A: Yes, symptoms that seem to develop gradually may indicate a different type of dementia from the one that presents with more sudden-onset symptoms. But understand that there is no entirely reliable timetable for everyone who develops dementia.

Symptoms of Alzheimer’s disease, for example, tend to develop gradually and progress more slowly than other types of dementia. However, progression is sometimes faster in early-onset Alzheimer’s compared with the disease in older adults.

Vascular dementia, on the other hand, can often develop suddenly. Early symptoms can sometimes be difficult to detect, as they can include struggles with planning and concentration and subtle changes in mood or behavior. Memory loss, which is among the first signs of Alzheimer’s disease, is among the later symptoms of vascular dementia.

Whether cognitive changes occur slowly or quickly, they should not be ignored or written off as normal aging or as a mood disorder such as depression. If you are aware of changes in your thinking skills or those around you express their concerns, get a medical evaluation.

Q: When a stroke makes it difficult to walk, speak, or engage in other basic functions, is it possible to predict whether or how much of those skills might return?

A: Researchers continue to develop physical tests and computer models designed to do just what you’re asking—better predict the recovery of certain functions affected by stroke. And while we are learning more about what is reasonable or realistic to expect in stroke recovery, there are no guarantees because every person’s stroke experience is unique.

What we do know is that the first one to three months after a stroke continue to be the most important in terms of recovery. Most improvements usually occur during this time period, though with effort and patience, many stroke survivors can continue to experience improvements years after the event. The key is committing to physical, occupational, and speech therapies (as appropriate), and understanding that setbacks and detours on the road to recovery are to be expected. The medical community’s ability to treat stroke and enhance recovery has come a long way in recent years, and there is every reason to believe that progress will continue.

Q: After being widowed several years ago, I noticed that I get very sad every winter. I assumed it was the holiday blues, but a friend suggested it might be seasonal affective disorder (SAD). I don’t remember feeling this way when I was younger. Can SAD develop later in life?

A: SAD is diagnosed more often in younger adults than older adults, but various circumstances can affect when a person first notices symptoms or experiences a worsening of symptoms. Older adults, especially those living alone and susceptible to isolation or loneliness, can have a particularly difficult time with SAD.

It’s not always easy to distinguish between the “holiday blues” and SAD, but there are some important distinctions. SAD is a form of clinical depression and tends to be accompanied by significant changes in sleeping patterns, difficulty managing situations, feeling angrier and more irritable than usual, low energy, and often a desire to be alone. It may start in the fall and last well into the new year. The holiday blues tend to be fairly situational and limited to the holiday season or holiday events. It’s a psychological condition that brings on feelings of sadness, but after the holidays those feelings tend to ease up.

You may find it helpful to talk with your health­care provider and consider counseling and/
or medications, particularly if you notice that this time of year leads to negative, potentially harmful thinking or unhealthy behaviors. MMM

The post Ask the Doctor: January 2023 appeared first on University Health News.

Though it’s perhaps the symptom we most associate with Alzheimer’s disease (AD), memory loss isn’t always the first indication of the chronic neurological condition. Declines in other aspects of cognition may be more obvious in the very early stages of AD. These include things like struggling to find the right words to describe or explain something. Judgment and reasoning may become impaired, and you may notice a person making decisions that are noticeably out of character. In some cases, vision and spatial issues surface early on. Such problems can make it difficult to judge distances and process information about three-dimensional objects. Having visuospatial difficulties could cause trouble climbing stairs or parking a car.

Non-memory symptoms are more common in early-onset AD, which is defined as the onset of AD prior to age 65. However, for most people with AD—regardless of when it develops or what symptoms show up first—memory loss will eventually occur and become progressively more severe. It’s also worth noting that not all cases of memory loss are due to AD. Likewise, changes in judgment and reasoning, as well as visuospatial difficulties, can spring from causes unrelated to AD or other forms of dementia.

Is there a simple way to distinguish between sadness and depression?

One way to think of sadness is as a normal, even healthy response to disappointment, loss, or other upsetting events or circumstances. Sadness is usually temporary and does not interfere too greatly with your everyday activities. Feelings of sadness can usually be defined as a reaction to something. You can often define the thing that is making you sad.

Depression, on the other hand, is a mental illness that may or may not have a trigger that you can identify, such as a stressful life event. Depression can develop for no apparent reason and linger for a long time. It affects not just your mood (as sadness does), but also the way you process information and relate to your environment. Depression symptoms also include more than sadness. You may experience feelings of worthlessness and hopelessness. Depression can also make it difficult to concentrate and make decisions, and sleeping patterns and appetite can change.

If you find that your feelings of sadness don’t lessen or go away, talk with family and friends you trust. Talk to your doctor or find a therapist to help you understand your feelings better. Even if what you’re feeling isn’t clinical depression (also known as a depressive disorder), working through feelings of sadness is important to regain some quality of life.

How long after a transient ischemic attack (TIA) does a stroke usually occur?

A TIA is sometimes referred to as a minor stroke, as it can have the identical symptoms of a stroke before resolving on its own. TIA symptoms tend to last a short time, while stroke symptoms usually persist. A full recovery from a TIA is common, though the long-term prognosis is concerning.

As your question suggests, a stroke often follows a TIA. Unfortunately, it is still difficult to predict when that may occur. A stroke could occur within a few days or a few months or not at all. A TIA should be considered a medical emergency, and the person experiencing symptoms should be evaluated for possible treatment. A TIA could lead to surgery or angioplasty to open up a blocked carotid artery. Preventive measures, such as daily blood thinners, or healthy lifestyle changes may be appropriate.

If you have stroke symptoms that last for only a few minutes, consider them a warning and an opportunity to get help before a full-fledged stroke occurs. A trip to the emergency room, even if you are starting to feel fine, may save your life.

The post Ask the Doctor: March 2022 appeared first on University Health News.

It’s become increasingly clear that diagnosis and treatment methods must be age appropriate. Fortunately, there are many options and combinations of treatments that can improve symptoms and the quality of life across a life span. Medication may be needed for short periods, or perhaps not at all. But the first step is to acknowledge that there is something wrong.

Unfortunately, people in their 60s and beyond tend to stigmatize depression more so than younger adults, making them less likely to ask for help. This is especially unfortunate given the link between depression and cognitive decline.

Mental Health Affects Overall Health

Geriatric psychologist Alan Castel, PhD, UCLA Department of Psychology, explains that many older adults may feel that health is mostly related to physical well-being and mobility and therefore may not pay attention to mental-health issues. But sharing how you feel emotionally is important to overall health and can help you get support and validation.

“When loved ones and/or a health professional ask, ‘How are you doing?’ it may be helpful to give an update on both your physical and mental health. Once you have articulated your feelings about your mental health, such as feeling lonely, depressed, or anxious, then other people, such as friends and family, can feel more comfortable sharing their own state of mind, which can be beneficial,” says Castel. “Seeking out a mental-health professional can also help with physical health, as it can help you engage in healthy behavior.”

Depression and Contributing Factors

A depression diagnosis often starts by asking people to self-report symptoms, such as persistent sadness and loss of pleasure in activities previously enjoyed. Evaluating symptoms in older adults, however, must include many considerations. For example, there’s a greater likelihood of neurological issues, such as from a stroke. A neurological exam assesses for motor and sensory skills, mental status, and changes in mood or behavior that may be affected by a stroke. A neurological evaluation may lead to a treatment plan different from a more traditional approach for clinical depression.

Similarly, an assessment of medication informs valuable next steps. More than 30 percent of adults over age 65 take five or more medications daily, and any one of them may have depression-related side effects. Sometimes adjusting a medication can be enough to reverse depressive symptoms. Underlying conditions may trigger or exacerbate depressed mood. For example, the relationship between heart disease and depression has been well-established.

A study presented at the American College of Cardiology annual meeting reported that people are twice as likely to die if they develop depression after being diagnosed with heart disease.

Last year researchers from the University of Technology in Sydney, Australia found that 24 percent of those with heart disease who had moderate symptoms of depression quit their cardiac rehabilitation program, compared with only 13 percent of those with mild or no symptoms of depression. The investigators recommend that clinicians screen for depression, anxiety, and stress among those starting cardiac rehabilitation, as they may need extra support to improve their mental health and stick with an exercise program.

Sometimes, people may assume that it’s normal to be unhappy when a person gets older. Given the challenges that may come with aging, such as more chronic conditions, health scares, and physical changes, it’s easy to understand why this assumption may occur. However, there are many studies that contradict this position and moreover suggest that many people are actually happier and more positive compared to younger people.

The key takeaway is that unhappiness is not normal in older age. It can be assessed and addressed.

Age-Appropriate Treatments

Medications require special attention because older adults don’t metabolize medications as they once did and often require lower doses. Side effects also may be experienced more intensely. And, of course, other medications must be considered into the prescribing mix.

Nonpharmacological interventions for depression work for many people, but staying the course is required for success. Sometimes it might mean taking a medication while allowing for lifestyle and other approaches to take hold. These approaches include talk therapy with a geriatric psychologist or mental-health expert experienced with older people, participating in physical activity most days of the week for at least 30 minutes daily, and eating healthfully by including fresh fruits, vegetables, lean protein, and complex carbohydrates into daily eating plans. Mental-health professionals can help people stay on task, which is especially crucial in the early days of treatment.

Daily physical activity offers multiple health benefits. For example, exercise has been shown to improve mood and increase/maintain muscle mass, which normally declines with aging. The latest research into the power of exercise comes from McMaster University in Canada. The study included men ages 65 and older who followed a 12-week program of intense exercise that included once-weekly high-intensity interval training, known as HIIT, combined with twice- weekly strength training. Blood samples and muscle changes were analyzed throughout the study. Just three months of this kind of training triggered gene expression within the muscles that increased production of neurotransmitters associated with improved mood, including serotonin. This effect has been demonstrated in the past, but only in younger people. This gene-triggering pathway appears to remain intact in older people, even with the decline in muscle mass. So, the adage, “it works if you work it,” applies even in your golden years.

UCLA Innovations Ahead

To help improve detection and treatment of depression, UCLA has launched a major new study, sponsored by and in collaboration with Apple. The goals include obtaining objective measures of factors such as sleep, physical activity, heart rate, and daily routines to illuminate the relationship between these factors and symptoms of depression and anxiety. The research utilizes Apple technology including iPhone, Apple Watch and Beddit, a sleep-monitoring device. Making the connection between quantifiable data and symptoms of anxiety and depression could enable health-care providers to note warning signs and prevent the onset of depressive episodes, track the effectiveness of treatment, and identify causes of depression.

“Current approaches to treating depression rely almost entirely on the subjective recollections of depression sufferers,” says Nelson Freimer, MD, UCLA distinguished professor of psychiatry and principal investigator on the study. “This is an important step for obtaining objective and precise measurements that guide diagnosis and treatment.”

The study came into play as the COVID-19 pandemic disrupted lives and spurred a focus on anxiety and depression, and when physical distancing requirements made scientific research challenging.

“UCLA and Apple designed this study so that all aspects of participation can be accomplished remotely,” Dr. Freimer says. “The pandemic has heightened anxiety and depression globally and has increased awareness of the importance of behavioral health to overall well-being. At the same time, physical distancing requirements have limited in-person mental health assessment and treatment, leading to expanded use and acceptance of telehealth. These changes highlight the importance of incorporating technologies like those to be tested in this study into clinical research and eventually into practice.”

The pilot phase of the study, with 150 participants recruited from  UCLA Health patients, began last August. The main phases, to take place from 2021 through 2023, will involve some 3,000 participants, drawn both from UCLA Health patient population and the UCLA student body.

The post What You Might Not Know About Depression appeared first on University Health News.

“Signs and symptoms of depression often develop gradually,” says David Mischoulon, MD, PHD, director of the Depression Clinical and Research Program at Massachusetts General Hospital. “They may begin with one or two of the usual symptoms, for example depressed mood or loss of interest in usual activities, and then gradually other symptoms may emerge over a period of days, weeks, or months.”

He adds that on other occasions, however, depression may develop abruptly, with more prominent changes in mood and behavior.  “This scenario is common after an acute trauma, such as a death in the family or the loss of a job,” Dr. Mischoulon explains. “Those individuals may become acutely depressed, with a wider range of depressive symptoms. In some cases, this may represent an acute reaction that may resolve relatively quickly as the patient begins to come to terms with the loss. In other cases, it may persist and grow into a full-blown major depressive episode.”

What Is Depression?

Depression is a common and serious illness that affects your feelings, thoughts, and behavior. Unhealthy changes in brain chemistry can trigger depression, though it’s not as simple as having too much of one chemical or not enough of another. There are millions of chemical reactions that affect mood and how you perceive and respond to your environment. You may have one depressive episode or multiple episodes. Depression can sometimes settle in for months or years.

As serious as depression is, it is also treatable. Effective treatment may require a combination of medications, talk therapy, and lifestyle changes, but with the help of a professional mental health-care provider and, if possible, the support of family and friends, many people can manage their depression and enjoy a fine quality of life.

What can be especially helpful is recognizing the early signs of depression, because that can lead to early treatment before the condition worsens.

Subtle Changes

Unlike certain physical ailments with symptoms that are impossible to ignore, depression often enters the picture stealthily, affecting behaviors that may not seem so serious at first. “Some people may notice a mild change in sleep patterns, such as some difficulty falling asleep or nighttime awakenings,” Dr. Mischoulon says. “Others may experience some mild loss of appetite, fatigue, or difficulty concentrating. The symptoms may be misattributed to other things, particularly if the individual has no previous experience with depression and/or has not read much about the subject. These individuals may go for longer periods without seeking help, and again may eventually get into a full-blown depressive episode.”

Other signs of depression include:

• Low energy, so even simple tasks require extra energy
• Irritability and restlessness
• Increasing difficulty concentrating
• Gradual loss of interest in activities you once enjoyed

When Behavior Is Affected

Those early symptoms of depression may be noticed only by the person experiencing the changes. However, close relatives who see the individual often may pick up on even the subtlest changes. “People’s moods often fluctuate, as part of normal life,” Dr. Mischoulon says. “We will have days when we feel happy and days when we feel down. When depression begins, the down periods usually start to outnumber good periods, and at that point, either the individual or those around him may notice the changes.” 

If not, it may not be long until depression starts to affect behavior at home, work, or anywhere else. The outward signs are much harder to miss. “Loss of motivation will eventually translate into decreased productivity, and this may become noticeable in the workplace or in school, particularly to those supervising the individual with depression,” Dr. Mischoulon says. “Insomnia, when it becomes more prominent, may be one of the things that leads the individual to seek help, since poor sleep results in tiredness during the day, and decreased function overall. Because there are consequences in different dimensions of the patient’s life, the depression may become more noticeable at this point.”

How to Respond

The path of depression can be unpredictable. You may think you’re handling things just fine, but symptoms can suddenly worsen. “If you notice that you are having symptoms of depression, whether there is an attributable cause or not, it would be a good idea to speak to a medical professional,” Dr. Mischoulon says. “Often, a primary care physician is the first line for identification of depression, particularly for those individuals who have not had depression before and may therefore not be receiving any psychiatric care. Even if the individual feels that he has the situation under control, it is a good idea to seek help, because depression may gradually worsen if left untreated. Such individuals may therefore become more severely depressed, and depression at that point may be more difficult to treat quickly and effectively.”

He adds that if you notice that a friend or acquaintance appears depressed, or is acting differently than usual, it is a good idea to reach out and ask if there is anything going on. “If it looks like your friend is seriously depressed, consider asking if he is having any thoughts about death or suicide,” Dr. Mischoulon advises. “There is a myth that asking someone about suicide is more likely to trigger a suicide attempt. This is not true. In fact, people will often welcome the chance to speak about their feelings, and the opportunity to be heard makes it less likely that they will hurt themselves. In such cases, you should advise your friend to seek professional help, and also make yourself available to them if they need to talk. This can have a tremendous benefit and potentially save your friend’s life.”

Allowing symptoms or signs of depression to go unaddressed means that they may worsen. “In general, it is best to err on the side of caution and seek professional advice when in doubt,” Dr. Mischoulon says. “If there is no depressive episode present, the reassurance from a professional could be well worth the time and expense. Not seeking help when needed, conversely, could have devastating consequences on the individual.”

The post Recognize the Earliest Signs of Depression appeared first on University Health News.

A: Fear and anxiety about a new disease can be overwhelming, and public health actions, such as social distancing, can make people feel isolated and lonely, and can increase stress and anxiety. Stress during an infectious disease outbreak can cause some of the following:

• Fear and worry about your health and the health of your family.
• Anxiety about your financial situation or your source of income.
• Changes in sleep or eating patterns.
• Difficulty sleeping or concentrating.
• Worsening of chronic health problems.

Different Types of Depression. There are several different types of depression, including situational and clinical depression. Situational depression is typically temporary and can be brought on by an event such as loss of a loved one. Clinical depression is complex and can arise for numerous reasons, including genetic vulnerability, severe life stressors, and medical conditions that affect the way your brain regulates your moods.

You may be depressed if, for more than two weeks, you’ve experienced several of the following symptoms:

• Feelings of hopelessness and/or pessimism.
• Feelings of guilt, worthlessness and/or helplessness.
• Irritability and restlessness.
• Loss of interest in activities or hobbies once pleasurable.
• Fatigue and decreased energy.
• Difficulty concentrating, remembering details and making decisions.

Find a Therapist. Talking to a mental health professional can help. To schedule a face‑to-face or telemedicine appointment, contact your insurance provider or follow this link https://bit.ly/34fmRyD to the Anxiety and Depression Association of America’s Find a Therapist web page.

Q: I have osteoarthritis in my hip, so swimming is my exercise of choice, but my gym pool is closed until further notice because of COVID-19.  What kind of exercises can I do that will be easy on my joints?

A: Good for you for recognizing the importance of keeping moving. If you don’t exercise, your muscles will get weaker, your arthritis symptoms will worsen, and you will lose vital strength and mobility. Walking, yoga and tai chi are three activity options that won’t stress your joints, don’t require a pool, and can be done at home or close to home.

Walking. You may worry that walking will cause your arthritic hip to deteriorate faster, but research suggests you can walk for at least 10,000 steps each day without doing additional damage to your arthritic hip joint. If you want some ”virtual” company or need support or direction, follow this link https://bit.ly/30ieJfG to learn about the Arthritis Foundation’s Walk With Ease program.

Yoga. People with arthritis who practice yoga regularly can reduce joint pain, improve joint flexibility and function, and lower stress and tension. Iyengar yoga is often recommended to people who have arthritis because it can be adapted for limited mobility. Assistive props, such as ropes and foam blocks, can be used during challenging poses. For example, if you have a hard time bending over and touching your toes, you can place a foam block on the floor and reach for that instead. Floor stretches are another great way to gain the benefits of yoga without inflicting undue stress on your joints. Follow this link
https://bit.ly/36jUty4 to learn how to do a dynamic reclined hip stretch sequence that can help you gently release tension around your hip joint and hamstrings.

Tai chi. With its gentle, fluid movements, tai chi is gaining popularity as a way to fight off arthritis pain and increase flexibility and strength without straining joints. Recent studies have found that the slow, graceful exercise, which originated centuries ago as a martial art, can improve balance, reduce stress and offer pain relief. For more info, follow this link https://bit.ly/3ikGudL to watch—or participate in—a tutorial on tai chi stretches for arthritis.

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Age-related changes, as well as other existing conditions, should be incorporated into diabetes management. An older person with several chronic conditions requires different care than someone who has only one or two. Whether that older adult is you or someone you love, Dr. Gupta says it’s important to consider cognitive health, individualized blood sugar goals, and the potential need for medication simplification.

Depression, Diabetes and Cognition

Studies have shown that people with diabetes are twice as likely to be depressed as those without the disease. However, that relationship also is “bidirectional,” meaning that having diabetes can lead to depression, and conversely, depression can lead to diabetes. For example, a person who is depressed may not eat well or exercise, thus gaining weight and triggering diabetes. A person with diabetes may become depressed about having the condition. A substantial body of literature also suggests that clinical depression is associated with diminished cognitive ability, dementia, and Alzheimer’s disease. For anyone over age 65, memory problems and depression become relevant in diabetes management. Thus, experts recommend yearly screening for early detection of mild memory loss and depression for older adults with diabetes.

“Poor glucose control for a long time is associated with worsening memory function,” says Dr. Gupta. “For those who screen positive for memory impairment, our goal is to simplify medication regimens and involve caregivers in all aspects of care.”

For example, she recommends that caregivers keep well-organized lists of diabetes medications, accompany the patient to doctor’s visits so that everyone is aware of any medication changes, and if a person is taking non-insulin medications, check blood sugars once or twice per day and notify the physician when blood glucose levels are that less than 70 milligrams per deciliter (mg/dl).

Beware of Low Blood Sugar

Diabetes medications help lower blood sugar levels. But there is such a thing as too low. Hypoglycemia, also known as low blood sugar, can cause confusion, dizziness, fatigue, and irregular heartbeat. It can also lead to personality changes, such as irritability, nervousness, and becoming argumentative or combative. Severe hypoglycemia has been linked to increased dementia risk.

“In our practice, if we see consistent blood sugars less than 100 mg/dl, we start backing off medications,” says Dr. Gupta. “Repeated low blood sugar episodes (below 70 mg/dl) can make it difficult for people to detect further low blood sugars. Usually they get sweaty, dizzy, or lightheaded, and people can feel that. But repeated low blood sugar episodes can make it difficult to feel symptoms. It also makes it difficult to sense abnormal cardiac rhythms, which can lead to sudden cardiac arrest.”

Metformin is typically recommended as a first-line treatment and rarely causes low glucose levels. On the other hand, sulfonylureas are associated with hypoglycemia and should be used with caution. In June of this year, the FDA issued an alert about excessive levels of N-Nitrosodimethylamine (NDMA) in several batches of extended-release metformin formulations. If you or a loved is taking this medication, consult with your pharmacist to see if the manufacturer of your metformin has been affected by the recall. Excessive exposure to NDMA has been linked to jaundice, nausea, fever, dizziness, and several types of cancer.

Broadly by the Numbers

In general, Dr. Gupta recommends that if an older person is relatively healthy and active, with intact cognition and three or fewer chronic illnesses, A1C less than 7.5 is the goal. Those with three or more serious conditions that require medications, have mild cognitive issues, are weak/frail, and have difficulty managing treatment, 8 to 8.5% A1C may be acceptable. As A1C is an average over three months, keeping an eye on daily blood sugars is best. Before a meal the reading should be in the 80-130 mg/dl range. Two hours after a meal, blood sugar should be lower than 80. However, don’t check too soon, as the numbers will be too high. For more information on diabetes and older adults, see Dr. Gupta’s excellent UCLA MD Chat video online at http://tiny.cc/ogg1rz.

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An afternoon of gardening might bring a smile to your face. A game of tennis can be a workout, but one that leaves you energized and feeling better than when you started. And just a half-hour of playing your favorite songs on piano lifts your spirits in ways few other activities can do.

You may not give much thought to the pursuits you enjoy, but they can serve an important role in helping to prevent the onset of depression or anxiety symptoms. It has to do with “mood homeostasis,” the ability to stabilize your mood by engaging in everyday, mood-modifying activities.

Such activities can include exercise, hobbies, or even housework, explains Cristina Cusin, MD, a staff psychiatrist at the Depression Clinical and Research Program at Massachusetts General Hospital. “Exercise can give you a very rapid response,” she says. “You feel better almost instantly with the release of endorphins.”

Dr. Cusin adds that while meditation doesn’t provide the same kind of immediate mood boost, it can lead to a greater sense of well-being in the long term. What’s important is identifying what works for you, as well as what can bring your spirits down.

Take Stock of Your Feelings

Dr. Cusin recommends paying close attention to your mood during and after particular activities. You may have never thought much about your daily walk around the neighborhood, but the next time you lace up your sneakers take note of whether that jaunt leads you to a happier destination. “It’s extremely important to self monitor,” she advises. “Identify the activities that leave you depleted and those that are enriching.”

But in a year that saw many mood-modifying activities become unavailable, mood homeostasis wasn’t as easily achieved by many people even if they didn’t realize the psychological importance of those behaviors. The closure of social gathering places, such as restaurants, parks, and community centers, severely curtailed mood-boosting activities people enjoy with others. “We are social ­animals, and with physical distancing, we lost one of the biggest stress ­relievers socializing,” Dr. Cusin says.

When options are limited, for whatever reason, Dr. Cusin encourages experimentation. Keeping a diary or log of your activities and feelings may help you identify your effective options. She also cautions that many unhealthy activities, including alcohol and drug use, can become easy substitutes for safer choices.

Dr. Cusin recommends having a variety of activities that improve your mood, as long as they are healthy, both physically and emotionally.

Limits of Mood Homeostasis

A study published recently in JAMA Psychiatry suggests that people with low mood and a history of depression may have an impaired ability to improve their mood with their choice of activities.

But Dr. Cusin, who specializes in treatment-resistant depression, says that interpreting the study’s findings needs to be done carefully. The study participants were volunteers who downloaded a smartphone app with which they could record their activities and feelings. The average age of the participants was 28, and there was no record of their psychiatric history. She warns against oversimplifying a person’s condition and suggesting that if someone with depression would only engage in more enjoyable activities, his or her mood would improve.

“You can’t put the blame on the person for not being able to regulate their mood,” she says. Treating clinical depression usually requires a combination of medication, psychotherapy and lifestyle changes. And even if a person wants to engage in mood-elevating activities, he or she may not know to start or may not have the resources to do so, Dr. Cusin says.

Takeaway

 While noting the activities that bring you up or down is helpful, Dr. Cusin adds that it’s also important to pay attention to your feelings throughout the day. “When someone asks how are you doing, don’t just answer, ‘Fine,’” she says. “Talk about your feelings and listen to others. This is the time to think about what you’re saying. Engage in a conversation. Helping someone else can help you regulate your mood, too.”

The post Regulating Your Mood May Come Down to Choosing the Right Activities appeared first on University Health News.

The drug ketamine has a long and controversial history. It was developed in the 1960s as an anesthetic that was widely used in the Vietnam War and in the 1980s became an illicit party drug. But its future may be as a much-needed rescue for people with treatment-resistant depression. And according to research at Massachusetts General Hospital (MGH), ketamine may also emerge as a solution for individuals with both depression and anxiety, a combination that has proven to be especially challenging to treat effectively. Naji C. Salloum, MD, with MGH and Harvard Medical School, and his colleagues analyzed data from an MGH ketamine study originally published in 2018 in the journal Molecular Psychiatry. The original study included 99 patients with treatment-resistant depression. One report found that ketamine was superior to placebo in reducing depressive symptoms and lengthening the time before a relapse of symptoms. A second report from that study found that the response to ketamine-combined treatment was superior to treatment with midazolam, a benzodiazepine that is sometimes given to patients prior to anesthesia before surgery. Ketamine appeared to be equally effective in helping people with and without anxious depression for the first three days. After that time, nonanxious individuals with depression responded better than those with anxiety. Still, MGH researchers are encouraged that further study will lead to better long-term treatments for people with clinical depression and anxiety. “Taken together, our results, as well as results of the two previous reports, highlight the potential role of ketamine in the treatment of anxious depression,” the researchers concluded in their report.

Related posts: “Learn the Many Cognitive and Emotional Benefits of Living a Life of Purpose“; “Newsbriefs: Caregivers Seek Less Mental & Physical Care; Fish Oil; Brain Inflammation“

The post MGH Study: Ketamine May Help with Anxious Depression appeared first on University Health News.

So What Are Psychobiotics?

Psychobiotics are live organisms that, when ingested in adequate amounts, produce a health benefit in patients suffering from psychiatric illness._[1]

But this definition, coined in 2013, is too limiting based on the latest research showing that you don’t need to have clinical depression, an anxiety disorder, or some other psychiatric disorder in order for psychobiotics to positively affect your brain._[2]

Anyone suffering from chronic stress, low mood, or anxiety-like symptoms has the potential to benefit from this class of probiotics.

How Do Psychobiotics Act on the Brain?

One way these “mind-altering” probiotics likely act is via their ability to produce various biologically active compounds, such as neurotransmitters. Several molecules with neuroactive functions such as gamma-aminobutyric acid (GABA), serotonin, catecholamines, and acetylcholine can be produced by gut bacteria._[3] When these neurotransmitters are secreted within the gut, they may trigger cells within the gut’s lining to release molecules that signal brain function and affect behavior.

A second way that psychobiotics appear to act on the brain is by exerting effects on the body’s stress response system, which involves the brain and the adrenal glands._[4] This system, known as the hypothalamic-pituitary-adrenal (HPA) axis, becomes dysfunctional in the context of chronic stress or illness. When HPA-axis dysfunction occurs, the production and rhythmic timing of cortisol and other stress-related hormones becomes disrupted. This is believed to play a central role in causing mood disorders and cognitive problems._[5]

A third way psychobiotics are hypothesized to act on the brain is through their anti-inflammatory actions._[6] Chronically elevated levels of inflammation throughout the body and brain are now known to be one of the major underlying causes of depression and other mood and cognitive disorders. This inflammation can stem from the gut, and some psychobiotics may have their effects in the brain by lowering inflammation.

Which Probiotics Are Psychobiotics?

Research is beginning to identify which probiotics have mild-altering effects and what those effects are. In studies in healthy people, different psychobiotics have been shown to boost mood and cognitive function and decrease stress and anxiety-like symptoms.

Certain psychobiotics have also been shown to treat depression, anxiety, and other mental health and cognitive issues in patients with psychological disorders and/or other medical conditions.

Psychobiotics for Depression and Anxiety

A clinical trial randomly assigned patients with major depressive disorder to receive either probiotic supplements or placebo for eight weeks._[7] The probiotic pills consisted of Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum (2 billion CFUs each).

After eight weeks, patients who received the probiotic had significantly decreased total scores on the Beck Depression Inventory, a widely used test to measure the severity of depression, compared with placebo. In addition, they had significant decreases in systemic inflammation as measured by hs-CRP, significantly lower insulin levels, reduced insulin resistance, and a significant rise in glutathione, the body’s master antioxidant.

Other psychobiotics have beneficial consequences on mood and anxiety-like symptoms in people without depressive or anxiety disorders.

In a study to investigate the possible effects on anxiety, depression, stress, and coping strategies in healthy human volunteers, a probiotic containing Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 (Probio’Stick®) alleviated psychological distress, particularly depression, anger-hostility, and anxiety, and improved problem solving when taken for 30 days._[8] The researchers concluded that L. helveticus R0052 and B. longum R0175 have beneficial psychological effects in healthy humans.

Psychobiotics can also help boost mood and ease anxiety in people suffering from various chronic diseases. The same probiotic studied above (Lactobacillus casei strain Shirota) was used in another double-blind, placebo-controlled trial in patients with chronic fatigue syndrome._[9]

Patients were randomized patients to receive either 24 billion colony forming units of Lactobacillus casei strain Shirota or a placebo daily for two months. The people taking the probiotic had a significant decrease in anxiety symptoms.

Many additional psychobiotics have been shown to treat depression and anxiety in animal studies. Lactobacillus plantarum strain PS128, for example, is known to increase dopamine and serotonin and decrease depression-like behaviors in mice._[10] In depressed mice that have been subjected to early-life stress, this same psychobiotic decreases cortisol, normalizes the stress response system (the HPA axis), and decreases depression._[11]

Both Bifidobacterium longum 1714 and Bifidobacterium breve 1205 reduce anxiety-like behavior and improve performance on cognitive tests in anxious mice._[12,13]

Psychobiotics for Stress

Psychobiotics have also been shown to help people and animals undergoing stress. A fermented milk drink (kefir) that contained Lactobacillus casei strain Shirota prevented stress-related cortisol increases and raised serotonin levels in stressed medical students._[14] Moreover, the probiotic drink decreased stress-related physical symptoms such as abdominal pain and cold symptoms.

The study authors concluded that taking Lactobacillus casei strain Shirota “…may exert beneficial effects preventing the onset of physical symptoms in healthy subjects exposed to stressful situations.”

Lactobacillus helveticus NS8 was compared to the SSRI, citalopram, in rats with depression, anxiety, and cognitive dysfunction due to chronic stress._[15] The probiotic worked better than citalopram in reducing stress-induced anxiety, depression, and cognitive dysfunction. It lowered cortisol and restored serotonin and other brain neurochemical levels to normal.

Other Lactobacillus helveticus-containing probiotics have also been shown to reduce stress-related depression and anxiety by affecting serotonin, cortisol, and other neuroactive compounds in animal studies._[16] For example, Lactobacillus helveticus R0052 combined with Lactobacillus rhamnosus R0011 normalized anxiety-like behavior and learning and memory impairments in immune-deficient rats with HPA-axis dysfunction._[17]

Are Some Prebiotics Also Psychobiotics?

Prebiotics, like probiotics, can also act as important regulators of mood and brain function. In a recent study, prebiotics were found to decrease the secretion of the stress hormone, cortisol, and improve emotional processing in healthy volunteers. Participants received one of two prebiotics (fructooligosaccharides, FOS, or Bimuno-galactooligosaccharides, B-GOS) or a placebo (maltodextrin) daily for three weeks. Morning cortisol levels were significantly lower after B-GOS intake compared with placebo.

Participants taking B-GOS also showed increases in the processing of positive versus negative attentional vigilance, which is an indication that the prebiotic had anti-anxiety effects. No effects were found after the administration of FOS._[18]

People with IBS often have anxiety and/or depression which has been found to directly correlate with dysbiosis and decreased gut microbial diversity._[19] A study found that a galactooligosaccharide-containing prebiotic mixture benefited anxiety in irritable bowel syndrome (IBS) sufferers._[20] Daily treatment with the prebiotic galactooligosaccharide mixture for 4 weeks reduced anxiety scores and had a significant positive impact on quality of life.

Psychobiotics: Summary

Overall, the results of these studies show that psychobiotics have the potential to positively impact brain function, boost mood, treat depression and anxiety, and help you handle stress.

The best psychobiotics and the best dosages for those psychobiotics have yet to be determined, but a number of them used in the studies described above are commercially available in probiotic tablets. Generally, at least 10 billion CFU’s per day are recommended for most probiotics, including psychobiotics, but higher or lower amounts may also be beneficial. Just make sure to give your psychobiotic a try for at least a month before deciding whether it’s working or not.

Good luck, and may your gut-brain connection be healthy!

This article was originally published in 2016. It is regularly updated. 

[1] Biol Psychiatry. 2013 Nov 15;74(10):720-6.
[2] Gastroenterology. 2013 Jun;144(7):1394-401, 1401.e1-4.
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[4] Neurogastroenterol Motil. 2014 Apr;26(4):510-20.
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[9] Gut Pathog. 2009 Mar 19;1(1):6.
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[16] Psychoneuroendocrinology. 2013 Sep;38(9):1738-47.
[17] Am J Physiol Gastrointest Liver Physiol. 2014 Oct 15; 307(8): G793–G802.
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[19] Neuropsychiatr Dis Treat. 2015; 11: 715–723.
[20] Aliment Pharmacol Ther. 2009 Mar 1;29(5):508-18.

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What Is Serotonin?

Serotonin, the “happy neurotransmitter,” is a powerful brain chemical intricately linked with mental health and is one of the best supplements for depression. Sufficient serotonin in the brain allows you to feel calm and optimistic and provides a sense of well-being, while serotonin deficiency has the opposite effect. Low serotonin levels (or abnormal serotonin function) is the most recognized underlying cause of depression.

Studies show that serotonin imbalances may not only lead to classic depression symptoms like sadness and pessimism, but other symptoms such as food cravings, sleep disturbances, aggression, panic, obsessiveness, and more. (See also our post “What Does Serotonin Do?“)

Watch for Serotonin Deficiency in the Aging Brain

As the brain ages, deficiencies in neurotransmitters such as serotonin are more likely to occur. Low serotonin is not so much a specific risk factor for mild cognitive impairment and Alzheimer’s as it is a sign that overall brain health and function are compromised. Likewise, boosting serotonin production may not necessarily prevent mild cognitive impairment or Alzheimer’s. Instead, low serotonin and the symptoms it causes should be seen as red flags that brain health is suffering, which increases the risk for mild cognitive impairment and Alzheimer’s.

Serotonin deficiency symptoms include:

• Depression
• Pessimism
• Anxiety
• Insomnia
• Repetitive thoughts and obsessive thinking
• Low self-esteem
• Irritability
• Shyness, fears, phobias or panic attacks
• PMS
• Cravings for sugar or carbohydrates
• Seasonal Affective Disorder (depression that’s worse in the winter)
• Feeling better after taking SSRIs (selective serotonin reuptake inhibitor antidepressant medications)

Many of the dietary and lifestyle pitfalls that increase the risk of mild cognitive impairment and Alzheimer’s can also deplete serotonin levels. These include processed diets based on sweets and starchy foods, lack of exercise, and chronic stress. But, the upside to this equation is the same factors that lower the risk of mild cognitive impairment and Alzheimer’s can also improve serotonin activity.

The aim is to lower inflammation in the body and brain, as inflammation blocks serotonin production. In fact, research increasingly shows depression to be a symptom of inflammation. Therefore, although diminished serotonin activity may be seen in patients with mild cognitive impairment and Alzheimer’s, it is most likely just one of many symptoms of a diet- and lifestyle-induced inflammatory process that has sabotaged and degenerated the brain to the point of memory loss and dementia.

How to Increase Serotonin Levels with Serotonin Supplements

The good news is that a number of serotonin supplements have been shown to increase serotonin and effectively treat symptoms of serotonin deficiency. SAM-e, 5-HTP, and L-tryptophan St. John’s Wort have each been shown in multiple human studies to affect serotonin imbalances and to treat depression. Let’s take a brief look at how to use each of these serotonin boosters to improve mood, treat insomnia, and ease other low serotonin symptoms.

5-HTP.  Your body makes 5-hydroxy tryptophan, or 5-HTP, from tryptophan, and then converts it into serotonin. When taken as a supplement, 5-HTP is well-absorbed and crosses the blood-brain barrier where it gets converted to serotonin. 5-HTP is believed to offer stronger serotonin support than L-tryptophan (see below). Clinical trials have confirmed the efficacy of 5-HTP supplements for depression, sleep disorders, binge eating and panic disorders._[1-3]

L-Tryptophan. L-Tryptophan is an essential amino acid required by the body to synthesize serotonin. As discussed above, the conversion of L-tryptophan to serotonin is a two-step process in which 5-HTP is synthesized as an intermediate step. Taking L-tryptophan as a serotonin supplement enhances the synthesis of serotonin and increases serotonin levels within the body._[4] Nevertheless, integrative practitioners report success with the use of L-tryptophan for insomnia, mild depression, and for people who do not tolerate 5-HTP since, compared to 5-HTP, L-tryptophan is generally considered more gentle. It has even been found to help non-depressed, healthy people process emotions in a more positive way._[5]

SAM-e. S-adenosyl methionine (SAM-e—pronounced Sammy), produced from the amino acid methionine, is present in all the body’s cells and is required for hundreds of reactions, including the synthesis of serotonin. As a supplement, SAM-e has been used extensively for treating depression in Europe for over 30 years, and a review of SAM-e studies published in the American Journal of Clinical Nutrition concluded that SAM-e supplementation was a safe and effective treatment for depression._[6] Drs. Richard Brown, M.D., of Columbia University and George Papakostas, M.D., of Harvard Medical School both advocate the use of SAM-e for clinical depression._[7,8]

Saint John’s Wort. Extracts of the flowering St. John’s wort plant exert their antidepressant actions by inhibiting the reuptake of serotonin as well as norepinephrine and dopamine, making more of these neurotransmitters available to the brain. For people suffering from mild to moderate depression, studies show that St. John’s wort extracts are significantly more effective than placebo._[9] They have been found to be better tolerated but to work just as well as standard antidepressant drugs._[9]

Safety First

Though having too little serotonin is not good for you, too much serotonin can cause harm. Do not take more than one serotonin booster at a time. Natural serotonin pills or other natural supplements for depression may not be appropriate for all types of depression and may not be compatible with certain types of depression medication. If you are taking an anti-depressant, vitamins for depression, or other natural supplements for anxiety and depression, consultation with a healthcare practitioner is strongly advised. A healthcare professional can also provide insight about the best supplements for anxiety treatment, or the best supplements for depression.

Other Natural Supplements for Anxiety and Depression

Depression, anxiety, and other mood disorders have other possible underlying causes in addition to serotonin deficiency. For example, read Could Your Depression Be Caused by a Sleep Disorder? Depression Can Be One of the Many Surprising Sleep Apnea Symptoms.

Other vitamins that help with depression include the neurotransmitter dopamine. Dopamine is also involved in mental-emotional health, and specific dopamine supplements may also be indicated. Learning more about all the potential underlying causes of depression and anxiety can help you target your natural treatment protocol.

For related reading, visit these posts:

• Serotonin: Vital Brain Chemical Affects Both Mood and Cognition
• It’s Difficult to Define Serotonin—This “Brain Chemical” Has Multiple Actions All Over the Body
• Serotonin Deficiency: A New Target for Mild Cognitive Impairment and Alzheimer’s
• Serotonin Deficiency: Is This Really a Cause of Depression?

Originally published in 2013, this post is regularly updated.

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[2] Eat Weight Disord. 2012 Mar;17(1):e22-8.
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[4] Anal Bioanal Chem. 2012 Feb;402(4):1593-600.
[5] Psychopharmacology (Berl). 2006 Jul;187(1):121-30.
[6] Am J Clin Nutr. 2002 Nov;76(5):1158S-61S.
[7] 141st APHA Annual Meeting. Abstract 283939. To be presented Nov 6, 2013.
[8] Can J Psychiatry. 2012 Jul;57(7):406-13.
[9] J Clin Psychiatry. 2009;70 Suppl 5:23-7.

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