Tag: depression

One-day mental health workshop improves teenagers’ mood for six months

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Teenagers can gain long-lasting mental health benefits from CBT

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A one-day school workshop based on cognitive behavioural therapy (CBT) led to small improvements in teenagers’ mood and stress levels for at least six months, a trial has found.

The result contrasts with several other recent trials of mental health interventions for schools, which found they slightly worsened children’s well-being.

In the past decade, CBT has become one of the most common kinds of talking therapy offered to people with depression or anxiety. Unlike more open-ended kinds of talking therapy, such as psychoanalysis, CBT is structured with the aim of encouraging people to change unhelpful ways of thinking or behavioural patterns, like focusing on upsetting events or avoiding social situations.

CBT also has the most supporting evidence from randomised trials involving adults with depression, anxiety or other mental health problems. Participants usually see a therapist for 1 hour a week for two or three months.

The latest trial was designed to assess whether a one-day course could have benefits for teenagers, in this case aged 16 to 18. The workshop was offered to students who felt they were experiencing stress, worries or low mood.

Three therapists delivered the course to groups of 16 pupils. It involved teaching them about CBT and techniques for relaxation and mindfulness – brief meditative practices – and offering practical tips about time management and getting enough sleep.

In 57 schools in England, 900 pupils were randomly selected to attend one of the workshops or to use existing mental health systems, such as being directed to health services.

After the workshops, the pupils were allowed up to three further phone calls with the therapists for support.

Those who took part in the workshops saw a decline in their symptoms of depression, compared with the control group, of just over 2 points on a 67-point scale, which is classed as a small effect.

But among the one-third of participants who had the highest depression scores to begin with, those who attended the workshops saw about a 4-point reduction in symptoms on average, which is classed as a moderate impact, says Ben Carter at King’s College London. “We found an effect that was far higher than we were expecting.”

The workshops also led to small improvements across the whole group in tests for anxiety and well-being, which lasted for at least six months.

June Brown, another member of the team at King’s, says there may be several reasons why this format seems more beneficial than other mental health interventions in schools. Some previous schemes involved teachers giving training on mindfulness to whole classes, rather than using therapists and focusing on teens who really are having problems, as in this trial, she says. Mindfulness also has less supporting evidence for its use in adults than CBT.

Jack Andrews at the University of Oxford says the findings are welcome. “The trial was very well designed,” he says. “These results are very promising.”

The therapists running the workshops are part of a new initiative that began in 2018 to have mental health professionals work within English schools. They are currently operating in schools that teach about a third of pupils in England, with coverage eventually planned for all schools.

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May 15, 2024
Psychedelic toxins from toads could treat depression and anxiety

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This desert-roaming toad releases a compound with potential benefits similar to those from LSD and psilocybin

Milan Zygmunt/Shutterstock

A psychedelic compound secreted by a poisonous toad could help treat depression and anxiety, according to a study in mice.

When frightened, Colorado river toads (Incilius alvarius) release a hallucinogenic compound related to the drug DMT from glands in their skin. DMT, or dimethyltryptamine, is similar in structure and effects to psilocybin, a hallucinogen found in “magic mushrooms”. Colorado river toads live in and around the Sonoran desert spanning parts of Arizona, California and Mexico, and people seeking out the groovy effects of the substance may either lick the toads directly, or extract the venom, dry it and smoke it.

Researchers at Mount Sinai Hospital in New York investigated the potential health benefits of the toad secretions. We know that psychedelics like psilocybin can treat depression in some people, but it isn’t fully clear why this compound helps. However, it appears to interact with serotonin receptors and reset the activity of neural circuits in the brain.

Most psychedelics research has explored the drug’s effects on a particular kind of serotonin receptor called 5-HT2A. But the team behind the new study focused on a more obscure serotonin receptor called 5-HT1A, which past studies suggest interacts with the toad toxin.

The researchers chemically tweaked the toad-derived compound to solely signal the 5-HT1A receptors – which eliminated its hallucinogenic effects – and gave it to mice with signs of stress and depression. They found that mice who received the compound drank more tasty sugar water and spent more time with peers – both signs of lowered anxiety and depression. Similar effects have been seen in people receiving LSD or psilocybin treatments.

“Frankly, that’s what we hope to see,” says Audrey Warren at Mount Sinai Hospital.

Because humans share similar receptors in their brains, the compound may offer therapeutic promise in people. “It’s our hope that down the line, someone could use the findings of our study to help design novel antidepressants for humans, but that’s certainly a long way out,” says Warren.

Until then, she cautions against licking Colorado river toads or smoking the poison. Along with intense hallucinations, it can lead to anxiety, vomiting, seizures and death.

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May 8, 2024
Diet’s impact on gut bacteria offers new clues in Parkinson’s disease management
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A recent Npj Parkinson’s Disease study investigates the association between diet and gut microbiome composition in an effort to identify the functional pathways that affect patients with Parkinson’s disease (PD).

Study: Diet and the gut microbiome in patients with Parkinson’s disease. Image Credit: Chinnapong / Shutterstock.com

Diet and PD risk

PD is one of the most common neurodegenerative diseases associated with aging. Some common symptoms associated with PD include progressive motor impairment, as well as non-motor symptoms, such as gastrointestinal (GI) dysfunction, depression, constipation, and cognitive impairment. Specific non-motor symptoms may manifest decades before clinical diagnosis during its prodromal stages.

Previous studies have shown that diet plays a critical role in PD incidence and progression. For example, those who adhere to a high-quality diet measured by the alternate Mediterranean Diet Score (aMED) and Alternative Healthy Eating Index (AHEI) are at a lower risk of PD, whereas lower Healthy Eating Index (HEI) —2015 scores have been associated with chronic constipation and hyposmia in PD patients.

Previously, a correlation between cognitive impairment and low fiber intake was established. Additionally, many patients diagnosed with PD at a relatively younger age have reported greater sugar consumption habits.

Poor diet and aging modify the composition of the gut microbiome, in which the concentration of beneficial bacteria decreases and harmful bacteria increases. The gut microbiome’s inadequate synthesis of essential nutrients and elevated levels of toxins could result in neurodegeneration and neuroinflammation.

PD patients typically exhibit lower levels of putative short-chain fatty acid (SCFA)- producing bacteria, such as Coprococcus and Butyricicicoccus, as well as higher levels of Akkermansia, pro-inflammatory bacteria. Importantly, SCFAs have anti-inflammatory properties that influence the enteric nervous system, modulate inflammation in the central nervous system, and support normal microglia development.

To date, few studies have examined the role of diet in the development and progression of PD. Therefore, additional research is needed to explore this relationship and ultimately use these findings to develop suitable interventions to alleviate GI symptoms in PD.

About the study

The current study investigated the association between diet and gut microbial diversity, composition, abundance, and its predicted metagenome in PD patients. To this end, a cross-sectional analysis was performed using a subgroup of PD patients from the Parkinson’s Environment and Gene (PEG) study that recruited 832 PD patients between 2001-2007 (PEG1) and 2011-2017 (PEG2).

Patients diagnosed with PD in the last three to five years, were residents of California for at least five years, and did not have other neurological conditions or a terminal illness were recruited. Fecal samples were collected from patients who were re-contacted between 2017-2020 (PEG-Gut).

A total of 85 participants fulfilled all eligibility criteria and were considered in the current analysis. The study cohort completed the Diet History Questionnaire II (DHQ II) for dietary assessments. Diet quality was measured using the HEI-2015, with total scores ranging between zero and 100 points.

Study findings

Most of the study participants were men of European ancestry, non-smokers, overweight, and well-educated. Interestingly, most PD patients developed constipation in the lowest HEI score tertile.

Consistent with previous reports, the current study confirmed the benefits of a high-quality diet in maintaining a healthy gut in PD patients. A healthy diet leads to reduced putative pro-inflammatory bacteria, which are abundantly found in PD patients as compared to healthy individuals.

Adherence to a high-quality diet with a high HEI score increased the abundance of SCFA-producing bacteria, such as Coprococcus1, Ruminococcaceae, Butyricicoccus, NK4A214 group, Hydrogenoanaerobacterium, Romboutsia, Negativibacillus, and Ruminococcaceae UCG-003 in PD patients. These bacteria synthesize butyrate that reduces inflammation, thereby providing energy for intestinal epithelial cells and strengthening the intestinal epithelium.

Those who reported greater consumption of added sugar exhibited decreased levels of Romboutsia Butyricicoccus and Coprococcus 1. Increased levels of amyloid-producing bacteria, Klebsiella, were also observed.

PD patients often exhibit increased levels of pro-inflammatory cytokines in the serum and colon, which reflects systemic inflammation that could ultimately activate microglia. The activation of microglia is inherently associated with the progression of PD.

Mechanistically, a healthy diet decreases taurine degradation, lipopolysaccharide biosynthesis, as well as the number of circulating lipopolysaccharides and systemic inflammation in PD. A healthy diet in PD patients also increases the Ruminococcaceae family genera in the gut, which supports taurine metabolism and reduces taurine degradation.

Conclusions

The current study indicated that a healthy diet could be extremely beneficial for PD patients, as it could reduce both motor and non-motor symptoms, as well as delay disease progression. Furthermore, a healthy diet increases the levels of putative anti-inflammatory butyrate-producing bacteria and decreases putative pro-inflammatory bacteria in PD patients.

Thus, the study findings emphasize the importance of adhering to a high-quality diet from the initial diagnosis of PD, as it could help maintain a healthy microbiome and delay disease progression. Nevertheless, it should be noted that the ability to maintain a healthy diet can become increasingly difficult as the disease progresses.
Journal reference:

Kwon, D., Zhang, K., Paul, K. C., et al. (2024) Diet and the gut microbiome in patients with Parkinson’s disease. Npj Parkinson’s Disease 10(1); 1-9. doi:10.1038/s41531-024-00681-7
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April 26, 2024
Researchers identify a ‘gene module’ involved in both depression and cardiovascular disease

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Depression and cardiovascular disease (CVD) are serious concerns for public health. Approximately 280 million people worldwide have depression, while 620 million people have CVD. It has been known since the 1990s that the two diseases are somehow related. For example, people with depression run a greater risk of CVD, while effective early treatment for depression cuts the risk of subsequently developing CVD by half. Conversely, people with CVD tend to have depression as well. For these reasons, the American Heart Association (AHA) advises to monitor teenagers with depression for CVD.

What wasn’t yet known is what causes this apparent relatedness between the two diseases. Part of the answer probably lies in lifestyle factors common in patients with depression and which increase the risk of CVD, such as smoking, alcohol abuse, lack of exercise, and a poor diet. But it’s also possible that both diseases might be related at a deeper level, through shared developmental pathways.

Now, scientists have shown that depression and CVD do indeed share part of their developmental programs, having at least one functional ‘gene module’ in common. This result, published in Frontiers in Psychiatry, provides new markers for depression and CVD, and could ultimately help to find drugs to target both diseases.

“We looked at gene expression profile in the blood of people with depression and CVD and found 256 genes in a single gene module whose expression at levels higher or lower than average puts people at greater risk of both diseases,” said first author Dr Binisha H Mishra, a postdoctoral researcher at Tampere University in Finland.

The authors define a gene module as a group of genes with similar expression patterns across different conditions and hence likely to be functionally related.

Young Finns study

Mishra and colleagues studied gene expression data in the blood of 899 women and men between 34 and 49 years old who were participants in the Young Finns study, one of largest studies of cardiovascular risk factors from childhood to adulthood to date. The Young Finns study began in 1980 with a cohort of almost 4,000 children and adolescents, then between three and 18 years old, randomly selected from five cities in Finland. The health of these participants has been followed ever since.

Finland has the highest estimated incidence of mental disorders in the EU, and is the ninth-highest ranking country in the world for the prevalence of depression. In contrast, the country has a relatively low prevalence of CVD, ranking in the bottom 20% worldwide for this class of diseases.

In 2011, the researchers running the Young Finns study tested the participants for symptoms of depression with a tried-and-tested questionnaire: Beck’s depression inventory (BDI-II), whose score increases with more severe symptoms. They also tested them for the risk of developing CVD through AHA’s ‘ideal cardiovascular health’ score, on a scale from zero (highest risk) to seven (lowest risk). Mishra et al. further analyzed these data for the present study.

It’s all in the blood

In 2011, whole blood had also been taken from each participant, and Mishra and colleagues here analyzed these samples with state-of-the-art gene expression methods.

They used advanced statistics to identify 22 distinct gene modules, of which just one was associated with both a high score for depressive symptoms and a low score for cardiovascular health.

The top three genes from this gene module are known to be associated with neurodegenerative diseases, bipolar disorder, and depression. Now we have shown that they are associated with poor cardiovascular health as well.”

Dr Binisha H Mishra, Postdoctoral Researcher, Tampere University in Finland

These genes are involved in biological processes such as inflammation that are involved in pathogenesis of both depression and cardiovascular disease. This helps to explain why both diseases often occur together.

Other genes in the shared module have been shown to be involved in brain diseases such as Alzheimer’s, Parkinson’s, and Huntington’s disease.

“We can use the genes in this module as biomarkers for depression and cardiovascular disease. Ultimately, these biomarkers may facilitate the development of dual-purpose preventative strategies for both the diseases,” said Mishra.

Source:

Journal reference:

Mishra, B. H., et al. (2024) Identification of gene networks jointly associated with depressive symptoms and cardiovascular health metrics using whole blood transcriptome in the Young Finns Study. Frontiers in Psychiatry. doi.org/10.3389/fpsyt.2024.1345159.

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April 25, 2024
Statistical analysis highlights the benefits of Mediterranean Diet on emotional well-being

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In a recent study published in Nutrients, a group of researchers investigated the relationship between adherence to the Mediterranean Diet (MD), subjective well-being (SWB), and various socioeconomic factors among adults in Greece and Cyprus.

Study: Exploring the Relationship between Mediterranean Diet Adherence and Subjective Well-Being among Greek and Cypriot Adults. Image Credit: monticello/Shutterstock.com

Background

The traditional MD, recognized by the United Nations Educational, Scientific and Cultural Organization (UNESCO), emphasizes plant-based foods and minimal processing. It is linked to reduced mortality and lower rates of chronic diseases such as cardiovascular issues and diabetes.

Recent studies suggest that adherence to the MD enhances SWB, attributing better quality of life to its high antioxidant and nutrient content. However, a shift toward Western dietary patterns is noted in Mediterranean regions like Greece and Cyprus, affecting health outcomes.

Further research is needed to understand better the complex interactions between diet, cultural factors, and SWB, and to address the inconsistencies found in existing studies.

About the study

The present study employed a cross-sectional design to explore correlations among MD adherence, SWB, and socioeconomic factors in Greece and Cyprus.

Participants completed the questionnaire online, which included the 14-item Mediterranean Diet Adherence Screener (MEDAS) score for assessing diet adherence, and a series of validated questions targeting SWB and emotional states.

These included assessments of life satisfaction, anxiety, and energy levels, utilizing a combination of Likert-type scales and multiple-choice questions.

The Ethics Committee of Research at the Democritus University of Thrace and the Cyprus Bioethics Committee granted the study’s ethical approval, ensuring it follows European data protection regulations.

The questionnaire was distributed in Greece following verification of the translation’s accuracy in a pilot sample. Recruitment was achieved through mailing lists, social media, and word-of-mouth, with confidentiality and anonymity maintained throughout.

Using a snowball sampling method, data collection took place via Google Forms from April 2019 until the end of 2020, just before the coronavirus disease 2019 (COVID-19) lockdowns.

Statistical analyses were conducted using SPSS, incorporating both parametric and non-parametric tests based on the data’s distribution, adhering to a 5% significance level.

Study results

The study initially collected 965 responses, from which 29 were excluded due to non-compliance with inclusion criteria, resulting in 936 valid responses for analysis.

The data underwent normalization checks via the Shapiro-Wilk test, with results suggesting an unusual distribution for several variables. Consequently, non-parametric tests like the Mann-Whitney U test and Kruskal-Wallis one-way ANOVA were utilized.

Demographic analysis revealed that the majority of respondents from both Greece and Cyprus were female, with average ages of 35.1 and 38.7 years, respectively. Income levels were categorized into low, medium, and high groups, reflecting the economic diversity of the sample.

Most respondents held higher education degrees and were in stable relationships, with a significant proportion being employed.

Health-wise, about 23% of respondents smoked, and over 40% were classified as overweight or obese. Notably, the majority of respondents scored within the medium range for adherence to the MD.

The study further examined the impact of MD adherence levels on SWB. Different levels of MD adherence (low, medium, high) showed statistically significant associations with SWB indicators such as life satisfaction, happiness, feelings of worry, tiredness, and depression.

Higher adherence levels were linked to more positive SWB outcomes and, interestingly, to healthier body mass index (BMI) values.

Principal Component Analysis (PCA) of SWB items identified key factors such as life satisfaction, happiness, and emotional well-being, which explained a significant portion of the variance within the responses.

These factors displayed notable differences in SWB responses based on the level of MD adherence, emphasizing the diet’s potential impact on emotional states.

A more detailed analysis using the Kruskal-Wallis test highlighted significant differences in SWB across the different MD adherence groups. Higher adherence was consistently associated with better SWB outcomes.

Furthermore, lifestyle factors such as smoking status and physical activity also showed correlations with SWB. Regular physical activity and non-smoking were linked to higher SWB scores.

Conclusions

In the study, higher adherence to the MD was significantly associated with enhanced SWB, manifesting in increased happiness, life satisfaction, and reduced negative feelings like worry and depression.

The research also underscored the positive impact of lifestyle habits such as spending time with friends and family, enjoying nature, engaging in physical activities, and non-smoking on SWB.

These findings, consistent with prior research, highlight the complex interplay of diet, lifestyle, and cultural factors in influencing well-being.

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April 24, 2024
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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April 23, 2024
Variability shown across patient characteristics

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In a recent study published in the BMC Medicine, a group of researchers identified the factors influencing the variability in depression prevalence among chronic pain sufferers and developed clinical prediction models for estimating depression likelihood in this group.

Study: Variability in the prevalence of depression among adults with chronic pain: UK Biobank analysis through clinical prediction models. Image Credit: fizkes/Shutterstock.com

Background

Chronic pain is a major global disability cause, affecting over 30% of the population and often coexisting with depression, which disables roughly 5% of adults worldwide. The relationship between chronic pain and depression is well-established; each condition has the potential to worsen the other.

Despite this, the prevalence of depression among those with chronic pain is variable, with estimates ranging from 15% to 85%, influenced by differences in depression definitions, pain severity, and demographic factors such as gender, additional health conditions, and socioeconomic status.

Further research is needed to refine the understanding of the complex relationship between chronic pain and depression and to enhance the accuracy and applicability of clinical prediction models across diverse populations.

About the study

The present study utilized data from the United Kingdom (UK) Biobank. It focused on participants who completed the “online mental health self-assessment” between 2016 and 2017 and the “experience of pain” questionnaire from 2019 to 2020.

The UK Biobank’s large dataset, combined with detailed surveys on pain and mental health, provided a unique platform for exploring chronic pain and its association with depression.

The “experience of pain” questionnaire was selected over the baseline data due to its more extensive array of pain types and additional variables related to pain characteristics.

Chronic pain was defined using criteria from the International Classification of Diseases 11th Revision, categorizing it as either widespread or regional based on participant responses. This distinction was important because the nature and location of pain are significant factors in the prevalence of depression among those affected.

Additionally, the study considered multisite pain and its impact on mood disorders, integrating questions about the most bothersome pain areas and the nature of the pain (neuropathic or not).

Depression was defined using a dual approach: a professional diagnosis linked from healthcare records and self-reported symptoms through a validated short form of the Composite International Diagnostic Interview.

This method aimed to capture a comprehensive view of participants’ lifetime mental health history, which is crucial for understanding fluctuating conditions like depression.

The study also used the Patient Health Questionnaire to assess current depression among participants, adding another layer to the analysis. Statistical analyses included logistic regression models developed to estimate depression probability among chronic pain sufferers.

The models integrated a range of predictors, including demographic details, pain characteristics, and lifestyle factors, highlighting the complexity of chronic pain’s impact on mental health.

Study results

The present comprehensive analysis involved 24,405 UK Biobank participants with chronic pain. Among these individuals, 3.7% reported present depression, 32.6% had a lifetime history of depression, 21.8% exhibited subthreshold depressive symptoms throughout their lives, and 45.6% had no lifetime history of depression.

The cohort predominantly comprised white individuals (97.1%) with an average age of 64.1 years, highlighting the need to consider a variety of demographic factors in understanding depression among those with chronic pain.

For those experiencing chronic widespread pain, 45.7% reported a lifetime history of depression, with prevalence rates varying significantly from 25.0% to 66.7% based on individual characteristics.

A prediction model incorporating variables such as age, body mass index (BMI), smoking status, physical activity, and medical history showed moderate discrimination and good calibration, suggesting its utility in clinical settings. Notably, age, gender, and BMI emerged as significant predictors of a lifetime history of depression.

Similarly, among those with chronic regional pain, 30.2% had a lifetime history of depression. The model for this group included predictors like the nature of pain and regular opioid use, and it demonstrated similar levels of discrimination and calibration.

Key predictors again included age, gender, and the specific characteristics of pain, which significantly influenced depression outcomes.

The study also assessed present depression, finding that 10.5% of individuals with chronic widespread pain and 2.5% of those with chronic regional pain were currently depressed.

Different predictors were relevant for these outcomes, with smoking status, physical activity, and comorbid conditions like chronic kidney disease playing significant roles. Models developed for current depression demonstrated moderate to high levels of discrimination and good calibration, indicating their potential reliability.

Additional analyses confirmed that the prediction models were generally robust across different types of regional pain, although some categories, like stomach and chest pain, showed slightly lower predictive accuracy.

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April 23, 2024
The vital role of therapeutic alliances in psychedelic treatment

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Drug effects have dominated the national conversation about psychedelics for medical treatment, but a new study suggests that when it comes to reducing depression with psychedelic-assisted therapy, what matters most is a strong relationship between the therapist and study participant.

Researchers analyzed data from a 2021 clinical trial that found psilocybin (magic mushrooms) combined with psychotherapy in adults was effective at treating major depressive disorder.

Data included depression outcomes and participant reports about their experiences with the drugs and their connection with therapists. Results showed that the stronger the relationship between a participant and clinician – called a therapeutic alliance – the lower the depression scores were one year later.

What persisted the most was the connection between the therapeutic alliance and long-term outcomes, which indicates the importance of a strong relationship.”

Adam Levin, Study Lead Author and Psychiatry and Behavioral Health Resident, College of Medicine, The Ohio State University

Past research has consistently found that as mental health treatments changed, a trusting relationship between clients and clinicians has remained key to better outcomes, said senior author Alan Davis, associate professor and director of the Center for Psychedelic Drug Research and Education in The Ohio State University College of Social Work.

“This concept is not novel. What is novel is that very few people have explored this concept as part of psychedelic-assisted therapy,” Davis said. “This data suggests that psychedelic-assisted therapy relies heavily on the therapeutic alliance, just like any other treatment.”

The study was published recently in the journal PLOS ONE.

Twenty-four adults who participated in the trial received two doses of psilocybin and 11 hours of psychotherapy. Participants completed the therapeutic alliance questionnaire, assessing the strength of the therapist-participant relationship, three times: after eight hours of preparation therapy and one week after each psilocybin treatment.

Participants also completed questionnaires about any mystical and psychologically insightful experiences they had during the drug treatment sessions. Their depression symptoms were assessed one week, four weeks, and up to one year after the trial’s end.

The analysis showed that the overall alliance score increased over time and revealed a correlation between a higher alliance score and more acute mystical and/or psychologically insightful experiences from the drug treatment. Acute effects were linked to lower depression at the four-week point after treatment, but were not associated with better depression outcomes a year after the trial.

“The mystical experience, which is something that is most often reported as related to outcome, was not related to the depression scores at 12 months,” Davis said. “We’re not saying this means acute effects aren’t important – psychological insight was still predictive of improvement in the long term. But this does start to situate the importance and meaning of the therapeutic alliance alongside these more well-established effects that people talk about.”

That said, the analysis showed that a stronger relationship during the final therapy preparation session predicted a more mystical and psychologically insightful experience – which in turn was linked to further strengthening the therapeutic alliance.

“That’s why I think the relationship has been shown to be impactful in this analysis – because, really, the whole intervention is designed for us to establish the trust and rapport that’s needed for someone to go into an alternative consciousness safely,” Davis said.

Considering that psychedelics carry a stigma as Schedule I drugs under the Controlled Substances Act, efforts to minimize negative experiences in future studies of their therapeutic potential should be paramount – and therapy is critical to creating a supportive environment for patients, the authors said.

This study ideally will help clearly position psychedelics treatment as a psychotherapeutic intervention moving forward – rather than its primary purpose being administration of a drug, Levin said.

“This isn’t a case where we should try to fit psychedelics into the existing psychiatric paradigm – I think the paradigm should expand to include what we’re learning from psychedelics,” Levin said. “Our concern is that any effort to minimize therapeutic support could lead to safety concerns or adverse events. And what we showed in this study is evidence for the importance of the alliance in not just preventing those types of events, but also in optimizing therapeutic outcomes.”

This work was supported by the Center for Psychedelic and Consciousness Research, funded by the Steven & Alexandra Cohen Foundation, the RiverStyx Foundation and private donors. It was also supported by the Center for Psychedelic Drug Research and Education (CPDRE), funded by anonymous donors.

Additional co-authors are Rafaelle Lancelotta, Nathan Sepeda and Theodore Wagener of Ohio State, and Natalie Gukasyan, Sandeep Nayak, Frederick Barrett and Roland Griffiths of the Center for Psychedelic and Consciousness Research at Johns Hopkins University, where Davis is an affiliate.

Source:

Journal reference:

Levin, A. W., et al. (2024) The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder. PLOS ONE. doi.org/10.1371/journal.pone.0300501.

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April 23, 2024
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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April 22, 2024
Study identifies potential strategy to diminish the devastating impacts of traumatic brain injuries

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For the roughly 1.5 million Americans per year who survive a traumatic brain injury, health outcomes vary widely. Not only can these injuries lead to a loss of coordination, depression, impulsivity, and difficulty concentrating, but they come with an amplified risk for developing dementia in the future.

The glaring absence of treatments for such a widespread condition drove a team of scientists at Gladstone Institutes to uncover, on a molecular level, how traumatic brain injuries trigger neurodegeneration-;and just as importantly, how to target that process to prevent long-term damage.

“We set out to address the fundamental question of exactly what happens in the brain after injury to ignite the damaging process that destroys neurons,” says Jae Kyu Ryu, PhD, a scientific program leader in the lab of Katerina Akassoglou, PhD at Gladstone Institutes.

Most traumatic brain injuries come as a result of falls, car crashes, or violent assaults, according to the Centers for Disease Control, but many also stem from sports accidents or certain military operations such as explosions. In each case, the external force is strong enough to move the brain within the skull, causing a significant breakdown in the blood-brain barrier and allowing blood to move in.

“We knew that a specific blood protein, fibrin, was present in the brain after traumatic brain injury, but we didn’t know until now that it plays a causative role in brain damage after injury,” says Ryu, who led the study that appears in the Journal of Neuroinflammation.

Ryu and others in Akassoglou’s lab have long investigated how blood that leaks into the brain triggers neurologic diseases, essentially by hijacking the brain’s immune system and setting off a cascade of harmful, often-irreversible effects. Fibrin, a protein that normally helps blood coagulate, is the culprit.

Across many neurological diseases, toxic immune responses in the brain are triggered by blood leaks and drive neurodegeneration. Neutralizing the toxic immune responses in the brain paves the way to new therapies for neurological diseases.”

Katerina Akassoglou, senior investigator at Gladstone and director of the Center for Neurovascular Brain Immunology at Gladstone and UCSF

In diseases such as Alzheimer’s and multiple sclerosis, abnormal leaks in the protective blood-brain barrier allow fibrin to seep into areas responsible for cognitive and motor functions causing neurodegeneration. But in this case, the traumatic brain injury itself causes the blood to leak into the brain. The new study showed, for the first time, that fibrin is responsible for turning good immune cells bad, causing dangerous inflammation and unleashing toxins that kill neurons.

The Gladstone team used state-of-the-art imaging technology to study mouse brains, as well as brains from people who experienced a traumatic brain injury. They also produced three-dimensional imaging of a whole intact mouse brain, showing blood-brain barrier leaks and abundant fibrin in traumatic brain injury. In both mouse and human brains, fibrin was present together with activated immune cells.

“It became clear that fibrin is activating these immune cells,” Ryu says. “We realized that we can prevent the toxic effects if we could block fibrin, but we had to do it in a precise way.”

The team leveraged genetic tools with a specific mutation in fibrin that can block it from activating immune cells without affecting the protein’s beneficial blood-clotting abilities. This is especially critical for traumatic brain injuries, as excessive bleeding into the brain has been known to occur among patients who were taking anticoagulant medications before their injury.

Akassoglou’s lab previously developed a drug, a therapeutic monoclonal antibody, that acts only on fibrin’s inflammatory properties, without adverse effects on blood coagulation. This fibrin-targeting immunotherapy protects from multiple sclerosis and Alzheimer’s disease in mice. A humanized version of this first-in-class fibrin immunotherapy is already in Phase 1 safety clinical trials by Therini Bio.

“It’s exciting to have a therapeutic option to neutralize blood toxicity in neurologic diseases,” Ryu says. “Future studies are needed to test the effects of the fibrin immunotherapy in traumatic brain injury.”

“This study identifies a potential new strategy to diminish the devastating impacts of brain injuries,” says Lennart Mucke, MD, director of the Gladstone Institute of Neurological Disease. “Brain injuries can have profound effects on a person’s cognitive abilities, emotional health, and motor skills, touching every part of their life. It will be interesting to explore whether blocking the disease-promoting effects of fibrin can improve the outcome of brain surgeries and reduce disability when implemented after traumatic brain injuries have occurred.”

Source:

Journal reference:

Dean, T., et al. (2024). Fibrin promotes oxidative stress and neuronal loss in traumatic brain injury via innate immune activation. Journal of Neuroinflammation. doi.org/10.1186/s12974-024-03092-w.

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April 22, 2024