1. Early stress confers lifelong vulnerability causing alterations in a specific brain region

    June 28, 2017 by Ashley

    From the Mount Sinai Hospital / Mount Sinai School of Medicine:

    Early life stress encodes lifelong susceptibility to stress through long-lasting transcriptional programming in a brain reward region implicated in mood and depression, according to a study conducted at the Icahn School of Medicine at Mount Sinai and published June 15 in the journal Science.

    The Mount Sinai study focuses on epigenetics, the study of changes in the action of genes caused not by changes in DNA code we inherit from our parents, but instead by molecules that regulate when, where, and to what degree our genetic material is activated. Such regulation derives, in part, from the function of transcription factors — specialized proteins that bind to specific DNA sequences in our genes and either encourage or shut down the expression of a given gene.

    Previous studies in humans and animals have suggested that early life stress increases the risk for depression and other psychiatric syndromes, but the neurobiology linking the two has remained elusive until now.

    “Our work identifies a molecular basis for stress during a sensitive developmental window that programs a mouse’s response to stress in adulthood,” says Catherine Peña, PhD, lead investigator of the study. “We discovered that disrupting maternal care of mice produces changes in levels of hundreds of genes in the VTA that primes this brain region to be in a depression-like state, even before we detect behavioral changes. Essentially, this brain region encodes a lifelong, latent susceptibility to depression that is revealed only after encountering additional stress.”

    Specifically, Mount Sinai investigators identified a role for the developmental transcription factor orthodenticle homeobox 2 (Otx2) as a master regulator of these enduring gene changes. The research team showed that baby mice that were stressed in a sensitive period (from postnatal day 10-20) had suppressed Otx2 in the VTA. While Otx2 levels ultimately recovered by adulthood, the suppression had already set in motion gene alterations that lasted into adulthood, indicating that early life stress disrupts age-specific developmental programming orchestrated by Otx2.

    Furthermore, the mice stressed during the early-life sensitive time period were more likely to succumb to depression-like behavior in adulthood, but only after additional adult stress. All mice acted normally before additional adult social stress, but a “second hit” of stress was more likely to trigger depression-like behavior for mice stressed during the sensitive time period.

    To test the prediction that Otx2 was actually responsible for the stress sensitivity, the research team developed viral tools that were used to either increase or decrease Otx2 levels. They found that suppression of Otx2 early in life was both necessary and sufficient for increased susceptibility to adult stress.

    “We anticipated that we would only be able to ameliorate or mimic the effects of early life stress by changing Otx2 levels during the early sensitive period.” says Dr. Peña. “This was true for long-lasting effects on depression-like behavior, but somewhat to our surprise we could also change stress sensitivity for short amounts of time by manipulating Otx2 in adulthood.”

    While early-life critical periods have been understood for processes such as language learning, little is known about whether there are sensitive periods in childhood when stress and adversity most impacts brain development and particularly emotion-regulation systems. This study is the first to use genome-wide tools to understand how early life stress alters development of the VTA, providing new evidence for sensitive windows in emotion development.

    “This mouse paradigm will be useful for understanding the molecular correlates of increased risk of depression resulting from early life stress and could pave the way to look for such sensitive windows in human studies,” says Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience and Director of the Friedman Brain Institute at Mount Sinai and senior investigator of the study. “The ultimate translational goal of this research is to aid treatment discoveries relevant to individuals who experienced childhood stress and trauma.”


  2. Study examines effect of CBT on chronic pain patients

    June 26, 2017 by Ashley

    From the European League against Rheumatism press release:

    The results of a study presented today at the Annual European Congress of Rheumatology (EULAR) 2017 has shown that Acceptance and Commitment Therapy, a form of cognitive behavioural therapy (CBT) that focuses on psychological flexibility and behaviour change, provided a significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation programme.

    This treatment also resulted in significant increases in self-efficacy, activity engagement and pain acceptance.

    To assess the potential benefits of an 8-week programme of group Acceptance and Commitment Therapy (ACT) in people with persistent pain, measures of pain acceptance and activity engagement were taken using the Chronic Pain Acceptance Questionnaire. Measures of psychological distress using the Hospital Anxiety and Depression Scale and self-efficacy were also taken at assessment, on the final day of the programme, and at the follow up six-month review.

    For those chronic pain patients with scores at all three time points, there were statistically significant improvements in all parameters between baseline and at six-months follow-up, including the change in mean score of depression, anxiety, self-efficacy, activity engagement and pain willingness (p<0.001).

    “To further validate the role of ACT in the treatment of chronic pain, specifically in a rheumatology context, a randomised controlled clinical trial that includes measures of physical and social functioning within a Rheumatology service would be desirable,” said lead author Dr. Noirin Nealon Lennox from Ulster University in Northern Ireland.

    ACT is a form of CBT that includes a specific therapeutic process referred to as “psychological flexibility”. ACT focuses on behaviour change consistent with patients’ core values rather than targeting symptom reduction alone. Evidence for this approach to the treatment of chronic pain has been mounting since the mid 2000’s. A previous systematic review had concluded that ACT is efficacious for enhancing physical function and decreasing distress among adults with chronic pain attending a pain rehabilitation programme.

    In this study, patients were referred into the ACT programme by three consultant rheumatologists over a five-year period. Over one hundred patients’ outcome measures were available for a retrospective analysis.


  3. Sleep duration impacts treatment response for depressed patients with insomnia

    June 21, 2017 by Ashley

    From the American Academy of Sleep Medicine press release:

    Preliminary results from a new study show that depressed patients with insomnia who sleep seven or more hours per night are more likely to benefit from cognitive behavioral therapy for insomnia (CBTI) and achieve depression remission.

    Results show that when insomnia and depression co-occur, longer pre-treatment objective sleep duration is predictive of remission of both disorders when patients are given a combination of CBTI for insomnia and antidepressant medication for depression.

    “A seven-hour, objective sleep duration of patients prior to entering treatment increased their chances of achieving both depression and insomnia remission by their treatment endpoints,” said lead author and co-principal investigator Jack D. Edinger, PhD, professor in the Section of Sleep Medicine at National Jewish Health in Denver, Colorado.

    The study involved 104 adults, including 75 women, who enrolled in the Treatment of Insomnia and Depression Study and completed one baseline night of polysomnography. Participants received 16 weeks of anti-depressant medication and were randomly assigned either to CBTI or sham insomnia therapy. The Hamilton Rating Scale for Depression (HAMD-17) and Insomnia Severity Index were administered at baseline and then bi-weekly during treatment to determine depression and insomnia remission.

    The study was part of a larger research project for which Edinger was co-investigator along with co-investigators Daniel Buysse, MD, from the University of Pittsburgh; Andy Krystal, MD, from Duke University and the University of California, San Francisco; and lead principal investigator Rachel Manber, PhD, professor of psychiatry and behavioral sciences at the Stanford University Medical Center.

    “Our findings highlight the importance of adequate objective sleep in the recovery from depression and insomnia,” said Manber. “The data suggest that short sleep duration may be a risk for refractory depression.”

    The research abstract was published recently in an online supplement of the journal Sleep and will be presented Monday, June 5, in Boston at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.


  4. Survey finds half of adults with anxiety or depression report chronic pain

    June 15, 2017 by Ashley

    From the Columbia University’s Mailman School of Public Health press release:

    In a survey of adults with anxiety or a mood disorder like depression or bipolar disorder, about half reported experiencing chronic pain, according to researchers at Columbia University’s Mailman School of Public Health. The findings are published online in the Journal of Affective Disorders.

    “The dual burden of chronic physical conditions and mood and anxiety disorders is a significant and growing problem,” said Silvia Martins, MD, PhD, associate professor of Epidemiology at the Mailman School of Public Health, and senior author.

    The research examined survey data to analyze associations between DSM-IV-diagnosed mood and anxiety disorders and self-reported chronic physical conditions among 5,037 adults in São Paulo, Brazil. Participants were also interviewed in person.

    Among individuals with a mood disorder, chronic pain was the most common, reported by 50 percent, followed by respiratory diseases at 33 percent, cardiovascular disease at 10 percent, arthritis reported by 9 percent, and diabetes by 7 percent. Anxiety disorders were also common for those with chronic pain disorder at 45 percent, and respiratory at 30 percent, as well as arthritis and cardiovascular disease, each 11 percent. Individuals with two or more chronic diseases had increased odds of a mood or anxiety disorder. Hypertension was associated with both disorders at 23 percent.

    “These results shed new light on the public health impact of the dual burden of physical and mental illness,” said Dr. Martins. “Chronic disease coupled with a psychiatric disorder is a pressing issue that health providers should consider when designing preventive interventions and treatment services — especially the heavy mental health burden experienced by those with two or more chronic diseases.”


  5. Study examines impact of deployment stress on well-being of vets

    June 11, 2017 by Ashley

    From the Boston University Medical Center press release:

    Experiencing stress-related mental health issues following deployment exposures increases risk of reduced well-being in other life domains in the years following military service for veterans. Gender plays an important role in these associations.

    The findings, which appear in Clinical Psychological Science, have implications for better understanding the challenges female and male veterans face upon returning from service and may lead to ways care can be optimized with consideration of the role gender may play.

    According to the researchers, previous studies have shown a relationship between the development of mental health issues, particularly PTSD, and decreased functioning and satisfaction with family and work for veterans. However, gender often has been overlooked as a variable, and the role of particular deployment stressors have not been extensively examined. “Our study illustrates the complex interplay between specific military exposures, mental health, and subsequent post deployment well-being between the genders,” explained lead author Brian Smith, PhD, assistant professor of psychiatry at Boston University School of Medicine and research psychologist in the Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System.

    In this study, which was completed at the VA Boston Healthcare System, 522 male and female Iraq and Afghanistan War veterans completed two surveys. The first was completed within two years of separation from military service, and included questions about veterans’ military experiences as well as their current mental health. The second survey was completed approximately three and a half years later and included questions about functioning and satisfaction in the domains of work, romantic relationships and parenting.

    The researchers concluded that each of the deployment stressors examined — warfare exposure, military sexual harassment and family stressors — had implications for veterans’ subsequent functioning and satisfaction in the areas of work and family. In addition, these exposures were often indirectly linked to functioning and satisfaction via mental health. Interestingly, the links differed between men and women. While PTSD symptoms played an important role for both genders, depression played a role as well, especially for female veterans. For example, PTSD linked all three deployment exposures and subsequent functioning and satisfaction in romantic relationships for men, while both PTSD and depression played significant roles for women. However, it is important to note that there were some similarities in risk as well. In the context of parenting, PTSD linked deployment exposures with reduced functioning for male and female veterans alike, and depression was the most important link in predicting lower satisfaction.

    In addition, there was evidence for direct effects of military exposures on work and family quality of life. Again, some differences between males and females were found. For example, family stressors during deployment were directly associated with increased risk for parental impairment for female veterans, whereas for men the effect was only indirect through PTSD. These findings support the position that men and women may experience different military exposures and react in different ways. “This understanding of risk for reduced well-being, including the role of gender differences, may provide further important insight as to how to best cater post-military services to veterans’ unique needs following military service,” added Smith. “From a clinical perspective, these findings suggest that services aimed at addressing returning veterans’ reintegration into work and family life might pay particular attention to male and female veterans’ experiences while deployed, as well as their current mental health.”


  6. Family support moderates college students’ feelings of loneliness

    June 10, 2017 by Ashley

    From the University of Michigan press release:

    When college students feel isolated and disconnected, support from family members can keep them from harming themselves during difficult times, according to a new University of Michigan study.

    “Parents can serve as a first-line of defense in efforts to prevent or reduce the risk of suicide in students,” said Edward Chang, the study’s lead author and a professor of psychology and social work.

    The study consisted of 456 Hungarian college students whose ages ranged from 18 to 35.

    Respondents rated the frequency of feeling isolated and the extent of family support. To assess for suicide risk, respondents indicated if they felt depressed or had suicidal thoughts during the past 12 months.

    When lonely students had high family support, they had fewer depressive symptoms compared to those with lower family support, the study found. The same results were found for those who thought about suicide–that family support provided a small but significant improvement from following through on self-harm.

    The findings, the researchers said, point to strategies to reduce heightened suicide risk in college students. For instance, parents might be trained to look for and identify early signs of risks, such as social isolation. Families must also get counselors involved to create more positive environments for students that may be at risk for suicide.

    Chang said the key is that as children grow up and out of the house, it’s important for parents to remain invested in the health of their child.

    “Going away to college does not mean that young emerging adults have sufficiently established a strong social support network or cultivated the sort of coping strategies to deal with their new roles as college students,” he said. “Parents represent a child’s foundation for support and growth.”

    And since parents and college students often are out of daily physical interactions, both parties would likely benefit from routinely letting each other know that they remain on their minds, he said.

    The findings appear in the Family Journal. The study’s other researchers were Olivia Chang, Tamás Martos, Viola Sallay, Jerin Lee, Kayla Stam, Casey Batterbee and Tina Yu.


  7. Probiotic use linked to improved symptoms of depression

    June 8, 2017 by Ashley

    From the McMaster University press release:

    Probiotics may relieve symptoms of depression, as well as help gastrointestinal upset, research from McMaster University has found.

    In a study published in the medical journal Gastroenterology, researchers of the Farncombe Family Digestive Health Research Institute found that twice as many adults with irritable bowel syndrome (IBS) reported improvements from co-existing depression when they took a specific probiotic than adults with IBS who took a placebo.

    The study provides further evidence of the microbiota environment in the intestines being in direct communication with the brain said senior author Dr. Premysl Bercik, an associate professor of medicine at McMaster and a gastroenterologist for Hamilton Health Sciences.

    “This study shows that consumption of a specific probiotic can improve both gut symptoms and psychological issues in IBS. This opens new avenues not only for the treatment of patients with functional bowel disorders but also for patients with primary psychiatric diseases,” he said.

    IBS is the most common gastrointestinal disorder in the world, and is highly prevalent in Canada. It affects the large intestine and patients suffer from abdominal pain and altered bowel habits like diarrhea and constipation. They are also frequently affected by chronic anxiety or depression.

    The pilot study involved 44 adults with IBS and mild to moderate anxiety or depression. They were followed for 10 weeks, as half took a daily dose of the probiotic Bifidobacterium longum NCC3001, while the others had a placebo.

    At six weeks, 14 of 22, or 64%, of the patients taking the probiotic had decreased depression scores, compared to seven of 22 (or 32%) of patients given placebo.

    Functional Magnetic Resonance Imaging (fMRI) showed that the improvement in depression scores was associated with changes in multiple brain areas involved in mood control.

    “This is the result of a decade long journey — from identifying the probiotic, testing it in preclinical models and investigating the pathways through which the signals from the gut reach the brain,” said Bercik.

    “The results of this pilot study are very promising but they have to be confirmed in a future, larger scale trial,” said Dr. Maria Pinto Sanchez, the first author and a McMaster clinical research fellow.


  8. Depression risk following natural disaster can be predicted via pupil dilation

    June 7, 2017 by Ashley

    From the Binghamton University, State University of New York press release:

    Pupil dilation could identify which individuals are at greatest risk for depression following disaster-related stress, and help lead to targeted interventions, according to new research from Binghamton University, State University of New York.

    Researchers at Binghamton University recruited 51 women who were living in the greater Binghamton, N.Y., area at the time of a catastrophic 2011 flood and who reported a life event indicating that they or their child had been impacted by the flood to some extent. To participate in the study, women were either required to have a lifetime history of major depressive disorder or no lifetime diagnosis of any DSM-IV mood disorders. The researchers’ findings indicated that decreased pupil dilation to emotional facial expressions predicted a significant increase in post-flood depressive symptoms, but only among women who experienced higher levels of flood-related stress.

    “One of the theories of depression is that there’s a lot of vulnerabilities for depression that lay latent until stress activates them,” said Mary Woody, Binghamton graduate student and lead author of the study. “Our idea with the flood is. Here’s this big objective experiment where there’s a disaster outside of everyone’s control, and it’s happening to the community and there’s kind of varying levels of stress that are happening at each of these family dyads. Our idea was to look at a vulnerability factor/risk factor pupil response and see if we could predict which families have the most depression following the flood if they had more of this particular risk factor.”

    The findings suggest that interventions designed to target deficits in cognitive-affective responding may be effective for prevention and intervention programs for depression following natural disasters.

    “In light of the current findings, it is certainly plausible that individuals displaying decreased pupillary response to emotional stimuli and relatively higher levels of disaster-related stress may be good candidates for cognitive therapy to alleviate their depression,” said Brandon Gibb, professor of psychology at Binghamton University, director of the Mood Disorders Institute and Center for Affective Science, and co-author of the study.

    The study is the first to examine how pupillary response to emotional stimuli may interact with life stress to predict prospective depression. If replicated and extended, the current findings may further our understanding of how cognitive-affective response plays a role in stress and depression and also aid clinicians in identifying those most at risk following a natural disaster, wrote the researchers.

    “After natural disasters only about 20-25 percent of people are going to go on to develop depression. Because there’s limited resources following a natural disaster, it will be way too expensive for us to be able to give them the psychiatric care,” said Woody. “One of the implications in this project is to be able to identify whom might be at greatest risk for depression following a natural disaster, so we may be able to design some sort of intervention that targets those individuals, and it is more cost effective in that way.”

    The paper, “Pupillary response to emotional stimuli as a risk factor for depressive symptoms following a natural disaster: The 2011 Binghamton flood,” will be published in Clinical Psychological Science.


  9. Does stress lead to lengthier periods of sick leave?

    June 5, 2017 by Ashley

    From the Deutsches Ärzteblatt International press release:

    The duration of a person’s unfitness for work is determined by more than his/her primary diagnosis. Patients often report psychological problems and a feeling of being burnt out. Antonius Schneider and colleagues analyzed whether an association exists between such psychological symptoms and the length of sick leave, even if patients received their sick note because of purely physical symptoms, such as back pain.

    The researchers studied the data of 225 patients, from 14 general practices, who had been issued with a sickness certificate. The diagnoses that prompted the sick leave varied. Respiratory disorders and disorders of the musculoskeletal system were the most common diagnoses. The longest mean periods of sick leave were documented for patients with diagnoses of skin diseases and mental disorders. All study participants completed a questionnaire that included the Maslach Burnout Inventory, General Survey, and Patient Health Questionnaire, with the scales depression, somatization, and anxiety. Patients’ characteristics such as sex, age, relationship status, and educational attainment were also captured.

    For the total study population, doctors’ sick notes were associated with longer periods of sick leave in patients with a lower level of educational attainment (less than 10 years of schooling), independently of the primary diagnosis. An association existed between the length of the sick leave period and emotional exhaustion, depersonalization, depression, anxiety, and somatization. When study participants were excluded whose unfitness for work was primarily due to psychological and psychiatric diagnoses, the sick leave period correlated with emotional exhaustion, somatization, and — almost statistically significantly — with depression. Sex and relationship status were not relevant.

    In a secondary analysis, age and formal education were associated with the duration of sick leave. Each year of increase in age led to an increase in the length of the sick leave period by 1.7%. In persons with higher levels of education, the length of sick leave was reduced by 40%. In terms of the psychological burden, an association of anxiety symptoms with the duration of unfitness to work was primarily noted.

    The authors conclude that a holistic approach in patient-centered communication, such as is applied in case of depression and anxiety, may be helpful in psychological or physical symptoms of unknown origin during the consultation with the primary care physician.


  10. How listening to music in a group influences depression

    June 2, 2017 by Ashley

    From the Frontiers press release:

    Listening to music together with others has many social benefits, including creating and strengthening interpersonal bonds. It has previously been shown that enjoying music in a group setting has an impact on social relationships, and that synchronizing with other group members to a beat influences how people behave to individuals both within and outside of the group. Similarly, the sharing of emotions has many social benefits as well: it helps us create and sustain relationships with others and to cement social bonds within a group, and it intensifies the potential for emotional responses. A question that still remains is whether sharing emotional and musical experiences with others might be a particularly powerful form of social bonding, and what the outcome of such an interaction might be.

    In this study, published in Frontiers in Psychology, the researchers wanted to investigate the self-reported effects on mood that comes with listening to sad music in group settings, and how mood is influenced by rumination (a maladaptive focus on negative thoughts), depression, and coping style. To do so, they recruited 697 participants who completed an online survey about “their ways of using music, types of musical engagement and the effect of music listening.” The participants also completed a number of additional questionnaires, which helped the researchers determine factors such as: the presence of symptoms of depression, anxiety and stress; general tendencies towards depression; coping styles, i.e. tendencies towards rumination or reflection (i.e. healthier tendencies to self-reflection); musical engagement as a measurement of wellbeing; as well as questionnaires addressing a variety of aspects of music listening, both alone and in a group. The results reveal two distinct behavioral patterns related to group music listening:

    1. Listening to sad music and talking about sad things tended to make people feel more depressed after listening to music. This kind of group rumination was more common in younger people, and likely reflects relative importance of both music and social relationships to younger people.

    2. Listening to inspiring music in a group and engaging in discussions about music and life is a more positive interaction that makes people feel good.

    These results provide some clues as to how people with depression use music, and why. “Behaviors relating to music use fall into distinct patterns, reflecting either healthy or unhealthy thought processes,” says Dr Sandra Garrido (corresponding author). “These results reveal important information about how people with depression use music.” The results shine a light on how music can facilitate the sharing of negative emotions, and show that the outcome is related to the coping styles and thinking patterns used in each setting, meaning that people with generally maladaptive coping styles are more likely to experience negative outcomes from group rumination of music.

    The results also show that young people may be especially vulnerable to the impacts of group rumination with music. “While young people with tendencies to depression who are a part of social groups may be perceived as receiving valuable social support, our results here suggest that the positive impacts of such group interactions depend on the types of processes that are taking place in the group,” explains Dr Garrido. “Susceptible individuals with a predilection for rumination may be most likely to suffer negative outcomes from group rumination, with social feedback deepening and exacerbating negative thoughts and feelings. However, group interactions that provide social support or opportunities for processing of emotions in a constructive way have a much higher likelihood of being positive.”

    These findings partially help clarifying under what conditions social interaction around music provide social benefits, and when it might instead amplify negative emotions. This opens up for further research to create a more detailed picture of how group interaction dynamics influence the outcome.