Category: Mental Health

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Mental Wellbeing in the Workplace

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The state of South Africa’s mental well-being is a cause for concern

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In Aon’s 2024 Global Medical Trend Rates Report, mental health is listed as a major contributor to morbidity, disability, injury and premature mortality; also increasing the risk of other health conditions. The state of South Africa’s mental wellbeing is cause for concern. The world has witnessed several major events that have also had widespread impacts on people’s mental health. Events such as the COVID-19 pandemic, natural disasters, economic uncertainties, social unrest and warfare have heightened stress levels and contributed to an increased focus on mental well-being. 

South Africans are distressed and struggling with their mental health:

  • In Sapien Labs’ Mental State of the World 2022 report, South Africa was ranked as the country with the highest percentage (35.8%) of its population that are distressed and struggling with mental health.
  • Another prominent trend highlighted in the Sapien Labs report is the declining mental well-being of each successively younger generation. This is reflected in the Western Cape Government’s report on anxiety, depression and adolescent suicide which found that 9% of all teenage deaths are due to suicide.
  • According to the World Health Organisation (WHO) more than 700 000 people die by suicide every year, with South Africa rated as the country with the ninth highest suicide rate in the world at 23.5 per 100k, with suicide alarmingly being the fourth leading cause of death among 15 – 19-year-olds.
  • A WITS University study found that a quarter (25.7%) of South Africans are depressed with only a quarter of these affected individuals seeking assistance.

According to Jacqui Nel, business unit head of healthcare at Aon South Africa, depression is likely to be the world’s leading burden of disease by the year 2030, if not sooner. “It is easy to measure an individual’s weight, Body Mass Index (BMI), glucose and cholesterol levels, but it is much harder to measure what is going on in a person’s mind. The top challenge that human resource professionals are concerned with is keeping the workforce engaged and productive in the face of ongoing retrenchments, the spiralling cost of living, load shedding and the fact that 44% of South Africans have impaired credit records. All these factors are converging to create enormous contributory pressures when it comes to anxiety levels experienced by employees,” says Jacqui.

One of the leading trends in the mental well-being of employees is burnout, which places employees at risk of developing depression. It was classified as an occupational phenomenon in 2019 by the World Health Organisation (WHO) with its occurrence rate increasing on an annual basis, and it has only escalated since the onset of the pandemic and the radical changes to work models since then. “Employees that are burnt out feel exhausted, distance themselves from their colleagues and their job and show a reduction in professional efficacy,” Jacqui explains.

Finding a sustainable work-life balance model

These factors are clear indicators that there is something radically amiss in our work-life balance, and we need to do better as a society and employers in embracing a more sustainable work-life model that is cognisant of the forces that are at play in the workforce environment. “It starts by building resilience, agility and a sense of belonging at an individual and organisational level, and most of all, better support structures,” Jacqui explains.

Workforce Resilience

Workforce resilience describes a person’s fundamental sense of security at work, a strong sense of belonging with the employer and the adaptability and motivation they need to reach their full potential.  “Workforce resilience matters because businesses that put their people first are more likely to thrive. By creating a workplace environment that provides security, motivation and belonging, employees and colleagues are better able to weather and process the fiercest of storms and pressures,” Jacqui explains.

Workforce Agility

Workforce agility describes a workforce that thrives on and embraces change rather than being threatened by it, a workforce that can develop future skills at speed and naturally pivots to stand out from the competition – all the while balancing investment and people risk with agility, creating value for the employer and the customer, alike.

“By investing in impactful Employee Assistance Programmes (EAP), employers empower their employees to better measure their progress and manage risk, enabling a diverse, inclusive and agile workforce. Workforce agility is the difference between merely surviving and thriving,” says Jacqui.

“It may even extend beyond an EAP, with organisations implementing programmes that are specific to the organisation’s challenges. Insights that are underscored by data and analytics, will be able to identify employee trends and concerns, enabling employers to wisely spend money where it is most required within the wellness of employees,” she adds.

Belonging

Belonging describes a connection to a community of peers and the support that each individual feels in relation to their working environment. “It is important because it enables a positive working life experience and underpins personal and professional growth, providing a voice and an opportunity to use it and be heard, regardless of role or rank. All the while, supporting wellbeing whilst driving diversity and innovation,” Jacqui explains.

“Fostering a sense of belonging in an employee starts by assessing how well the personality traits of a possible candidate align with the cultural fit of the organisation during the recruitment phase. It also extends to how well employees are supported during their time in the organisation, allowing them to naturally become agents of change and role models for the organisation’s culture by living the company ethos and way of operating to inspire adoption throughout,” Jacqui explains.

At the heart of this entire process, is the implementation of a well-rounded Employee Assistance Programmes (EAP) that is designed to support employees in dealing with personal and work-related stressors that may affect their well-being, mental health and productivity. This could include:

  • Confidential counselling sessions.
  • Assessments of an employee’s situation and referral to the correct counselling and support.
  • Crisis intervention for employees who are dealing with trauma such as bereavement, have been victims of violent crime or gender-based violence.
  • Offering work-life services that could range from finding childcare to legal assistance or financial planning.
  • Offering educational workshops and seminars on aspects such as personal finance through to health and wellbeing.
  • Wellness programmes that promote healthy habits and stress reduction and management techniques.
  • Consultation for managers and supervisors.

“There has been a significant increase in awareness and understanding of mental health issues as efforts by mental health advocates, employer groups and individuals have contributed to destigmatising mental health. This increased awareness has led to more open conversations about mental health in various sectors of society and it is here where Employee Assistance Programmes (EAP) play a crucial role in supporting employers and opening the doors for candid conversations and getting the needed help and support. The services of a trusted and skilled advisor are key in helping organisations develop and operate an EAP that is fit for your business and your people and their unique circumstances. “

“While there is a cost involved that is carried by the business, the results far outweigh the investment.  It’s about providing employees and management with the means to weather the storms of an increasingly complex world of work, find a balance in their personal lives and come out on the other side with resilient and agile people who have a strong sense of belonging and purpose. This is about supporting employees to manage stress, improve productivity, and enhance their overall quality of life and wellbeing, which in turn improves workplace dynamics, contributing to a positive and productive work environment where skilled and valued employees want to be,” Jacqui concludes.

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Cannabis Users Found to Have Higher Levels of Empathy

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A study of regular cannabis users and non-users found that users tend to have a greater understanding of the emotions of others, based on psychological assessments. Brain imaging tests also revealed that cannabis users’ anterior cingulate – a region generally affected by cannabis use and related to empathy – had stronger connectivity with brain regions related to sensing the emotional states of others within one’s own body.

The study, published in the Journal of Neuroscience Research, included 85 regular cannabis users and 51 non-consumers who completed psychometric tests and a subset of 46 users and 34 nonusers who underwent functional magnetic resonance imaging exams.

“Although further research is needed, these results open an exciting new window for exploring the potential effects of cannabis in aiding treatments for conditions involving deficits in social interactions, such as sociopathy, social anxiety, and avoidant personality disorder, among others,” said co-author Víctor Olalde-Mathieu, PhD, of the Universidad Nacional Autónoma de México.

Source: Wiley

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Stopping Long-term ADHD Meds is Common among Young People

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A pair of new studies has show that many patients stop taking ADHD medications within the first year, while those who take higher doses of ADHD medications long term seem to have a higher risk of some cardiovascular diseases. This is according to two new studies led by researchers from Karolinska Institutet and published in The Lancet Psychiatry and JAMA Psychiatry.

The Lancet Psychiatry study found that more than half of all teenagers, young adults and adults who received ADHD medication had stopped taking it within the first year. The proportion was slightly lower in children, whose decisions are made for them by carers, yet 35% still stopped their medication within a year.

Young adults risk falling between the cracks

The researchers analysed prescription data from over 1.2 million patients who started ADHD medication in Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, the UK, Sweden and the USA. The pattern was the same in all countries/regions.

“It’s unlikely that so many people discontinue their treatment because their ADHD symptoms have remitted, meaning that the high rate of early discontinuation may be a major barrier to effective treatment,” says Zheng Chang, senior researcher at Karolinska Institutet who led both studies. “We haven’t been able to analyse the direct causes in this study, but common reasons for discontinuing ADHD medication are adverse reactions and lack of effect.”

The highest rate of medication discontinuation occurred among 18 to 19-year-olds. This is when they leave child and adolescent psychiatry and enter adult psychiatry, a transition where they risk falling between the cracks. This is a shortcoming that the healthcare services must remedy, researchers say.

“We need to improve the transition to adult psychiatry and spread knowledge about the fact that problems associated with ADHD often persist over time,” says Isabell Brikell, research coordinator at Karolinska Institutet, and one of the first authors of the study in The Lancet Psychiatry. “In addition, new digital tools such as simple SMS-based inventions could be used to help people with ADHD manage their medication.”

Denmark sticks out

A country that sticks out in the statistics is Denmark, which had a much lower proportion of children who discontinue their treatment within a year – 18%, as opposed to the mean of 35%. Compared with other Nordic countries like Sweden and Norway, the prescription of ADHD drugs is lower, which could suggest that medication is only prescribed to those with severe ADHD and the greatest need, researchers say.

“Sweden has a relatively high prescription rate of ADHD medication compared with many other European countries, so it is possible that we over-prescribe here,” says Zheng Chang.

In another study conducted with over 275 000 Swedish ADHD patients published in JAMA Psychiatry, Dr Chang and his research group examined ADHD medication use for up to 14 years. They were then able to show that ADHD medication when taken for a longer time and in higher doses than average is associated with a higher risk of some cardiovascular diseases, primarily hypertension and arterial disease. 

The risk of cardiovascular disease increased by approximately 4% per annum. The risk increase was greatest in the first few years of treatment and then levelled off, and it was only statistically significant at doses higher than 1.5 times the average daily dose (the defined daily dose, DDD). This means that those treated with lower doses are not likely to develop cardiovascular disease, according to the researchers.

Follow-up of patients advised

“There is a long list of drugs that have been linked to a comparable increased risk of hypertension when used long-term such as the one found here, so patients should not be alarmed by these findings,” says Le Zhang, postdoc researcher in Dr Chang’s research group and first author of the JAMA Psychiatry study. “However, in clinical practice, the raised risk should be carefully weighed against the recognised benefits of treatment on a case-by-case basis. Doctors should also regularly follow up the ADHD patients to find signs and symptoms of cardiovascular disease while they’re on medication over the long-term.” 

Since this is an observational study, it is not possible to conclude that it is the ADHD medication that leads to an increased risk of cardiovascular disease. As the researchers point out, it could depend on other medications, symptom severity or lifestyle factors.

Source: Karolinska Institutet

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Major Study Finds No ‘Smoking Gun’ Mental Health Harm from Internet

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Links between internet adoption and psychological well-being are small at most, despite popular assumptions about negative psychological impacts of internet technologies and platforms, according to an international study involving two million people published in the journal Clinical Psychological Science.

The study examined data from people aged 15 to 89 in 168 countries, yet found smaller and less consistent associations than would be expected, if the internet were causing widespread psychological harm, according to the Oxford Internet Institute research team.

Professor Andrew Przybylski, Oxford Internet Institute and Assistant Professor Matti Vuorre, Tilburg University and Research Associate, Oxford Internet Institute, carried out the study, which shows the last two decades have seen only small and inconsistent changes in global well-being and mental health. 

Professor Przybylski says, “We looked very hard for a ‘smoking gun’ linking technology and well-being and we didn’t find it.”

Professor Vuorre notes, “We studied the most extensive data on well-being and internet adoption ever considered, both over time and population demographics. Although we couldn’t address causal effects of internet use, our descriptive results indicated small and inconsistent associations.”

Results filtered by age group and gender did not reveal any specific demographic patterns among internet users, including women and young girls. In fact, for the average country, life satisfaction had increased more for females over the period.

According to Professor Przybylski, “We meticulously tested whether there is anything special in terms of age or gender, but there is no evidence to support popular ideas that certain groups are more at risk.”

The team maintains, “We put our findings under a more extreme test to see if there are matters which we have missed and we did find increased mobile broadband adoption predicted greater life satisfaction, but this association was too small to be of practical significance.”

But, the team insists, technology companies need to provide more data, if there is to be conclusive evidence of the impacts of internet use. The research says, Research on the effects of internet technologies is stalled because the data most urgently needed are collected and held behind closed doors by technology companies and online platforms. 

“It is crucial to study, in more detail and with more transparency from all stakeholders, data on individual adoption of and engagement with Internet-based technologies. These data exist and are continuously analysed by global technology firms for marketing and product improvement but unfortunately are not accessible for independent research.

In today’s study, the researchers contrast two different studies of data on well-being and mental health against the countries’ per capita internet users and mobile broadband subscriptions and use, to see if internet adoption predicts psychological well-being.  In the second study they use data on rates of anxiety, depression and self-harm from 2000–2019 in some 200 countries and analyse their associations with internet adoption.

Wellbeing was assessed using data from face to face and phone surveys by local interviewers in the respondents’ native languages. Mental health was assessed using statistical estimates of depressive disorders, anxiety disorders and self-harm in some 200 countries from 2000 to 2019, as estimated by aggregated health data from WHO member states.

Source: Oxford University

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Psychologists Reveal Magicians’ Secret Trick: A Low Risk of Depression

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Magicians are less likely to suffer from the mental health challenges faced by other creative people, like musicians and comedians, according to a new study published in the journal BJPsych Open. From comedians like Robin Williams, to poets and painters like Sylvia Plath and Van Gogh, many famous names have had well-publicised mental health disorders.

While not fully understood, there is growing evidence of a link between these health challenges and creativity. This new research led by Aberystwyth University shows that on some key measures, magicians are apparently an exception to this trend.

The study measured the psychological traits of 195 magicians and 233 people from the general population and compared with data from other creative groups. The academics’ work shows that on three key measures of psychosis or degrees of losing contact with reality, magicians are significantly less likely to suffer than artists, musicians and comedians. Magicians were less likely than all other creatives to have unusual experiences, such as hallucinations or cognitive disorganisation, which can make it hard to concentrate. Indeed, on many measures magicians appear to be less prone to these conditions than the general population. Their mental health profiles are most similar to those of mathematicians and scientists.

Dr Gil Greengross from the Department of Psychology at Aberystwyth University commented: “There is a common perception that many creative people have mental illnesses, and such illnesses make them more creative. This is the first study to show a creative group with lower scores on psychotic traits than the general population. Our research shows that members of at least one creative group, magicians, do not exhibit higher levels of mental disorders. The results demonstrate that the association between creativity and psychopathology is more complex than previously thought, and different kinds of creative work could be associated with either high or low psychoticism or autistic traits.

“The study highlights the unique characteristics of magicians, and the possible myriad associations between creativity and mental disorders among creative groups. One thing that distinguishes magicians from most other performing artists is the precision required in their performances. So, compared to other performers, it is more difficult to overcome errors. Magic tricks are largely ‘all or nothing’ acts that culminate in an ‘aha’ moment of surprise and awe. Failed magic tricks leave a greater impact than unfunny jokes, and are harder to compensate for, as they are few and far between. So, in addition to requiring highly technical skills, regardless of the type of magic performed, the high stakes of magic performances make magicians a unique creative group to study amongst all artistic professions.”

Dr Greengross from Aberystwyth University added: “What distinguishes magicians from most other creative people is that they not only create their own magic tricks but also perform them, while most creative groups are either creators or performers. For example, poets, writers, composers and choreographers create something that will be consumed or performed by others. In contrast, actors, musicians and dancers perform and interpret the creation of others. Magicians, like comedians and singer-songwriters, are one of the rare groups that do both.

“Magicians scored low on impulsive nonconformity, a trait that is associated with anti-social behaviour and lower self-control. These traits are valuable for many creative groups such as writers, poets and comedians whose creative acts are often edgy and challenge conventional wisdom. Magicians can also be equally innovative and push the limits of what is thought to be possible in magic, such as David Copperfield’s famous flying illusion. However, many magicians perform familiar tricks or some variations of them without feeling the need to innovate.”

Source: Aberystwyth University

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Having Pets did not Result in Better Well-being During COVID

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Although pets are generally perceived as having a positive impact on well-being, a new study has found that there was no association between well-being and owning a pet during the COVID pandemic. This finding, published in the Personality and Social Psychology Bulletin, was in spite of pets owners reporting that pet ownership improved their lives.

There is a general understanding that pets have a positive impact on one’s well-being. A new study by Michigan State University found that although pet owners reported pets improving their lives, there was not a reliable association between pet ownership and well-being during the COVID-19 pandemic.

The study assessed 767 people over three periods in May 2020. The researchers took a mixed-method approach that allowed them to look at several indicators of well-being while also asking people in an open-ended question to reflect on the role of pets from their point of view. Pet owners reported that pets made them happy. They claimed pets helped them feel more positive emotions and provided affection and companionship. They also reported negative aspects of pet ownership like being worried about their pet’s well-being and having their pets interfere with working remotely.

However, when their happiness was compared to nonpet owners, the data showed no difference in the well-being of pet owners and nonpet owners over time. The researchers found that it did not matter what type of pet was owned, how many pets were owned or how close they were with their pet. The personalities of the owners were not a factor.

“People say that pets make them happy, but when we actually measure happiness, that doesn’t appear to be the case,” said William Chopik, an associate professor in MSU’s Department of Psychology and co-author of the study. “People see friends as lonely or wanting companionship, and they recommend getting a pet. But it’s unlikely that it’ll be as transformative as people think.”

The researchers explored several reasons why there is not a difference between the well-being of pet owners and nonpet owners. One of them being that nonpet owners may have filled their lives with a variety of other things that make them happy.

Source: Michigan State University

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Glucocorticoid Levels Influence the Development of PTSD after Trauma

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Posttraumatic stress disorder (PTSD) is a debilitating condition that arises after experiencing traumatic events. While many people experience trauma, only about 25–35% of them develop PTSD. Understanding the factors that make certain individuals more susceptible is crucial for both prevention and treatment.

A new study led by Carmen Sandi and Simone Astori at EPFL now reveals how the development of PTSD is influenced by glucocorticoids, which are stress hormones such as cortisol. The work, which is published in Biological Psychiatry, provides significant insights into the behavioural and biological traits associated with PTSD vulnerability.

“There are considerable differences in the levels of glucocorticoids that individuals release to the bloodstream when stressed,” says Carmen Sandi. “Low glucocorticoid levels are frequently observed in PTSD patients following trauma exposure and were initially suspected to be a consequence of trauma exposure.”

She continues: “The possibility that this could be a trait constituting a pre-existing PTSD risk factor has been an outstanding open question for many years, but tackling it has been challenging due to the difficulties of both collecting biological measures before trauma exposure, and having access to relevant animal models in which the causal role of these traits can be investigated.”

To explore how a reduced hormonal response to stress might be linked to PTSD symptoms, the researchers used a genetically selected rat model that mimics people with blunted responses to cortisol. To do this, the team used MRI scans to measure the volume of different brain regions, trained rats to associate a cue with fear, recorded their sleep patterns, and measured their brain activity.

By combining these methods, the researchers discovered that a blunted responsiveness to glucocorticoids led to a “correlated multi-trait response” that includes impaired fear extinction (in males), reduced hippocampal volume, and rapid-eye movement sleep disturbances.

To explain the terms: Fear extinction is a process by which a conditioned fear response diminishes over time; problems with fear extinction are a hallmark of PTSD. Rapid-eye movement is crucial for memory consolidation, and disturbances in this type of sleep pattern have long been associated with PTSD.

But the study didn’t end there: the researchers treated the rats with the equivalent of human cognitive and behavioral therapy to reduce their learned fears. After that, they gave the rats corticosterone. As a result, both excessive fear and disturbances in rapid-eye movement sleep receded. Not only that, but the increased levels of the stress-related neurotransmitter norepinephrine in the brain also returned to normal.

“Our study provides causal evidence of a direct implication of low glucocorticoid responsiveness in the development of PTSD symptomatology following exposure to traumatic experiences, i.e., impaired fear extinction,” says Carmen Sandi. “In addition, it shows that low glucocorticoids are causally implicated in the determination of other risk factors and symptoms that were until now only independently related to PTSD.”

Silvia Monari, the study’s first author, adds: “In a nutshell, we present mechanistic evidence – previously missing – that having low glucocorticoids such as cortisol in humans is a condition for causally predisposed individuals to present all to-date vulnerability factors for developing PTSD, and causally involved in deficits to extinguish traumatic memories.”

Source: Ecole Polytechnique Fédérale de Lausanne

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Scientists Identify Stress-linked Gene in Treatment-resistant Depression

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It has long been appreciated that major depressive disorder (MDD) has genetic as well as environmental influences. In a new study in Biological Psychiatry, researchers identify a gene that interacted with stress to mediate aspects of treatment-resistant MDD in an animal model.

Jing Zhang, PhD, at Fujian Medical University and senior author of the study, said, “Emerging evidence suggests that MDD is a consequence of the co-work of genetic risks and environmental factors, so it is crucial to explore how stress exposure and risk genes co-contribute to the pathogenesis of MDD.”

To do that, the authors used a mouse model of stress-induced depression called chronic social defeat stress (CSDS) in which mice are exposed to aggressor mice daily for two weeks. They focused on a gene called LHPP, which interacts with other signalling molecules at neuronal synapses. Increased expression of LHPP in the stressed mice aggravated the depression-like behaviours by decreasing expression of BDNF and PSD95 by dephosphorylating two protein kinases, CaMKIIα and ERK, under stress exposure.

Dr Zhang noted, “Interestingly, LHPP mutations (E56K, S57L) in humans can enhance CaMKIIα/ERK-BDNF/PSD95 signaling, which suggests that carrying LHPP mutations may have an antidepressant effect in the population.”

MDD is an extremely heterogeneous condition. Differences in the types of depression experienced by people influence the way they respond to treatment. A large subgroup of people with depression fail to respond to standard antidepressant medications and have “treatment-resistant” symptoms of depression. These patients often respond to different medications, such as ketamine or esketamine, or to electroconvulsive therapy. Notably, esketamine markedly alleviated LHPP-induced depression-like behaviours, whereas the traditional drug fluoxetine did not, suggesting that the mechanism might underlie some types of treatment-resistant depression.

John Krystal, MD, Editor of Biological Psychiatry, said of the work, “We have limited understanding of the neurobiology of treatment-resistant forms of depression. This study identifies a depression risk mechanism for stress-related behaviours that fail to respond to a standard antidepressant but respond well to ketamine. This may suggest that the risk mechanisms associated with the LHPP gene shed light on the poorly understood biology of treatment-resistant forms of depression.”

Dr Zhang added, “Together, our findings identify LHPP as an essential player driving stress-induced depression, implying targeting LHPP as an effective strategy in MDD therapeutics in the future.”

Source: Elsevier

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Fear is in the Eye of the Beholder, Researchers Find

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Looking away from something frightening may be due to a specific cluster of neurons in a visual region of the brain, according to new research at the University of Tokyo. Researchers found that, in fruit fly brains, these neurons release a chemical called tachykinin which appears to control the fly’s movement to avoid facing a potential threat. Fruit fly brains can offer a useful analogy for larger mammals, so this study, published in Nature Communications, may help studies of human reactions to fearful situations and phobias.

“We discovered a neuronal mechanism by which fear regulates visual aversion in the brains of Drosophila (fruit flies). It appears that a single cluster of 20-30 neurons regulates vision when in a state of fear. Since fear affects vision across animal species, including humans, the mechanism we found may be active in humans as well,” explained Assistant Professor Masato Tsuji from the Department of Biological Sciences at the University of Tokyo.

The team used puffs of air to simulate a physical threat and found that the flies’ walking speed increased after being puffed at. The flies also would choose a puff-free route if offered, showing that they perceived the puffs as a threat (or at least preferred to avoid them). Next the researchers placed a small black object, roughly the size of a spider, 60 degrees to the right or left of the fly. On its own the object didn’t cause a change in behavior, but when placed following puffs of air, the flies avoided looking at the object and moved so that it was positioned behind them.

To understand the molecular mechanism underlying this aversion behavior, the team then used mutated flies in which they altered the activity of certain neurons. While the mutated flies kept their visual and motor functions, and would still avoid the air puffs, they did not respond in the same fearful manner to visually avoid the object.

“This suggested that the cluster of neurons which releases the chemical tachykinin was necessary for activating visual aversion,” said Tsuji. “When monitoring the flies’ neuronal activity, we were surprised to find that it occurred through an oscillatory pattern, ie, the activity went up and down similar to a wave. Neurons typically function by just increasing their activity levels, and reports of oscillating activity are particularly rare in fruit flies because up until recently the technology to detect this at such a small and fast scale didn’t exist.”

By giving the flies genetically encoded calcium indicators, the researchers could make the flies’ neurons shine brightly when activated. Thanks to the latest imaging techniques, they then saw the changing, wavelike pattern of light being emitted, which was previously averaged out and missed.

Next, the team wants to figure out how these neurons fit into the broader circuitry of the brain. Although the neurons exist in a known visual region of the brain, the researchers do not yet know from where the neurons are receiving inputs and to where they are transmitting them, to regulate visual escape from objects perceived as dangerous.

“Our next goal is to uncover how visual information is transmitted within the brain, so that we can ultimately draw a complete circuit diagram of how fear regulates vision,” said Tsuji. “One day, our discovery might perhaps provide a clue to help with the treatment of psychiatric disorders stemming from exaggerated fear, such as anxiety disorders and phobias.”

Source: University of Tokyo

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The Eyes may Hold the Secret to the Greatest Benefits from TMS Therapy

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A pair of recently published studies from researchers at UCLA Health suggest that measuring changes in how pupils react to light could help predict recovery from depression and personalise transcranial magnetic stimulation (TMS) treatment of major depressive disorder.

TMS is a safe, non-invasive therapy that uses magnetic fields to stimulate parts of the brain involved in mood regulation. While TMS is proven effective, not all patients respond equally well to the therapy. The ability to predict who will benefit most could allow doctors to better customise and target treatments.

In two recent studies, UCLA scientists found that the pupil’s response to light before treatment correlated with improvements in depression symptoms over the course of therapy. Pupil size reflects activation of the autonomic nervous system, which controls involuntary functions and is negatively impacted in people with depression.

The first study, appearing in the Journal of Affective Disorders, reports on outcomes for 51 patients who underwent daily TMS sessions. Before receiving treatment, researchers measured the patients’ baseline pupillary constriction amplitude, or CA: how much the pupil shrinks when exposed to light. The pupil’s constriction is an indicator of parasympathetic nervous system function. The researchers found a significant association between baseline pupil constriction amplitude and symptom improvement, indicating that a greater constriction amplitude at baseline was associated with a better outcome. In other words, those with larger pupil constriction in response to light at baseline showed greater symptom improvement over their full treatment.

The second study, published in Brain Stimulation, went further and compared patients who were treated for depression with one of two common TMS protocols: 10Hz stimulation and intermittent theta burst stimulation (iTBS). In 10Hz stimulation, magnetic pulses are delivered in a continuous and relatively high-frequency stimulation. iTBS is a faster form of stimulation with bursts of three pulses at 50Hz, repeated with short breaks between bursts. This pattern is thought to mimic the natural rhythm of certain brain activities.

The researchers found that people with slower pupillary constriction had significantly greater improvement in depression after 10 sessions if they received iTBS rather than 10Hz treatment.

“These results suggest we may be able to use a simple test of the pupil to identify who is most likely to respond to electromagnetic stimulation of the brain to treat their depression,” said researcher Cole Citrenbaum, lead author of both studies.

Tailored TMS treatments

The researchers propose that measuring pupillary reactivity before starting TMS could guide treatment selection. “Additionally, we may be able to tailor the frequency of stimulation to the individual patient to maximise their benefit from treatment,” Citrenbaum said.

“At the present time, about 65% of patients treated with TMS have a substantial improvement in their depression,” said Dr Andrew F. Leuchter, senior author of both studies. “Our goal is to have more than 85% of patients fully recover from depression. As we better understand the complex brain activity underlying depression, we move closer to matching patients with the treatments that ensure their full recovery. Pupil testing may be one useful tool in reaching this goal.”

The studies add to growing evidence on the benefits of biologically-based personalization in treating major depression. UCLA researchers plan further trials to confirm the value of pupillometry in optimizing transcranial magnetic stimulation.

Source: University of California – Los Angeles Health Sciences