersby, PTSD was highest among those who had sustained injuries (35%), followed by those with low-income (31%), and Hispanic (30%) respondents. Read More

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Ketamine: A Promising New Treatment For Depression

Ketamine is a fast-acting liquid anesthetic used mainly by veterinarians; it's also used in human medicine, even in children, because it doesn't depress breathing.

It's also an illegal club drug, known as "special K" or "vitamin K."

The street version is usually sold in a powder form that can be snorted or mixed into drinks, or dissolved into a liquid and injected.

It acts like LSD, causing vivid hallucinations in users and a sensation of floating outside their bodies.

Researchers at Yale University have discovered that a single dose of ketamine helps the brain to form new synaptic connections between neurons and can begin to relieve depressive symptoms in a little as 40 minutes.

In contrast, Prozac and other types of antidepressants can take anywhere from two weeks to a full month before they start to demonstrate any real results, in which benefits can only be seen in about a third of patients. This new antidepressant is now being tested in Canada with promising results.

Dr. James Kennedy, director of the neuroscience research department at the Centre for Addiction and Mental Health in Toronto states that ketamine might alleviate what has been known as a “major clinical problem”. The 2 - 4 weeks that patients await relief is a critical time where devastating outcomes, such as suicide, can occur because they begin to feel more energetic but depressive symptoms remain. Not only is there hope for those with difficult to treat depression, ketamine could actually save lives.

Earlier studies involving patients with "treatment-resistant" depression have found that those given a single dose of ketamine experience rapid and significant improvement in symptoms.

In a small study published earlier this month on patients with bipolar depression, 71 per cent of participants responded to ketamine versus six per cent who responded to placebo.

In addition to being fast-acting, studies show that relief can last for 7 – 10 days, according to professor of psychiatry and neurobiology at Yale, Ronald Duman, who calls ketamine a “magic drug”.

Duman also believes that this so-called magic drug may be able to reverse the effects of stress on the brain by repairing damaged connections between neurons caused by chronic stress.

Although ketamine may not be the ideal long-term solution for treating depression, it could certainly lead to the development of similar compounds that may produce the same effect, but can be more easily administered with less potential for abuse.

"Imagine someone who is in the ER (emergency department) and is highly suicidal. It would be a way to decrease the suicidal risk" says Dr. Pierre Blier, director of mood disorders research at the Institute of Mental Health Research and Canada Research Chair in Psychopharmacology at the Royal Ottawa Mental Health Centre, who has started using ketamine on some of his patients.

Sources:
'Magic drug' gives hope to bipolar patients - Ketamine is mainly used as an anesthetic by vets but shows promise in treating depression

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Deep Brain Stimulation May Delay Alzheimer's Disease

Researchers in Toronto, Canada have developed an experimental brain surgery that may delay the progression of Alzheimer’s disease. Six subjects with Alzheimer’s disease and an average age of 61 experienced this surgery called deep brain stimulation. The subjects continued to take their Alzheimer’s medication throughout the study.

Scientists implanted “electrodes in the brain's hippocampus, which plays a role in long-term memory. The electrical conductor acts as a pacemaker-like device in the head just beneath the skin. It is connected to a battery pack in the chest.”

Consequently, the mini-mental state exam, a cognitive test, revealed that half of the participants experienced a slow-down in the degenerative effects Alzheimer’s disease has on the brain, while the other half continued to decline in a manner typical of the disease’s progression.

While this new research has produced some promising results, deep brain stimulation is not a novel idea since it has been around for decades. For instance, Dr. Andres Lozano, a neurosurgeon at Toronto's University Health Network, experimented with its effects on Parkinson’s disease without success, unfortunately.

Although not all subjects experienced positive outcomes with this surgery, 64 year old, former city counselor from Brampton, Ontario, Robert Linton, recalled vivid memories of a day he spent fishing.

"I'm with my son," Linton recalled to reporters at Toronto Western Hospital. "I could see that muskie coming right at me as I was sitting in the chair, in Technicolor". "That's the power of touching a spot in your brain. I'm sold on it."

Currently, Lozano and his research team are recruiting roughly 50 people willing to install the stimulator. The plan is to activate half of the stimulators immediately and the other half only six months later all the while participants’ knowledge of its activation will remain unknown in order to truly test the benefits of the device.

Although, the true value of this device is not yet known, the actual retail cost if this treatment became available, would be between $15,000 and $20,000 per patient with a battery life of up to five years.

At the moment, I’m unsure whether I approve of this type of treatment. For one, results are insufficient therefore there is no real proof that the surgery will benefit enough people. Secondly, I am reminded of electroconvulsive therapy and I cannot get the image of Nurse Ratched delivering shock therapy out of my head…

Deep brain stimulation tested for Alzheimer's

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The Nose Offers New Hope For Quadriplegics

Recently, Professor Noam Sobel, electronics engineers Dr. Anton Plotkin and Aharon Weissbrod and research student Lee Sela of the Weizmann Institute's Neurobiology Department, have invented a device that could allow persons with disabilities to navigate wheelchairs or communicate simply by inhaling and exhaling through the nose. In addition, this sniffing technology could be useful in assisting health surgeons or pilots perform certain procedures as their nose could act as a third hand.

How exactly can our breaths achieve such feats? “The new system identifies changes in air pressure inside the nostrils and translates these into electrical signals.” Testing was completed with volunteers and quadriplegics and results proved to be very promising. The subjects were able to manoeuvre a wheelchair or play a computer game with as much ease and precision as with a mouse or joystick.

Sniffing is a precise motor skill that is controlled, in part, by the soft palate […] the soft palate is controlled by several nerves that connect to it directly through the braincase. This close link led Sobel and his scientific team to theorize that the ability to sniff -- that is, to control soft palate movement -- might be preserved even in the most acute cases of paralysis. Functional magnetic resonance imaging (fMRI) lent support to the idea, showing that a number of brain areas contribute to soft palate control. This imaging revealed a significant overlap between soft palate control and the language areas of the brain, hinting to the scientists that the use of sniffing to communicate might be learned intuitively.

From this theory, a device that measures changes in air pressure was created with a sensor that fits into the opening of the nostrils. Furthermore, an alternate version that diverts air into the nostrils was produced for patients on respirators. Interestingly, roughly 75% of those on respirators could control and operate the device.

Still, the most striking is that individuals with locked-in syndrome, a state in which their cognitive functions are intact but their bodies are completely paralyzed so that they are “locked” inside their bodies, were able to communicate effectively with their loved ones on account of this new invention. Finally, these patients were able to share their thoughts and feelings with their families for the first time in a very long time.

“One patient who had been locked in for seven months following a stroke learned to use the device over a period of several days, writing her first message to her family. Another, who had been locked in since a traffic accident 18 years earlier wrote that the new device was much easier to use than one based on blinking. Another ten patients, all quadriplegics, succeeded in operating a computer and writing messages through sniffing.”

Moreover, wheelchair navigation can be done effortlessly with this technology. A certain number of inhales or exhales instruct the chair to navigate in certain directions. Two successive sniffs will make the wheelchair advance forward and two exhales will reverse the chair. One inhale followed by an exhale will steer to the left, while an exhale followed by an inhale steers to the right.

Consequently, the technology has received such acclaim that four of the research subjects are still using the device to communicate. Researchers’ claim that this system is fairly inexpensive to manufacture, not to mention easy for people to learn and operate in comparison to other types of similar technology already in use. Yeda Research and Development Company are currently looking to develop and distribute the technology to the general public, therefore it may not be long until this technology is put to good use.

Invention Enables People With Disabilities Communicate and Steer a Wheelchair by Sniffing

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Does Meditation Really Improve Attention?

New research has studied the effects of Buddhist meditation on attention span when focusing on a specific task that requires a person to distinguish small differences on a computer screen.

"You wonder if the mental skills, the calmness, the peace that they express, if those things are a result of their very intensive training or if they were just very special people to begin with," says Katherine MacLean, who worked on the study as a graduate student at the University of California, Davis.

A group of 60 people were hand-picked from readers of Buddhist-themed magazines or via word of mouth. Half of the participants were selected to attend a 3 month meditation retreat in Colorado with the study’s co-author and meditation teacher/Buddhist scholar B. Alan Wallace, while the remainder awaited their retreat. Every subject had previously attended a minimum of three 5-10 day meditation retreats in the past.

At three points during the retreat, each participant took a test on a computer to measure how well they could make fine visual distinctions and sustain visual attention. They watched a screen intently as lines flashed on it; most were of the same length, but every now and then a shorter one would appear, and the volunteer had to click the mouse in response.

The assignment, which lasted about 30 minutes, was quite boring making focusing a difficult task. MacLean explains that this type of task is ideal for assessing meditation training since meditation is not about peaceful relaxation; rather it is more demanding to be so focused without distraction.

Evidently, subjects improved their ability to distinguish short lines from the long ones with more meditation training. The study suggests that this occurs because of the participants are more capable of sustaining their attention, which in turn improved their performance on the task at hand. “This improvement persisted five months after the retreat, particularly for people who continued to meditate every day.”

A few obvious questions come to mind regarding the reliability and validity of this study. How did the participants meditate? How did eyesight affect results of the study? Are results similar for participants that have no background in meditation? Have participants improved because of increased ability to focus via meditation or because they’ve practiced the same task again and again? Was the task always the same or did it vary? How did the improvements for those that continued to meditate after the retreat compare to those that did not?

Although the researchers have studied this same group of participants in many studies, this experiment is the most comprehensive study of intensive meditation to date. “Future analyses of these same volunteers will look at other mental abilities, such as how well people can regulate their emotions and their general well-being.”

Meditation Helps Increase Attention Span

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Omega-3 Supplements: A Promising New Treatment for Depression

A new study published in the Journal of Clinical Psychiatry has revealed that Omega-3 supplements can be an effective method of treating major depression in patients who do not have anxiety disorders.

At first glance, the efficacy of Omega-3 was not clearly demonstrated; however with further analysis it was clear that Omega-3 improved depressive symptoms as efficiently as those treated with antidepressants.

The experiment studied 432 male and female subjects with major depression over a period of 8 weeks, from October 2005 to January 2009. Each day of the study, half of the participants were given three capsules of OM3 Emotional Balance, a fish oil supplement which contains 1050 mg of eicosapentaenoic acid (EPA) and 150 of docosahexaenoic acid (DHA). The remaining participants took three identical capsules containing sunflower oil, which was flavored with fish oil to maintain the anonymity of the placebos. Researchers ensured a double-blind effect where neither subject nor researcher could identify either group.

“In contrast with typical clinical studies designed to assess the effectiveness of antidepressants, this study included a high proportion of patients with complex and difficult-to-treat conditions, including patients resistant to conventional antidepressant treatments and patients also suffering from an anxiety disorder. The aim was to assess the value of Omega-3 supplementation in a group of individuals more like those treated in outpatient clinics.”

Statistics show that roughly 11% of men and 16% of women in Canada are likely to suffer from major depression at some point in their lives. Currently, depression is listed as the world’s fourth leading cause of death and it is anticipated that it could be the second by the year 2020.

“Epidemiological and neurobiological studies have suggested that a relative deficit in polyunsaturated fatty acids of the Omega-3 group may predispose individuals to psychological disorders such as depression.”

Supplements are likely to be more attractive alternatives to the many patients with depression that cease pharmacotherapy after only a few months because of their fear of stigmatization or side effects. These alternatives need to be more adequately studied so that new treatments may be developed. Ideally, additional research directly comparing Omega-3 with conventional antidepressants could speed up the process toward more effective treatments for depression.

Treating Depression With Omega-3: Encouraging Results from Largest Clinical Study

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Supreme Court Ruling A Victory?

In recent news, the Supreme Court of Canada has made a historic ruling that will allow administrative tribunals to find Charter violations and resolve legal disputes using the Charter of Rights and Freedoms.

“The Canadian Charter of Rights and Freedoms is a bill of rights entrenched in the Constitution of Canada. The Charter guarantees certain political rights to Canadian citizens and civil rights of everyone in Canada from the policies and actions of all levels of government. It is designed to unify Canadians around a set of principles that embody those rights. The Charter was signed into law by Queen Elizabeth II of Canada on April 17, 1982.”

Mr. Paul Conway, who has been detained on a psychiatric ward for 27 years for sexual assault and assaulting a police officer in the 70s, asked the Ontario Review Board to release him and affirm his rights under the Charter. However, the board rejected his request because they did not have jurisdiction to rule under the Charter of Rights and Freedoms.

“The Ontario Review Board annually reviews the status of every person who has been found to be not criminally responsible or unfit to stand trial for criminal offences on account of a mental disorder. The Ontario Review Board is established under the Criminal Code of Canada. The Board is made up of judges, lawyers, psychiatrists, psychologists and public members appointed by the Lieutenant Governor in Council.”

Now, the Supreme Court ruled in favour of allowing administrative tribunals to apply the Charter in their fields of expertise. The ruling opened up the possibility for an array of litigation issues between patients and institutions that can be heard at almost any tribunal in the country. Moreover, the Charter will likely be used by many others in various circumstances, such as by prisoners to execute their rights for special privileges, by parents to dispute school policies and by employees to contest against job conditions.

“Systemically, one can speculate as to the infinite potential of far-reaching implications for the masses. This decision may protect their rights, but my own situation remains status quo. I am locked in the system. I would like to live productively and pro-actively in the community. But, for me, the beat goes on”, says Mr. Conway.

On the surface it seems that prisoners with mental illness will benefit, but many experts see this as a setback. As Kristin Taylor, a CAMH lawyer explains that this “will bring new complexities to the process.” It may take longer for cases to be heard and completed, thereby delaying the process for others. “Richard O’Reilly, a psychiatrist at London’s St. Joseph’s Health Centre, predicted that Charter issues will swamp hearings that are routinely held to consider patient consent, capacity and treatment plans.” However, all sorts of, what might appear to others, as minor Charter rights issues will likely clog up the judicial process.

In addition, June Conway-Beeby, executive director of Ontario Friends of Schizophrenics, believes that patients and their families will be negatively affected by this ruling and states: “It is a only a victory for lawyers, who – from what I have observed recently in many court cases – do not understand the reality of severe mental illnesses”.

Of course this seems like quite the victory from a legal standpoint. “David Baker, a Toronto disability-rights litigator, agreed that the ruling will be very useful at tribunals that are responsible for meting out state benefits – such as reimbursement for medical treatment outside Canada, or special education programs in public schools.”

Besides the legal ramifications this entails, where is Mr. Conway now?

“I was put in an area of high supervision and confinement,” he said. “They stopped taking me into the community. I haven’t had fresh air and sunshine for almost a year now. I feel ostracized and separated and alienated. The system hates me. The system is vindictive.”

He also plans to keep fighting the law while refusing medication as part of his treatment, which may have already freed him…

Legal victory was historic, but plaintiff remains in psychiatric ward
Canadian Charter of Rights and Freedoms
Ontario Review Board

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A Look Into The Future: Could Bone Marrow Transplant Cure OCD?

Previous research has found that mice, which are missing the Hox genes, a group of core developmental genes, groom themselves compulsively to the point of removing their own hair and leaving self-inflicted sores. Additionally, a more recent study has discovered a link between the Hoxb8 gene and behaviors similar to those found in people with obsessive compulsive spectrum disorder (OCD) and that these mice can be cured with a bone marrow transplant.

“It turns out that the Hoxb8 gene in question plays an important role in the development of immune cells known as microglia, which reside in the brain. Studies in which the researchers labeled Hoxb8 cells found that they show up in the brain exclusively in bone marrow-derived microglia. When they transplanted healthy bone marrow from control mice into the mutant animals, normal microglia made it to the animals' brains in about four weeks' time and many of the animals then stopped their incessant grooming, allowing their hair to grow back in, within three months of the procedure.”

Microglia is a type of glial cell that acts as the first and main form of active immune defense in the central nervous system. During the process of blood cellular formation, some hematopoietic stem cells, which are any cells within the bone marrow whose function is to produce blood cells, give rise to microglia. According to Mario Capecchi of Howard Hughes Medical Institute and University of Utah School of Medicine, hox genes are heavily involved in hematopoietic stem cells, which are critical for the proper number and placement of embryonic segment structures, such as legs, antennae, and eyes.

Capecchi explains that “the classic job of microglia, which outnumber neurons in the brain, is to scan the brain for problems […] When they find that something is wrong -- maybe a pathogen has invaded or there has been a stroke -- they change their shape to infiltrate the area and "clean up the mess." Amazingly, microglia can scan the whole brain in only an hour.

These cells maneuver around the brain and make stops at active neuronal synapses monitoring brain activity. From this research, Capecchi believes that microglia may also regulate neural activity and when it is unable to, as in the case of Hoxb8 mutants, pathologies like OCD-like behaviors may result. The exact way in which microglia controls brain activity is not yet known; however these findings suggest that the immune system may have a larger role in mental health disorders. Capecchi states:

"we have provided strong support for the hypothesis that the excessive pathological grooming behavior exhibited by Hoxb8 mutant mice is caused by a defect in microglia. That a behavioral deficit could be corrected by bone marrow transplantation is indeed surprising. The therapeutic implications of our study on amelioration of neurological behavioral deficits in humans have not escaped us."

Capecchi explains that a connection exists between the immune system and disorders such as depression, autism, Alzheimer's, OCD and schizophrenia, but it has never been entirely clear. This study should lead to more exciting discoveries in how microglia can affect neural activity and behavior. Perhaps our vast knowledge of the immune system could lead to more discoveries and treatments for mental illness.

Compulsive Behavior in Mice Cured by Bone Marrow Transplant
Microglia

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Older Adults May Have Higher Risks Associated With Drinking

Contrary to popular belief, risks associated with alcohol consumption do not only strike the young. “A new study by researchers at the David Geffen School of Medicine at UCLA has found that more than a third of drinkers 60 years old and older consume amounts of alcohol that are excessive or that are potentially harmful in combination with certain diseases they may have or medications they may be taking.”

Researchers studied data from 3,308 older patients from primary care clinics in and around Santa Barbara, California. However, the sample used is more likely to be white, married, well-educated with high income. In addition, findings are based on self-reports, which also weakens the validity of this study.

Despite a clear lack of generalizability and reliability, researchers have found that the risk associated with drinking in older adults who already have certain illnesses or take medications while consuming alcohol are just as numerous as those at risk from alcohol consumption alone.

The Comorbidity Alcohol Risk Evaluation Tool (CARET) was used to assess drinking habits among these older adults. Results determined whether they were considered to be at risk if they fell into any of the following categories:

• more than 2 drinks consumed on most days of the week


• one to two drinks consumed on most days in combination with other illnesses like gout, hepatitis or nausea


• one to two drinks consumed on most days in combination with medications, such as antidepressants or sedatives

The specific findings include:

• 34.7 percent (1,147) of older adults were at risk due to drinking alone or to drinking in combination with comorbidities or medications, and 19.5 percent fell into multiple risk categories.


• Of those at risk, 56.1 percent fell into at least two risk categories, and 31 percent fell into all three.


• Participants who had not graduated from high school had 2.5 times the odds of at-risk drinking as those who had completed graduate school.


• Respondents with annual household incomes between $80,000 and $100,000 had 1.5 times the odds of being at-risk as those with incomes under $30,000.


• Respondents who were 80 or older had half the odds of at-risk drinking as those between the ages of 60 and 64.


• Asians had less than half the odds of at-risk drinking as Caucasians.

Results must be taken with a grain of salt when applying them to the general population as a 62-year-old married white male with a high annual household income cannot compare to an 85-year-old widowed Asian female with a low an annual income. The study also makes no mention of drinking habits prior to older age.

Regardless of the various inconsistencies, results do suggest that Physicians may need to pay more attention to the drinking habits of certain older adults and any possible interactions that may exist between alcohol consumption and other illnesses or medications since this study has shown that as many as one in three older adults in this study’s sample that continue to drink into older adulthood are more at risk.

High Rates of at-Risk Drinking Among Elderly Adults, Study Finds

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Antidepressants Could Reduce the Effects of Stroke

The Buck Institute for Age Research has been studying the possibility that antidepressants and mood stabilizers, like lithium for example, could have positive effects on stroke victims. The growth of new neurons has been known to diminish the effects of a stroke as well as dramatically improve impaired functions after a stroke, while those types of medications have been found to encourage neurogenesis in rodents.

"What this study shows more convincingly than in the past is that the production of new neurons after stroke is beneficial in rodents," said Buck faculty member and senior author David Greenberg, MD, PhD. "Assuming that neurogenesis is also beneficial in humans, drugs approved by the FDA for other purposes and already shown to promote new neuron growth in rodents might be worth studying as a potential treatment for stroke in humans. For example, antidepressants are often used to treat post-stroke depression, but their potential for improving outcome from stroke itself is less certain."

Researchers compared the size of a stroke and the recovery from stroke in genetically altered mice that either had the ability to grow new neurons or not. It was discovered that mice without the ability to grow new neurons suffered strokes 30% larger; whereas the mice with the ability to grow new neurons showed dramatic improvement of motor functions following a stroke.

Although this new research sounds very exciting, Greenberg cautions that people should not attempt to treat themselves until clear evidence is made official as testing has not been rigorous enough to determine if negative effects exist or whether these positive effects can be seen in humans. Testing these medications that stimulate the growth of neurons could lead to other exciting discoveries for many other age-related disorders, such as Alzheimer’s, Parkinson’s and Huntington’s disease.

“Stroke is the third leading cause of death in the U.S. and is the leading cause of serious long-term disability in this country. Treatments for stroke are limited. Clot busting drugs, which have to be given within hours of the stroke, have been of great benefit to a small number of patients, but stroke is not usually diagnosed in time for them to be used.”

What is a stroke?

A stroke (sometimes called a cerebrovascular accident (CVA)) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain, caused by a blocked or burst blood vessel. This can be due to ischemia (lack of glucose and oxygen supply) caused by thrombosis or embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or inability to see one side of the visual field.

What factors lead to a higher risk of stroke?

• advanced age
  
• hypertension
  
• a previous stroke or transient ischemic attack (TIA)
  
• diabetes
  
• high cholesterol
  
• cigarette smoking
  
• atrial fibrillation

What are the symptoms of stroke?

Symptoms of a stroke that affects the central nervous system include:

• hemiplegia and muscle weakness of the face
  
• numbness
  
• reduction in sensory or vibratory sensation

Generally, the symptoms affect one side of the body and the side affected is typically opposite to the affected brain area.

Symptoms of a stroke that affects the brain stem include:

• altered smell, taste, hearing, or vision
  
• drooping of eyelid and weakness of ocular muscles
  
• decreased reflexes (gag, swallow, pupil reactivity to light)
  
• decreased sensation and muscle weakness in the face
  
• balance problems and nystagmus (involuntary eye movement)
  
• altered breathing and heart rate
  
• weakness in sternocleidomastoid muscle with an inability to turn the head to one side
  
• weakness in tongue (inability to protrude and/or move from side to side)

Symptoms of a stroke that affects the cerebral cortex include:

• aphasia (inability to speak or understand language from involvement of Broca's or Wernicke's area)
  
• apraxia (altered voluntary movements)
  
• visual field defect
  
• memory deficits (with damage to the temporal lobe)
  
• hemineglect (a deficit in attention to and awareness of one side of space is observed when there is damage to the parietal lobe)
  
• disorganized thinking, confusion, hypersexual gestures (with damage to the frontal lobe)
  
• anosognosia (persistent denial of the existence of a, usually stroke-related, deficit)

Symptoms of a stroke that affects the cerebellum include:

• trouble walking
  
• altered movement coordination
  
• vertigo and or disequilibrium

What are the long-term effects?

Disability affects 75% of stroke survivors enough to decrease their employability. Stroke can affect patients physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion. Dysfunctions correspond to areas in the brain that have been damaged.

Some of the physical disabilities that can result from stroke include:

• paralysis
  
• numbness
  
• pressure sores
  
• pneumonia
  
• incontinence
  
• apraxia (inability to perform learned movements)
  
• difficulties carrying out daily activities
  
• appetite loss
  
• speech loss
  
• vision loss
  
• pain
  
• coma
  
• death

Some of the mental disabilities that can result from stroke include:

• anxiety
  
• panic attacks
  
• flat affect (failure to express emotions)
  
• mania
  
• apathy
  
• psychosis
  
• depression (characterized by lethargy, irritability, sleep disturbances, lowered self esteem, and withdrawal)
  
• emotional lability (a rapid switch between emotional highs and lows and an inappropriate expression of emotions
  
• speech problems
  
• dementia
  
• attention and memory problems
  
• anosognosia (persistent denial of the existence of a, usually stroke-related, deficit)
  
• hemispatial neglect (inability to attend to anything on the side of space opposite to the damaged hemisphere)
  
• seizures

All resulting affects of stroke are dependent on the severity of brain damage.

Antidepressants as Treatment Immediately Following a Stroke?
Stroke

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Chitosan Could Heal Spinal Cord Injuries

Richard Borgens and his team from the Center for Paralysis Research at the Purdue School of Veterinary Medicine have discovered that chitosan can repair damaged nerve cell membranes. In doing so, the repaired membranes of nerve cells can re-establish the spinal cord's ability to transmit signals to the brain, thus restoring motor abilities.

“Chitosan (pronounced /ˈkaɪtɵsæn/) is a linear polysaccharide composed of randomly distributed β-(1-4)-linked D-glucosamine (deacetylated unit) and N-acetyl-D-glucosamine (acetylated unit).” It is produced commercially by deacetylation of chitin, a derivative of glucose. Chitin can be found in crabs, lobsters, shrimps, insects, squid, octopuses and cell walls of fungi to name a few.

Firstly, the researchers converted chitin to chitosan. They then isolated and compressed a segment of a guinea pig’s spinal cord. Following this, they applied chitosan and a fluorescent dye into the cells through damaged membranes. All of the neurons in the spinal cord tissue remained unstained by the dye under the microscope. While measuring the guinea pig’s brain response, it was noted that signals could not reach the brain because of the damaged spinal cord. “However, 30•min after injecting chitosan into the rodents, the signals miraculously returned to the animals' brains.” Hence, the nerve cells had been successfully repaired.

Borgens and his team also discovered that the levels of LDH leakage from the spinal cord tissue treated with chitosan were lower than those in undamaged spinal cords. “Lactate dehydrogenase catalyzes the interconversion of pyruvate and lactate with concomitant interconversion of NADH and NAD+. It converts pyruvate, the final product of glycolysis to lactate when oxygen is absent or in short supply, and it performs the reverse reaction during the cori cycle in the liver.” Understanding the function of LDH is quite complex, however, in layman’s terms, high levels of LDH are an indication of tissue breakdown or necrosis.

In addition, the researchers uncovered that the sugar repaired any damaged portions of the cell membrane, not only the compressed portion. During their studies, they also found that chitosan could likely be used to repair mitochondrial membranes. “Mitochondria have been implicated in several human diseases, including mitochondrial disorders and cardiac dysfunction, and may play a role in the aging process.” Could further research lead to developing treatments for certain genetic disorder and neurodegenerative diseases?

Chitosan
First Evidence That Chitosan Could Repair Spinal Damage
Lactate dehydrogenase
Mitochondrion

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Neuromarketing: A New Use for fMRI

It’s no surprise that before the human brain and its particularities can be fully understood that corporations will be utilizing major life-enhancing equipment for their own personal gain. Researchers at Duke University and Emory University suggest in their recent analysis that functional MRI can be used as a cost-effective marketing tool.

“Functional Magnetic Resonance Imaging (fMRI) is a type of specialized MRI scan. It measures the hemodynamic response (change in blood flow) related to neural activity in the brain or spinal cord of humans or other animals. It is one of the most recently developed forms of neuroimaging. Since the early 1990s, fMRI has come to dominate the brain mapping field due to its relatively low invasiveness, absence of radiation exposure, and relatively wide availability.”

“So-called "neuromarketing" takes the tools of modern brain science, like the functional MRI, and applies them to the somewhat abstract likes and dislikes of customer decision-making. Though this raises the specter of marketers being able to read people's minds (more than they already do), neuromarketing may prove to be an affordable way for marketers to gather information that was previously unobtainable, or that consumers themselves may not even be fully aware of, says Dan Ariely, the James B. Duke professor of psychology and behavioral economics at Duke.”

In essence, the results from the study of brain scans that boost sales for materialistic items like food and cars is viewed as more valuable than the understanding of mental illness. Evidently, many people view this as a misuse or abuse of valuable medical resources in an attempt at controlling society.

There is no need to describe the obvious ethical issues involved in such techniques that allows marketers to peek into the brains of their consumers, but considerations must be given to consumers’ awareness, consent, and understanding of what could be an invasion of privacy. Moreover, how could toy companies employ such a method?

Despite these concerns, this type of marketing technique could actually do some good by reducing the number of advertisements that use shock tactics and sexual imagery as main selling points for their products. In addition, companies might actually improve their products to meet consumer expectancy.

Obviously the main function of this technique is not to increase scientific knowledge, but a by-product of such marketing tools could lead to a better understanding of how the human brain creates, stores, recalls and relates information. Furthermore, side-effects of such studies could also mean healthier advertising, for instance, reducing negative influences that lead to over-consumption.

If this is where advertising is going, we can only hope that companies will employ professionals to interpret the brain scans as images must be carefully interpreted by individuals with extensive training since misinterpretation could have serious consequences, even for companies promoting their products.

“Neuromarketing may never be cheap enough to replace focus groups and other methods used to assess existing products and advertising, but it could have real promise in gauging the conscious and unconscious reactions of consumers in the design phase of such varied products as "food, entertainment, buildings and political candidates," Ariely says.”

Nonetheless, there could never be enough benefits from this type of marketing to hold more value than the fMRI’s initial intent, in my opinion.

Brain Scans Could Be Marketing Tool of the Future
Functional magnetic resonance imaging
What is ‘neuromarketing’? A discussion and agenda for future research

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Paxil Reduces Benefits of Cancer Treating Drugs

A study in the British Medical Journal found that paroxetine, better known as paxil, decreases the benefits of the cancer treating drug tamoxifen. In addition, they found an increased risk of death in breast cancer patients the longer both drugs were taken concurrently.

Tamoxifen is a popular breast cancer treatment that can be taken for up to five years to prevent a recurrence. Conversely, paroxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant that is typically used to treat major depression, obsessive-compulsive, panic,social anxiety, and generalized anxiety.

Paroxetine has revealed promise for easing the hot flashes that can occur after cancer treatment. However, this anti-depressant has been known to have side effects such as nausea, somnolence, and sexual problems. This medication is also associated with significant weight gain and adult suicide.

Researchers studied the health records of 2,430 women taking tamoxifen between the years 1993 and 2005. They discovered that roughly 25% or 630 of these women were also taking paroxetine. Of the 1,074 women that died during this period, 374 of them died from breast cancer according to Ontario's cancer registry.

“Tamoxifen is an extremely important drug for breast cancer," said Dr. David Juurlink, a co-author of the study and a scientist at the Institute for Clinical Evaluative Sciences in Toronto. Paroxetine "takes that benefit away by interfering with the body's normal handling of tamoxifen. Specifically, researchers concluded that paroxetine blocks or inhibits an enzyme called cytochrome P450 2D6, which is needed to metabolize tamoxifen into its active form.

Although the evidence suggests that this anti-depressant must be stopped, researchers caution against abruptly ceasing treatment with paroxetine because of withdrawal effects and worsening of depressive symptoms.

Interestingly, the study did not find any increased risk of death among the smaller sample of women taking tamoxifen combined with some other SSRI, such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and venlafaxine (Effexor). However, this smaller sample size may confound the study’s conclusiveness; however it does suggest that attractive alternatives exist.

Furthermore, there are always unanswered questions when it comes to research that focus on health records as several variables are unknown and uncontrolled. That being said, the slightest risk identified should be enough to stop using this medication, especially when there are equally effective substitutes.

Also, in recent news…

“In the first Paxil birth defect trial that resulted in a $2.5 million verdict against GlaxoSmithKline in October 2009, the infant, Lyam Kilker, was born with three heart defects; an atrial septal defect, a ventricular septal defect, and an interrupted aortic arch, after his mother took Paxil while pregnant.”

Antidepressant interferes with breast-cancer drug
Paroxetine
Paxil Birth Defect Trial - Battle of the Experts

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Virtual Reality Therapy Could Benefit Victims of Haiti Earthquake

Cyberpsychology is the study of the human mind and behavior in the context of human-technology interaction. Computer-mediated forms of counseling include e-mails or chats online with a therapist; however cyberpsychology is not limited to the use of internet technology as it also includes cyborgs, artificial intelligence, and virtual reality. This type of therapy can be used to treat various types of mental illness including Post Traumatic Stress Disorder.

PTSD is common in soldiers returning from combat duty, victims of sexual or physical assault and survivors of imprisonment or hostage situations. It is also common among individual that have experienced acts of terrorism, accidents or natural disasters and those diagnosed with a life-threatening illness. Conventional approaches to treat PTSD include antidepressant medication and psychotherapy; however recovery rates are far from acceptable.

“Exposure therapy has been recognized as a highly promising method for treating patients with PTSD. Rather than relying on patients' visualization skills to ‘relive’ the traumatic experience, technological strategies such as virtual reality (VR) provide a controlled environment in which patients can experience a situation or scenario while learning to cope with their emotional responses.”

When natural disasters occur relief efforts typically focus on immediate needs, such food, clothing, shelter, first aid, emotional support and family reunification. Treatment of ongoing mental health should play a vital role in the response. The implementation of this type of tool could have major benefits for mass casualty survivors.

In Haiti, for instance, individuals are experiencing major losses that will affect them for years to come. The loss of loved ones, displacement, medical injuries and material loss are all psychologically devastating. In addition, the victims of this tragedy are likely to be disturbed by memories of the trauma and experience flashbacks of mass graves and friends, neighbours and even family members burned or trapped under collapsed buildings. Furthermore, the destroyed buildings and homes, and the absence of family members will continue to serve as traumatic reminders.

“‘Empty situations’ posed by the sense of an absence of personal location, deprives the victim of a safe ‘holding environment’ so necessary for the recovery process. These secondary adversities caused by displacement function as a barrier to the effort required in ‘processing’ the trauma of personal loss.” Rebuilding the lost structure in their lives is necessary for recovery, however efforts cannot end there. Extended treatment is essential to full or near full recovery, therefore, funding should be applied to ongoing mental health treatment. Virtual reality treatment in safe clinical settings could be part of that effort.

Virtual reality treatment is not a quick fix. It consists of many sessions of gradual exposure and it is most often combined with cognitive behavioral therapy and anxiety management in order to cope with the recreation of the traumatic events. It is important to note that the virtual recreation consists only of certain aspects of the event and not the exact recreation of the event itself.

Evidently, time, money and effort of this type of approach far exceeds the efforts of distributing supplies, however success rates are far more important than quick and easy methods. Moreover, this type of therapy should really be considered for relief personnel as their mental health is also at risk from their experiences. Recovering from the effects of a natural disaster is a lengthy process and the treatment for its effects on mental health is an even lengthier one.

Posttraumatic Stress Disorder: Virtual Reality and Other Technologies Offer Hope
Cyberpsychology
The risk of PTSD following the earthquake in Haiti

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It's Not a Concussion; It's a Brain Injury

The term concussion originates from the Latin concutera, which means to shake violently or the Latin concussus, which refers to the action of striking together. It is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion are often used interchangeably.


The American Academy of Neurology Guidelines ranks the severity of a concussion into 3 grades:

Grade I - Confusion, symptoms last < 15 minutes, no loss of consciousness

Grade II - Symptoms last > 15 minutes, no loss of consciousness

Grade III - Loss of consciousness

Concussion Symptoms:

• Headache
  
• Dizziness
  
• Vomiting
  
• Nausea
  
• Lack of motor coordination
  
• Difficulty balancing
  
• Light sensitivity
  
• Seeing bright lights
  
• Blurred vision
  
• Double vision
  
• Tinnitus
  
• Convulsions
  
• Confusion
  
• Disorientation
  
• Difficulty focusing attention
  
• Loss of consciousness
  
• Post-traumatic amnesia
  
• Confusion
  
• Slurred or incoherent speech
  
• Changes in sleeping patterns
  
• Difficulty with reasoning, concentrating, and performing everyday activities
  
• Crankiness
  
• Loss of interest in favorite activities or items
  
• Tearfulness
  
• Displays of emotion that are inappropriate to the situation

**Common symptoms in children include restlessness, lethargy, and irritability.

Typically symptoms will go away without treatment. Roughly 1% of treated concussions require surgery for a brain injury. Most often plenty of rest is prescribed with a gradual return to normal activities at a pace that does not cause symptoms to worsen.

Medications may be prescribed to treat symptoms associated with the concussion, such as sleep problems and depression. Analgesics such as ibuprofen can be taken for headaches that frequently occur after a concussion, but acetaminophen is preferred to minimize the risk for complications, such as intracranial hemorrhage. Individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor as they may interfere with the healing process.

Observation to monitor for worsening condition is an important part of treatment. Unconsciousness or altered mental status, convulsions, severe, persistent headache, extremity weakness, vomiting, or new bleeding or deafness in either or both ears suggests that another visit to the doctor is needed. No conclusive evidence suggests that it is necessary to wake a patient up every few hours or not.

Symptoms usually go away entirely within three weeks, though they may persist, or complications may occur. Although the mortality rate is almost zero, repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome.

Certain factors may lengthen recovery time, such as longer periods of amnesia or loss of consciousness, substance abuse, clinical depression, poor health or additional injuries sustained and life stress. For unknown reasons, having had one concussion significantly increases a person's risk of having another. Having previously sustained a concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. The prognosis is likely to differ between adults and children; however little research has been done on concussion in the pediatric population. Concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, victims of concussion exhibited the following effects:

• A decrease in episodic memory (times, places, associated emotions, and other contextual knowledge)
• A decrease in response inhibition
• Delayed P3a/P3b waves recorded via EEG
• An increase in the cortical silence period
• Reduced muscle speed otherwise known as bradykinesia (slow movement)

In recent news, Canadian researchers suggest that the term concussion is scraped from medical terminology as doctors and parents quite often underestimate the severity of these types of injuries.

“Carol DeMatteo, an occupational therapist and associate clinical professor in the School of Rehabilitation Science at McMaster University in Hamilton, Ont., says children diagnosed with concussions are treated differently from kids with other mild brain injuries.” These children are often sent home from the hospital and returned to school much sooner than those treated for mild brain injuries.

The term mild brain injury takes on a more negative connotation that concussion, which tends to suggests that the prognosis is obviously good. Concussion should not be taken as lightly as evidence suggests people who have experience multiple concussions risk neurological damage or even Alzheimer's disease and other dementias.

Natasha Richardson’s tragic death is a perfect example of what might happen when brain injuries are not taken seriously enough. On 16 March 2009, Richardson sustained a head injury when she fell while taking a skiing lesson at the Mont Tremblant Resort in Quebec. The injury was followed by a lucid interval, when she appeared to be fine as she was able to talk and act normally. Paramedics were told they were not needed. She returned to her hotel room and about three hours later was taken to a local hospital in Sainte-Agathe-des-Monts after complaining of a headache. About 7 hours following her fall, she was transferred by ambulance to Hôpital du Sacré-Cœur, in Montreal, in critical condition. The following day she was flown to Lenox Hill Hospital in New York City, where she died on 18 March. An autopsy conducted by the New York City Medical Examiners Office on 19 March revealed the cause of death was an "epidural hematoma due to blunt impact to the head", and her death was ruled an accident. There is a lot of controversy surrounding her death as many believe it could have been prevented with proper medical care.

If the term "mild traumatic brain injury" replaced "concussion", it would help people understand that this type of injury is serious and that it is an injury to the brain, not just the head. It could also save lives and prevent more serious complications later in life.

'Concussion' underplays severity of injury: doctors
Concussion
Natasha Richardson

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Antidepressants May Increase Risk of Stroke or Death in Postmenopausal Women

“The Women's Health Initiative (WHI) of the National Institutes of Health followed more than 160,000 postmenopausal U.S. women for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.”

The researchers collected data from 136,000 participants that were not taking antidepressant medications when they first began the study. It was noted during their first follow up between one and three years later that roughly 5,500 of those women had begun taking antidepressants. “The research team compared that group's subsequent history of cardiovascular disease with that of participants who had not started taking antidepressants.”

Results showed that the women taking antidepressants had a small, but statistically significant increased risk of stroke and/or death compared to participants declaring that they were not taking antidepressants.

Lead author, Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, explains that although it is necessary to treat depression because it is a serious illness, it is equally important for older women to discuss their treatment options with their physician before committing to one because of the various risks involved.

The DSM IV defines depression as experiencing feelings of sadness, helplessness and hopelessness. It is a state of low mood and aversion to activity. Episodes of depressed mood are a core feature in various psychological disorders.

Some symptoms of depression can include:

• Anxiety
  
• Sleep disturbances
  
• never seem to be enough
  
• dullness
  
• chronic sadness never seeming to end
  
• obsessions
  
• shakiness when feeling most down
  
• mood swings

Medications used to treat depression:

Tricyclic antidepressants

• Amitriptyline
  
• Imipramine
  
• Nortriptyline
  
• Desipramine

Side effects: Fatigue, dry mouth, blurred vision, light-headedness

Selective serotonin-reuptake inhibitors (SSRI)

• Fluoxetine
  
• Fluvoxamine
  
• Sertraline
  
• Paroxetine

Side effects: Nausea, gastrointestinal upset, sleep disturbances, headache, agitation

Reversible inhibitors of monoamine oxidase:

• Moclobemide

Side effects: Insomnia, headache, constipation

5-HT2 antagonists:

• Nefazodone

Side effects: Fatigue, light-headedness, nausea, headache

Serotonin-norepinephrine reuptake inhibitors:

• Venlafaxine

Side effects: Nausea, agitation, sweating

MAOIs (monoamine oxidase inhibitors):

• Phenelzine (Nardil)
  
• Tranylcypromine (Parnate)
  
• Isocarboxazid (Marplan)
  
• Selegiline (Emsam)

Side effects: Drowsiness, Constipation, Nausea, Diarrhea, Stomach upset, Fatigue, Dry mouth, Dizziness, Low blood pressure, Light-headedness, Decreased urination, Decreased sexual function, Sleep disturbances, Muscle twitching, Weight gain, Blurred vision, Headache, Increased appetite, Restlessness, Shakiness, Trembling, Weakness, Increased sweating

“Depression is a known risk factor for cardiovascular disease and premature death, and one of the reasons that tricyclic antidepressants are used less frequently is their potential for negative effects on heart function. Selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders.”

Although no relationship was established between antidepressant use and heart disease, follow-up appointments nearly six years later indicated that participants using antidepressants had an increased risk of death and those treated with SSRIs had an increased risk of stroke.

Even though results seem frightening it seems to me that further investigation is needed as there are several problems with this study. The researchers have not distinguished whether the problem really lies within the link between antidepressants and cardiovascular disease or depression itself and cardiovascular disease. Prior studies will show that depression has risks that are just as high as those who use antidepressants in this study. If anything, the study may indicate that treatment with antidepressants could exacerbate those risks. After careful review of this study, it seems difficult to place blame on antidepressants, but more could be revealed with further investigation.

Additionally, the study does not specify whether these women were being treated for depression or for anxiety nor is there any indication that lifestyle factors such as stress, smoking or diet have been accounted for. Furthermore, the study is too group-specific; therefore it cannot suggest that results can be generalized to the other populations, such as men or premenopausal women unfortunately.

Despite the lack of concrete evidence, it seems logical that women with cardiovascular risks would benefit from exploring treatment options other than antidepressants, but in the end, for most, the benefits of antidepressants may far outweigh the costs.

Increased Risk of Death, Stroke in Postmenopausal Women Taking Antidepressants, Study Finds
Monoamine Oxidase Inhibitors
Medications for Treating Depression

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No Evidence That Ginkgo Biloba Benefits Cognition

A recent study, Ginkgo Evaluation of Memory (GEM), by Beth E. Snitz, Ph.D., of the University of Pittsburgh, demonstrates that the use of the herbal supplement Ginkgo biloba does not slow the rate of cognitive decline among older adults as construed.

“The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.”

In 2000, older adults that had normal to mild cognitive impairment were chosen and observed. The researchers placed the subjects into 3 distinct groups. Some were given a placebo over the 8 year period. Others were given either Ginkgo biloba or the placebo, where their group identity was not disclosed to the participant or the experimenter. The third group was randomly assigned to either of the groups. Double-blind studies are said to achieve greater scientific rigor than other types of research. The conclusion of this double-blind study is that Ginkgo biloba is not effective in reducing the incidence of Alzheimer dementia or dementia in general. In addition, no evidence was found to support any effects on memory, language, attention, visuospatial abilities and executive functions. Furthermore, no differences were detected through age, sex, race, education or baseline cognitive status.

Basically, no evidence was found to support the widely marketed fact that Ginkgo biloba slows the rate of cognitive decline.

What is Ginkgo Biloba?

Ginkgos are very large trees, normally reaching a height of 66–115 feet, with some specimens in China being over 50 m. The tree has an angular crown and long, somewhat erratic branches, and is usually deep rooted and resistant to wind and snow damage. A combination of resistance to disease, insect-resistant wood and the ability to form aerial roots and sprouts makes ginkgos long-lived, with some specimens claimed to be more than 2,500 years old. Extreme examples of the Ginkgo's tenacity may be seen in Hiroshima, Japan, where six trees growing between 1–2 km from the 1945 atom bomb explosion were among the few living things in the area to survive the blast. While almost all other plants and animals in the area were destroyed, the ginkgos, though charred, survived and were soon healthy again. The trees are alive to this day.

Extracts of Ginkgo leaves contain flavonoid glycosides and terpenoids and have been used pharmaceutically. Ginkgo supplements are usually taken in the range of 40–200 mg per day. Ginkgo has many alleged nootropic properties, and is mainly used as a memory and concentration enhancer, and an anti-vertigo agent. According to some studies, in a few cases, Ginkgo can significantly improve attention in healthy individuals. Allegedly, the effect is almost immediate and reaches its peak in 2.5 hours after intake.

Ginkgo has been used for…

• Alzheimer's disease
  
• Improving blood flow
  
• Protecting against oxidative cell damage
  
• Blocking the effects of platelet-activating factor (platelet aggregation, blood clotting)
  
• Intermittent claudication
  
• Easing the symptoms of tinnitus
  
• Improving cognition and fatigue in those with multiple sclerosis
  
• Arresting the development of vitiligo

Ginkgo may have undesirable effects, especially for individuals with blood circulation disorders and those taking anticoagulants such as ibuprofen, aspirin, or warfarin. Ginkgo should also not be used by people who are taking certain types of antidepressants (monoamine oxidase inhibitors and selective serotonin reuptake inhibitors) or by pregnant women, without first consulting a doctor.

Side effects can include…

• possible increased risk of bleeding
  
• gastrointestinal discomfort
  
• nausea
  
• vomiting
  
• diarrhea
  
• headaches
  
• dizziness
  
• heart palpitations
  
• restlessness

Other precautions…

Ginkgo biloba leaves contain long-chain alkylphenols together with the extremely potent allergens, the urushiols (similar to poison ivy). Individuals with a history of strong allergic reactions to poison ivy, mangoes, and other urushiol-producing plants are more likely to experience an adverse reaction when consuming Ginkgo-containing pills, combinations, or extracts.

The nut-like gametophytes inside the seeds are particularly esteemed in Asia, and are a traditional Chinese food. When eaten by children, in large quantities (over 5 seeds a day), or over a long period, the raw gametophyte (meat) of the seed can cause poisoning by MPN (4-methoxypyridoxine).

Bottom line...

It is very important to remember that herbal supplements are not regulated by the FDA in the US and Canada’s regulation of such health products is quite often confusing and inconsistent. Therefore, personal responsibility is essential when relying on this type of treatment.

Ginkgo Biloba Does Not Appear to Slow Rate of Cognitive Decline

Wikipedia

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