Magic mushroom compound at least as good as antidepressant in UK study

LONDON (Reuters) – Psilocybin, the psychedelic active compound in magic mushrooms, may be at least as effective as a leading antidepressant drug and could help more patients into remission from severe depression, a small study by British scientists has found.

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The findings, in the first-of-a-kind head-to-head comparison of psilocybin therapy and the antidepressant escitalopram, suggests the psychoactive ingredient has promise as a potential mental health treatment, the researchers said.

“Remission rates were twice as high in the psilocybin group than the escitalopram group,” Robin Carhart-Harris, who designed and led the study as head of the centre for psychedelic research at Imperial College London, told a briefing.

“One of the most important aspects of this work is that people can clearly see the promise of properly delivered psilocybin therapy by viewing it compared with a more familiar, established treatment,” he said. “Psilocybin performed very favourably in this head-to-head.”

Depression is one of the leading causes of ill health worldwide, and existing treatments are often ineffective or have adverse side effects that lead patients to stop taking them.

Carhart-Harris warned that while these findings – published in the New England Journal of Medicine – were encouraging, patients with depression should not try to self-medicate with magic mushrooms. “That would be an error of judgment,” he said.

The research involved 59 patients with moderate to severe depression who got either a high dose of psilocybin and a placebo, or escitalopram plus a dose of psilocybin so low as to be classed as non-active and unlikely to have an effect.

This design was aimed at ensuring the two arms of the trial were as alike as possible for those taking part.

Treatment response, defined as a reduction of at least 50% in depression scores from baseline, was seen in 70% of people in the psilocybin group and 48% in the escitalopram group.

Results also showed that remission of symptoms – measured as a score of 0 to 5 at week six – was seen in 57% of the psilocybin group compared with 28% in the escitalopram group.

Carhart-Harris said participants’ reports suggested the psilocybin had a more “fundamental” effect than antidepressants.

“I think it’s getting more at the root causes of suffering,” he said. “There’s a kind of epistemic quality to the treatment, a revelatory quality, where people report feeling that they understand more fully why they’re depressed.”

The Imperial team, co-led by David Nutt, a professor of neuropsychopharmacology, has been exploring the potential of psilocybin for many years.

In 2016 they published a small study showing psilocybin could help ease a severe condition known as treatment-resistant depression.

The latest study was conducted under specific controlled conditions with two therapists and a regulated dose formulated in laboratory conditions, Nutt told the briefing, and taking magic mushrooms without such safeguards could be dangerous.

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Pandemic taking ‘massive toll’ as women fight depression

Denise Welch talks to depression sufferer for MHFA England

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Almost 60 percent of women feel more stressed or overwhelmed since the pandemic began, compared with 41 percent of men. The survey, commissioned by the British Association for Counselling and Psychotherapy (BACP), revealed that almost half of women (48 percent) now feel more depressed or hopeless, while only 38 percent of men feel the same way.

One in 10 women who accessed counselling services have done so for the first time in the past six months, and just over half of those said it was influenced by Covid-19.

BACP’s annual public perceptions survey was conducted as part of its Friends First campaign, which is urging meeting up as part of the “rule of six friends”.

This comes after the recent relaxing of restrictions, meaning groups of six can now meet outdoors.

The campaign also wants to help people spot the signs of deteriorating mental health and encourage loved ones to seek professional support if needed.

Some 87 percent have become more conscious of the mental health of friends and family since the pandemic and 37 percent of those who have never had counselling before said they would consider it if a friend or family member suggested it.

Lorraine Collins, a registered BACP counsellor based in London, said: “The onset of the pandemic brought a rapid emotional gear shift for women in the home that has seen a disproportionate effect on their mental health.

“Stress factors such as no longer having physical or mental space to decompress, coupled with expectations to manage everything under one roof while working and being the main care givers, has made a real impact.”

BACP’s Fiona Ballantine Dykes, a senior counsellor and supervisor, said: “While we recognise the important role that friends and family will play in the mental wellbeing of their loved ones, we are acutely aware that overcoming mental health obstacles requires professional help.

“It’s important that people try to spot the signs of where support is needed, such as someone retreating from conversations or not responding to messages.

“Equally as important is that friends do not become overwhelmed and give the wrong advice, however well meant.”

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Women experienced high rates of mental health problems early in COVID-19 pandemic

A study at the University of Chicago Medicine found U.S. women experienced increased incidence of health-related socioeconomic risks (HRSRs), such as food insecurity and interpersonal violence, early in the COVID-19 pandemic. This was associated with "alarmingly high rates" of mental health problems, including depression and anxiety. The research was published April 5 in the Journal of Women's Health.

Other studies have found evidence for higher rates of anxiety and depression and related issues, such as alcohol overuse, connected to the pandemic — but this study is the first to link early pandemic-related changes in HRSRs to mental health effects in women.

Most national surveys tend to report aggregated findings rather than stratifying by gender. Those early studies gave us snapshots of the health and behaviors of the whole population, but gave us limited insight on women. Yet, women constitute the majority of the essential workforce, including healthcare workers, and we wanted to make sure that women's experiences were being documented."

Stacy Lindau, MD, Professor of Obstetrics and Gynecology and Medicine-Geriatrics, UChicago Medicine

The researchers conducted a survey of 3,200 U.S. women over the age of 18 between April 10 and 24, 2020. More than 40% of participants reported experiencing at least one HRSR during the prior year, which included issues such as food insecurity, housing instability, difficulties with their utilities, transportation challenges and interpersonal violence; 22% reported experiencing two or more HRSRs during the year before the pandemic.

But by the first spring of the pandemic, nearly half of all women — including 29% of those who did not experience pre-pandemic HRSRs — reported new (incident) or worsening HRSRs. The greatest challenge was an increase in food insecurity. Nearly 80% of those without pre-pandemic HRSRs who reported a new HRSR became food insecure. Almost a quarter experienced interpersonal violence.

"It's incredible and concerning that nearly half of women — including more than a quarter of those who had no health-related socioeconomic risks — had experienced incident or worsening conditions," said Lindau. "It's even more striking that more than a quarter of the women who had none of these risks in January or February 2020 now had at least one by April.

That points to the likelihood that a large portion of women were already near the edge of vulnerability. When the world shut down, transportation became more difficult, food access became harder, and very soon after the crisis began, many women found themselves struggling to meet basic needs."

Those who experienced socioeconomic risks prior to the pandemic also experienced the greatest increase in insecurity. Three-quarters of women with pre-pandemic HRSRs experienced new or worsening risks during the early pandemic; 38% experienced two or more, with more than half experiencing increased food insecurity.

Significantly, the survey also found that 29% of women reported symptoms of depression and anxiety — nearly twice the estimated pre-pandemic rates. One in six women screened positive for symptoms of post-traumatic stress, a rate similar to that seen after other significant disasters, such as the SARS and Ebola epidemics. Those who experienced at least one new or worsening HRSR were at significantly higher risk of experiencing anxiety and post-traumatic stress.

"Given very high rates of these problems, we're really concerned about the current capacity of our mental health system," said co-author Marie Tobin, MD, Professor of Psychiatry at UChicago Medicine. "Women are principally responsible for parenting, family caregiving and other essential work — they are key to managing and recovering from this pandemic, and now are afflicted by very significant socioeconomic risk levels that appear to be drivers of anxiety, depression and traumatic stress. We should be especially concerned that socioeconomically vulnerable women are at high risk for developing pandemic-related psychiatric morbidity."

These results, the investigators say, should help spur healthcare providers and policy makers to address the underlying and modifiable health-related socioeconomic risk factors in order to prevent these negative outcomes.

"We can't change a person's gender, but we can act to ensure that all people have the basic nutrition and shelter they need to survive," said Lindau. "We can intervene on transportation barriers, we can pass policies to delay or offset rent or utilities payments. These are modifiable factors that can be addressed by leveraging the humanitarian resources of our communities and implementing policies that ensure everyone can live independently with their basic needs met. Ensuring equitable access to the basics would be a powerful buffer against mental illness in general and could help mitigate costly and painful mental health crisis among women and everyone who depends on us in the context of this and other public health emergencies."

Source:

University of Chicago Medical Center

Journal reference:

Lindau, S. T., et al. (2021) Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women. Journal of Women's Health. https://doi.org/10.1089/jwh.2020.8879.

Posted in: Medical Condition News | Women's Health News | Disease/Infection News

Tags: Alcohol, Anxiety, Cancer, Children, Depression, Geriatrics, Gynecology, Health Systems, Healthcare, Hospital, Medicine, Mental Health, Nutrition, Obstetrics, Pandemic, Parenting, Physiology, Psychiatry, Public Health, Research, SARS, Stress

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Brain imaging may predict treatment outcomes for adolescents with anxiety disorders

As with any complex machine, sometimes a simple crossed wire or short circuit can cause problems with how it functions. The same goes for our brains, and even when the short circuit is uncovered, sometimes experts don't have a quick fix.

A new study reveals that an evidence-based treatment may "fix" this human short circuit and, with the help of brain imaging, might predict treatment outcomes for adolescents with anxiety disorders. University of Cincinnati researchers say this could determine medication effectiveness more quickly to help patients.

Study results showed that brain imaging was able to predict — after just two weeks of treatment with almost 80% accuracy — how much a patient would improve.

We also see [through imaging] that the medication in this study increases the strength of the connection between a brain area that generates anxiety and an area that serves as a 'brain brake' for the fear center. In essence, the medication allows the brain to dampen the overactivity of fear areas, and we see this dampening very early in the course of treatment using imaging."

Jeffrey Strawn, MD, Study's Senior Author, Associate Professor and Anxiety Expert, Department of Psychiatry and Behavioral Neuroscience at UC

In this National Institutes of Health-sponsored study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers used brain imaging (MRI) to see how 41 adolescents, ages 12-17, with anxiety disorders responded to a medication called escitalopram, versus a placebo, over eight weeks. Escitalopram is a medication known as a selective serotonin reuptake inhibitor (SSRI) that is approved by the Food and Drug Administration for depression in adolescents and for both depression and anxiety in adults.

Strawn, who is also a physician at Cincinnati Children's Hospital Medical Center and UC Health, says SSRIs work by boosting the activity of serotonin in the brain. Serotonin is one of the chemical messengers that nerve cells use to communicate with one another and one that is involved in anxiety disorders. These medications block the recycling of serotonin into nerve cells, making more serotonin available to improve transmission of messages between neurons.

"These medications are an effective treatment for many adolescents with anxiety disorders. However, how much a specific patient will benefit is difficult to predict," he continues.

He says clinicians typically need six to eight weeks of the patient being on the medication in order to evaluate whether or not the treatment is going to work. "But with the brain imaging in this study, doctors could determine — after just two weeks — if they would need an alternative treatment. Knowing this early in treatment could greatly improve outcomes for patients," he adds. "This study helps clinicians understand how the medication — even early in treatment — changes brain circuits that are involved in anxiety and can help to get patients back to their normal lives more quickly."

Larger studies are needed to further test this, but the results are promising and, as Strawn notes, are really important for better treating adolescents with anxiety disorders.

"Anxiety disorders are the most common mental illnesses in the U.S., with approximately 4.4 million children and adolescents affected," he says. "These disorders are not only common in children and teens, but, if untreated, result in considerable personal and economic cost over the lifetime.

"This study uncovers a way to predict how effectively a medication will treat anxiety in kids and reveals that brain changes occur within two weeks of starting the medication. Additionally, the changes that occur in the brain can predict treatment response and improvement over time which is incredibly beneficial for physicians and can help us determine promising biomarkers for drug development. While not necessarily a quick fix, this could be a quicker fix that could help patients tremendously and improve their quality of life."

Source:

University of Cincinnati

Journal reference:

Lu, L., et al. (2021) Acute Neurofunctional Effects of Escitalopram in Pediatric Anxiety: A Double-Blind, Placebo-Controlled Trial, California. Journal of the American Academy of Child and Adolescent Psychiatry. doi.org/10.1016/j.jaac.2020.11.023.

Posted in: Child Health News | Medical Science News | Medical Research News

Tags: Adolescents, Anxiety, Brain, Children, Depression, Hospital, Imaging, Mental Health, Nerve, Neurons, Neuroscience, Placebo, Psychiatry, Serotonin

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More under-30 Americans report anxiety, depression during pandemic – CDC

(Reuters) – More young adults in the United States reported feeling anxious or depressed during the past six months of the COVID-19 pandemic, and fewer people reported getting the help they needed, according to a U.S. government study released on Friday.

The percentage of adults under age 30 with recent symptoms of an anxiety or a depressive disorder rose significantly about five months after the U.S. imposed COVID-19 related lockdowns, and reported rising deaths from the fast-spreading virus.

Between August 2020 and February 2021, this number went up to 41.5% from 36.4%, as did the percentage of such people reporting that they needed, but did not receive, mental health counseling.

The study suggests that the rise in anxiety or depressive disorder symptoms reported correspond with the weekly number of reported COVID-19 cases.

The findings are based on a Household Pulse Survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) and the Census Bureau to monitor changes in mental health status and access to care during the pandemic.

“Trends in mental health can be used to evaluate the impact of strategies addressing adult mental health status and care during the pandemic,” the authors of the study wrote in the CDC’s Morbidity and Mortality Weekly Report released on Friday.

The study also found those with less than a high school education were more at risk, though it did not provide an explanation for it.

Even with more vaccines gaining authorization beginning late 2020, the effects of the pandemic on mental health continued into 2021.

During Jan. 20, 2021 through Feb. 1, 2021, about two in five adults aged over 18 years experienced recent symptoms of an anxiety or a depressive disorder, the survey found.

Demand for mental health and meditation apps, and investments in tech startups building these apps have also risen during this period.

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We studied depression messages on YouTube videos and found dangerous and stigmatizing stereotypes prevail

depressed

Rates of depression have tripled in the U.S. since the beginning of the COVID-19 pandemic, and most recent estimates suggest these numbers remain elevated compared with pre-pandemic rates of mental health problems.

Even before the pandemic, depression was a leading source of disability, affecting over 17 million Americans each year. In a society where mental health education is not uniformly taught in schools, and where most people with depression go untreated, this is a recipe for disaster.

Psychologists have proposed ways to reform mental health care such as increasing access to care through telehealth. These actions are important. However, few experts have provided recommendations for how everyday citizens can flatten the depression curve by reducing stigma.

To better understand why depression stigma persists, my colleagues Ansley Bender and Jon Rottenberg and I examined how depression is depicted in the public sphere. In a recently published study, we systematically coded 327 YouTube videos on depression based on how they presented depression’s causes, prognosis and recommended treatment.

We hoped to gain insight into how one channel of social media presents information on depression. We learned that popular messages on YouTube may unknowingly perpetuate stigma and misconceptions about depression.


https://youtube.com/watch?v=ZwMlHkWKDwM%3Fcolor%3Dwhite

Stigma makes depression even harder

While we are no longer in the era of mental institutions and lobotomies, stigma toward depression is alive and well. In a 2018 study that provided 1,173 Americans with a vignette depicting someone with depression, 30% rated them as “violent,” and 20% supported the use of involuntary treatment. In everyday life, many people with depression hear declarations that “depression isn’t real” or “depressed people are just weak and lazy.” Public perception, it seems, either exaggerates or downplays the severity of depression—neither of which captures the truth.

Stigma like this worsens people’s ability to cope with and seek help for depression. For example, a review of 144 studies found that stigma considerably lowers the chance that a person with depression will seek treatment. This is concerning—especially for those who struggle with thoughts of suicide. Former U.S. surgeon general Vice Adm. Jerome M. Adams has called stigma the nation’s No. 1 killer.

YouTube says: Nature or nurture

We found that about 50% of the YouTube videos we viewed presented depression as a biological condition, like a “brain disease” or “chemical imbalance.” Over 40% discussed how situational circumstances like losing a job, experiencing abuse, or other life events can cause depression. But these messages are only partially true.

In most cases, depression is the result of a combination of biological, environmental and psychological circumstances, though just 8% of videos showed messaging consistent with this understanding. This is called the biopsychosocial model and is the consensus across clinical psychology and psychiatry. Framing depression as either biological or situational can narrow one’s view of potential treatments, so it is important to convey accurate information about the illness.


https://youtube.com/watch?v=y_T9Jg0U2DA%3Fcolor%3Dwhite

For instance, studies show when people are told that their depression is caused by a chemical imbalance, they are more likely to favor antidepressant treatments over other treatments. In other words, these messages may lead people to accidentally ignore other evidenced-based treatments that could help them, including therapy, exercise and lifestyle changes and social support.

The reality is that many treatments work for depression. It might, however, take time for those with depression to find the right treatment combination that works for them.

Further, while many believe that talking about biological origins decreases depression stigma, a review of studies actually found it can have the opposite effect. The story goes like this: When people view depression as a brain disease, they are less likely to blame someone for having depression. However, they are also more likely to view the person with depression as “different,” “dangerous” and “untreatable.” Studies show these beliefs may lessen people’s willingness to support or feel empathy for those with depression.

YouTube says: Depression lasts for years…sometimes a lifetime

This message is partial truth, but the science suggests a more complicated picture. For some, depression can last for years depending on their life circumstances and access to treatment. For others, depression may last for only a few months. A 2011 review of depression studies concluded “the majority of individuals who experience depression will recover within one year.”

Making this distinction is important because it reminds us that depression is not permanent; even though depression, by its nature, can make us feel as if everything is hopeless and won’t improve … or if things do get better, they will inevitably get worse again.

It is important for all of us, in these times of uncertainty, isolation, and worry about our loved ones, to remind ourselves and one another that, with time and direct efforts to improve our mental health, we can persevere.


https://youtube.com/watch?v=6O7Tpqvtzt8%3Fcolor%3Dwhite

YouTube says: There are quick fixes

Some of the most irresponsible videos I watched suggested that depression can be “fixed” with a few “simple lifestyle hacks.” Such videos are reminiscent of overpromising self-help gurus. Quick-fix assertions like “just exercise, you’ll feel better” are not only invalidating but untrue. It’s concerning that these videos disguise themselves with scientific-sounding words.

The video “10 Foods to Eat to Fight Depression” shows how the public can be misled. With over 1 million views, the video states, “Dark chocolate can help raise serotonin levels in the body” to fight depression. Unfortunately for people with depression who love chocolate, this scientific-sounding claim is not accurate. Our diet of course affects our mood. But it is oversimplified to say that eating chocolate cures depression.

These messages could lead people to downplay and invalidate the severity of depression. Imagine how a person with depression would feel upon hearing “I know you can’t get out of bed, but have you tried eating a Snickers?”

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Depression risk higher among stroke survivors, especially female patients

Stroke patients were nearly 50% more likely than heart attack patients to develop depression, and female stroke patients had a higher risk of depression than their male counterparts, according to two preliminary studies by the same research group to be presented at the American Stroke Association's International Stroke Conference 2021.

The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

In what researchers described as one of the largest study of post-stroke depression to-date, they conducted two investigations using the same U.S. Medicare dataset of patients ages 65 or older hospitalized for ischemic stroke or heart attack from July 2016 to December 31, 2017.

Among more than 11 million Medicare beneficiaries who were admitted during the two-year study period, there were 174,901 with admission for ischemic stroke and 193,418 with admission for heart attack.

Patients were followed for 1.5 years, and patients with prior history of depression in the six months preceding their stroke or heart attack were excluded.

Depression following stroke is almost three times as common as it is in the general population and may affect up to a third of stroke patients. Patients with post-stroke depression also experience poorer quality of life and outcomes."

Laura K. Stein, M.D., M.P.H., Study Lead Author and Assistant Professor, Neurology, Icahn School of Medicine, Mount Sinai

Stein is also a attending neurologist at Mount Sinai and Mount Sinai Queens Stroke Centers in New York City.

In the first study (Presentation 22), researchers found:

  • The risk of depression was about 50% more likely among patients who had a stroke (174,901) compared to patients who had a heart attack (193,418).
  • History of anxiety was found in 10.3% of ischemic stroke patients and 11.8% of heart attack patients. Ischemic stroke patients with a history of anxiety were 1.7 times more likely to develop depression than patients without anxiety.
  • History of anxiety was the strongest predictor of post-stroke depression, while being discharged home resulted in less depression.
  • White patients were 1.33 times more likely to be diagnosed with post-stroke depression.
  • Patients 75 and older were 0.79 times less likely to be diagnosed with post-stroke depression.

"We did not expect that the cumulative risk of depression would remain so persistently elevated. This finding supports that post-stroke depression is not simply a transient consequence of difficulties adjusting to life after stroke," Stein said.

In another analysis by the same researchers (Presentation 21), female stroke patients (90,474) had a 20% higher risk of developing depression than male stroke patients (84,427).

Drawing from the same Medicare pool of patients, a comprehensive inpatient, outpatient and subacute nursing follow-up helped to detect new-onset depression more accurately compared to studies that don't have follow up from multiple settings where depression may be tracked.

Researchers calculated the increasing risk for depression in females vs. males over 1.5 years of follow-up. "Our current findings highlight the need for active screening and treatment for depression in the time period immediately and well after the stroke and the importance of screening all stroke patients for post-stroke depression, including women and those with a history of mental illness," Stein said.

Source:

American Heart Association

Posted in: Medical Research News | Medical Condition News | Women's Health News

Tags: Anxiety, Brain, Cerebrovascular Disease, Depression, Disability, Health Insurance, Heart, Heart Attack, Ischemic Stroke, Medicare, Medicine, Neurology, Nursing, Pathophysiology, Public Health, Research, Stroke

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Decrease in exercise more closely linked with higher rates of depression during the pandemic

Decreases in exercise more closely linked with higher rates of depression during the pandemic

Exercise has long-been recommended as a cognitive-behavioral therapy for patients of depression, yet new evidence from the University of California of San Diego suggests that the COVID-19 pandemic changed the nature of the relationship between physical activity and mental health.

In a study of college students conducted before and during the pandemic, findings revealed the average steps of subjects declined from 10,000 to 4,600 steps per day and rates of depression increased from 32% to 61%.

The research, recently published in the Proceedings of the National Academy of Sciences, also revealed short-term restoration of exercise does not meaningfully improve mental well-being.

“This raises many possible explanations, including that the impact of physical activity may require a longer-term intervention,” said co-author Sally Sadoff, associate professor of economics and strategy at UC San Diego’s Rady School of Management. “At the same time, our results clearly show that those who maintained physical exercise throughout the pandemic were the most resilient and least likely to suffer from depression.”

Sadoff added there is a 15 to 18 percentage point difference in depression rates between participants who experienced large disruptions to their mobility, compared to those who maintained their habits.

Sadoff and coauthors from the University of Pittsburg and Carnegie Mellon University point to the alarming trend of increased depression among young adults (ages 18-24) during the pandemic, which is two-times higher than the general population.

The students in the study answered repeated surveys about their well-being and time use over the course of a semester. From March to July 2020, depression rates skyrocketed by 90%, compared to pre-pandemic levels.

Fitbit data helps fill in the gaps in understanding mobility’s role in mental health

The study enrolled multiple cohorts of hundreds of U.S. college students from February 2019 through July 2020. In addition to filling out surveys, participants received wearable devices (Fitbits) that track their activity levels. Participants in the 2020 cohort began the study in February and continued participating after their university moved all classes online in March and encouraged students not to return to campus.

Among the subjects, sleep increased by 25 to 30 minutes per night, time spent socializing declined by more than half (less than 30 minutes per day), and screen time more than doubled to five or more hours per day.

The researchers found large declines in physical activity during COVID-19 was most strongly associated with higher rates of depression. Physical activity minutes translate to about 10 minutes in which the heart rate is raised enough to burn at least 1.5 times as many calories as it does at rest.

Those who experienced declines of one to two hours of physical activity per day were most at risk for depression during the pandemic, while participants who were able to maintain their daily habits were at the lowest risk.

“This relationship is one that only emerges during the pandemic,” the authors note. “Before the pandemic, there was not a very strong connection between changes in physical activity and mental health, but our analyses suggest that disruption to physical activity is a leading risk factor for depression during this period.”

Short-term restoration of exercise habits does not provide mental health relief

In order to examine whether a policy intervention could help counteract some of the pandemic’s adverse impacts to mental health, the researchers implemented a randomized experiment.

Half of the participants were incentivized to walk at least 10,000 steps per day for two weeks. The strategy significantly increased their average steps by about 2,300 steps per day and physical activity by almost 40 minutes per day, compared to the other half of subjects. However, the impact of exercise did not translate into an improvement in mental health, nor did it encourage the students to keep up the physical activity after the two-week period ended.

“Physical activity may have important interactions with other lifestyle behaviors such as social interactions,” the authors write. “It could also be the case that the relationship between physical activity and depression is driven more by mental health than it is by lifestyle habits.”

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Study reveals a neural basis for how the brain enables odors to elicit memories

Odors evoke powerful memories, an experience enshrined in literature by Marcel Proust and his beloved madeleine.

A new Northwestern Medicine paper is the first to identify a neural basis for how the brain enables odors to so powerfully elicit those memories. The paper shows unique connectivity between the hippocampus–the seat of memory in the brain–and olfactory areas in humans.

This new research suggests a neurobiological basis for privileged access by olfaction to memory areas in the brain. The study compares connections between primary sensory areas–including visual, auditory, touch and smell–and the hippocampus. It found olfaction has the strongest connectivity. It's like a superhighway from smell to the hippocampus.

During evolution, humans experienced a profound expansion of the neocortex that re-organized access to memory networks. Vision, hearing and touch all re-routed in the brain as the neocortex expanded, connecting with the hippocampus through an intermediary–association cortex–rather than directly. Our data suggests olfaction did not undergo this re-routing, and instead retained direct access to the hippocampus."

Christina Zelano, Study Lead Investigator and Assistant Professor, Neurology, Northwestern University Feinberg School of Medicine

The paper, "Human hippocampal connectivity is stronger in olfaction than other sensory systems" was published March 4 in the journal Progress in Neurobiology.

Epidemic loss of smell in COVID-19 makes research more urgent In COVID-19, smell loss has become epidemic, and understanding the way odors affect our brains–memories, cognition and more–is more important than ever, Zelano noted.

"There is an urgent need to better understand the olfactory system in order to better understand the reason for COVID-related smell loss, diagnose the severity of the loss and to develop treatments," said first author Guangyu Zhou, research assistant professor of neurology at Northwestern. "Our study is an example of the basic research science that our understanding of smell, smell loss and future treatments is built on."

Below is a Q & A with Zelano about the importance of the sense of smell, olfactory research and the link to COVID-19.

Why do smells evoke such vivid memories?

"This has been an enduring mystery of human experience. Nearly everyone has been transported by a whiff of an odor to another time and place, an experience that sights or sounds rarely evoke. Yet, we haven't known why.

The study found the offactory parts of the brain connect more strongly to the memory parts than other senses. This is a major piece of the puzzle, a striking finding in humans. We believe our results will help future research solve this mystery.'

How does smell research relate to COVID-19?

"The COVID-19 epidemic has brought a renewed focus and urgency to olfactory research. While our study doesn't address COVID smell loss directly, it does speak to an important aspect of why olfaction is important to our lives: smells are a profound part of memory, and odors connect us to especially important memories in our lives, often connected to loved ones.

The smell of fresh chopped parsley may evoke a grandmother's cooking, or a whiff of a cigar may evoke a grandfather's presence. Odors connect us to important memories that transport us back to the presence of those people."

Loss of smell linked to depression and poor quality of life

"Loss of the sense of smell is underestimated in its impact. It has profound negative effects of quality of life, and many people underestimate that until they experience it. Smell loss is highly correlated with depression and poor quality of life.

"Most people who lose their smell to COVID regain it, but the time frame varies widely, and some have had what appears to be permanent loss. Understanding smell loss, in turn, requires research into the basic neural operations of this under-studied sensory system.

"Research like ours moves understanding of the olfactory parts of the brain forward, with the goal of providing the foundation for translational work on, ultimately, interventions."

Source:

Northwestern University

Journal reference:

Zhou, G., et al. (2021) Human hippocampal connectivity is stronger in olfaction than other sensory systems. Progress in Neurobiology. doi.org/10.1016/j.pneurobio.2021.102027.

Posted in: Medical Science News | Medical Research News | Medical Condition News

Tags: Brain, Cigar, Cortex, Deafness, Depression, Evolution, Hippocampus, Medicine, Neocortex, Neurology, Olfaction, Research

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Severe Atopic Dermatitis Often Puts a Dent in Quality of Life

In his role as head of the division of pediatric behavioral health at National Jewish Health, Denver, Bruce G. Bender, PhD, helps children and adults navigate the adverse effects of severe atopic dermatitis (AD) on their quality of life.

Dr Bruce Bender

“There have been many surveys of adults with AD who report impairment of their sleep, reduced activity level, increased work absence, financial burden, emotional distress, and social avoidance,” he said at the Revolutionizing Atopic Dermatitis virtual symposium. “Similarly, children with AD or their parents report emotional distress, reduced activity, and increased school absence, social avoidance, and sleep disturbance. Families report financial burdens, conflict, particularly among the adults, social avoidance, sleep disturbance in the parents, and reduction of well-being in the siblings.”

Getting adequate sleep is especially challenging for patients with AD, and loss of sleep can have serious daytime consequences. In an effort to objectively measure sleep change in this population, Bender and colleagues recruited 14 adults with AD and 14 healthy controls who wore an ActiGraph for 1 week and completed questionnaires about sleep, itch, and quality of life. Patients with AD were awake almost twice as many minutes each night as the healthy controls (a mean of 57.3 vs. 32.3 minutes, respectively; = .0480). Consequently, their sleep efficiency was significantly reduced based on the Pittsburgh sleep quality index (a mean of 90.6 vs. 95; = .0305).

In another study, Bender and colleagues enrolled 20 adults with AD who underwent 2 nights of polysomnography and actigraphy. The lab was set up to measure a scratching event, which was recorded when a burst of electromyographic activity of at least 3 seconds was accompanied by a visible scratching motion. “We learned that sleep efficiency as measured by both PSG and actigraphy correlated with total body surface area and scratching index,” he said. “As we might assume, the more skin involved, the more patients scratch, the less well they sleep.”

Behavioral, Neurocognitive Effects

In a separate study of AD, sleep, and behavior, the researchers studied 1,041 children with asthma who were enrolled in the Childhood Asthma Management Program at eight North American sites. They used baseline parent ratings on standardized sleep and behavior rating scales and found that increased awakenings were associated with increased school absence and daytime behavior problems. “So, not only do children with AD sleep less well, but this shows up to impair their functioning during the day,” said Bender, professor of psychiatry at the University of Colorado, Denver.

In a report from Australia, researchers set out to explore the association between sleep and neurocognitive function in 21 children with eczema and 20 healthy controls. Participants underwent cognitive testing and polysomnography. The authors found that the children with eczema demonstrated lower test scores. Reduced scores were correlated with parental reports of sleep problems but not polysomnography.

In a much larger study funded by the Agency for Healthcare Research and Quality, investigators analyzed data on 354,416 children and 34,613 adults from 19 U.S. population surveys including the National Health Interview Survey 1997-2013 and the National Survey of Children’s Health 2003/4 and 2007/8. They found that AD was associated with ADHD in children (adjusted odds ratio, 1.14) and adults (aOR, 1.61). Higher odds of ADHD were found in children who had significant sleep disturbance (aOR, 16.83) and other allergic disease and asthma (aOR, 1.61).

“All of these findings show that AD can impact quality of life, especially sleep, with the result of poorer daytime functioning,” Bender said. “But those studies don’t answer this question: Are patients with AD at increased risk for psychological disorders such as depression and anxiety?”

Impact on Depression, Anxiety

Two systematic reviews on the topic suggest that patients with AD are twice as likely to experience depression. One was published in 2018 and the other in 2019. The 2018 review reported a little more than a twofold increase (OR, 2.19), the 2019 review a little bit less (OR, 1.71).

“At the more severe end of the depression continuum, we sometimes see suicidal ideation and suicide attempts,” Bender said. “A number of studies have asked whether these are increased in patients with AD. Quite a few studies collectively show an increased incidence of suicidal ideation. The question of suicide attempts is reflected in fewer studies. And while the result is small, it is significant. There is a significant increase reported of suicide attempts in AD patients.”

The 2018 review also found an increased incidence of anxiety in AD patients: a little more than twofold in adults (OR, 2.19) and a little less than twofold in children (OR, 1.81).

“It’s a two-way relationship between AD and psychological factors,” Bender said. “We generally think about AD – the stress that it brings, the burden that it puts on children, adults, and families. But it can work the other way around,” he said, referring to patients who have psychological problems, experience a great deal of stress, have trouble being adherent to their treatment regimen, and find it difficult to resist scratching. “The behavioral/psychological characteristics of the patient also drive the AD. It is well established that acute and chronic stress can result in a worsening of skin conditions in AD patients.”

Behavioral health interventions that have been described in the literature include cognitive therapy, stress management, biofeedback, hypnotherapy, relaxation training, mindfulness, habit reversal, and patient education — some of which have been tested in randomized trials. “All of them report a decrease in scratching as a consequence of the behavioral intervention,” Bender said.

“Other studies have been reported that look at the impact of behavioral interventions on the severity of the skin condition. Most report an improvement in the skin condition from these behavioral interventions but it’s not a perfect literature.” Critiques of these studies include the fact that there is often not enough detail about the intervention or the framework for the intervention that would allow a clinician to test an intervention in another study or actually pull that intervention into clinical practice (Cochrane Database Syst Rev. 2014 Jan 7;2014[1]:CD004054), (Int Arch Allergy Immunol.2007;144[1]:1-9).

“Some of the studies lack rigorous designs, some have sampling bias, and some have inadequate outcome measurements,” he said. “We really need additional, high-quality studies to look at what is helpful for patients with AD.”

Bender reported having no financial disclosures.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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