Antidepressants versus running for depression: Is there a winner?

by European College of Neuropsychopharmacology

Credit: Pixabay/CC0 Public Domain

The first study to compare effects of antidepressants with running exercises for anxiety, depression and overall health shows that they have about the same benefits for mental health—but a 16-week course of running over the same period scores higher in terms of physical health improvement, whereas antidepressants lead to a slightly worse physical condition, as has been suggested by previous studies. However, the drop-out rate was much higher in the group which initially chose exercise.

14 oct 2023--Professor Brenda Penninx (Vrije University, Amsterdam) is set to present the work at the 36th ECNP Congress, Barcelona, 7–10 October 2023, after recent publication in the Journal of Affective Disorders, saying, "We wanted to compare how exercise or antidepressants affect your general health, not just your mental health."

The researchers studied 141 patients with depression and/or anxiety. They were offered a choice of treatment; SSRI antidepressants for 16 weeks, or group-based running therapy for 16 weeks. 45 chose antidepressants, with 96 participating in running. The members of the group which chose antidepressants were slightly more depressed than the members of the group which chose to take running.

Professor Penninx said, "This study gave anxious and depressed people a real-life choice, medication or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group."

Treatment with antidepressants required patients to adhere to their prescribed medication intake but this generally does not directly impact on daily behaviors. In contrast, exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging persons to go outside, set personal goals, improve their fitness and participate in a group activity.

The antidepressant group took the SSRI Escitalopram for 16 weeks. The running group aimed for two to three closely supervised 45-minute group sessions per week (over 16 weeks). The adherence to the protocol was lower in the running group (52%) than in the antidepressant group (82%), despite the initial preference for running over antidepressants.

At the end of the trial, around 44% % in both groups showed an improvement in depression and anxiety, however the running group also showed improvements in weight, waist circumference, blood pressure, and heart function, whereas the antidepressant group showed a tendency towards a slight deterioration in these metabolic markers.

Brenda Penninx said, "Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation."

"It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant.

"We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behavior will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution."

She added, "Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good—and maybe even better—choice for some of our patients."

"In addition, let's also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health."

This is adapted from a commentary recently published in the journal European Neuropsychopharmacology.

Commenting, Dr. Eric Ruhe (Amsterdam University Medical Centers) said, "These are very interesting results that again show that physical health can influence mental health and that treatment of depression and anxiety can be achieved by exercising, obviously without the adverse effects of antidepressant drugs. "

"However, several remarks are important. First the patients followed their preference, which is common practice, but ideally we should advise patients what will work best. Following this choice is understandable from a pragmatic point of view when patients have strong preferences, which you have to take into account when doing a study like this.

"The downside is that the comparisons between groups might be biased compared to doing this in a truly randomized study. For example, patients in the antidepressant group were more depressed which might be associated with less chance of persisting engagement in the exercises. So, we have to be careful not to overinterpret the comparisons between groups, which the authors acknowledge properly.

"Finally, a very important finding is the difference in adherence between the interventions: 52% in the exercise group and 82% in the antidepressant group. This shows that it is more difficult to change a lifestyle habit than taking a pill. This is not exclusively found in psychiatry, indicating that we also have to focus on how to improve compliance to healthy behavior. This could have tremendous impact on health care more generally, but also on psychiatric diseases."

More information: Josine E. Verhoeven et al, Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders, Journal of Affective Disorders (2023). DOI: 10.1016/j.jad.2023.02.064

Conference abstract: "Medication and lifestyle interventions in regulating immune function and mental health."

 

No evidence that depression is caused by low serotonin levels, finds comprehensive review

by University College London

Credit: Pixabay/CC0 Public Domain

After decades of study, there remains no clear evidence that serotonin levels or serotonin activity are responsible for depression, according to a major review of prior research led by UCL scientists.

31 jul 2022--The new umbrella review—an overview of existing meta-analyses and systematic reviews—published in Molecular Psychiatry, suggests that depression is not likely caused by a chemical imbalance, and calls into question what antidepressants do. Most antidepressants are selective serotonin reuptake inhibitors (SSRIs), which were originally said to work by correcting abnormally low serotonin levels. There is no other accepted pharmacological mechanism by which antidepressants affect the symptoms of depression.

Lead author Professor Joanna Moncrieff, a Professor of Psychiatry at UCL and a consultant psychiatrist at North East London NHS Foundation Trust (NELFT), said: "It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.

"The popularity of the 'chemical imbalance' theory of depression has coincided with a huge increase in the use of antidepressants. Prescriptions for antidepressants have risen dramatically since the 1990s, with one in six adults in England and 2% of teenagers now being prescribed an antidepressant in a given year.

"Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence."

The umbrella review aimed to capture all relevant studies that have been published in the most important fields of research on serotonin and depression. The studies included in the review involved tens of thousands of participants.

Research that compared levels of serotonin and its breakdown products in the blood or brain fluids did not find a difference between people diagnosed with depression and healthy control (comparison) participants.

Research on serotonin receptors and the serotonin transporter, the protein targeted by most antidepressants, found weak and inconsistent evidence suggestive of higher levels of serotonin activity in people with depression. However, the researchers say the findings are likely explained by the use of antidepressants among people diagnosed with depression, since such effects were not reliably ruled out.

The authors also looked at studies where serotonin levels were artificially lowered in hundreds of people by depriving their diets of the amino acid required to make serotonin. These studies have been cited as demonstrating that a serotonin deficiency is linked to depression. A meta-analysis conducted in 2007 and a sample of recent studies found that lowering serotonin in this way did not produce depression in hundreds of healthy volunteers, however. There was very weak evidence in a small subgroup of people with a family history of depression, but this only involved 75 participants, and more recent evidence was inconclusive.

Very large studies involving tens of thousands of patients looked at gene variation, including the gene for the serotonin transporter. They found no difference in these genes between people with depression and healthy controls. These studies also looked at the effects of stressful life events and found that these exerted a strong effect on people's risk of becoming depressed—the more stressful life events a person had experienced, the more likely they were to be depressed. A famous early study found a relationship between stressful events, the type of serotonin transporter gene a person had and the chance of depression. But larger, more comprehensive studies suggest this was a false finding.

These findings together led the authors to conclude that there is "no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations."

The researchers say their findings are important as studies show that as many as 85-90% of the public believes that depression is caused by low serotonin or a chemical imbalance. A growing number of scientists and professional bodies are recognising the chemical imbalance framing as an over-simplification. There is also evidence that believing that low mood is caused by a chemical imbalance leads people to have a pessimistic outlook on the likelihood of recovery, and the possibility of managing moods without medical help. This is important because most people will meet criteria for anxiety or depression at some point in their lives.

The authors also found evidence from a large meta-analysis that people who used antidepressants had lower levels of serotonin in their blood. They concluded that some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentrations. The researchers say this may imply that the increase in serotonin that some antidepressants produce in the short term could lead to compensatory changes in the brain that produce the opposite effect in the long term.

While the study did not review the efficacy of antidepressants, the authors encourage further research and advice into treatments that might focus instead on managing stressful or traumatic events in people's lives, such as with psychotherapy, alongside other practices such as exercise or mindfulness, or addressing underlying contributors such as poverty, stress and loneliness.

Professor Moncrieff said: "Our view is that patients should not be told that depression is caused by low serotonin or by a chemical imbalance, and they should not be led to believe that antidepressants work by targeting these unproven abnormalities. We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not."

Co-author Dr. Mark Horowitz, a training psychiatrist and Clinical Research Fellow in Psychiatry at UCL and NELFT, said: "I had been taught that depression was caused by low serotonin in my psychiatry training and had even taught this to students in my own lectures. Being involved in this research was eye-opening and feels like everything I thought I knew has been flipped upside down.

"One interesting aspect in the studies we examined was how strong an effect adverse life events played in depression, suggesting low mood is a response to people's lives and cannot be boiled down to a simple chemical equation."

Professor Moncrieff added: "Thousands of people suffer from side effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise. We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is not grounded in science."

The researchers caution that anyone considering withdrawing from antidepressants should seek the advice of a health professional, given the risk of adverse effects following withdrawal. Professor Moncrieff and Dr. Horowitz are conducting ongoing research into how best to gradually stop taking antidepressants.

More information: Joanna Moncrieff et al, The serotonin theory of depression: a systematic umbrella review of the evidence, Molecular Psychiatry (2022). DOI: 10.1038/s41380-022-01661-0

Provided by University College London 

 

Pandemic depression persists among older adults, study finds

by McMaster University

Credit: CC0 Public Domain

The COVID-19 pandemic has had a significant impact on the mental health of older people living in the community, with those who are lonely faring far worse, according to new research from McMaster University.

04 dec 2021--Using data from the Canadian Longitudinal Study on Aging (CLSA), a national team of researchers found that 43% of adults aged 50 or older experienced moderate or high levels of depressive symptoms at the beginning of the COVID-19 pandemic, and that increased over time.

Loneliness was the most significant predictor of worsening depressive symptoms, with other pandemic-related stressors, such as family conflict, also increasing the odds.

The study was published in the journal Nature Aging today.

The research was led by Parminder Raina, a professor in the Department of Health Research Methods, Evidence, and Impact and scientific director of the McMaster Institute for Research on Aging.

"The COVID-19 pandemic has had a disproportionated impact on older adults, with groups of people who were already marginalized feeling a far greater negative impact," said Raina, lead principal investigator of the CLSA.

"Those who were socially isolated, experiencing poorer health and of lower socioeconomic status were more likely to have worsening depression as compared to their pre-pandemic depression status collected as part of the Canadian Longitudinal Study on Aging since 2011."

The research team included CLSA principal investigators Christina Wolfson of McGill University, Susan Kirkland of Dalhousie University, Lauren Griffith of McMaster, along with a national team of investigators.

They used telephone and web survey data to examine how health-related factors and social determinants such as income and social participation, impacted the prevalence of depressive symptoms during the initial lockdown starting March 2020 and after re-opening following the first wave of COVID-19 in Canada.

Caregiving responsibilities, separation from family, family conflict, and loneliness were associated with a greater likelihood of moderate or high levels of depressive symptoms that got worse over time.

Women were also more likely to have higher odds of depressive symptoms during the pandemic compared to men, and a greater number of women reported separation from family, increased time caregiving as well as barriers to caregiving.

Overall, older adults had twice the odds of depressive symptoms during the pandemic compared to pre-pandemic. But those with lower income and poorer health, either due to pre-existing health conditions or health concerns reported during the pandemic, experienced a greater impact.

"These findings suggest the negative mental health impacts of the pandemic persist and may worsen over time and underscores the need for tailored interventions to address pandemic stressors and alleviate their impact on the mental health of older adults," Raina added.

The findings mark the first published COVID-19 research emerging from the CLSA, a national research platform on aging involving more than 50,000 community-dwelling middle-aged and older adults at recruitment. The platform is funded by the Government of Canada through and Canadian Institutes of Health Research and the Canada Foundation for Innovation.

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More information: Parminder Raina, A longitudinal analysis of the impact of the COVID-19 pandemic on the mental health of middle-aged and older adults from the Canadian Longitudinal Study on Aging, Nature Aging (2021). DOI: 10.1038/s43587-021-00128-1. www.nature.com/articles/s43587-021-00128-1

Provided by McMaster University 

From depression to Parkinson's disease: The healing power of dance

by Adrianna Mendrek, The Conversation

Historically, the body and movement have been widely disregarded within psychotherapy. But times are changing, as a growing movement of somatic and dance therapies are gaining scientific credibility. Credit: Shutterstock

Why do we stop dancing when we grow up? Why do we disconnect and alienate ourselves from the body? It is surprising to me that dance/movement therapy (DMT) is not more popular within the fields of psychology and psychotherapy globally.

08 dec 2019--For a couple of decades, I devoted my attention as a researcher in behavioral neurobiology and psychiatry almost exclusively to the brain and mental health, neglecting the rest of the body.

I was trained in the late 1990s, the decade of the brain. I have been mesmerized by the complexity of the brain, completely forgetting that it is part of the entire organism, intimately connected and reciprocally interacting with the entire body.

Interestingly, in my personal life my body has played a central role. My way to deal with any mental health problems has been through long walks, dancing and yoga.

This is partly why in the past few years, as a professor in psychology at Bishop's University, I have started incorporating bodywork in my teaching and research, and why I entered a dance/movement therapy training program in Canada this summer.

Understanding the body in motion

Dance/movement therapy goes beyond simply dancing. DMT uses dance and movement to promote insight, integration and well-being, as well as to diminish undesirable symptoms in various clinical populations.

Unlike mainstream talk therapies, DMT uses the entire body to approach the client primarily on a non-verbal and creative level. The body in motion is both the medium and the message. DMT recognizes the moving body as the centre of the human experience, and that body and mind are in constant reciprocal interaction.

Just like with more traditional psychotherapies, DMT can be applied in a wide range of ways. It may involve talking, different types of music or no music at all. It can be done in groups, with individuals or with couples. Therapists sometimes dance with their clients and at other times observe.

A group therapy session may involve a warm-up and check-in as to where we are at emotionally, mentally and physically. It may be followed by the development of a theme, which emerges spontaneously or has been prepared by a therapist (for example, working with difficult emotions). It ends with grounding (reconnecting with our bodies and our selves in the present moment) and closure (for example, a gesture, a sound, a word).

An introduction to dance/movement therapy from the American Dance Therapy Association.

All of this is done with our bodies in motion or stillness, but some verbal sharing, journaling, drawing and other elements may be added.

Dance/movement therapy has been around for several decades but it has never become widely popular, possibly due to a lack of well-designed research studies. This has changed and I would like to highlight here a few recent studies supporting the benefits of dance and DMT on emotional regulation, cognitive function and neural plasticity.

A positive effect on depression

One of the main reasons people dance is to modify their emotional state; typically, they strive to feel more joy and happiness and to reduce stress and anxiety. Since its inception dance therapy, similar to somatic psychotherapies, has emphasized the reciprocal interaction between body and mind, and the ability to regulate emotions via changes in body postures and movements.

The exploration of new movements can evoke novel perceptions and feelings. It may also facilitate seeing a wider range of possibilities in a given situation. Some new or old movement patterns may evoke repressed material and enhance better understanding of oneself and one's environment and history.

One of the most compelling studies supporting this idea examined complex improvised movements, and identified unique sets of movement components that can elicit the feelings of happiness, sadness, fear or anger. The associations between emotions and specific motor components have been used in the past for diagnosis or emotion recognition. This study goes further and proposes specific techniques for modifying emotions.

A recent systematic review of research on dance/movement therapy specifically found it to be effective in the treatment of adults with depression.

Improvements in Parkinson's disease

Dance typically involves learning sequences of steps and movements in space, in coordination with music. In other words, it requires substantial physical and cognitive engagement and, as such, it should improve not only muscle tone, strength, balance and coordination, but also memory, attention and visuospatial processing.

When comparing relatively long-term dance interventions (of six and 18 months) to conventional fitness training, several studies have found improvements in attention and verbal memory and neuroplasticity in healthy older adults. Researchers also found improvements in memory and cognitive function for older adults with mild cognitive impairment after a 40-week dance program.

In addition, a recent meta-analysis of seven randomized controlled trials comparing the effects of dance therapy to non-dance interventions in Parkinson's disease found that dance was especially beneficial for executive function, the processes that help us plan, organize and regulate our actions.

A new report from WHO/Europe provides evidence of the benefits of the arts for mental and physical health.

Changes in brain structure

Dancing engages extensive areas of the cerebral cortex as well as several deep brain structures.

A recent descriptive systematic review included eight well-controlled studies, all of which demonstrated changes in brain structure following dance intervention. These changes included:increased hippocampal and parahippocampal volume (involved in memory), increased gray matter volume in the precentral gyrus (involved in motor control) and white matter integrity in the corpus callosum (involved in communication between the two hemispheres).

Overall, these studies are compatible with the idea of using dance and DMT in various neurological and psychiatric disorders —such as Parkinson's disease, Alzheimer's disease and mood disorders —as well as in the general population.

New possibilities for feeling and perceiving

It is clear that dance has a powerful effect on the human body and psyche.

DMT from its inception emphasized that the body is inseparable from, and in constant reciprocal interaction with, the mind. As such, sensations, perceptions, emotions and thinking affect our body and the way we move. By observing the body we can deduce mental states.

Conversely, our posture and our movements have the power to transform our mental states, to evoke repressed memories, to release spontaneity and creativity, to reorganize our brains. New ways of moving and dancing may produce new ways of feeling and perceiving the world.

This is one of the most exciting and profound aspects of DMT and it is shocking that the body, movement and dance have been almost entirely ignored by mainstream psychotherapy. It is time to change that!

Provided by The Conversation 

Long-term study data shows DBS is effective treatment for most severe form of depression

by The Mount Sinai Hospital

Credit: CC0 Public Domain

A study published online on Friday, October 4, in the American Journal of Psychiatry found that deep brain stimulation (DBS) of an area in the brain called the subcallosal cingulate (SCC) provides a robust antidepressant effect that is sustained over a long period of time in patients with treatment-resistant depression—the most severely depressed patients who have not responded to other treatments.

06 oct 2019--The long-term data presented in this study, conducted at Emory University and led by Helen S. Mayberg, MD, now Professor of Neurology, Neurosurgery, Psychiatry, and Neuroscience, and Founding Director of the Nash Family Center for Advanced Circuit Therapeutics at the Icahn School of Medicine at Mount Sinai, validates earlier work conducted by the research team and lays the foundation for additional studies to refine and optimize DBS for these patients.

Deep brain stimulation, currently approved by the U.S. Food and Drug Administration to treat essential tremor, Parkinson's disease, epilepsy, and obsessive-compulsive disorder, is a neurosurgical procedure involving the placement of a neurostimulator (sometimes referred to as a "brain pacemaker"), which sends high-frequency electrical impulses through implanted electrodes deep in the brain to specific brain areas responsible for the symptoms of each disorder.

Dr. Mayberg led the first trial of DBS of the subcallosal cingulate white matter, known as Brodmann Area 25, for treatment-resistant depression patients in 2005, demonstrating that it could have clinical benefit. Subsequent small open-label trials produced similarly favorable results, yet despite these encouraging open-label results, a multi-center, randomized trial was halted early due to a lack of statistically significant antidepressant response at the designated, six-month a priori time point.

"Despite the fact that larger trials were halted early, what my colleagues and I were seeing as we continued to follow patients from our initial trials was that over time, they were getting better and not only that, they were staying better. So we stayed the course," says Dr. Mayberg. "Over eight years of observation, most of our study participants experienced an antidepressant response to the deep brain stimulation of Area 25 that was robust and sustained. Given that patients with treatment-resistant depression are highly susceptible to recurrent depressive episodes, the ability of DBS to support long-term maintenance of an antidepressant response and prevention of relapse is a treatment advance that can mean the difference between getting on with your life or always looking over your shoulder for your next debilitating depressive episode."

Specifically, the study documents the long-term outcome data (4-8 years) for 28 patients who were enrolled in an open-label clinical trial of SCC DBS for treatment-resistant depression. Response and remission rates were maintained at or above 50 percent and 30 percent, respectively, through years 2-8 of the follow-up period. Three-quarters of all participants met the treatment response criterion for more than half of their participation in the study, with 21 percent of all participants demonstrating continuous response to treatment from the first year forward. Of 28 participants, 14 completed at least eight years of follow-up, 11 others completed at least four years, and three dropped out prior to eight years of participation. Data presented through this study support the long-term safety and sustained efficacy of SCC DBS for treatment-resistant depression.

"While clinical trials generally are structured to compare active and placebo treatments over the short term, our research results suggest that the most important strength of DBS in this hard-to-treat clinical population lies in its sustained effects over the long term," says Andrea Crowell, MD, Assistant Professor of Psychiatry and Behavioral Health Sciences at Emory University School of Medicine. "For people suffering from inescapable depression, the possibility that DBS can lead to significant and sustained improvement in depressive symptoms over several years will be welcome news."

All study participants met criteria for either major depressive disorder or bipolar disorder type 2 and were in a current depressive episode of at least 12 months duration with non-response to at least four antidepressant treatments, psychotherapy, and electroconvulsive therapy. All study participants underwent SCC DBS surgery at Emory University School of Medicine with the same surgeon and received the same device. The first 17 participants were implanted between 2007-2009 in an open-label trial with a one-month, single-blind, stimulation-off, lead-in period. An additional 11 participants with major depressive disorder were implanted using tractography-guided anatomical targeting between 2011 and 2013. A total of 178 patient-years of data were collected and combined for analysis in this long-term follow-up study. Participants were seen by a study psychiatrist weekly for 32 weeks, starting at least four weeks prior to surgery. Visits were then tapered to every six months for years 2-8 of the study. Currently, 23 patients continue in long-term follow-up.

"At the Center for Advanced Circuit Therapeutics at Mount Sinai, we are currently gearing up for the next phase of this research, now funded by the National Institutes of Health Brain Initiative. Our new study will recruit treatment-resistant depression patients, as before, but they will be implanted with a new research prototype DBS system (Summit RC+S) that allows simultaneous recordings of brain activity directly from the site of stimulation during active DBS therapy. Advanced imaging, behavioral, and physiological assessments will also be performed at regular intervals in the lab. These studies will provide an unprecedented opportunity to monitor the trajectory of recovery over days, weeks, and months at the neural level," says Dr. Mayberg. "Building on preliminary findings from Emory, we anticipate that these brain signatures will provide important new insights into DBS mechanisms and, importantly, will help guide future decisions about DBS management that can further optimize clinical outcomes in our patients."

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Journal information: American Journal of Psychiatry 

Provided by The Mount Sinai Hospital 

The pet effect: Researchers find furry friends ease depression, loneliness after spousal loss

by Kara Irby, Florida State University

Credit: CC0 Public Domain

As Healthy Aging Month is underway this September, Florida State University researchers have found the companionship of a pet after the loss of a spouse can help reduce feelings of depression and loneliness in older adults.

17 sept 2019--The study, funded by The Gerontological Society of America and the WALTHAM Centre for Pet Nutrition and published in The Gerontologist, examined depressive symptoms and loneliness among people age 50 and older who experienced the loss of a spouse through death or divorce.

"Increasingly, there's evidence that our social support networks are really beneficial for maintaining our mental health following stressful events, despite the devastation we experience in later life when we experience major social losses," said Dawn Carr, lead author and FSU associate professor of sociology. "I was interested in understanding alternatives to human networks for buffering the psychological consequences of spousal loss."

Carr and her team compared individuals who experienced the loss of a spouse to those who stayed continuously married. Then they explored whether the effects of spousal loss differed for those who had a pet at the time of the death or divorce.

They found all individuals who lost their spouse experienced higher levels of depression. However, people without a pet experienced more significant increases in depressive symptoms and higher loneliness than those who had pets. In fact, those who had a pet and experienced the death or divorce of their spouse were no lonelier than older adults who didn't experience one of those events.

"That's an important and impressive finding," Carr said. "Experiencing some depression after a loss is normal, but we usually are able to adjust over time to these losses. Persistent loneliness, on the other hand, is associated with greater incidents of mortality and faster onset of disability, which means it's especially bad for your health. Our findings suggest that pets could help individuals avoid the negative consequences of loneliness after a loss."

Carr's team used data from a sample of older adults who participated in an experimental survey about human animal interaction as part of the University of Michigan's Health and Retirement Study in 2012, and linked the data with additional data collected between 2008 and 2014. They identified pet owners as those participants who either had a cat or a dog.

"In everyday life, having a cat or dog may not make you healthier," Carr said. "But when facing a stressful event, we might lean on a pet for support. You can talk to your dog. They're not going to tell you you're a bad person, they're just going to love you. Or you can pet your cat, and it's calming."

The researchers noted that additional studies should be conducted to explain why having pets helps maintain mental health better. However, Carr suggested part of it may relate to whether you feel like you matter to someone.

"Oftentimes, the relationship we have with our spouse is our most intimate, where our sense of self is really embedded in that relationship," Carr said. "So, losing that sense of purpose and meaning in our lives that comes from that relationship can be really devastating. A pet might help offset some of those feelings. It makes sense to think, 'Well at least this pet still needs me. I can take care of it. I can love it and it appreciates me.' That ability to give back and give love is really pretty powerful."

The findings have potential consequences for social policies. For instance, it may be beneficial to include companion animals in the treatment of people residing in senior-living facilities, or reducing barriers to pet ownership in such settings.

More information: Dawn C Carr et al. Psychological Health Benefits of Companion Animals Following a Social Loss, The Gerontologist (2019). DOI: 10.1093/geront/gnz109

Provided by Florida State University 

Regular trips out guard against depression in old age

Credit: CC0 Public Domain

Regular visits to the cinema, theatre or to museums could dramatically reduce the chances of becoming depressed in older age a new study has found.

14 dec 2018--Researchers at University College London found a clear link between the frequency of 'cultural engagement' and the chances of someone over 50 developing depression. It is the first such study to show that cultural activities not only help people manage and recover from depression but can actually help to prevent it.
Their study, published in the British Journal of Psychiatry, found people who attended films, plays or exhibitions every few months had a 32 per cent lower risk of developing depression, with those attending once a month or more having a 48 per cent lower risk.
Now its lead author, Dr. Daisy Fancourt, wants to encourage greater awareness of the benefits so that people can take better control of their own mental health.
She said: 'Generally speaking, people know the benefits of eating their five-a-day and of exercise for their physical and mental health, but there is very little awareness that cultural activities also have similar benefits. People engage with culture for the pure enjoyment of doing so, but we need to be raising awareness of their wider benefits too.'
The study looked at data on more than 2,000 people over the age of 50, who took part in the long-running English Longitudinal Study of Ageing (ELSA). This provides a rich source of information for researchers like Dr. Fancourt and her colleagues, covering the health, social, wellbeing and economic circumstances of older people in England.
Along with her colleague, Urszula Tymoszuk, Dr. Fancourt was able to look at data collected from people's answers to questionnaires and in one-to-one interviews over the course of ten years. This included information about how often they visited the theatre, concerts or the opera, the cinema, art galleries, exhibitions or museums. Their answers also revealed when participants reported being diagnosed with depression, and when they experienced symptoms that the pair could then measure on a scale widely used to spot people at risk of depression.
Even when the results were adjusted to take account of differences in people's age, gender, health and their levels of wealth, education and exercise, the benefits of cultural activities remained clear. Those benefits were also independent of whether or not people had contact with friends and family or took part in social activities like clubs and societies.
The researchers believe the power of these cultural activities lies in the combination of social interaction, creativity, mental stimulation and gentle physical activity they encourage.
Dr. Fancourt said: 'We were very pleasantly surprised by the results. Notably we find the same relationship between cultural engagement and depression amongst those of high and low wealth and of different levels of education—the only thing that differs is the frequency of participation.
'Cultural engagement is what we call a "perishable commodity". For it to have long-term benefits for mental health, we need to engage in activities regularly. This is similar to exercise: going for a run on the first of January won't still have benefits in October unless we keep going for runs.'
She added: 'Depression is a major issue affecting millions of people. If we are starting to feel low or isolated then cultural engagement is something simple that we can do to proactively help with our own mental health, before it gets to the point where we need professional medical help.'
Dr. Amanda Thompsell, chair of the old age faculty at the Royal College of Psychiatrists, said: 'This paper highlights the good news story that doing something enjoyable is not just for pleasure—it can be positively beneficial for older people's mental health. The findings suggest that engaging in regular cultural activities such as visiting the theatre or cinema could be a way to reduce the risk of developing depression.
'However, such activities on their own won't treat depression. This requires an approach based on the use of talking therapies, complemented by the use of medication where an older person doesn't respond or when they have more severe depression.
'The College welcomes this paper and encourages further research into the important area of old age mental health.'

More information: Daisy Fancourt et al, Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing, The British Journal of Psychiatry(2018). DOI: 10.1192/bjp.2018.267


Provided by Cambridge University Press

Drug combination for treatment-resistant depression not more effective than a single antidepressant

Credit: CC0 Public Domain

Psychiatrists and GPs increasingly combine mirtazapine with an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-noradenaline reuptake inhibitor) antidepressant for patients whose depression does not respond to a single antidepressant.

01 nov 2018--A large clinical trial led by researchers at the Universities of Bristol, Exeter, Keele, Manchester and Hull York Medical School, and published in the British Medical Journal today, looked at the effectiveness of adding mirtazapine to an SSRI or SNRI in patients who remain depressed after at least six weeks of conventional (SSRI or SNRI) antidepressant treatment. They found that this combination was no more effective in improving depression than placebo and call on doctors to rethink its use.
The study, funded by the National Institute for Health Research, also found that patients taking mirtazapine in combination with another antidepressant had more adverse effects and were more likely to stop treatment than those who took an antidepressant and placebo.
Depression is one of the top five contributors to the global burden of disease and by 2030 is predicted to be the leading cause of disability in high income countries. People with depression are usually managed in primary care in the UK and antidepressants are often the first line of treatment. However, many patients do not respond to antidepressants.
The National Institute for Health and Care Excellence (NICE) advises GPs to reconsider treatment if there has been no response after four to six weeks of treatment. The practice of adding mirtazapine has grown as psychiatrists and GPs search for effective ways of treating those who don't respond to a single antidepressant. Previous small-scale studies had shown that this combination might be effective.
Dr. David Kessler from the Centres for Academic Mental Health and Academic Primary Care at the University of Bristol, and lead author of the study, said: "Half of patients in primary care who take antidepressants remain depressed despite sticking to their treatment, yet there is little evidence about how to treat those for whom the drugs don't work.
"Our study has found that there is unlikely to be a clinically important benefit for mirtazapine over placebo in addition to an SSRI or SNRI antidepressant in primary care patients with treatment resistant depression, and that the combination is not well tolerated. We recommend that GPs think very carefully before adding mirtazapine as a second antidepressant in this group of patients. This is particularly important when there are clear alternatives such as cognitive behavioural therapy, which has been shown to be effective in this group of patients."

About the study

Patients were aged over 17 years, were being treated for depression in primary care, and had been taking an SSRI or SNRI antidepressant for at least six weeks. They were still depressed using International Classification of Diseases (ICD-10) criteria. All 480 patients who took part continued to take their SSRI or SNRI and were randomly assigned to one of two groups: either additionally taking mirtazapine or a placebo. Neither the patients nor researchers knew to which group each patient had been assigned. They were followed up at 12, 24 and 52 weeks to see whether their depression had improved.
At 12 weeks just under 40 per cent of patients had responded to treatment as measured by a halving of the severity of their depressive symptoms; there was a small difference in favour of the mirtazapine group but it was not clinically important and the study could not rule out the possibility of 'no effect'. Outcomes at the later time points showed even smaller differences between the groups with no evidence of worthwhile benefit over the longer term.

More information: David S Kessler et al. Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR), BMJ(2018). DOI: 10.1136/bmj.k4218


Provided by University of Bristol

Plant-rich diets may prevent depression – new evidence

Credit: DronG/Shutterstock.com

Being depressed can negatively affect your appetite and what you eat, but can bad eating habits bring your mood down? Our latest study, a systematic review of the best available evidence, found a clear link between the quality of a person's diet and their risk of depression. And it goes beyond the effect of diet on body size or other aspects of health that can affect mental health.

29 sept 2018--We took extra care in including only studies that took age, sex, income, body size, general health, smoking and physical activity into account in their analyses. That way we could be sure that the associations between diet and the risk of depression are independent of these factors.
We aggregated the results of several studies and found a clear pattern that following a healthier, plant-rich, anti-inflammatory diet can help prevent depression. Of the 41 studies in our review, four specifically looked at the link between a traditional Mediterranean diet and depression over time on 36,556 adults. We found that people with a more Mediterranean-like diet had a 33% lower risk of developing depression than people whose diet least resembled a Mediterranean diet.
Following a traditional Mediterranean diet, that is avoiding processed foods and foods that are high in saturated fat and sugar (pro-inflammatory foods) and favouring foods rich in omega-3, fibre, vitamins, magnesium and polyphenols, can reduce the risk of depression.

Biological explanation

Diet can influence mental health by causing damage to the brain. This can be due to oxidative stress (a harmful chemical process), insulin resistance, changes in blood flow and inflammation. A diet rich in anti-inflammatory and anti-oxidant components, commonly found in fruit, vegetables, nuts and wine (which should be drunk in moderation), can directly affect the brain by protecting it from oxidative stress and inflammation. Inflammation can also affect the neurotransmitters (the brain's messenger molecules) responsible for regulating emotion.
Recent research in humans also suggests that diet can affect the formation of brain cells (neurons), particularly in a part of the brain called the hippocampus, which is associated with mood regulation.
There is also new evidence regarding the microbes in your gut, known as the gut microbiota. These microbes can break down the nutrients we eat and create molecules that may be inflammatory or that stimulate neural activity. They communicate with the gut and brain neurons and can therefore influence behaviour.
Diet is a key modulator of gut microbiota. In animal studies, eating plant-based foods improves the microbial composition in the gut, whereas high-fat diets appear to disrupt the microbial balance. When there is an imbalance in the microbes in your gut, it can cause the intestines to become permeable, letting big molecules pass into the bloodstream, and these molecules can interact with brain function.

Nutritional psychiatry

The field of nutritional psychiatry has emerged recently – around a decade ago – and it is growing rapidly. But results from observational studies, despite giving us an indication on the direction of the association, can't tell us if the link is causal – only a randomised controlled trial can do this.
The recent SMILES trial was the first study to provide evidence that diet can affect depression. People allocated to the Mediterranean diet group improved their depressive symptoms after 12 weeks, compared with the control group who received social support.
The growing evidence for nutritional psychiatry suggests that GPs and mental health professionals should now seriously consider including dietary counselling for patients who are at risk of depression.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation

Online therapy proves effective for treating depression and anxiety

Providing an online computerized cognitive behavioral therapy (CCBT) program, both alone and in combination with an Internet Support Group (ISG), is a more effective treatment for anxiety and depression than a doctor's usual primary care, researchers from the University of Pittsburgh found. Results were published today in JAMA Psychiatry.

12 nov 2017--Bruce Rollman, M.D., M.P.H., professor of medicine and director of the Pitt Center for Behavioral Health and Smart Technology, led the National Institutes of Mental Health-funded Online Treatment for Mood and Anxiety Disorders Trial, which enrolled 704 depressed and anxious patients from 26 UPMC-affiliated primary care offices across western Pennsylvania.
UPMC primary care physicians referred patients ages 18 to 75 to the trial between August 2012 and September 2014 using an electronic health record prompt. Eligible and consenting patients were then randomized to one of three groups: care manager-guided access to the eight-session Beating the Blues CCBT program (CCBT-alone); care manager-guided access to both the CCBT program and a password-protected, moderated ISG that patients could access at any time via their smartphone or desktop computer (CCBT+ISG); or to their primary care physician's usual care.
Over the six-month intervention, 86 percent of patients randomized to CCBT started the program and completed an average of 5.4 sessions. Seventy-five percent of patients assigned to the ISG logged into the site at least once, and 62 percent made one or more posts or comments, with an average of 10.5 posts and comments per person. The maximum number of posts and comments from one participant was 306.
Six months later, patients randomized to the CCBT+ISG and CCBT-alone groups both reported significant improvements in their mood and anxiety symptoms versus patients receiving usual care, and these improvements lasted for six months after the end of the intervention. However, the addition of the moderated ISG provided no additional benefit over guided access to CCBT only. Additionally, the more CCBT sessions patients completed, the greater the improvement in their symptoms, highlighting the critical importance of patient engagement with online interventions.
Despite proven effectiveness at treating mood and anxiety disorders and use by many patients abroad, CCBT remains largely unknown and underutilized within the U.S., Rollman said. ISGs that enable individuals with similar conditions to access and exchange self-help information and emotional support have thrived in recent years, but benefits have yet to be established in randomized trials. This trial was the first to examine the effectiveness of incorporating either a CCBT program or an ISG into a collaborative care program for treating depression or anxiety in primary care.
"Providing access to these effective emerging technologies may be an ideal method to deliver mental health treatment to depressed and anxious patients at scale, especially to those who live in areas with limited access to care or personal obligations that make in-person counseling difficult to obtain," Rollman said. "Our study findings have important implications for transforming the way mental health care is delivered in primary care and focus further attention on the emerging field of e-mental health in the United States."

More information: Bruce L. Rollman et al. Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care, JAMA Psychiatry (2017). DOI: 10.1001/jamapsychiatry.2017.3379


Provided by University of Pittsburgh

One hour of exercise a week can prevent depression

A landmark study led by the Black Dog Institute has revealed that regular exercise of any intensity can prevent future depression - and just one hour can help.
Published today in the American Journal of Psychiatry, the results show even small amounts of exercise can protect against depression, with mental health benefits seen regardless of age or gender.

04 oct 2017--In the largest and most extensive study of its kind, the analysis involved 33,908 Norwegian adults who had their levels of exercise and symptoms of depression and anxiety monitored over 11 years.
The international research team found that 12 percent of cases of depression could have been prevented if participants undertook just one hour of physical activity each week.
"We've known for some time that exercise has a role to play in treating symptoms of depression, but this is the first time we have been able to quantify the preventative potential of physical activity in terms of reducing future levels of depression," said lead author Associate Professor Samuel Harvey from Black Dog Institute and UNSW.
"These findings are exciting because they show that even relatively small amounts of exercise - from one hour per week - can deliver significant protection against depression.
"We are still trying to determine exactly why exercise can have this protective effect, but we believe it is from the combined impact of the various physical and social benefits of physical activity.
"These results highlight the great potential to integrate exercise into individual mental health plans and broader public health campaigns. If we can find ways to increase the population's level of physical activity even by a small amount, then this is likely to bring substantial physical and mental health benefits."
The findings follow the Black Dog Institute's recent Exercise Your Mood campaign, which ran throughout September and encouraged Australians to improve their physical and mental wellbeing through exercise.
Researchers used data from the Health Study of Nord-Trøndelag County (HUNT study) - one of the largest and most comprehensive population-based health surveys ever undertaken - which was conducted between January 1984 and June 1997.
A healthy cohort of participants was asked at baseline to report the frequency of exercise they participated in and at what intensity: without becoming breathless or sweating, becoming breathless and sweating, or exhausting themselves. At follow-up stage, they completed a self-report questionnaire (the Hospital Anxiety and Depression Scale) to indicate any emerging anxiety or depression.
The research team also accounted for variables which might impact the association between exercise and common mental illness. These include socio-economic and demographic factors, substance use, body mass index, new onset physical illness and perceived social support.
Results showed that people who reported doing no exercise at all at baseline had a 44% increased chance of developing depression compared to those who were exercising one to two hours a week.
However, these benefits did not carry through to protecting against anxiety, with no association identified between level and intensity of exercise and the chances of developing the disorder.
According to the Australian Health Survey, 20 percent of Australian adults do not undertake any regular physical activity, and more than a third spend less than 1.5 hours per week being physically active. At the same time, around 1 million Australians have depression, with one in five Australians aged 16-85 experiencing a mental illness in any year.
"Most of the mental health benefits of exercise are realised within the first hour undertaken each week," said Associate Professor Harvey.
"With sedentary lifestyles becoming the norm worldwide, and rates of depression growing, these results are particularly pertinent as they highlight that even small lifestyle changes can reap significant mental health benefits."


Provided by University of New South Wales

World-first ketamine trial shows promise for geriatric depression

Australian researchers have completed the world's first randomised control trial (RCT) assessing the efficacy and safety of ketamine as a treatment for depression in elderly patients.
The results, published in the latest American Journal of Geriatric Psychiatry, provide preliminary evidence suggesting ketamine's effectiveness as an antidepressant when delivered in repeated intravenous doses.

28 july 2017--Led by a team of researchers from UNSW Sydney and Black Dog Institute, the trial tested different doses of ketamine among 16 older age participants (aged over 60 years) who had treatment-resistant depression, administered at Wesley Hospital.
"These findings take us a big step forward as we begin to fully understand the potential and limitations of ketamine's antidepressant qualities," said lead author UNSW Professor Colleen Loo, who is based at Black Dog Institute.
"Not only was ketamine well-tolerated by participants, with none experiencing severe or problematic side effects, but giving the treatment by a simple subcutaneous injection (a small injection under the skin) was also shown to be an acceptable method for administering the drug in a safe and effective way."
Participants received increasing doses of ketamine over a period of five weeks, with doses optimised for each individual participant using a new dose-titration approach developed by Professor Loo's Sydney research team and collaborators.
As part of the double-blind, placebo-controlled trial, an active control treatment which causes sedation similar to ketamine, was used to substitute for one of the treatment sessions. Researchers monitored for mood and other side-effects after each treatment session.
Following the RCT, participants also received 12 ketamine treatments in an open-label phase to investigate the effectiveness of multiple doses of ketamine.
By the six-month follow-up, 43% of participants (7 of 14) who completed the RCT had entered remission, with five remitting at amounts below the commonly-used dose of 0.5 mg/kg. Repeated treatments also resulted in a higher likelihood of remission or a longer time to relapse, with an overall response and remission rate of 68.8% for the patients receiving ketamine treatment.
"Elderly patients with severe depression face additional barriers when seeking treatment for the condition. Many medications may cause more side effects or have lower efficacy as the brain ages," said co-author Dr Duncan George from UNSW.
"Older people are also more likely to have co-morbidities like neurodegenerative disorders and chronic pain, which can cause further complications due to ketamine's reported side effects.
"Our results indicate a dose-titration method may be particularly useful for older patients, as the best dose was selected for each individual person to maximise ketamine's benefits while minimising its adverse side effects."
Previous studies into ketamine treatments for older people with depression – which are limited to just five case reports – show mixed success, with findings limited by small sample sizes.
More broadly, little is known about ketamine's potential side effects at different doses, which include cognitive and dissociative effects, elevated blood pressure and heart rate, liver inflammation and urinary problems.
"These results are a promising early piece of the puzzle, but the risks of ketamine use are still not wholly understood. Future studies with greater sample sizes are needed to formally assess ketamine's side effects, such as its impact on liver function," Professor Loo added.

More information: Duncan George et al. Pilot Randomized Controlled Trial of Titrated Subcutaneous Ketamine in Older Patients with Treatment-Resistant Depression, The American Journal of Geriatric Psychiatry (2017). DOI: 10.1016/j.jagp.2017.06.007


Provided by University of New South Wales

First large-scale population analysis reinforces ketamine's reputation as antidepressant

Better known as an anesthetic or as an illicit hallucinogenic drug, ketamine has also long been noted for alleviating depression. But ketamine has not been tested in a large clinical trial, and all evidence of its antidepressant effects has come from anecdotes and small studies of fewer than 100 patients. 

10 jun 2017--Now, in the largest study of its kind, researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego mined the FDA Adverse Effect Reporting System (FAERS) database for depression symptoms in patients taking ketamine for pain. They found that depression was reported half as often among the more than 41,000 patients who took ketamine, as compared to patients who took any other drug or drug combination for pain.
The study, published May 3 in Scientific Reports, also uncovered antidepressant effects for three other drugs typically used for other purposes—Botox, the pain reliever diclofenac and the antibiotic minocycline.
"Current FDA-approved treatments for depression fail for millions of people because they don't work or don't work fast enough," said senior author Ruben Abagyan, PhD, professor of pharmacy. "This study extends small-scale clinical evidence that ketamine can be used to alleviate depression, and provides needed solid statistical support for wider clinical applications and possibly larger scale clinical trials."
Abagyan led the study with pharmacy students Isaac Cohen and Tigran Makunts, and Rabia Atayee, PharmD, associate professor of clinical pharmacy, all at Skaggs School of Pharmacy.
The FAERS database contains more than 8 million patient records. The research team focused on patients in the database who received ketamine, narrowing their study population down to approximately 41,000. They applied a mathematical algorithm to look for statistically significant differences in reported depression symptoms for each patient.
"While most researchers and regulators monitor the FAERS database for increased incidences of symptoms in order to spot potentially harmful drug side effects, we were looking for the opposite—lack of a symptom," Cohen said.
The team found that the incidence of depression symptoms in patients who took ketamine in addition to other pain therapeutics dropped by 50 percent (with an error margin less than 2 percent) compared to the patients who took any other drug or drug combination for pain. Patients who took ketamine also less frequently reported pain and opioid-associated side effects, such as constipation, as compared to patients who received other pain medications.
According to Abagyan, it is possible that another factor common to patients taking ketamine was driving the antidepressant effect, such as the fact that ketamine also relieves pain. That's why they compared ketamine patients with patients taking other pain medications. That control group eliminated the possibility that people who take ketamine have less depression because they have less pain. Abagyan says it's still possible, though unlikely, the effect could be due to a still unidentified confounding factor.
Three other drugs with previously under-appreciated antidepressant effects also emerged from this analysis: Botox, used cosmetically to treat wrinkles and medically to treat migraines and other disorders; diclofenac, a nonsteroidal anti-inflammatory drug (NSAID); and minocycline, an antibiotic.
After the diclofenac finding, Abagyan and team went back and looked at ketamine patients who did not also take NSAIDs and compared them to patients who took any other combination of drugs for pain except NSAIDs. Depression rates in patients taking ketamine remained low.
The researchers hypothesize that the antidepressant effects of diclofenac and minocycline may be due, at least in part, to their abilities to reduce inflammation. For Botox, the potential mechanism for reducing depression is less clear. The team is now working to separate Botox's beauty effects (which could indirectly make a person feel better emotionally) and its antidepressant effects. To do this, they are first using FAERS data to determine if collagen fillers and other cosmetic treatments similarly affect depression rates.
According to the World Health Organization, more than 300 million people experience depression worldwide. If not effectively treated, depression can become a chronic disease that increases a person's risk of mortality from suicide, heart disease or other factors. Depression is currently treated with five classes of antidepressants, most commonly serotonin reuptake inhibitors.
For financial and ethical reasons, ketamine has never been tested for its safety and effectiveness in treating depression in a large-scale clinical trial, but it reportedly works much more rapidly than standard antidepressants. Ketamine is relatively inexpensive and is covered by most health insurance plans if three other antidepressants fail.
"The approach we used here could be applied to any number of other conditions, and may reveal new and important uses for thousands of already approved drugs, without large investments in additional clinical trials," Makunts said.

More information: Isaac V. Cohen et al, Population scale data reveals the antidepressant effects of ketamine and other therapeutics approved for non-psychiatric indications, Scientific Reports (2017). DOI: 10.1038/s41598-017-01590-x


Provided by University of California - San Diego