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  • Social media messages may sway young people’s beliefs about mental illness

    Social media messages may sway young people’s beliefs about mental illness

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    Even subtle differences in the wording of social media messages may be enough to sway young people’s beliefs about depression and anxiety and their treatment.

    In a new study, researchers found that college students were more optimistic about the possibility of successfully treating mental health problems after they read social media messages conveying what is called a “growth mindset.”

    But social media posts written with a “fixed mindset” led young people to feel that depression and anxiety were more stable and innate, and not so easy to treat.

    Growth mindset is the belief that a feature, such as mental health, can be improved with effort. A fixed mindset is the belief that a feature can’t change, no matter how hard you try.

    The results are important because young people spend a lot of time on social media and those with depression and anxiety may be encountering a lot of messages about their condition, said Whitney Whitted, lead author of the study and a doctoral student in psychology at The Ohio State University.

    “These relatively subtle messages may be influencing whether they believe they have any possibility of working through their depression and anxiety and getting better,” Whitted said.

    The study, published recently in the Journal of Clinical Psychology, involved 322 undergraduate students.

    Participants viewed a series of messages (tweets) from the social media site X, formerly Twitter. They were randomly assigned to view tweets about mental health with a growth mindset or a fixed mindset, or a control condition in which the tweets did not involve mental health at all.

    In the fixed mindset condition, the tweets portrayed mental health as a fixed condition that does not change. (For example, one tweet said, “I can’t wait for my seasonal depression to be over so that I can get back to my regular depression.”)

    Participants in the growth mindset condition read tweets that emphasized the fluid nature of mental health and the ability to recover from and take control of mental illness. (In one tweet, the user captioned “I got this” to a meme that read “telling those anxious thoughts who’s really in control.”)

    After reading the tweets, participants completed a survey assessing their beliefs about how long depression and anxiety normally last and whether they ever go away; the effectiveness of treatment for depression and anxiety; and beliefs about how much control people have in recovering from mental illness.

    Results showed that participants who read the growth mindset tweets were more likely than others to say depression and anxiety don’t have to be permanent conditions and that people can take steps to alleviate the symptoms.

    In contrast, those who read the fixed mindset tweets had less optimistic views about the permanence of mental illness and the ability of people to treat it.

    It is notable that this short intervention had an impact, said study co-author Jennifer Cheavens, professor of psychology at The Ohio State University.

    “It was just a few minutes of people reading these tweets with small variations in how the messages about mental illness were framed,” Cheavens said. “But it made a difference in what these participants reported they believed.”

    Of course, it is not known how long the changes connected to reading the social media messages will last. But the results could be encouraging for several reasons.

    For one, it suggests that growth mindset social media messages may help persuade people with depression or anxiety that it is worthwhile to seek help, the researchers said.

    It can also help with people who are already in therapy.

    We want our clients to put in the hard work necessary to overcome their problems – but they have to believe it is possible.


    This study suggests there may be ways to give them a boost, to help persuade them that working hard in therapy can pay off in the end.”


    Jennifer Cheavens, professor of psychology, The Ohio State University

    Whitted said the findings are especially important now, given how much time young people spend on social media. Participants in this study reported using social media one to three hours a day.

    “What we found is that what young adult college students view on social media has the potential to impact what they believe about mental illness,” Whitted said.

    “It is important that the messages they receive accurately reflect what we know about mental illness, especially the fact that it is treatable.”

    Other co-authors were Matthew Southward of the University of Kentucky; Kristen Howard of the Milwaukee VA Medical Center/Medical College of Wisconsin; Samantha Wick of Miami University; and Daniel Strunk of Ohio State.

    Source:

    Journal reference:

    Whitted, W. M., et al. (2024). Seeing is believing: The effect of subtle communication in social media on viewers’ beliefs about depression and anxiety symptom trajectories. Journal of Clinical Psychology. doi.org/10.1002/jclp.23647.

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  • Delving into burning issues about heart disease and much more

    Delving into burning issues about heart disease and much more

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    The hottest science in the prevention of heart disease awaits at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC). The annual congress of the European Association of Preventive Cardiology (EAPC), a branch of the ESC, takes place 25 to 27 April at the Megaron – Athens International Conference Centre, Greece. Explore the scientific programme.

    Don’t miss the late breaking science sessions for cutting-edge research in preventive cardiology, including unhealthy food and beverage trends in adolescents and the links between physical activity and smoking in children. Novel research will be presented in hundreds of scientific abstracts including data on stair climbing, insomnia, dairy products, and the potential connections between air pollution, mental health, and cardiovascular disease. Plus scientific sessions delving into burning issues about heart disease, sex, and much more…

    Patients often have insecurities after a heart event and we will discuss important questions such as when sexual activity can be resumed after a heart attack. We know that exercise helps prevent cardiovascular disease, so is sexual activity enough ‘exercise’?”

    Dr. Nicolle Kränkel, Congress Programme Committee Chair

    Hear experts examine the links between the heart and brain in a session exploring common pathways between depression and heart disease, and how patients with cardiac conditions can stop worrying.

    Dr. Kränkel said: “After a heart attack, patients are often scared and depressed. Depression and anxiety can also impact heart health. Additionally, awareness and cognition of one’s heart health play a large role in adhering to a healthy lifestyle. There is also crosstalk between the heart and other organs. That’s why this year’s congress theme is ‘Cardiovascular risk: The heart and beyond’ – exploring how we can harness these interactions to improve heart health and overall wellbeing.”

    Other important questions that you should attend to hear the answers to:

    Heart health and the young:

    • How do energy drinks affect the hearts of adolescents?
    • Is doping dangerous for the heart? Find out in a session dedicated to stimulants and their effects on the heart.
    • What is the impact of e-cigarettes on young hearts?

    Lifestyle issues:

    • Weight loss update: different approaches to weight loss are needed from childhood to old age – hear how one size does not fit all. And it’s not only about losing fat: learn about personalising exercise in obese patients.
    • What’s new in smoking cessation, including digital tools?
    • Can heart healthy diets be affordable? And the latest evidence on demographic and socio-economic disparities in nutrition. Check out nutrition for a better heart.

    And finally, could a vaccine prevent heart disease? Get up-to-the-minute scientific evidence on immunity and cardiovascular risk and what’s on the horizon.

    Source:

    European Society of Cardiology (ESC)

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  • Korean fermented food Doenjang shows promise in alleviating menopausal symptoms

    Korean fermented food Doenjang shows promise in alleviating menopausal symptoms

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    In a recent study published in the journal Nutrients, researchers compare the efficacy between traditional and commercial Doenjang in alleviating menopausal syndrome.

    Study: Evaluation of menopausal syndrome relief and anti-obesity efficacy of the Korean fermented food doenjang: a randomized, double-blind clinical trial. Image Credit: mino choi / Shutterstock.com

    Treating menopause

    Menopause leads to hormonal changes that may cause psychological and physical symptoms like hot flashes, sleep disturbances, insomnia, sweating, atrophy of the genitourinary system, and anxiety. Menopausal symptoms are often treated with hormone replacement therapy (HRT), primarily progesterone and estrogen.

    Soy consumption, especially in Asian countries, is associated with lower rates of menopausal symptoms, thereby offering a natural substitute for HRT when it may be contraindicated or otherwise undesirable due to possible side effects such as breast cancer or cardiovascular disease.

    Doenjang, a form of soybean paste consumed in Korea, is rich in antioxidants and fermented with beneficial microorganisms like Bacillus subtilis, Aspergillus oryzae, Rhizopus, and Mucor. Previously, Doenjang has been identified as a potential solution for alleviating menopausal symptoms; however, careful evaluation is needed to identify formulations that may be most effective for this purpose.

    About the study

    In the current study, researchers conducted an eight-week randomized and double-blind clinical trial involving postmenopausal women with menopausal syndrome.

    The Kupperman index is a widely accepted diagnostic tool for menopausal syndrome that measures a wide range of vasomotor, urinary tract, psychoneurological, motor, digestive, and systemic symptoms. Scores below 20 indicate mild symptoms, while those between 20 and 40 signify moderate severity. Scores exceeding 40 indicate severe symptoms and scores of 60 or more denote a particularly severe manifestation of the syndrome.

    Participants received Doenjang supplementation in three forms, including high-content beneficial microorganism traditional Doenjang (HDC), low-content beneficial microorganism traditional Doenjang (LDC), and commercially available Doenjang (CD).

    Medication compliance, vital signs, and side effects were evaluated after four weeks of supplementation. Researchers collected measures of menopausal syndrome relief, including the Kupperman index, at the beginning and end of the trial, along with bioelectrical impedance analysis (BIA) results, weight, lipid profiles, serum blood markers, and inflammatory markers.

    Safety assessments included blood chemistry, hematological tests, and monitoring for side effects. Obesity indicators and inflammation markers were also assessed, as were changes in the gut microbiome analyzed through stool tests.

    Doenjang pills were prepared through a traditional fermentation process and freeze-dried for clinical trials. Statistical analysis included chi-square tests, analysis of variance (ANOVA), and paired t-tests to compare baseline and post-intervention data.

    Study findings

    A total of 56 individuals were included in the study and received HDC, LDC, or CD, none of whom reported any adverse events. Anthropometric parameters, including age, weight, and body mass index (BMI), did not differ significantly among the study participants.

    Safety assessments indicated no adverse effects on liver or kidney function, with some improvements in blood urea nitrogen (BUN), uric acid, and total protein levels in the HDC group. Doenjang was not associated with anti-obesity effects; however, its use reduced LDL cholesterol levels.

    Kupperman index scores significantly decreased in all groups following the administration of Doenjang, with improvements observed in various symptoms. Microbiome analysis showed decreased Firmicutes and increased Bacteroidetes across all groups, with beneficial bacteria increasing and harmful bacteria decreasing, particularly in the CD group.

    Short-chain fatty acid analysis indicated varied effects across groups. Overall, while Doenjang showed promise in alleviating menopausal symptoms and modifying gut microbiota, its effects on obesity and inflammation were limited.

    Conclusions

    Traditional Doenjang fermented with beneficial microorganisms was found to be superior in its ability to mitigate menopausal symptoms as compared to commercial Doenjang. Nevertheless, a significant reduction in Kupperman index scores was observed across all groups, with the most notable improvement observed in LDC recipients.

    LDL cholesterol levels decreased in both traditional Doenjang groups, thus indicating its potential cardiovascular benefits. Although Doenjang was not associated with anti-obesity or anti-inflammatory effects, its treatment positively influenced gut microbiota by increasing beneficial bacteria and reducing the levels of harmful bacteria.

    Taken together, these findings demonstrate that traditional Doenjang has the potential to effectively alleviate menopausal symptoms, particularly when considering cardiovascular health, with implications for improving intestinal health through its impact on gut microbiota.

    Some limitations of the current study include the inability to control participants’ lifestyle factors, the short study duration, and the small sample size. Thus, future studies with larger samples and longer durations to elucidate the therapeutic potential of Doenjang.

    Journal reference:

    • Han, A.L., Ryu, M.S., Yang, H., et al. (2024). Evaluation of menopausal syndrome relief and anti-obesity efficacy of the Korean fermented food doenjang: a randomized, double-blind clinical trial. Nutrients. doi:10.3390/nu16081194

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  • How cannabis gets you high and alters your perception

    How cannabis gets you high and alters your perception

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    Driving under the influence of cannabis: How high is too high?

    Driving under the influence of cannabis increases the risk of traffic accidents, but despite plenty of research into cannabis use by drivers, there is no consensus on deciding who is too high to drive

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  • Animal study suggests early Western diet exposure linked to lasting memory issues

    Animal study suggests early Western diet exposure linked to lasting memory issues

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    In a recent study published in the journal Brain, Behavior, and Immunity, researchers developed an initial-life Western diet (WD) murine model associated with long-term hippocampal (HPC) dysfunction to examine the neurobiological processes underlying these effects.

    Study: Western diet consumption impairs memory function via dysregulated hippocampus acetylcholine signalingStudy: Western diet consumption impairs memory function via dysregulated hippocampus acetylcholine signaling

    The Western diet, abundant in processed foods, saturated fat, and simple carbohydrates, has been linked to poor memory performance, particularly in hippocampus-dependent functions. The neurobiological processes underlying Western diet during development, which contribute to long-term hippocampus damage, remain unknown. WD-associated changes in HPC neuronal functions have been discovered, including synaptic plasticity alterations, decreased brain-derived neurotrophic factor (BDNF) levels, and increased neuro-inflammation markers. Disruptions in acetylcholine (ACh) signaling may contribute to long-term Western diet-associated memory impairment.

    About the study

    In the present study, researchers investigated the long-term effects of early-life Western diet intake on hippocampal episodic memory and the mediating effects of hippocampal acetylcholine signaling dysregulation on behavioral consequences.

    The study used a relevant Western diet model incorporating dietary choice (from several sugar-dense and fatty foods and drink alternatives) and macronutrients that simulate a current human WD to investigate whether the gut microbiota functionally associates with early childhood WD-induced memory deficits, possibly through alterations in HPC ACh activity.

    To depict an initial-life Western diet model in rats, the researchers adopted the ‘junk food’ cafeteria-style diet (CAF). During the juvenile and teenage periods (postnatal days 26–56), rats were fed a cafeteria-style diet (with ad libitum intake of high-fat and high-sugar items; CAF) or regular chow (CTL). The researchers conducted metabolic and behavioral evaluations before and following a healthy eating intervention that began in early adulthood. They provided control rats (CTL) with the same amount of food and beverage receptacles but filled them with regular chow.

    The team monitored body weight and food intake three times a week. They estimated the total kilocalorie content ingested from each CAF diet component by multiplying food and drink weights for every rodent by the component’s energy density. They computed kilocalorie consumption from every macronutrient for CAF-fed animals based on kilocalorie intake per CAF diet component and the macronutrient composition of each. Memory problems were sustained even after 30 days of healthy eating in the first group, and subsequent cohorts were administered Western diets until 30 days (PN 56). The researchers assessed protein indicators of acetylcholine tone in CAF and CTL rats’ dorsal HPCs (HPCd). They used novel object in context (NOIC) to evaluate HPC-dependent contextual episodic memory and novel location recognition (NLR) to assess spatial recognition memory.

    Researchers explored the role of ACh neurotransmission in the human brain (HBC) and its possible impact on memory performance. They investigated the amounts of proteins involved in ACh signaling in the HPC and conducted correlational studies between important microbial taxa and VAChT levels. They also explored changes in acute ACh signaling dynamics throughout an episodic memory challenge in CAF versus CTL rats. After a 30-day healthy dietary intervention, they measured ACh signaling using fiber photometry in vivo. The researchers also investigated whether pharmacological treatment of ACh receptor agonists may reverse long-term memory problems in CAF rodents.

    Results

    The study found that initial-life hydrocortical WD (hydrocortical WD) intake causes long-term abnormalities in hippocampus-dependent memory performance in CAF rodents, independent of a healthy dietary intervention. The researchers observed significant differences in spatial recognition memory using NLR and NOIC, indicating that initial-life Western diet intake does not result in robust discrepancies in recognizing a novel item in memory tests that did not engage the HPC.

    Early childhood WD did not affect locomotor activity indicators or anxiety, implying that chronic HPC-dependent memory deficits caused by WD are unaffected by changed anxiety-like mannerisms or locomotor activity. The researchers also detected gut microbiome changes in CAF animals, with significant variations at the genus level between CAF animals and controls. However, these early significant differences showed reversal following the healthy dietary intervention. Correlational studies between particular taxons and memory performances in the NOIC test after the initial life Western diet access duration remained significant after FDR adjustment. Bifidobacterium and Lactococcus abundances showed negative associations with NOIC-evaluated memory ability, but Lactobacillus intestinalis showed positive associations.

    Early childhood WD causes long-term decreases in the chronic HPC ACh signaling tone. Immunoblotting examinations of dorsal HPC tissue obtained during the healthy dietary intervention period indicated no variations in ChAT or AChE levels; however, CAF rats exhibited lower levels of VAChT than CTL rats. Early childhood WD alters acute ACh signaling patterns during memory testing, resulting in lower performance among CAF rats.

    The study found that early exposure to a Western diet (WD) was associated with long-term episodic memory deficits mediated by altered hippocampal acetylcholine (ACh) transmission. The α7 nicotinic receptor is a critical mediator of WD-induced memory dysfunction. The gut flora is unlikely to be involved in the long-term HPC dysfunction associated with early childhood WD. Further research is required to improve understanding of the functional relationship between abnormal HPC ACh signaling and WD-associated memory deficits among females.

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  • Study shows antipsychotic drugs increase health risks in dementia patients

    Study shows antipsychotic drugs increase health risks in dementia patients

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    In a recent British Medical Journal study, researchers assess the adverse effects associated with the use of antipsychotic drugs in people with dementia.

    Study: Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. Image Credit: Fahroni / Shutterstock.com

    The role of antipsychotics in dementia management

    Individuals diagnosed with dementia undergo functional disability and progressive cognitive decline. Some common psychological and behavioral symptoms of dementia include anxiety, depression, apathy, aggression, delirium, irritability, and psychosis.

    To manage psychological and behavioral symptoms of dementia, patients are commonly treated with antipsychotics. The United Kingdom National Institute for Health and Care Excellence currently recommends the use of antipsychotics only when non-drug interventions are ineffective in alleviating behavioral and psychological symptoms of dementia. However, there has been an increase in antipsychotic use during the recent coronavirus disease 2019 (COVID-19) pandemic, which has been attributed to lockdown measures and the unavailability of non-pharmaceutical treatments.

    In the U.K., risperidone and haloperidol are the only antipsychotics that have received approval for the treatment of behavioral or psychological symptoms of dementia. In 2003, the United States Food and Drug Administration (FDA) highlighted the risks, such as stroke, transient ischaemic attack, and mortality, associated with the use of risperidone in older adults with dementia. 

    Based on multiple study reports, regulatory guidelines have been formulated in the U.K., U.S., and Europe to reduce inappropriate prescriptions of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia. To date, few studies have provided evidence of the association between antipsychotic drug prescriptions in older adults with dementia and risks of multiple diseases, such as myocardial infarction, venous thromboembolism, ventricular arrhythmia, and acute kidney injury.

    About the study

    The current study investigated the risk of adverse outcomes associated with antipsychotics in a large cohort of adults with dementia. Some adverse outcomes considered in this study were venous thromboembolism, stroke, heart failure, ventricular arrhythmia, fracture, myocardial infarction, pneumonia, and acute kidney injury.

    Over 98% of the U.K. population is registered with National Health Service (NHS) primary care general practice. All relevant data were collected from the electronic health records held at the Clinical Practice Research Datalink (CPRD), which is associated with over 2,000 general practices. CPRD comprises the Aurum and GOLD databases, which can be considered as broadly representative of the U.K. population.

    Individuals above 50 years of age and diagnosed with dementia were recruited. Importantly, none of the study participants were under antipsychotic intervention one year before their diagnosis.

    The researchers utilized a matched cohort design, in which each patient who used antipsychotics after their initial dementia diagnosis was matched using the incidence density sampling method. This method considered up to 15 randomly selected patients who were diagnosed with dementia on the same date but were not prescribed antipsychotic drugs.

    Antipsychotics increase the risk of adverse effects in dementia patients

    Across the two cohorts, the mean age of the participants was 82.1 years. A total of 35,339 participants were prescribed an antipsychotic during the study period.

    The mean number of days between the first diagnosis of dementia and the date of a first antipsychotic prescription was 693.8 and 576.6 days for Aurum and GOLD, respectively. The most commonly prescribed antipsychotics were risperidone, haloperidol, olanzapine, and quetiapine.

    The current population-based study revealed that adults with dementia prescribed antipsychotics are at a greater risk of venous thromboembolism, myocardial infarction, stroke, heart failure, pneumonia, fracture, and acute kidney injury than non-users. This observation was based on analyzing 173,910 adults with dementia selected from both databases. 

    The increased risk of adverse outcomes was most prevalent among current and recent users of antipsychotic drugs. After 90 days of antipsychotic use, the risk of venous thromboembolism, pneumonia, acute kidney injury, and stroke was higher than non-users. However, antipsychotic drugs did not impact the risk of ventricular arrhythmia, appendicitis, and cholecystitis.

    As compared to the use of risperidone, haloperidol was significantly associated with an increased risk of pneumonia, fracture, and acute kidney injury. Although the adverse effects of haloperidol were higher than quetiapine, no significant differences were observed between risperidone and quetiapine for the risk of fracture, heart failure, and myocardial infarction. The risk of pneumonia, stroke, acute kidney injury, and venous thromboembolism was lower for quetiapine as compared to risperidone.

    Conclusions 

    The current study highlights how antipsychotic drugs affect older adults with dementia. The use of these drugs was associated with many serious adverse outcomes, such as stroke, acute kidney injury, pneumonia, venous thromboembolism, heart failure, and myocardial infarction.

    In the future, these risks must be considered, along with cerebrovascular events and mortality, while making regulatory decisions about the use of antipsychotic drugs for the treatment of dementia in older adults.

    Journal reference:

    • Mok, L. H. P., Carr, M. J., Guthrie, B., et al. (2024) Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ. doi:10.1136/bmj.2023.076268

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  • Esketamine after childbirth cuts risk of postnatal depression by three-quarters

    Esketamine after childbirth cuts risk of postnatal depression by three-quarters

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    In a recent study published in the British Medical Journal, researchers investigated whether low-dose esketamine delivered after labor improves post-delivery depression in women with prenatal depression.

    Study: Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial. Image Credit: christinarosepix / ShutterstockStudy: Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial. Image Credit: christinarosepix / Shutterstock

    Background

    Perinatal depression is common among women, particularly in low-income nations, and has negative consequences for both the mother and her child. Mothers with depression frequently feel anxiety, weaker connections, and lower attachment. Their kids are more likely to experience behavioral and emotional issues, as well as long-term psychological and developmental disorders. Poor physical health, a lack of social support, a low socioeconomic level, insufficient education, and a history of violent exposure are all risk factors for prenatal depression.

    Prenatal depression is a primary predictor of postnatal depression, and pharmacological therapies are occasionally required. Esketamine, a rapid-onset antidepressant, offers potential advantages for treatment-resistant depression, but its effect on women with perinatal depression is unknown. Previous studies have mainly focused on cesarean births, omitting moms who are depressed or at high risk of developing depression after delivery.

    About the study

    In the present randomized, placebo-controlled, double-blinded, controlled trial, researchers evaluated whether low-dose esketamine administered immediately after birth lowers depression in moms suffering from prenatal depression for 42 days.

    The researchers conducted the trial at five hospitals across China between June 19, 2020, and August 3, 2022. They included pregnant women aged 18 years and above with mild, moderate, or severe prenatal depression [defined as Edinburgh postnatal depression scale (EPDS] scores equal to or above 10) hospitalized for delivery. They excluded women with pre-pregnancy mood disorders, severe pregnancy complications, physical status III or higher, or contraindications to ketamine or esketamine use, such as severe cardiovascular disease, refractory hypertension, or hyperthyroidism. Exclusion criteria included American Society of Anesthesiologists (ASA) physical status III or higher.

    The researchers randomized the individuals in a 1:1 ratio to the esketamine group (0.20 mg per kg body weight) or placebo group, with drugs administered intravenously during the initial 40 minutes post-delivery while clipping the birth cord. The primary research outcomes were major depressive events after 42 days of delivery, identified using mini-international neuropsychiatric interviews.

    Secondary study outcomes included EPDS scores on days one and 42 after childbirth and the Hamilton Depression Rating Scale (HDRS) score 42 days after delivery. The researchers monitored adverse occurrences until 24 hours after delivery. They used logistic regression to determine the relative risk (RR) values. They used imputed missing primary outcome data in post-hoc sensitivity analyses.

    The researchers measured anxiety using the Zung self-rating anxiety scale, social assistance using the social support rating scale, marital satisfaction using the ENRICH (evaluation and nurturing relationship issues, communication, and happiness) scale, and agitation-sedation using the Richmond agitation-sedation scale. Maternal data included epidural analgesia acceptance, delivery style, fluid infusion, and blood loss, as well as the use of additional analgesics and sedatives. Bodyweight, sex, Apgar scores at one and five minutes after delivery, and initial destination were all recorded.

    Results

    The researchers screened 14,243 women and randomly assigned 364 to the study groups. The average participation age was 32 years. After 42 days, 12 (6.7%) esketamine recipients and 46 (25%) placebo recipients experienced a severe depressive episode (RR 0.3). After accounting for missing data, 14 (7.7%) of esketamine recipients and 46 (25%) of placebo recipients experienced severe depressive episodes (RR 0.3). The protocol analysis yielded comparable results.

    Esketamine-treated women had lower EPDS scores on day 7 and day 42 (median difference, -3). Individuals receiving esketamine also had reduced HDRS scores 42 days after delivery (mean difference, -4). Neuropsychiatric adverse event occurrence (including dizziness, diplopia, and hallucinations) was higher among individuals receiving esketamine (45%, n=82) compared to those receiving placebo 22% (n=40); however, the symptoms lasted <24 hours, with none requiring pharmacological therapy.

    Esketamine-treated women had lower EPDS scores on day seven and 42 (median difference, -3). Individuals receiving esketamine also had reduced HDRS scores 42 days after delivery (mean difference, -4). Neuropsychiatric adverse event occurrence (including dizziness, diplopia, and hallucinations) was higher among individuals receiving esketamine (45%, n=82) compared to those receiving placebo 22% (n=40); however, the symptoms lasted <24 hours, with none requiring pharmacological therapy.

    Overall, the study found that a single modest dosage of 0.2 mg/kg of esketamine administered soon after childbirth reduces major depressive events among women with prenatal depressive symptoms by almost three-quarters at 42 days postpartum. Esketamine increased the frequency of neuropsychiatric symptoms, but they were brief and lasted <24 hours, requiring no medication. The antidepressant effect of low-dose esketamine appears to continue longer in women with prenatal depression than in the overall population with depression. Further analysis is required to establish whether the reaction continues after 42 days.

    Journal reference:

    • Shuo Wang et al., Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial, BMJ 2024;385:e078218, DOI: 10.1136/bmj-2023-078218, https://www.bmj.com/content/385/bmj-2023-078218

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  • Cannabis compound d-limonene reduces anxiety-inducing effects of THC

    Cannabis compound d-limonene reduces anxiety-inducing effects of THC

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    A Johns Hopkins Medicine-led research team has added to evidence that a chemical found naturally in cannabis (also known as marijuana) can -; in the right amounts -; lessen the anxiety-inducing effects of tetrahydrocannabinol (THC), the primary psychoactive sister chemical found in cannabis. The finding has the potential to advance the medicinal use of THC, and reduce the risks of its recreational use in some people.

    The substance, called d-limonene, is one of the most abundant terpenes, or essential oils, in the cannabis plant, and has shown promise in rodent studies in reducing anxiety behaviors. However, there has been little research on d-limonene or other terpenes in humans. As a group, terpenes are responsible for the taste, aroma and color of plants.

    In a recent study, first published online April 1 in the Journal of Drug and Alcohol Dependence, investigators tested the effects of vaporized d-limonene alone and mixed with THC to examine the anxiety-reducing effects in humans. They found the addition of d-limonene significantly reduced overall ratings of feeling “anxious/nervous” and “paranoid” compared with rating the effect of THC alone.

    As cannabis legalization becomes more prevalent, its use for both medicinal and non-medicinal purposes is expanding rapidly. In recent years, selective breeding of cannabis plants has resulted in strains that contain upwards of 20% – 30% THC, compared with an average of 12% a decade ago. This may make it more difficult for users to be consistent with the amount of THC they consume on a given occasion.

    THC interacts with receptors in the brain to produce feelings of relaxation and euphoria. However, researchers say that when a user is exposed to higher-than-usual doses of THC, the drug can also trigger anxiety, fear and panic.

    People use cannabis to help reduce anxiety, depression and post-traumatic stress disorder, but since THC levels vary widely, if a person overshoots their tolerance of THC, cannabis can induce anxiety rather than relieve it. Our study demonstrates that d-limonene can modulate the effects of THC in a meaningful way and make THC more tolerable to people using it for both therapeutic and non-therapeutic purposes.”


    Ryan Vandrey, Ph.D., study senior author, professor of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine

    In the study, 20 healthy adults with a median age of 26 participated in up to 10 outpatient sessions, during which they inhaled vaporized d-limonene alone, vaporized THC alone, vaporized THC and d-limonene together, or vaporized distilled water (as a placebo).

    The study was double-blinded, meaning neither the researchers nor participants knew who was receiving which mixture. Twenty participants completed nine test sessions, while 12 participants also took part in an optional tenth session of THC combined with a triple-dose (15 milligrams) of d-limonene to test the extreme extent of the essential oil’s dose response curve. This was conducted after appropriate safety data were obtained from the lower doses (1 milligram and 5 milligrams).

    In all participants, the researchers measured subjective drug effects, subjective ratings of mood, vital signs (heart rate and blood pressure) and cognitive performance (measures of memory, psychomotor ability and attention) at baseline, and then an additional nine times after initial exposure over the course of each of the six-hour test sessions. They also collected blood and urine samples from each subject before, during and after each six-hour session to test for THC and d-limonene levels.

    The research team concluded that combining d-limonene with THC significantly reduced subjective indicators/reports of THC-induced anxiety in participants. These reductions were greater as the dose of d-limonene was increased.

    Additionally, they saw no interference with THC’s subjective, cognitive or physiological effects when co-administered with d-limonene, as well as no effects from d-limonene alone that differed from the placebo test.

    “This study is a first step in uncovering how we can mitigate risks of THC when used in medicine, and also is targeted at making cannabis safer for the general, non-therapeutic consumer,” says study lead author Tory Spindle, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

    The researchers plan to continue experimenting with other terpenes alone and in combination with THC to see how they interact with each other, as well as replicate the d-limonene study in larger and more diverse clinical populations. They also plan to test alternative methods of administration, such as oral ingestion.

    Along with Vandrey and Spindle, members of the study team from Johns Hopkins Medicine are George Bigelow, Lauren Pollak and C. Austin Zamarippa. Other team members are Ethan Russo at CReDO Science, and Uwe Christians, Jost Klawitter, Cristina Sempio, Touraj Shokati, Bridget Tompson and Alexandra Ward at the University of Colorado Anschutz Medical Campus. 

    Spindle has served as a consultant for Canopy Health Innovations Inc. and has received research funding from Cultivate Biologics. Vandrey has served as a consultant or received honoraria from Mira1a Therapeutics Inc., Jazz Pharmaceuticals, Charlotte’s Web, Syqe Medical Ltd. and WebMD. Russo is the founder and CEO of CReDo Science and a scientific adviser to True Terpenes.

    A patent application (PCT/US2022/014296) has been submitted by The Johns Hopkins University on behalf of Vandrey, Spindle and Russo for the use of d-limonene to reduce THC-induced anxiety, based on the data presented in this study (after the trial concluded and data were analyzed).

    Source:

    Journal reference:

    Spindle, T. R., et al. (2024). Vaporized D-Limonene Selectively Mitigates the Acute Anxiogenic Effects of Δ9-Tetrahydrocannabinol in Healthy Adults Who Intermittently Use Cannabis. Drug and Alcohol Dependence. doi.org/10.1016/j.drugalcdep.2024.111267.

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  • New review explores the key gender differences in sleep, circadian rhythms and metabolism

    New review explores the key gender differences in sleep, circadian rhythms and metabolism

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    A new review of research evidence has explored the key differences in how women and men sleep, variations in their body clocks, and how this affects their metabolism.

    Published in Sleep Medicine Reviews, the paper highlights the crucial role sex plays in understanding these factors and suggests a person’s biological sex should be considered when treating sleep, circadian rhythm and metabolic disorders.

    Differences in sleep

    The review found women rate their sleep quality lower than men’s and report more fluctuations in their quality of sleep, corresponding to changes throughout the menstrual cycle.

    Lower sleep quality is associated with anxiety and depressive disorders, which are twice as common in women as in men. Women are also more likely than men to be diagnosed with insomnia, although the reasons are not entirely clear. Recognizing and comprehending sex differences in sleep and circadian rhythms is essential for tailoring approaches and treatment strategies for sleep disorders and associated mental health conditions.”


    Dr Sarah L. Chellappa from the University of Southampton and senior author of the paper

    The paper’s authors also found women have a 25 to 50 per cent higher likelihood of developing restless legs syndrome and are up to four times as likely to develop sleep-related eating disorder, where people eat repeatedly during the night.

    Meanwhile, men are three times more likely to be diagnosed with obstructive sleep apnoea (OSA). OSA manifests differently in women and men, which might explain this disparity. OSA is associated with a heightened risk of heart failure in women, but not men. 

    Sleep lab studies found women sleep more than men, spending around 8 minutes longer in non-REM (Rapid Eye Movement) sleep, where brain activity slows down. While the time we spend in NREM declines with age, this decline is more substantial in older men. Women also entered REM sleep, characterized by high levels of brain activity and vivid dreaming, earlier than men.

    Variations in body clocks

    The team of all women researchers from the University of Southampton in the UK, and Stanford University and Harvard University in the United States, found differences between the sexes are also present in our circadian rhythms.

    They found melatonin, a hormone that helps with the timing of circadian rhythms and sleep, is secreted earlier in women than men. Core body temperature, which is at its highest before sleep and its lowest a few hours before waking, follows a similar pattern, reaching its peak earlier in women than in men.

    Corresponding to these findings, other studies suggest women’s intrinsic circadian periods are shorter than men’s by around six minutes.

    Dr Renske Lok from Stanford University, who led the review, says: “While this difference may be small, it is significant. The misalignment between the central body clock and the sleep/wake cycle is approximately five times larger in women than in men. Imagine if someone’s watch was consistently running six minutes faster or slower. Over the course of days, weeks, and months, this difference can lead to a noticeable misalignment between the internal clock and external cues, such as light and darkness.

    “Disruptions in circadian rhythms have been linked to various health problems, including sleep disorders, mood disorders and impaired cognitive function. Even minor differences in circadian periods can have significant implications for overall health and well-being.”

    Men tend to be later chronotypes, preferring to go to bed and wake up later than women. This may lead to social jet lag, where their circadian rhythm doesn’t align with social demands, like work. They also have less consistent rest-activity schedules than women on a day-to-day basis.

    Impact on metabolism

    The research team also investigated if the global increase in obesity might be partially related to people not getting enough sleep – with 30 per cent of 30- to 64-year-olds sleeping less than six hours a night in the United States, with similar numbers in Europe.

    There were big differences between how women’s and men’s brains responded to pictures of food after sleep deprivation. Brain networks associated with cognitive (decision making) and affective (emotional) processes were twice as active in women than in men. Another study found women had a 1.5 times higher activation in the limbic region (involved in emotion processing, memory formation, and behavioral regulation) in response to images of sweet food compared to men.

    Despite this difference in brain activity, men tend to overeat more than women in response to sleep loss. Another study found more fragmented sleep, taking longer to get to sleep, and spending more time in bed trying to get to sleep were only associated with more hunger in men.

    Both women and men nightshift workers are more likely to develop type 2 diabetes, but this risk is higher in men. Sixty-six percent of women nightshift workers experienced emotional eating and another study suggests they are around 1.5 times more likely to be overweight or obese compared to women working day shifts.

    The researchers also found emerging evidence on how women and men respond differently to treatments for sleep and circadian disorders. For example, weight loss was more successful in treating women with OSA than men, while women prescribed zolpidem (an insomnia medication) may require a lower dosage than men to avoid lingering sleepiness the next morning.

    Dr Chellappa added: “Most of sleep and circadian interventions are a newly emerging field with limited research on sex differences. As we understand more about how women and men sleep, differences in their circadian rhythms and how these affect their metabolism, we can move towards more precise and personalized healthcare which enhances the likelihood of positive outcomes.”

    Sex differences in sleep, circadian rhythms, and metabolism: Implications for precision medicine is published in Sleep Medicine Reviews and is available online.

    The research was funded by the Alexander Von Humboldt Foundation, the US Department of Defense and the National Institute of Health.

    Source:

    University of Southampton

    Journal reference:

    Lok, R., et al. (2024). Sex differences in sleep, circadian rhythms, and metabolism: Implications for precision medicine. Sleep Medicine Reviews. doi.org/10.1016/j.smrv.2024.101926.

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  • Study confirms the mental health benefits of weight training for older individuals

    Study confirms the mental health benefits of weight training for older individuals

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    Weight training can help reduce body fat and increase muscle strength and mass in older people, contributing to functional autonomy and avoidance of falls and injury. Furthermore, recent studies have shown that it can also benefit the mental health of older people, especially those who suffer from anxiety and depression.

    These benefits were confirmed by a study reported in the journal Psychiatry Research. The study involved a systematic review and meta-analysis of more than 200 articles on the subject. The analysis was conducted by Paolo Cunha, a postdoctoral fellow with a scholarship from FAPESP at the Albert Einstein Jewish-Brazilian Institute of Education and Research (IIEPAE) in São Paulo, Brazil. 

    “Resistance training has been shown to be one of the most effective non-pharmacological strategies for healthy aging. It promotes countless health benefits, including improvements to mental health,” Cunha said.

    The findings of the study are highly promising, he continued. Besides improvements to symptoms of anxiety and depression in the general population, weight training appears to have a more significant effect on people with a confirmed diagnosis of anxiety or depression disorder.

    “Epidemiological studies have shown that the decrease in muscle strength and mass that occurs naturally as we age may be associated with an increase in mental health problems, given the existence of various physiological mechanisms that bring about functional and structural changes and that are controlled by the brain,” Cunha said.

    Another important mental health benefit, he added, is that when weight training is done in a group, it contributes to more social interaction among those involved.

    Recommended exercises

    The investigation also pointed to the best ways of structuring one’s training to improve mental health. “How the training is done appears to influence the results achieved. The information obtained so far suggests that older people should ideally do weight training exercises three times a week, with three sets of each exercise and sessions that are not too long – six exercises would seem to be sufficient. Do less, but do it well: a short set produces better results. This is meaningful information, as we lack guidelines with specific recommendations for resistance training that focuses on mental health parameters,” Cunha said.

    While there are many possible ways to prescribe resistance training programs designed to improve the health, autonomy and quality of life for older people, most result directly or indirectly in improvements to symptoms of anxiety and depression, regardless of the intensity and volume of the exercises involved, according to Edilson Cyrino, last author of the article and principal investigator for the study. He is a professor at the State University of Londrina (UEL) and coordinates the Active Aging Longitudinal Study, a project begun in 2012 to analyze the impact of resistance training on parameters relating to the health of older women.

    Another point observed by the researchers was that the use of training machines and free weights appears to be more beneficial for mental health than exercises that involve elastic bands or calisthenics (using the weight of the person’s body), for example. 

    We don’t have statistics comparing the two kinds of training, but the analysis showed that resistance training with weights and other gear is more effective in terms of improving the mental health of older people, largely because the intensity and volume of the exercises can be more precisely controlled.”


    Paolo Cunha, postdoctoral fellow, Albert Einstein Jewish-Brazilian Institute of Education and Research (IIEPAE), São Paulo, Brazil

    In the article, the researchers note that despite the incontestable mental health benefits of weight training, important gaps remain and should be filled by further studies. “Generally speaking, most studies have involved a small number of volunteers, which hinders an understanding of how the phenomenon occurs and the main mechanisms that explain it. This research field has expanded in recent years and has ample room for more advances,” Cunha said.

    Cunha is currently conducting a project in partnership with the Research Group on Clinical Intervention and Cardiovascular Disease (GEPICARDIO) at the Albert Einstein Jewish Brazilian Hospital (HIAE) to analyze the impact of long periods of sedentarism on vascular and cognitive functions in older people.

    Source:

    São Paulo Research Foundation (FAPESP) 

    Journal reference:

    Cunha, P. M., et al. (2024). Can resistance training improve mental health outcomes in older adults? A systematic review and meta-analysis of randomized controlled trials. Psychiatry Research. doi.org/10.1016/j.psychres.2024.115746.

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