A new investigational medication may help patients with depression find relief patients with treatment-resistant depression

Recent data from the National Institutes of Health shows more than 16 million American adults over age 18 had at least one major depressive episode in the previous year.

The condition, known as major depressive disorder (MDD), is characterized by a depressed mood or a loss of interest in activities for at least two weeks that impairs a person’s social, occupational or educational functions.

About 7 million Americans with MDD are treated with first-line antidepressant medications. However, the therapy doesn’t work for about 4 million of those patients, who then try second-line medications. Still, that therapy doesn’t work for about 3 million people. 

Treatment-resistant depression

When two lines or more of antidepressant therapies fail to work, those patients are diagnosed with treatment-resistant depression (TRD).

Patients with TRD are typically prescribed antidepressants, talk therapy and other treatments, hoping for something to work.

The treatment approach has been, “trial and error with great difficulty,” says Charles B. Nemeroff, M.D., Ph.D., the chief of psychiatry at the University of Miami Hospital.

Innovation in research

A new investigational drug — AXS-05: a novel, oral product combining existing medicines bupropion and dextromethorphan — may be a breakthrough treatment. The investigational drug is being evaluated as part of the STRIDE-1 (Symptom Treatment in Resistant Depression 1) phase 3 study.

“There haven’t been major developments in new therapies for depression therapies in years,” says Cedric O’Gorman, M.D., MBA, senior vice president of Clinical Development and Medical Affairs for Axsome Therapeutics, the company that makes AXS-05.

Treating depression

Dr. Nemeroff, who is not an advisor to Axsome Therapeutics, is enthused that new therapies are in development. He advises patients, “You can’t give up, because the odds are you’re going to respond to one treatment or another.”

His patient, Michelle Rovere, 56, has TRD and was suicidal in 2016.

“I’d become a burden to myself, to my husband, to my children,” she says, concluding, “I was in so much emotional pain.”

Rovere, who takes antidepressants, is in talk therapy and is feeling well.

“Peace and mental wellness are achievable,” she says.

Patients with MDD who are currently depressed and have failed one or two antidepressant treatments are encouraged to see if enrollment in the STRIDE-1 clinical trial may be suitable for them. https://www.trdstudy.com/

Five Steps to Helping Someone Who May Be Considering Suicide

The National Suicide Prevention Lifeline offers five steps to help someone who may be considering suicide.

1. Ask: There is a common misconception that asking someone if they have/ are considering killing themselves puts the idea in their head — it does not. Do not be afraid to ask!

2. Keep them safe: If someone admits to considering suicide, it is important to seek immediate medical attention, especially if they shared their plan with you or have access to firearms, the number one cause of suicide (50 percent).

3. Be there: Listen without judgment and with empathy. Let them know they have a shoulder to lean on when they need.

4. Help them connect: Help them find a support system to reach out to. Support is very important for someone battling the idea of suicide. Those who have attempted to harm themselves are often at risk of another attempt at suicide.

5. Follow up: Following up could mean preventing thoughts of suicide or another attempt.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741-741. You can reach Trans Lifeline at 877-565-8860 (U.S.) or 877-330-6366 (Canada) and The Trevor Project at 866-488-7386.

10 Interesting Facts about the Human Brain

The human brain is one of the most important organs in a human body. It helps us think, reason, remember, and learn new things. In fact, our brain and its superior functioning differentiate from animals and other creations of the Almighty.

Here are 10 interesting facts about the Human brain:

  1. The human brain weighs 3 pounds
  2. It comprises 60% of fat and is one of the fattest organs in the human body
  3. Human brain has the capacity to generate approximately 23 watts of power when awake.
  4. Of the total blood and oxygen that is produced in our body, the brain gets 20% of it.
  5. When the blood supply to the brain stops, it is almost after 8-10 seconds that the brain starts losing the consciousness.
  6. The brain is capable of surviving for 5 to 6 minutes only if it doesn’t get oxygen after which it dies.
  7. The blood vessels that are present in the brain are almost 100,000 miles in length.
  8. There are 100 billion neurons present in the brain.
  9. In early pregnancy, the neurons develop at an alarming rate of 250,000 per minute.
  10.  As we grow older, we are unable to remember new things. According to the researchers in the US it is because the brain is unable to filter and remove old memories which prevent it from absorbing new ideas.

To teach the working of the human brain as well as its important functions to kids, you must buy a model of the human brain.

 

** ScienceFirst - 2015

Signs of Teen Depression

Signs that their teen is depressed: Excessive irritability or generally depressed mood. Trouble sleeping or excessive sleeping. Sudden severe weight gain or weight loss. (Dreamstime/TNS)

It’s no secret that teenagers can be moody, but research shows that ongoing moodiness often is far more serious. Dr. Janna Gewirtz O’Brien, a Mayo Clinic pediatrician, says teen depression is much more common than most people realize.

“This is something that affects teenagers of all walks of life, of all backgrounds, and actually of ages from as young as 12 — sometimes even younger — and up to the young adult years,” O’Brien says.

She says new guidelines suggest screening all teens for depression starting at age 12.

“About half of kids are not identified with depression when they have it in the primary care setting, so we need to make sure that we’re catching more of those,” O’Brien says. “We can do better.”

She says parents also should look for these five signs that their teen is depressed:

• Excessive irritability or generally depressed mood.

• Trouble sleeping or excessive sleeping.

• Sudden severe weight gain or weight loss.

• A sudden drop in grades in school.

• Sudden loss of interest in activities they used to enjoy.

“So if somebody reaches out to you, an adolescent reaches out and says: ‘I’m worried. I’m depressed. Or I’m thinking about harming myself,’ that is something to be taken very seriously,” O’Brien said.

 

** Mayo clinic News

Helping a Family Member or Friend with Depression

 

When someone you love and care about experiences the symptoms of mental illness, you face unique challenges yourself, including complex family dynamics, social isolation and often unpredictable behavior. Getting support for yourself is essential for you to be able to be helpful for the person you care about.

Learn more about your loved one’s condition. Learning about the condition your loved one experiences will help you better understand and support them. Read personal accounts of lived experience, full of tips and advice on the NAMI website (www.NAMI.org)

Recognize early symptoms. Depression often has warning signs, such as a low mood, feeling fatigued or having trouble sleeping. Discuss your friend or family member’s past episodes with them to help them improve their ability to recognize the signs early.

Communicate.  Speak honestly and kindly. Don’t scold or blame people with depression or urge them to “try harder” to “just be happy.” Instead, make specific offers of help and follow through with those offers. Tell the person you care about them. Ask them how they feel and truly listen.

React calmly and rationally. Even if your family member or friend is in a crisis, it’s important to remain calm. Listen to their concerns and make them feel understood—then take the next step toward getting help.

Find emotional support from others. Share your thoughts, fears and questions with other people who have loved ones with similar conditions. Connect with others through online message boards.

Listen and be kind.

** NAMI 2017

 

Migraine News....Migraine in Children

For both children and adults, migraine impacts those around them (e.g., causes problems for their loved ones, such as parents and/or partners). Studies have demonstrated increased burden on family members as a result of migraine, with the burden for children with migraine falling on parents or caregivers  and adult migraine burden falling on partners or spouses (and children in the family). Such burden includes increased stress on family members, decreased relationship quality, and decreased family involvement in leisure or social activities. Such stressors are also related to increases in anxiety and depression in family members. Increased stressors on family are often positively correlated with higher levels of migraine-related disability in children and adults.

Migraine is, in turn, influenced by family members; however, this relationship has not been widely studied across age groups, with most research in this domain focusing on the parent-child relationship. Existing research has demonstrated that certain parenting variables can negatively impact children's migraine because of children's heavy dependence on their caregivers . For example, existing problems with family communication can lead to increased problems with pain management in children as well as increased relational difficulties between parents and children. Additionally, pre-existing physical or mental health concerns in parents can have negative impact on frequency, intensity, and ability to manage migraine in their children. Such conditions can include parents with chronic pain conditions (including migraine), and mental health conditions such as depression and anxiety. Importantly, it can be difficult to determine if conditions such as depression and anxiety in parents developed as a result of managing a child with migraine.

Lifestyle recommendations

Recommendations of daily lifestyle activities for migraine management are typically consistent across age groups. These recommendations include consistent intake of food, staying hydrated, and sleeping and exercising regularly.. Specifically, at minimum, food intake should include three meals a day (without skipping meals). Hydration recommendations vary slightly depending on age and activity level, but include an average of 8-10 cups of non-caffeinated fluid per day (greater physical activity includes increased recommendations of fluid intake). Consistent with best practice for physical activity regardless of migraine diagnosis, exercising 30 minutes or more 3-5 times per week is recommended. And finally, recommended duration of sleep also varies by age, but falling asleep and waking around the same time on a consistent bases is encouraged..

While such recommendations are consistent across age groups, some age-related challenges faced by adults may interfere with their ability to adhere to these practices . For example, adults with migraine typically have more health-related comorbidities as a result of ageing that make it difficult for them to regularly exercise. Age related changes in sleep can also result in less consistent sleeping patterns and fewer hours of sleep each night for adults.

 

 

Source:  PMC5885754 NCBI

 

Symptoms of Bipolar Disease

Depression involves feelings of sadness and emptiness or a loss of pleasure or interest in things.  These feelings last most of the day, on most days for at least 2 weeks.  These symptoms are severe enough to impact negatively on work, relationships and everyday life.

 

Bipolar Depression Symptoms  include:

1. Feeling sadness or emptiness.
2. Losing interest or pleasure in one’s usual enjoyments.
3. Changes in appetite (up OR down), and/or substantial and unplanned loss of weigh or weight gain.
4. Insomnia.
5. Excessive tiredness or sleepiness, and/or lack of energy.
6. Restlessness and agitation.
7. Reduced sex drive.
8. Lack of motivation.
9. Feeing worthless.
10. Feeling guilty about things you are not responsible for.
11. Indecision.
12. “Fuzzy” thinking, problems concentrating, or memory loss.
13. Thoughts of self harm or suicide.
14. Hallucinations.

15. Delusions.

Could a blood test lead to new treatments for Depression?

Depression is among the leading causes of disability worldwide, with more than 300 million people suffering from this mental illness, according to the World Health Organization.

Despite how common depression is, scientists still have a lot to learn about it.

Among what is known is that depression is not a single disease but a variety of feelings and behaviors that may have different underlying causes.

“Depressive disorders can present differently in different people. What is known now is that depression affects not just the brain but the whole organism,”said Natalie Rasgon, a professor of psychiatry and behavioral sciences at Stanford University.

But a new study of which Rasgon is a senior author finds evidence of a possible biomarker for major depressive disorder, which could lead to better treatments for this sometimes crippling disease.

The study by a group of researchers from around the U.S. and in Sweden finds that a specific, naturally-occurring chemical, called acetyl-L-carnitine, or LAC, is lower in the blood of people suffering from depression. The research was published this week in Proceedings of the National Academy of Sciences.

“Previous animal studies convincingly showed the role of LAC in models of depression. This study is the first confirmation of the results from animal studies in human subjects with depression,” Rasgon told ABC News.

Levels of the chemical were lower among people with more severe depression

Researchers measured LAC levels in the blood of 116 participants, and found that those with depression had significantly lower levels of the chemical than healthy individuals. Two groups of people at two different hospitals were examined, with the same results.

LAC levels were especially low among people whose depression was more severe, who began suffering from the disease at an earlier age or who had a history of childhood trauma. Levels were lowest among females whose depression did not get better with medications or therapy, known as “treatment-resistant depression,” and who had suffered childhood trauma or neglect.

The human body naturally produces LAC from a nutrient called carnitine, but researchers found that carnitine levels were the same in people with and without depression. This suggests that differing levels of LAC can be attributed to depression and not to diet.

 

What do we know about this chemical?

LAC performs a number of important tasks, including regulating how the brain and nervous system use energy. It also can interact with DNA to change how certain genes are expressed.

In previous studies, LAC has been shown to effectively and rapidly improve symptoms of depression in mice.

A review of multiple studies published in the Journal of Psychosomatic Medicine in 2017 showed that acetyl-L-carnitine may be better than a placebo in treating depression and may be as effective as common antidepressants but with fewer side effects. The review authors noted the studies were very small and larger trials are necessary to confirm any benefit.

There is a LAC supplement that has been used for dementia, but a 2003 review from Cochrane found it is unlikely to be of benefit for this purpose. Some studies suggest a benefit for a type of nerve pain called neuropathy.

But it is important to note this study did not test if LAC can be used for the treatment of depression.

“We are at the very beginning of this discovery and can’t recommend people to buy this supplement at the GNC store,” warned Rasgon.

How further research might lead to possible treatments

LAC has potential to be a biomarker, something measurable in the body that reflects the presence of a disease. As such, it could potentially be used to screen for and diagnose severe or treatment-resistant depression and allow for earlier and more aggressive treatment.

Researchers hope future studies could shed light on whether physical activity, dietary habits, and sleep may affect LAC levels.

This study also found that people on antidepressant drugs still had lower levels of LAC in their blood, suggesting that taking supplements of the chemical might be helpful or possibly even necessary to fully benefit from a medication.

This research, together with prior studies, suggests that correcting a deficiency in LAC could be a step toward more targeted treatments of depression, especially for those who suffered childhood trauma or began having depression at an early age.

We are excited with these results and are working on extending them to further understand the role of LAC in patients receiving treatment for depression,”Rasgon said. “It is one of the pieces of a very large puzzle that constitutes depressive disorders as an illness.”

While this study has important implications in understanding depression, Rasgon cautioned that it requires larger studies to confirm the findings. “There are many questions to be answered – who will ultimately benefit from taking this supplement, what is the right dose, what is the appropriate duration of use.”

The study was a collaboration between researchers at Stanford, Rockefeller University, Duke University, Weill Cornell Medical College, the Icahn School of Medicine at Mount Sinai, and the Karolinska Institute in Sweden.

Michael MacIntyre is a psychiatry resident working with the ABC News Medical Unit.

Exercise and Migraines

Methods for Migraine Prevention

 

We’re often raving about the benefits of various types of exercise.  Yoga, running, strength-training, spinning--the list seems endless and continues to grow.  In some people, exercise has had incredible effects on symptoms of chronic disease.  But for some, exercise also causes migraines. 

If you suffer from migraines, you know that they are painful, debilitating headaches that can interrupt your entire day.  So, how does exercise affect the brain?  And how can exercise exacerbate or prevent migraines?  We asked Dr. Ashok Patel, Medical Director of the Memory and Aging Center of Toms River, NJ, for more information.

Some of us go for a run with no issue, and we even feel better afterward.  What happens differently in people with migraines?

So, actually, exercise seems to counteract the severity of migraines in some people, while exacerbating the migraines of others.  Exercise has tremendous benefits to your circulation, getting blood flowing everywhere and boosting immunity, plus regulating breathing, hormones, and strengthening bone and muscle. 

With migraines, the effects would be easier to explain if we knew the entire pathway from trigger to migraine, but we don’t know yet.  Some believe migraines are caused by neuronal overstimulation, others believe they’re a vascular problem.  Most believe migraines are caused by both--no one knows the exact mechanism yet.  What we do know is that there are ways to treat and prevent migraines.  Ideally, avoid the exact trigger, eat right, stay hydrated, and exercise just enough. 

If we’re unsure of our trigger(s), what’s the best way to differentiate them?

The best way to differentiate between triggers is to pay close attention to your environment and actions before, during, and after each migraine occurs.  When you feel a migraine coming, take note of what you’ve eaten within the last few hours, where you’ve been or what you’ve been doing. Then track the events over time.  Eventually a pattern will become clear.

And if exercise is our trigger, then how can we cope with it?

Exercise isn’t a trigger that people should avoid.  First, see if there’s a certain exertion level or type of exercise that causes or exacerbates your migraine.  If there is, then avoid overexertion.  On the other hand, if, say, running in general seems to cause a migraine, then switch to other options, like yoga or biking.  Sometimes, taking NSAIDs before exercising prevents migraines.  But because the effects are different for different people, consult your physician for the right treatment regimen.

Are medications available to prevent or help treat migraines?

Acetaminophen or ibuprofen or other NSAIDs should help with mild attacks. For severe or chronic migraines, prescription medications are available.  Your doctor can learn which medication suits you best, based on your history and their knowledge of all your options.  If you’ve tried everything, and nothing seems to work, clinical trials are also available.  There’s a chance that you don’t have to live with so much pain.  

 Consult your physician immediately if your headaches are recurring or debilitating, or if one is debilitatingly painful for a very short amount of time (seconds to a minute).

For a free consultation, schedule an appointment with us today (732) 244-2299

Being There for A Loved One Who Needs Professional Help

Mental health issues can be disruptive not only for the person affected but the whole family. Sometimes it's necessary for loved ones to intervene.

When a loved one is having emotional struggles, family and close friends will do anything they can to help.

In many instances, a caring conversation is all one needs to put things in perspective. In other cases, a person may need professional help, such as undergoing counseling or seeing a doctor.

Determining the intensity of one’s distress is the first step to deciding the appropriate level of assistance. It's normal to feel intense depression after a difficult break-up or experience debilitating grief after a loved one has passed. Sometimes, life gets disrupted, one temporarily reacts in an emotional manner and empathetic support is all that is needed.

Others may have on-going mental health concerns, such as depression or anxiety. These types of mood issues are created by a chemical imbalance in the brain that is further influenced by one’s personality traits. With therapy and medication as well as understanding family members, many are able to productively manage their day-to-day affairs.

There is, however, a small group with severe mental illness, such as bipolar disorder, schizophrenia or drug addiction, whose struggles disrupt not only their own life but also the lives of those around them. These individuals are in acute distress and often rationalize, deny and make excuses for their bad behavior. Many are unwilling to seek help, and an intervention  is needed.

It is a truly caring person who understands when circumstances are out of control. Often times both the troubled individual and a supportive family member have visited multiple doctors and seen a variety of therapists. Nothing seems to be help. Unfortunately, in these situations, it may be time to consider an in-patient mental health facility.

Accepting that a loved one is in major distress and requires residential treatment will create a great deal of anxiety for most family members. Some may feel like they are a bad spouse or a bad parent. In reality, there are many situational and biological factors that contribute to a person’s downward spiral into severe mental illness.

It's also normal to question if something as drastic as an intervention is the best way to move forward. Family members who are in persistent distress and lie or hide their illness may not accept help in a traditional manner. If one is constantly making excuses for the behaviors of a sick family member, desires to leave a spouse because of their emotional outbursts or wants to kick a son or daughter out of the house because of their substance use, it's time to intervene.

Engaging in an intervention would sadden any concerned person. Even when one understands that providing a residential treatment option is the best course of action, the guilt can be overwhelming. This emotion may stem from a sense of powerlessness, self-doubt that an intervention is necessary or internalized blame that you are the cause of the problem.

Interventions are, however, a loving, supportive process that can motivate one to accept assistance. When the meeting occurs, it's common for the person in crisis to deny there is a problem or promise to change because they're unable to fully grasp their situation. Stay the course. On some level, the suffering individual knows he or she is in a bad place.

Reach out to a knowledgeable professional to assist with the emotional roller coaster a mentally ill family member can create. To avoid pitfalls that often occur during the intervention process, most mental health experts recommend engaging a professional interventionist, a mental health expert who is experienced with taking ill people to treatment centers. Check with your local National Council on Alcoholism and Drug Abuse or National Alliance on Mental Illness office to find a specialist.

Interventions are appropriate for any individual who is experiencing a mental health crisis, not just those who have addiction issues. Bringing family and friends together to help a person create change is a powerful motivator to get healthy.

Don’t wait for someone to hit bottom before intervening. Debilitating mental health issues and drug or alcohol addiction, can result in a person hurting themselves or others. Psychological and medical issues are, in many ways, the same. The earlier a problem is identified and treated, the better chance one has to successfully recover.

 

Source:   Russell Hyken

The Power of Positive Thinking

About half the carriers of a gene variant called APOE 4 get dementia. But scientists don't know why the other half don't.   It may be all in your attitude. Researchers surveyed 1, 250 older adult carriers of APOE 4 gene variants on their beliefs about aging.  They presented statements such as "True or False: The older I get, the  more useless I feel"  Those who were most positive about aging were significantly less likely to develop dementia over the next four years.  In fact, their risk for dementia was the same as if they didn't carry the risk increasing gene variant at all.

 

Source:  PLOS One

Mindfulness Meditation

Mindfulness Meditation has a couple of different components. Mindfulness brings awareness and clarity to feelings and emotions in the present moment, which helps to realize your needs, wants, and triggers for stress. Mindfulness also helps you to focus on the present moment which can create peace and happiness in your life instead of depression (focusing on the past) and anxiety (worrying about the future). Mindfulness meditation also allows you to clear your mind of everything. Working to clear your mind for a couple minutes a day can greatly reduce stress and “unclog” the negative thoughts that can impact your mental and physical health. Mindfulness mediation allows for self-acceptance, appreciation, and gratitude. You will feel both mental and physical, benefits of mindfulness meditation. You will also learn about yourself and experience personal growth. Here’s how to start your mindfulness meditation practice:

  • Find a quiet space where you feel comfortable
  • Sit or lay down and close your eyes
  • Take three deep breaths in through the nose, feel your tummy expand outward. Then exhale through the nose, feeling your tummy push back in toward the spine
  • Work to clear your mind. Bring awareness to your immediate thoughts and work to block them out. Silencing the mind is the difficult part. We are not used to turning off our mind chatter. Where is it that your mind wanders toward? You can learn about yourself through this practice. Ultimately you want to be calm and have a clear mindset. A cue word often helps. I use the word “settle” and this helps to focus on quieting my thoughts.
  • Focus on your breath, deep inhales and exhales, find your body relaxing
  • Settle your shoulders, feel where the tension leaves your body (I find most of my tension releases through my face and shoulders)
  • Do this for 3-5 minutes every morning or before bed

You can feel the benefits of mindfulness anywhere! Here is how you can find mindfulness wherever you are:

  • Wherever you find yourself during the day, take at least 2 minutes to really soak in your surroundings
  • Block unwanted or negative thoughts (Your list of things to do, what is for dinner, your weight gain, a fight)
  • Use a cue word to help block your thoughts
  • Dive into your surroundings using your senses (what are you seeing, touching, feeling, hearing)
  • Find beauty and appreciation for what it is you are doing in the present moment

Source:   The Daily Positive - Guest Post