Tag Archives: mood disorders

Both obese and anorexic women short on “feel-good” chemical

If you’re anorexic or obese, there’s a good chance you’re depressed, too. More than 50 percent of anorexic women and 43 percent of obese people suffer from depression.

Surprisingly, a new study shows the biochemistry contributing to depression and anxiety in those two opposite physical conditions appears to be the same. Both obese and anorexic women have low levels (50 percent of normal or less) of allopregnanolone, a steroid that enhances the signal produced when the neurotransmitter GABA binds to its receptors, resulting in a general feeling of well being. Women in either weight category with low levels of allo were more likely to suffer from depression or anxiety.

Several previous studies have connected low allo levels with depression in the past, but its levels have never before been linked to anorexia or obesity.

Meds that increase the body’s ability to convert progesterone into allo could be helpful for treating depression and anxiety in these women who are outside normal body weights. We need more research before going that route, though. Scientists are working on that.

If your weight is at either end of the spectrum and you’re feeling depressed, come on in. We can talk about how to successfully modify your behavior to get you to a healthier weight along with what medications might help.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Depression: Physiological differences in teenage boys and girls

By the time they hit 15, teenage girls are twice as likely as teenage boys to suffer from depression.

This could be because girls tend to think more negatively, dwelling on social and body image stressors. They’re also more likely to have experienced sexual abuse and other negative events. On a biological level, their hormones fluctuate more and they’re more vulnerable to inflammation.

A group of scientists from the U.K. and the U.S. wanted to understand what was happening in the brains of depressed teenage boys versus depressed teenage girls. They hooked up both depressed and non-depressed boys and girls to fMRI equipment and gave them a task: Press a button when you see a happy word. Don’t press it when you see a sad word. (Such an activity puts something called cognitive control to the test. Impaired cognitive control has been associated with depression.) Then they watched what happened in the subjects’ brains.

To keep it simple, they saw differences between the sexes, specifically in the brain’s supramarginal gyrus (an area thought to be involved in emotional responses) and posterior cingulate (an area associated with control, awareness, and memory). When faced with a cognitive control task, there’s a lot less activation going on for males with depression compared to healthy males–depressed and healthy female brains were relatively similar in that situation.

So what does this new knowledge do for the study of depression? It emphasizes that teenage boys and teenage girls suffering from depression have different things going on in their brains. The way we treat –and try to prevent –the disorder should, therefore, be different.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

The future of depression treatment is in your blood

I’ve written before about how prescribing medication for depression can be an imprecise science. Often it takes multiple tries before we find the right drug or combination of drugs to send your depression into remission.

A study from Dr. Madhukar Trivedi (front) demonstrated that measuring a depressed patient’s C-reactive protein level can help doctors prescribe an antidepressant that is more likely to work. (utsouthwestern.edu)

Scientists are working on that problem, though, and a new study shows promising results: Researchers found that a simple blood test can indicate which type of medication is most likely to work on a given patient.

In this study, researchers took finger pricks of patients’ blood and measured levels of a protein called C-reactive protein (CRP). They treated the patients with one of two medication options and found that people with low levels of the protein responded a lot better to one medication, while people with high levels of the protein responded a lot better to the other.

There is a lot more research to be done. More medications need to be tested alongside CRP measurements, and other markers need to be found to fill in the gaps where CRP isn’t enough of an indicator.

This is a promising start, though, and I’m excited to see where further research goes.

Go here to read more about the study.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Promising new treatment for depression

Here’s some good news for people who have been having a hard time finding treatment that works for their depression: Scientists are on their way to developing a new and improved one.

The hippocampus.
The hippocampus.

Researchers recently figured out which pathway in the brain antidepressants affect. They call it the BMP signaling pathway, and it’s in the hippocampus. They learned that Prozac and other drugs interrupt this pathway, triggering the brain to produce more neurons — neurons that affect mood.

Armed with this new understanding, they turned to the lab mice. Researchers injected the mice with a brain protein already known to block the BMP pathway. They discovered the protein–called Noggin–does a better job blocking the pathway than traditional antidepressants do.  But more importantly, mice receiving this treatment showed strong signs of overcoming depression.

I mentioned a couple weeks ago that I wasn’t sure what depression looked like in rats (or mice), but this study enlightened me on some symptoms: When you hang mice upside down by their tails, some will struggle for a long time to right themselves, and some will give up. Giving up is a sign of depression. Similarly, if you put mice in a complicated maze, some explore and some cower. Cowering is a sign of depression, too.

The mice who were receiving the Noggin injections struggled more and explored more than their counterparts who weren’t receiving treatment.

I’m always excited by new discoveries about how the brain works. With our growing understanding, medication for depression will only get better and better.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Medicating for depression: The basics

Today I want to take a few minutes to go back to the basics: Let’s talk about prescribing medication for depression. It’s a process that my colleagues and I engage in every day, but for new patients it’s unfamiliar and deserves an introduction.

When someone comes to me with depression (and we’re talking about regular depression this time–bipolar depression is a whole different topic), the first decision we make together is whether we’ll treat with therapy, medication, or both. In my experience, a combination of the two is the most effective approach, but every patient is different. Today we’ll just talk about the medication side of treatment.

Antidepressants

Once we’ve decided to proceed with medication, we usually start with an antidepressant. There are several kinds of antidepressants, so we choose one that has been shown to best treat your particular symptoms — lack of motivation, irritability, trouble sleeping, sleeping too much, fatigue, trouble concentrating, restlessness, suicidal thoughts, or loss of enjoyment of the things you normally enjoy, for example. We talk about side effects, your family history, your ability and willingness to take pills regularly, other medications you’re taking, and your other health conditions and make a decision from there. We adjust the dosage as we watch your symptoms and side effects over the next several weeks.

If you’d like a breakdown of different types of antidepressants, I recommend this article from the Mayo Clinic.

What I really  want to focus on today is what we do when the antidepressant we choose is not working for you. The largest and best study out there on medicating for depression found that about a third of depressed people are “cured” by the first antidepressant prescribed to them — their depression symptoms go into remission.
If you’re not one of the lucky third, my next step is usually to try another type of antidepressant. In that same study, about 25 percent of the people who tried a second antidepressant went into remission. Those results are good enough to make trying again a strong option.

If the second antidepressant doesn’t work, we can choose to either try a third antidepressant — the study showed 12 to 20 percent of patients are cured by the third antidepressant — or we can try adding another medication on top of what you’re already taking. That’s called augmenting the antidepressant.

There are three main types of medications we can add to your antidepressant regimen: mood stabilizers, thyroid hormones, and antipsychotics. I’ve found that each of these has the potential to activate the antidepressant you’re already taking. Even if you haven’t experienced any improvement with the antidepressant, it can start to work when combined with something else.

Mood stabilizers

When you hear mood stabilizers, think Lithium. Lithium is one of the most studied and proven medications out there. You may think of it as a treatment for bipolar disorder, but it can work well as an augmentation for your antidepressant. I use it when there’s a history of bipolar in a patient’s family or when a patient’s moods are turbulent — maybe they struggle with anxiety and insomnia in addition to depression. There are other mood stabilizers out there that work well, too: I often prescribe Lamictal, for example.

Thyroid hormones

Adding thyroid hormones to antidepressants is a course that hasn’t been studied as well as adding mood stabilizers, but it appears to work well and be tolerated better than lithium in a lot of patients. The most commonly prescribed thyroid hormone for depression is called T3. It’s often used to speed up the effects of an antidepressant, but it works to enhance antidepressants at later stages, too.

Antipsychotics

The third augmentation option is an antipsychotic. Originally designed for treating schizophrenia, this class is becoming more and more popular for treating depression. A lot of my patients have seen huge improvements after adding an antipsychotic. My favorite is Abilify. People tolerate it well and see good results: Two studies from several years ago showed about a quarter of people who added Abilify to an ineffective antidepressant saw a remission of their depression. Abilify can be expensive, though, depending on your insurance, and if it is, I try other antipsychotics first.

There are so many options for treating depression, and different people respond better to different drugs. It’s hard to know in advance which option will work the best, so it can take several tries before we hit on the right strategy.

The good news is that if you’re on medication and it’s not working, that’s not the end of the line. Far from it. There is some combination out there that will work for you; we just have to find it.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Sleep and your mental health

Let’s talk about sleep: To put it simply, you need it. It’s so important for your mental health.

For starters, disrupted sleep is connected with suicide. A team of researchers recently investigated that link and came up with three “pathways” from sleep problems to suicidal thoughts:

  1. There are fewer mental health resources available at night, so suicidal thoughts that arise are more difficult to contain.
  2. Life gets harder when you’re tired. You’re more depressed, you’re less active, you think more negatively, and it’s harder to focus.
  3. Sleep can be an alternative to suicide — an easy escape from distressing thoughts. If you’re using it as an escape during the day, then what’s left at night?

Other studies have connected sleep and depression, too:

  • New mothers with post-partum depression have more sleep problems than their non-depressed counterparts. The worse their sleep, the worse their depression.
  • Too little or too much sleep appears to activate genes associated with depression.
  • People running on less sleep have an impaired ability to regulate their emotions — certain circuits in their brains aren’t working as well.
  • Teens who go to bed later are more likely to suffer from depression.

If you’re depressed, let’s talk about sleep. Addressing that can be part of the solution.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

What causes psychosis?

There has been a lot in the news lately about people suffering from psychotic episodes. Recently, a man, whom many thought was under the influence of bath salts, took off his clothes and chewed off the face of a homeless man. Toxicology reports denied him being under the influence of bath salts but confirmed marijuana being in his system. Another news event broadcasted the sad episode of a Jet Blue pilot who started behaving in an erratic way,  talking in religion themes and Iraq and the end of the world. He had to be restrained by flight attendants and passengers on the airplane before the plane making an emergency landing.
What causes psychosis? Is this a biochemical or genetic condition? Are there environmental factors or health habits that contribute to it? What can be done to treat or prevent the condition from happening?

The definition of psychosis found in Wikepedia is: refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.
The two major categories of mental illnesses we often associate with psychosis are the mood disorders such as Depression and Bipolar Disorder as its substypes as well as Schizophrenia. In Bipolar Disorder these psychotic episodes occur during the manic phases of the illness. There are other condtions that can cause psychosis. People under the influence of psychostimulants such as Ritalin or Cocaine or Methamphetamine may become psychotic, particularly if predisposed genetically to psychosis. Lately, in the news we have heard about people acting strangely under the influence of Bath Salts. And very recently, marijuana may have been a factor in the face eating incident.
In later years there is another cause that is being more and more recognized. Children who experience trauma may exhibit psychotic symptoms, particularly hearing voices. These children often don’t meet criteria for drug usage, mood disorders like Bipolar illness or Schizophrenia.
I personally have concerns about Marijuana. Many people would like to think that Marijuana is harmless. It is used for some chronic health issues like pain control and lack of appetite. Unfortunately, it is also being used inappropriately. I have had patients who come see me for an Anxiety problem who have complained to me that pot makes them anxious or even “crazy”. Pot will do this in people that are genetically predisposed toward psychosis. I once saw a promising young 18 year old man deterioriate and contract Schizophrenia, and Marijuana was believed to be the major culprit.

What is the treatment? It depends on the cause. If it is Bipolar Disorder, mood stabilizers and psychotherapy are the treatment of choice. Schizophrenia will probably require antipsychotic medication. If psychostimulants brought it on, they probably will need to be discontinued. For children with the history of trauma, medications may not be as effective as psychotherapy. Although many may find some benefit from both. Finally, the cause of the psychosis of the Jet Blue pilot was found to be the lack of sleep. I can’t emphasize enough the role of sleep in good mental health. I teach all my patients sleep hygiene who come to see me. A brain cannot heal or function optimally without a good nights sleep. What is the optimal amount? About 7-8 hours for most people.

ADHD and Dr. Amen Contributions

I am a big fan of Dr. Amen. I find his neuroimaging work to be highly fascinating. Not everyone agrees and some question his science. You may have seen some of his programs on the brain on PBS over the last few years.   I have been using Dr. Amen’s mental health questionnaires on my patients for years. I especially love his ADHD assessments. He identifies at least 6 different types of ADHD that have to be treated differently from each other to get the best results. I have been using them with my patients for the last number of years and have seen some highly effective results from the treatments advocated. Some types of ADHD may necessitate an antidepressant. Other types may be helped best by stimulants. Others may need a mood stabilizer. Some types need a combination of a few types of medications. There are also some supplements that can be effective in its treatment. Of course, as shown last month, there are other psychosocial types of treatment that can help including Cognitive Behavioral Therapy.
 
It is exciting to see all the advancements that are being made with understanding ADHD and its treatment. One day there may even be gene therapy to prevent the problem in the first place. Until then, we can use all the best of what science has to offer us.