Category: Mental Health

Categories : Mental HealthTags :

New Study Highlights How to Improve Mental Health Integration in SA Primary Healthcare

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As we commemorate Mental Illness Awareness Month and Psychosocial Disability Awareness Month, a staggering 92% of South Africans living with mental health conditions are not receiving the treatment they need. Yet, research continues to show that collaborative care—where mental health and primary care providers work together—can significantly improve patient outcomes, service satisfaction, and overall quality of life. People with serious mental illness (SMI) are particularly vulnerable as SMI is associated with marked functional impairment and high levels of stigma. SMIs typically include psychotic disorders, bipolar and related disorders, major depression, and severe anxiety and stress-related disorders.

A new study published in Cambridge Prisms’ Global Mental Health explores how integrating community psychiatric services into primary health care (PHC) clinics improves access for individuals with SMI in South Africa. However, the study also reveals persistent challenges related to limited resources, weak management systems, and fragmented collaboration between health care providers as key setbacks.

Conducted in the Sedibeng District, the research forms part of a broader study series focused on patients’ experiences. It is modelled on global evidence to assess the impact of community-based collaborative care—a model increasingly adopted worldwide to strengthen mental health delivery in PHC settings.

Why Integrated Mental Health Care?

Also known as Integrated Care, this health care model plays a vital role in improving access to mental health services by bringing care closer to communities. It relies on bringing together PHC providers such as physicians, nurses and mental health providers to deliver coordinated, person-centred care.  

Integrated care is believed to yield better health outcomes for individuals living with SMIs, who often have comorbid physical health conditions. Saira Abdulla, the lead researcher in the study and Wits PhD fellow based at Centre for Health Policy says the paper highlights key shortfalls in how collaborative care is implemented in this district. This includes poor communication, unclear roles within multidisciplinary teams, and the absence of case managers to coordinate care, with providers instead coordinating care in an ad-hoc manner.

Infrastructure and Staffing Challenges in Integrating Mental Health into Primary Care in Sedibeng

In the Sedibeng District, community-based psychiatry services have been integrated into select primary healthcare (PHC) clinics through two operational models: co-located and physically integrated services. In co-located settings, psychiatric teams operate from separate spaces adjacent to PHC clinics and use independent systems for clinical records. By contrast, physically integrated services are delivered within the same spaces as PHC clinics, using shared management structures and record-keeping systems.

However, a recent study reveals that PHC facilities in the district are not adequately designed to support the specific requirements of psychiatric care. The lack of private, secure consultation spaces compromises confidentiality, as mental health consultations often take place in shared rooms used by multiple healthcare providers.

Physically integrated clinics were found to be particularly constrained, with concerns ranging from overcrowded waiting areas—often without seating—to general safety risks. These conditions compromise the therapeutic environment essential for effective mental health care and highlight the broader systemic challenges of integrating psychiatric services meaningfully within the PHC framework.

The study also underscores a critical shortage of human resources. Most clinics have only five psychiatric nurses on site, while two to four doctors rotate between clinics, offering adult psychiatric consultations just once a week. With monthly patient volumes ranging from 580 to 910, the current staffing levels severely limit the ability to deliver consistent, high-quality care.

Key findings

·        Integration does not guarantee collaboration

While all the elements of full collaboration were not achieved in either setting, the physically integrated setting provided a better opportunity for communication among staff (due to shared files, physical proximity and good management with mental health interest and experience) However, these advantages were still hindered by poor infrastructure and inadequate resources.

·        Integration Models Matter

The study found that physically integrated clinics (shared space and records) had better communication and collaboration between mental health and PHC providers. Co-located clinics (separate buildings and records) suffered from poor communication and siloed teams.

·        Resource and Infrastructure Constraints

Both clinics faced inadequate space, supplies, and staff, although the physically integrated clinic was the most under-resourced. In both settings, insufficient resources were further exacerbated by high caseloads.

·        Leadership is Critical for Collaboration

The study highlighted the importance of management in fostering teamwork. Stronger leadership qualities were evident in the physically integrated clinic, which led to reduced staff conflict and improved communication. In contrast, the co-located clinic was impacted by poor management and a lack of managerial oversight, leading to conflict among staff members. The failure to appoint a permanent Chief Director at the district level has also led to a lack of strategy, and frustration among clinic staff.

·        Resistance from PHC Doctors to Manage Mental Health

PHC physicians and doctors are often reluctant to manage stable psychiatric patients, leading to unnecessary referrals. Some providers did not feel equipped to provide quality care and others felt that collaborating with community psychiatry staff would increase their workload.

As low and middle-income countries move towards integrating mental health into PHC, this paper highlights that the type of integration approach needs to be functional at all levels to enhance the health outcomes of the most vulnerable.

Provided by University of the Witwatersrand

Categories : Mental HealthTags :

Addictive Screen Use, Not Time, Linked to Youth Suicide Risk

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New research shows that youth who become increasingly addicted to social media, mobile phones or video games are at greater risk of suicidal thoughts, suicide attempts and emotional or behavioural issues. The study, published in JAMA, was led by researchers at Weill Cornell Medicine, Columbia University and University of California, Berkeley.

Unlike previous studies that focused on total screen time at one point in a child’s life, this study looked at how young people’s patterns of compulsive or “addictive” use changed over time. These patterns included feeling unable to stop using a device, experiencing distress when not using it or using it to escape from problems. In contrast, simply spending more time on screens at 10 years old wasn’t associated with worse suicide-related and mental health outcomes.

“For parents and educators, the discussion around mobile phones and social media has focused on limiting or banning use, but our results indicate more complex factors are involved,” said first author Dr Yunyu Xiao, assistant professor of population health sciences at Weill Cornell Medicine. “Clinical trials have shown that limiting cell phone use, for instance during school hours, was not effective in reducing the risk of suicidal behaviour or improving other aspects of mental health.”

This study could signal a paradigm shift in how the impact of screen time on youth mental health is addressed. “Testing interventions that work against other types of addiction may be one way to approach this type of social media and mobile phone use,” Dr Xiao said.

Quantity Versus Quality

Over four years, the researchers tracked nearly 4300 youths aged 9 to 10 when they first started the study. Using machine learning and data from participant interviews, the researchers characterised three addictive use trajectories for social media and mobile phone usage and two for addictive use with video games. When graphed, these trajectories depicted relative levels of addictive behaviours.

By age 14, almost one in three participants had a high addictive use trajectory for social media and one in four for mobile phones. More than 40% of the youths had a high addictive use trajectory for video games. These adolescents were significantly more likely to report suicidal thoughts or behaviours, as well as symptoms of anxiety, depression, aggression or rule-breaking.

The researchers also found that each type of digital activity showed unique patterns of association with suicide-related behaviours and mental health symptoms. For social media and mobile phones, the high and increasing addictive use trajectories were associated with a two to three times greater risk of suicidal behaviours and suicidal ideation compared with the low addictive use trajectory. The higher use trajectories were also associated with either internalising symptoms such as anxiousness and depression, or externalising symptoms, including aggressiveness or inattentiveness.

“Parents may want to pay more attention to how their kids are using their digital devices and consider having them evaluated for signs of addictive use, said co-first author Dr Yuan Meng, postdoctoral associate in population health sciences at Weill Cornell. “If an addiction is identified, limiting use of mobile phones and social media for part of the day, may potentially reinforce addictive behaviors, so seeking professional advice is essential.”

Source: Weill Cornell Medicine

Categories : Mental HealthTags :

Why Frequent Nightmares May Shorten Your Life by Years

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Timothy Hearn, Anglia Ruskin University

Waking up from a nightmare can leave your heart pounding, but the effects may reach far beyond a restless night. Adults who suffer bad dreams every week were almost three times more likely to die before age 75 than people who rarely have them.

This alarming conclusion – which is yet to be peer reviewed – comes from researchers who combined data from four large long-term studies in the US, following more than 4,000 people between the ages of 26 and 74. At the beginning, participants reported how often nightmares disrupted their sleep. Over the next 18 years, the researchers kept track of how many participants died prematurely – 227 in total.

Even after considering common risk factors like age, sex, mental health, smoking and weight, people who had nightmares every week were still found to be nearly three times more likely to die prematurely – about the same risk as heavy smoking.

The team also examined “epigenetic clocks” – chemical marks on DNA that act as biological mileage counters. People haunted by frequent nightmares were biologically older than their birth certificates suggested, across all three clocks used (DunedinPACE, GrimAge and PhenoAge).

The science behind the silent scream

Faster ageing accounted for about 39% of the link between nightmares and early death, implying that whatever is driving the bad dreams is simultaneously driving the body’s cells towards the finish line.

How might a scream you never utter leave a mark on your genome? Nightmares happen during so-called rapid-eye-movement sleep when the brain is highly active but muscles are paralysed. The sudden surge of adrenaline, cortisol and other fight-or-flight chemicals can be as strong as anything experienced while awake. If that alarm bell rings night after night, the stress response may stay partially switched on throughout the day.

Photo by Andrea Piacquadio

Continuous stress takes its toll on the body. It triggers inflammation, raises blood pressure and speeds up the ageing process by wearing down the protective tips of our chromosomes.

On top of that, being jolted awake by nightmares disrupts deep sleep, the crucial time when the body repairs itself and clears out waste at the cellular level. Together, these two effects – constant stress and poor sleep – may be the main reasons the body seems to age faster.

The idea that disturbing dreams foreshadow poor health is not entirely new. Earlier studies have shown that adults tormented by weekly nightmares are more likely to develop dementia and Parkinson’s disease, years before any daytime symptoms appear.

Growing evidence suggests that the brain areas involved in dreaming are also those affected by brain diseases, so frequent nightmares might be an early warning sign of neurological problems.

Nightmares are also surprisingly common. Roughly 5% of adults report at least one each week and another 12.5% experience them monthly.

Because they are both frequent and treatable, the new findings elevate bad dreams from a spooky nuisance to a potential public health target. Cognitive behavioural therapy for insomnia, imagery-rehearsal therapy – where sufferers rewrite the ending of a recurrent nightmare while awake – and simple steps such as keeping bedrooms cool, dark and screen free have all been shown to curb nightmare frequency.

Before jumping to conclusions, there are a few important things to keep in mind. The study used people’s own reports of their dreams, which can make it hard to tell the difference between a typical bad dream and a true nightmare. Also, most of the people in the study were white Americans, so the findings might not apply to everyone.

And biological age was measured only once, so we cannot yet say whether treating nightmares slows the clock. Crucially, the work was presented as a conference abstract and has not yet navigated the gauntlet of peer review.

Despite these limitations, the study has important strengths that make it worth taking seriously. The researchers used multiple groups of participants, followed them for many years and relied on official death records rather than self-reported data. This means we can’t simply dismiss the findings as a statistical fluke.

If other research teams can replicate these results, doctors might start asking patients about their nightmares during routine check-ups – alongside taking blood pressure and checking cholesterol levels.

Therapies that tame frightening dreams are inexpensive, non-invasive and already available. Scaling them could offer a rare chance to add years to life while improving the quality of the hours we spend asleep.

Timothy Hearn, Senior Lecturer in Bioinformatics, Anglia Ruskin University

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

Categories : Immune System Mental HealthTags :

Autoimmune Disease Linked to Doubling in Depression, Anxiety, Bipolar Risks

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Risks higher in women than in men with the same condition
Chronic exposure to systemic inflammation may explain associations, say researchers

Photo by Sydney Sims on Unsplash

Living with an autoimmune disease is linked to a near doubling in the risk of persistent mental health issues, such as depression, generalised anxiety, and bipolar disorder, with these risks higher in women than in men, finds a large population-based UK study, published in the open access journal BMJ Mental Health.

Chronic exposure to the systemic inflammation caused by the autoimmune disease may explain the associations found, say the researchers.

A growing body of evidence suggests that inflammation is linked to mental ill health, but many of the published studies have relied on small sample sizes, limiting their statistical power, note the researchers.

In a bid to overcome this, they drew on data from 1.5 million participants in the recently established Our Future Health dataset from across the UK. Participants’ average age was 53; just over half (57%) were women; and 90% identified as White.

On recruitment to Our Future Health, participants completed a baseline questionnaire to provide personal, social, demographic, health and lifestyle information.

Health information included lifetime diagnoses–including for their biological parents–for a wide range of disorders, including autoimmune and psychiatric conditions.

Six autoimmune conditions were included in the study: rheumatoid arthritis; Graves’ syndrome (thyroid hormone disorder); inflammatory bowel disease; lupus, multiple sclerosis; and psoriasis.

The mental health conditions of interest were self-reported diagnoses of affective disorders, defined as depression, bipolar, or anxiety disorder.

In all, 37 808 participants reported autoimmune conditions and 1 525 347 didn’t. Those with autoimmune conditions were more likely to be women (74.5% vs 56.5%) and more likely to report lifetime diagnoses of affective disorders for their biological parents:  8% vs 5.5% for fathers; 15.5% vs 11% for mothers.

Chronic and pathogenic immune system activation—including the presence of markers of inflammation—is a hallmark of many autoimmune conditions. And in the absence of direct measurements of inflammatory biomarkers, an autoimmune condition was regarded as a proxy for chronic inflammation in this study.

The lifetime prevalence of any diagnosed affective disorder was significantly higher among people with an autoimmune disorder than it was among the general population: 29% vs 18%.

Similar associations in lifetime prevalence emerged for depression and anxiety: 25.5% vs just over 15% for depression; and just over 21% vs 12.5% for anxiety.

While the overall prevalence of bipolar disorder was much lower, it was still significantly higher among those with an autoimmune disorder than it was among the general population:  just under 1% compared with 0.5%.

The prevalence of current depression and anxiety was also higher among people with autoimmune conditions.

And the prevalence of affective disorders was significantly and consistently higher among women than it was among men with the same physical health conditions: 32% compared to 21% among participants with any autoimmune disorder.

The reasons for this aren’t clear, say the researchers, but “theories suggest that sex hormones, chromosomal factors, and differences in circulating antibodies may partly explain these sex differences,” they write.

“Women (but not men) with depression exhibit increased concentrations of circulating cytokines and acute phase reactants compared with non-depressed counterparts. It is therefore possible that women may experience the compounding challenges of increased occurrence of autoimmunity and stronger effects of immune responses on mental health, resulting in the substantially higher prevalence of affective disorders observed in this study,” they add.

Overall, the risk for each of the affective disorders was nearly twice as high—87-97% higher—in people with autoimmune conditions, and remained high even after adjusting for potentially influential factors, including age, household income, and parental psychiatric history.

No information was available on the time or duration of illness, making it impossible to determine whether autoimmune conditions preceded, co-occurred with, or followed, affective disorders, note the researchers.

No direct measurements of inflammation were made either, and it was therefore impossible to establish the presence, nature, timing or severity of inflammation, they add.

“Although the observational design of this study does not allow for direct inference of causal mechanisms, this analysis of a large national dataset suggests that chronic exposure to systemic inflammation may be linked to a greater risk for affective disorder,” they conclude.

“Future studies should seek to determine whether putative biological, psychological, and social factors—for example, chronic pain, fatigue, sleep or circadian disruptions and social isolation—may represent potentially modifiable mechanisms linking autoimmune conditions and affective disorders.”

And they suggest that it may be worth regularly screening people diagnosed with autoimmune disease for mental health conditions, especially women, to provide them with tailored treatment early on.

Source: BMJ

Categories : Mental Health Surgeries & ProceduresTags :

Self-esteem Increases by 131% Within One Year of Bariatric Surgery

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Self-esteem scores more than doubled within one year of weight-loss surgery, according to a new study* presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2025 Annual Scientific Meeting.

Researchers from Geisinger Medical Center found that after bariatric surgery self-esteem scores rose to 77.5 from 33.6 – a more than 40-point increase. The higher the score on a scale from 0 to 100, the higher the level of self-esteem and quality of life. The amount of weight loss appears to fuel the increase in self-esteem — scores were highest among those who lost the most weight despite demographics differences including gender, age, and race or type of bariatric procedure.

Researchers used a prospectively maintained database to identify 5,749 patients aged 18 and older with body mass index (BMI) of 35 or more who had metabolic and bariatric surgery between 2006 and 2019. Patients completed the Impact of Weight Quality of Life (iwQOL) survey pre-operatively and 12 months after the operation to assess weight stigma and their quality of life.

“Understanding weight stigma and psychosocial factors associated with obesity is essential to offering holistic care. While these factors should not dictate the decision to have bariatric surgery, they should be an important part of the conversation,” said study co-author Justin Dhyani, MD, Geisinger Medical Center in Danville, PA.

Weight stigma is associated with adverse health outcomes including depression, anxiety, disordered eating, and low self-esteem. Among adults with obesity, the prevalence of weight discrimination is 19% to 42%, with higher rates reported among those with higher BMIs and women.

“Weight stigma is a serious issue that places an extra psychological burden on patients struggling with obesity and there is no excuse for it,” said Ann M. Rogers, MD, MD, FACS, FASMBS, President, ASMBS, who was not involved in the study. “This study shows we need to understand what patients are going through and be supportive and empowering of them as they navigate their health and make decisions about treatment.”

Source: American Society for Metabolic and Bariatric Surgery

Categories : Mental Health PaediatricsTags :

Catch-up Sleep on the Weekend Can Improve Teens’ Anxiety

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Photo by Eren Li

A new study presented at the SLEEP 2025 annual meeting found that teens who get moderate, but not excessive, catch-up sleep on weekends have fewer symptoms of anxiety symptoms.

Results show that teens who got up to two more hours of sleep on weekends than on weekdays exhibited fewer anxiety symptoms compared with those who did not sleep longer on weekends. However, longer durations of catch-up sleep on weekends were associated with slightly more internalising symptoms.

“The results show that both sleeping less on weekends than weekdays and sleeping substantially more on weekends were associated with higher anxiety symptoms,” said lead author Sojeong Kim, a doctoral candidate in the department of clinical psychology and psychology graduate advisor at the University of Oregon in Eugene. “In contrast, moderate catch-up sleep – defined as less than two hours – was associated with lower anxiety symptoms, suggesting that some weekend recovery sleep may be beneficial.”

The American Academy of Sleep Medicine recommends that teenagers 13 to 18 years of age should sleep 8 to 10 hours on a regular basis to promote optimal health. However, CDC data show that only 23% of high school students get sufficient sleep on an average school night.

“Many teens try to make up for lost sleep by sleeping in on weekends,” Kim said.

Consistently getting sufficient sleep is associated with better health outcomes including improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. In contrast, insufficient sleep in teenagers is associated with increased risks of problems such as depression and suicidal thoughts.

The study involved 1877 adolescents with a mean age of 13.5 years. Sleep duration was estimated using Fitbit devices, while internalising symptoms were assessed using the Child Behavior Checklist survey. Weekend catch-up sleep was calculated as the difference between weekend and weekday sleep duration.

Kim noted that it is important to identify the right amount of catch-up sleep that is beneficial to teens who restrict their sleep during the week.

“Too little or too much sleep variability from weekday to weekend may contribute to the symptoms someone is trying to combat, like physical or mental fatigue and feelings of anxiety,” she said.

Source: American Academy of Sleep Medicine

Categories : Mental HealthTags :

Psilocybin Dose Provides Two Years of Relief from Cancer Depression

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Phase 2 trial reveals that a single dose of psilocybin offers long-term relief from symptoms of depression and anxiety.

Photo by Marek Piwnicki: https://www.pexels.com/photo/macro-photography-of-a-psilocybin-mushroom-13695325/

New results from a clinical trial reveal that a single dose of psilocybin can provide sustained reductions in depression and anxiety in individuals with cancer suffering from major depressive disorder. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

People with cancer often struggle with depression. In this phase 2 trial, 28 patients with cancer and major depressive disorder received psychological support from a therapist prior to, during, and following a single 25mg dose of psilocybin.

During clinical interviews conducted 2 years later, 15 (53.6%) patients demonstrated a significant reduction in depression, and 14 (50%) had sustained depression reduction as well as remission. Similarly, psilocybin reduced anxiety for 12 (42.9%) patients at 2 years.

An ongoing randomised, double-blind trial is currently evaluating up to two doses of 25mg of psilocybin versus placebo as treatment for depression and anxiety in patients with cancer. This study is building on the single-dose study in an effort to bring a larger majority of the patients into remission of depression and anxiety.

“One dose of psilocybin with psychological support to treat depression has a long-term positive impact on relieving depression for as much as 2 years for a substantial portion of patients with cancer, and we’re exploring whether repeating the treatment resolves depression for more than half of the patients,” said lead author Manish Agrawal, MD, of Sunstone Therapies. “If randomised testing shows similar results, this could lead to greater use of psilocybin to treat depression in patients with cancer.”

Source: Wiley

Categories : Cardiovascular Disease Mental HealthTags :

Extensive Study Refutes the Notion that Statins Have Antidepressant Effect

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Lipid-lowering medicines, known as statins, are prescribed in cases of high cholesterol levels, to reduce the risk of atherosclerosis, heart attack and stroke. The results of some small studies suggest that statins could also have an antidepressive effect. Researchers from Charité – Universitätsmedizin Berlin have now conducted an extensive study to investigate this claim. However, they could not verify that statins cause any additional antidepressive effects. As a result, the researchers suggest following the general guidelines and prescribing statins to help lower cholesterol, but not to manage depression. The study has now been published in JAMA Psychiatry.

Cholesterol-lowering drugs are the most commonly prescribed medicines globally. They have anti-inflammatory effects and lower the production of cholesterol in the liver, which in turn reduces the risk of developing cardiovascular diseases. In the past, numerous small studies have suggested that statins may also have antidepressive effects, alongside these more common properties. “If statins really did have this antidepressive effect, we could kill two birds with one stone,” says study leader Prof Christian Otte, Director of the Department of Psychiatry and Neurosciences on the Charité Campus Benjamin Franklin. “Depression and adiposity, or obesity, are among the most common medical conditions globally. And they actually often appear together: Those who are obese are at a higher risk of depression. In turn, those with depression are at a higher risk of obesity.” Obese patients often have higher cholesterol levels, so statins are administered to reduce the risk of cardiovascular diseases. But could they also alleviate depression?

An extensive, controlled study

Led by Christian Otte, the research team conducted a comprehensive study to investigate the potential antidepressive effects of statins that have been suggested. A total of 161 patients took part in the study, all of whom suffered from both depression and obesity. During the 12-week study, all participants were treated with a standard antidepressant (Escitalopram). Half of the participants also received a cholesterol-lowering drug (Simvastatin), while the other half were given a placebo. It was decided at random who would receive statins and who would be given the placebo – the recipients of each were unknown to both the medical team and the participants. This ensured a randomized and double-blind study that would produce reliable results. “This method should show us whether we can observe a stronger antidepressive effect among participants treated with statins, compared to those in the placebo group,” explains co-lead author Dr. Woo Ri Chae, Charité BIH Clinician Scientist at the Department of Psychiatry and Neurosciences.

The researchers used established clinical interviews and self-completed questionnaires to record the severity of depression in the patients at the beginning and end of the study. Blood samples were taken from the participants to determine their blood lipid levels and level of the C-reactive protein (CRP), which are known indicators of inflammatory processes in the body. “People with obesity and/or depression commonly exhibit slightly raised inflammatory markers in the blood. For some of those affected, this can actually be the cause of depression,” explains Christian Otte. “And this is precisely where we began with our hypothesis on the potential antidepressive effect of statins: If administering statins leads to an improvement in inflammatory markers, could this also possibly be accompanied by an antidepressive effect for some of the study participants?”

Traditional antidepressants remain the gold standard

At the beginning of the study, the participants ranged from moderately to severely depressed. Over the course of the 12-week study, the depression symptoms in all patients showed clear improvement – there was, however, no difference between those who received statins and those in the placebo group. “Administering the cholesterol-lowering drug improved blood lipid levels, as expected, and the inflammatory marker CRP also displayed a marked reduction,” says Woo Ri Chae. “So, unfortunately, this does not point to an additional antidepressive effect.” Christian Otte adds: “When it comes to treating depression, statins therefore have no additional benefit. To our present knowledge, traditional antidepressants remain the gold standard.” According to current guidelines, statins should be prescribed to reduce the risk of atherosclerosis and cardiovascular diseases. The researchers recommend that the same should naturally also apply for patients suffering from depression.

In further studies, Christian Otte’s team will conduct a more thorough analysis of the blood samples taken as part of this research on a cellular and molecular level, to reveal potential differences and correlations. The researchers are also continuing to work at full speed on improved strategies for treating patients with depression who also suffer from other conditions.

Categories : Mental Health NeurologyTags :

Extending Ketamine’s Relieving Effect on Depression

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For 30% of people with major depressive disorder (MDD), antidepressants don’t work. When infused at a low dose, ketamine shows remarkable efficacy as a rapidly acting antidepressant, with effects observed within hours even in patients who have been resistant to other antidepressant treatments. One drawback is that consistent infusions of ketamine are needed to maintain symptoms at bay, which could result in side effects, such as dissociative behaviours and the possibility of addiction, and stopping treatment can result in relapse.

In a new study published in Science, Lisa Monteggia’s and Ege Kavalali’s labs show that it is feasible to substantially extend the efficacy of a single dose of ketamine from its current duration of up to a week to a longer period of up to two months.

“The premise of this study, which was led by Zhenzhong Ma, a fantastic research assistant professor, was based on a testable mechanistic model that we developed that accounts for ketamine’s rapid antidepressant action,” Monteggia said.

Previously, researchers in the field had determined that ketamine’s antidepressant effect requires the activation of a key signalling pathway called ERK, but only ketamine’s long-term effects – not its rapid effects – are abolished when ERK is inhibited. As a fast-acting antidepressant, ketamine relies on ERK-dependent synaptic plasticity to produce its rapid behavioural effects. Ma and colleagues hypothesised that they could maintain ketamine’s effects for longer periods by enhancing ERK activity. 

In the recent paper, Ma discovered that ketamine’s antidepressant effects could be sustained for up to two months by using a drug called BCI, which inhibits a protein phosphatase and results in increased ERK activity. By inhibiting the phosphatase, the authors retained ERK’s activity and augmented the synaptic plasticity that drives ketamine’s prolonged antidepressant effects. 

lthough the use of BCI makes the application of these results to the clinic difficult, Monteggia said that the results provide a proof of principle that ketamine’s antidepressant action can be sustained by targeting intracellular signaling. She and Kavalali, the William Stokes Professor of Experimental Therapeutics and the chair of the Department of Pharmacology, have worked on the project since its inception and hope that it will foster other studies looking to identify specific molecules to enhance and sustain the action of a single dose of ketamine.

Ultimately, this work will be a stepping stone toward improving MDD patients’ lives by reducing the burden of treatment.

Source: Vanderbilt University

Categories : Mental HealthTags :

Social Connection is Still Underappreciated as a Medically Relevant Health Factor

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Research confirms that social isolation and loneliness significantly impact health and mortality, even if not listed on death certificates. Brigham Young University psychology and neuroscience professor, Julianne Holt-Lunstad, has published extensively on the topic, including a landmark 2010 meta-analysis and a 2023 framework on assessment and treatment. She also served as lead scientist on the 2023 Surgeon General Advisory and is advising the World Health Organization on an upcoming report that addresses the pressing health threat of loneliness and isolation and a global agenda on social connection.

Social connection is now a legitimate health factor, but Holt-Lunstad and doctoral student, Andrew Proctor, recently published two studies showing that most of us (the general population and medical providers) still don’t think social connection affects physical health. And even the professionals who recognise the importance report that they don’t have time or tools to help patients address social concerns.

Proctor, who authored a study recently published in Springer Nature, explained that before the study, they had been watching how the pandemic was influencing internet searches around the topics of isolation and loneliness.

“I have a marketing background, so I thought that maybe the public perception had changed since COVID. Social distancing, isolation and loneliness were huge buzzwords on the internet as seen through Google Trends and BuzzSumo (an online trend analyzer). Everything around these search terms was super viral during that time, and so we wondered if perceptions about social connection had changed,” said Proctor.

With loneliness and isolation trending on the internet, the researchers set up a study. In a nationally representative sample of US adults, as well as samples from the UK and Australia, they surveyed 2,392 people about their perceptions of health risks associated with isolation and loneliness. The data showed that, despite the pandemic and other campaigns, people still underestimate the importance of social connection for physical health. And the underestimation exists equally among the lonely and the socially connected.

“The study identified blind spots in medical care,” said Proctor. “Social connection is like a vital sign. What if we didn’t care about high blood pressure? Or what if we never knew smoking was bad for us? Social connection is like a key vital sign. We just don’t tend to recognize it.”

In a closely connected study, Holt-Lunstad and Proctor, along with coauthors from top research medical centers, surveyed 681 healthcare providers (primarily doctors) about perceptions of health risks associated with poor social connection. Similar to the general population from the first study, healthcare providers underestimated social connection as a medically relevant health factor.

The researchers gleaned some unexpected insights due to an unintentional time lag in data collection in the second study.

“We completed the data collection at two different time points because we were waiting for institutional approvals. Our first cohort was healthcare providers through the University of Utah Health System. Slightly later, we had a second major cohort of University of California San Francisco (UCSF) physicians,” said Holt-Lunstad. “What was interesting is that the perceived importance of social factors was a bit higher among the UCSF group.”

Source: Brigham Young University