Can Depression Change Your DNA?

New research points to significant modifications of an important gene that suggests depression may play a role in changing the very makeup of the brain.

Researchers at the Robarts Research Institute at The University of Western Ontario compared the brains of people who committed suicide with those who died suddenly of natural causes, such as a heart attack. They found that the genome in suicidal, depressed people was chemically modified by a process that is normally involved in regulating the essential characteristics of all cells in the body.

The brain tissue was collected during autopsies and may eventually help explain an underlying cause of major depression and suicide.

This is apparently the first study to show that proteins that modify DNA directly are more highly expressed in the brains of people who commit suicide. These proteins are involved in chemically modifying DNA in a process called epigenomic regulation.

Michael O. Poulter, the lead researcher explains, “We have about 40,000 genes in every cell and the main reason a brain cell is a brain cell is because only a small fraction of the genes are turned on. The remaining genes that are not expressed are shut down by an epigenetic process called DNA methylation.”

The rate of methylation in the suicide brains was found to be much greater than that of the control group. Importantly, one of the genes they studied was shown to be heavily chemically modified and its expression was reduced. This particular gene plays a major role in regulating brain activity. “Interestingly, the nature of this chemical modification is long term and hard to reverse, and this fits with depression,” says Poulter.

“The whole idea that the genome is so malleable in the brain is surprising. Finding that epigenetic mechanisms continue to influence gene expression is pretty unusual,” says Poulter.

“These observations open an entirely new avenue of research and potential therapeutic interventions.”

The research was published in the journal Biological Psychiatry.

Source: The University of Western Ontario

Fda gives thumbs up to kiddie bipolar: is kol syndrome next?

Philip Dawdy at Furious Seasons noted that the FDA has officially approved the existence of child bipolar disorder. Prior to it being included in the DSM, and with considerable controversy in the professional community, the FDA jumps on board. Nice. Thanks to Philip for chasing down the FDA's official view.A few questions for consideration by the FDA (and others) that I mentioned a few months ago:1. Does child bipolar really exist in substantial quantity?2. Does treatment help kids with this "disorder"?3. Why would a leading "expert" in child "bipolar disorder" say that up to 75% of children who are "bipolar" become suicidal without citing any supporting evidence?Joe Biederman must be proud -- the FDA will now help him and his posse save countless lives through the administration of treatments (like, say, Seroquel) for "child bipolar" that lack any sort of substantive evidence base. But who cares -- even without professional consensus or any sort of official word from the FDA, the treatment of child bipolar has already flown the coop in a big way. Realistically, I suppose that the FDA's view is irrelevant -- drug marketers and key opinion leaders wield more influence than anyone at FDA when it comes to how physicians view psychiatric diagnoses. KOL Syndrome: On a related note, perhaps the FDA (or the DSM-V committee) can approve KOL Syndrome as a disorder. That would be Key Opinion Leader Syndrome. For case examples, please see here, here, here, here, here, and here. The prevalence of KOL Syndrome seems to be increasing and seems related to the widespread adoption of irrational prescribing as well as information laundering. Symptoms include: Providing false "education" to physicians as a service to your corporate clientsCalling one or more of one's own articles "commercial pieces of crap," then recanting Hiding blatant conflicts of interest Writing misleading review articles that falsely tout the efficacy of one or more drugs, Magically converting results that show a product is a dud into results showing that a product is safe and effectiveMaking a boatload of money through ties to various drug or medical device companies, then claiming that such corporate ties have absolutely no influence on your professional judgmentAs an author, calling a study's results positive, then calling these same results negative a few years later without noticing the contradiction. Giving tasty sound bites in press releases about the wonders of various medications in one's capacity as an "independent" scientist Back to kiddie bipolar: Do some adolescents have bipolar disorder? Sure. Five-year-olds? That's where I start getting suspicious...Also see an excellent post from John Grohol at Psych Central on youth bipolar and some of the logical problems regarding how its treatment is advocated. And Furious Seasons also notes that the FDA database raises questions about two of the drugs touted as safe and effective for kiddie bipolar. (Source: Clinical Psychology and Psychiatry: A Closer Look)

Come one, come all…..snack on my remains!

I feel like I’m being eaten alive lately. So, before, there’s nothing left but my asshole poontang body cavities, come on in and get a nibble, too!   I’m sick and tired of being a buffet for hungry losers and starving crazies.   I QUIT I QUIT I QUIT I QUIT I QUIT I QUIT and, all yeah…..I FRIGGIN’ QUIT! WTF has happened to me? When [...] (Source: bipolar chicks blogging)

1999- 2008: ocd: adhd: childhood bipolar disorder:tyrannical forces: fda: pediatric childhood bipolar disorder is valid

(Source: soulful sepulcher)

Treating Bipolar Disorder in Children

A letter to the editor in today’s The Boston Globe by Janet Wozniak suggests that since the U.S. Food and Drug Administration (FDA) approved the use of two atypical antipsychotic medications last year for pediatric bipolar disorder, it is proof the disorder exists:

The FDA approvals of Risperdal and Abilify for this purpose not only suggest that at the proper dose, these atypical antipsychotic medications are safe and effective for use as indicated, but affirm that the FDA accepts the validity of pediatric bipolar disorder and the need to treat it.

Tortured circular logic notwithstanding, the writer — the director of (surprise, surprise!) the pediatric bipolar disorder program at Mass. General — knows that the FDA is not any kind of scientific arbiter of research into diagnoses.

The FDA has for decades widely accepted that there may be childhood versions of adult disorders (and adult versions for childhood disorders, most famously attention deficit disorder). Nobody has denied that there may indeed by a childhood version of bipolar disorder, only that the criteria to meet such a disorder are not widely accepted nor official. And therefore, prescribing these medications, while FDA-allowed, doesn’t mean we automatically should. Especially since there have been zero long-term studies conducted on teens or children with these medications. Children and teens, as the writer knows, are more susceptible to anything that might negatively impact their still-developing brains. Can the writer say with 100% certainty that these drugs, when given to a teen, won’t cause some cognitive or memory issue 10 years from now? No, and neither can anyone else.

When patients suffer, and available treatments are lacking, it is the job of experts to innovate and explore new options for hope. The approval of these drugs in children has followed the conventional and widely accepted path that begins with observations in a limited number of patients followed by small but systematic observational studies that are then validated by large, controlled trials.

According to the FDA, however, the latter is not entirely true for Risperdal’s approval:

The efficacy of Risperdal in the treatment of manic or mixed episodes in children or adolescents with bipolar I disorder was demonstrated in a three-week, randomized, double-blind, placebo-controlled, multicenter trial in patients who were experiencing a manic or mixed episode. Treated patients generally had fewer symptoms, including a decrease in their elevated mood and hyperactivity, and other symptoms of their illness.

That study included just 169 teenage subjects (not the 400 alluded to in Janssen’s press release on the approval; the additional subjects come from other studies submitted as proof of its effectiveness but that the FDA did not consider). The other studies were all open-label studies, meaning everybody knew they were receiving an active medication.

So the reality is that it only takes a medium-sized trial of 169 subjects for all of 3 weeks to get additional approvals from the FDA for a drug. Hardly overwhelming evidence.

The letter was in response to Arnold S. Relman’s op-ed 2 weeks ago which was commenting upon the alleged inappropriate pharmaceutical payments made to 3 prominent psychiatrists at Mass. General (which just also happens to be Janet Wozniak’s institution… coincidence?).

The fact is, pediatric bipolar disorder is not officially recognized by the only diagnostic system in use in the U.S. today, and its inclusion in the next revision of the system is not at all clear. Just because the FDA approves a drug for it doesn’t change this fact.

Treating bipolar disorder in children

A letter to the editor in today’s The Boston Globe by Janet Wozniak suggests that since the U.S. Food and Drug Administration (FDA) approved the use of two atypical antipsychotic medications last year for pediatric bipolar disorder, it is proof the disorder exists: The FDA approvals of Risperdal and Abilify for this purpose not only suggest that at the proper dose, these atypical antipsychotic medications are safe and effective for use as indicated, but affirm that the FDA accepts the validity of pediatric bipolar disorder and the need to treat it. Tortured circular logic notwithstanding, the writer — the director of (surprise, surprise!) the pediatric bipolar disorder program at Mass. General — knows that the FDA is not any kind of scientific arbiter of research into diagnoses. The FDA has for decades widely accepted that there may be childhood versions of adult disorders (and adult versions for childhood disorders, most famously attention deficit disorder). Nobody has denied that there may indeed by a childhood version of bipolar disorder, only that the criteria to meet such a disorder are not widely accepted nor official. And therefore, prescribing these medications, while FDA-allowed, doesn’t mean we automatically should. Especially since there have been zero long-term studies conducted on teens or children with these medications. Children and teens, as the writer knows, are more susceptible to anything that might negatively impact their still-developing brains. Can the writer say with 100% certainty that these drugs, when given to a teen, won’t cause some cognitive or memory issue 10 years from now? No, and neither can anyone else. When patients suffer, and available treatments are lacking, it is the job of experts to innovate and explore new options for hope. The approval of these drugs in children has followed the conventional and widely accepted path that begins with observations in a limited number of patients followed by small but systematic observational studies that are then validated by large, controlled trials. According to the FDA, however, the latter is not entirely true for Risperdal’s approval: The efficacy of Risperdal in the treatment of manic or mixed episodes in children or adolescents with bipolar I disorder was demonstrated in a three-week, randomized, double-blind, placebo-controlled, multicenter trial in patients who were experiencing a manic or mixed episode. Treated patients generally had fewer symptoms, including a decrease in their elevated mood and hyperactivity, and other symptoms of their illness. That study included just 169 teenage subjects (not the 400 alluded to in Janssen’s press release on the approval; the additional subjects come from other studies submitted as proof of its effectiveness but that the FDA did not consider). The other studies were all open-label studies, meaning everybody knew they were receiving an active medication. So the reality is that it only takes a medium-sized trial of 169 subjects for all of 3 weeks to get additional approvals from the FDA for a drug. Hardly overwhelming evidence. The letter was in response to Arnold S. Relman’s op-ed 2 weeks ago which was commenting upon the alleged inappropriate pharmaceutical payments made to 3 prominent psychiatrists at Mass. General (which just also happens to be Janet Wozniak’s institution… coincidence?). The fact is, pediatric bipolar disorder is not officially recognized by the only diagnostic system in use in the U.S. today, and its inclusion in the next revision of the system is not at all clear. Just because the FDA approves a drug for it doesn’t change this fact. (Source: World of Psychology)

Happiness Wanes As Women Age

New research suggests the difficulty in achieving life goals cause women to end up unhappier than men later in life — even though they start out happier.

The study, authored by Anke Plagnol of the University of Cambridge, and Richard Easterlin of the University of Southern California is forthcoming in the Journal of Happiness Studies.

The investigation is the first to use nationally representative data spanning several decades to examine the role of unfulfilled desires in a person’s sense of well-being.

As the researchers explain, expectations of success may vary among those raised in different generations (i.e., an economic depression). Data sets from a range of time periods may also have different demographic compositions.

In their analysis, the researchers control for birth cohort and demographic characteristics such as race and education. They find that women are, on average, happier than men in early adulthood – but the glow wears off with time. Specifically, after the age of 48, men’s overall happiness exceeds women’s happiness.

These gender patterns of overall happiness correlate to patterns in two significant aspects of life satisfaction: family and finances.

As Plagnol explains: In later life it is “men [who] come closer to fulfilling their aspirations, are more satisfied with their family lives and financial situations, and are the happier of the two.”

Women and men have fairly similar life goals when it comes to love, the study reveals. Nine out of 10 people of both genders reach adult life wanting a happy marriage.

“Differences between men and women in aspirations for marriage and children are fairly small,” says Plagnol, who received her Ph.D. from USC in 2007. “Gender differences in satisfaction depend largely on attainment.”

The saddest period of the average man’s life – his 20s – is also the period when he is most likely to be single.

Young men are also more dissatisfied than young women with their financial situations, not because they are worse off, but because they want more and therefore experience a greater “shortfall,” the researchers explain.
But age alters many things, including men’s money woes and lackluster love lives.

After 34, men are more likely to be married than women, and the gap only widens with age, mirroring men’s growing satisfaction with family life.

Men also become more satisfied with their financial situations over time, as reflected in their increased spending power. The researchers found that men tend to covet big-ticket items that might not be within reach until later in life, such as a car or vacation home.(A notable exception: women want more “nice clothes” than men, the researchers found.)

These findings are consistent with an earlier study by Easterlin showing that recent generations are less satisfied than previous generations, despite having more.

“Of course, one doesn’t have to be married to be happy, but if that’s something you really want – and it is for most people – then the failure to attain it can have an impact on your overall happiness,” Plagnol says, adding that those in a relationship also tend to be in a stronger financial position than those who must depend solely on their own resources.

Some age milestones:

41: Age at which men’s financial satisfaction exceeds women’s financial satisfaction
48: Age at which men’s overall happiness exceeds women’s overall happiness
64: Age at which men’s satisfaction with family life exceeds women’s satisfaction

Source: University of Southern California

Fda says pediatric bipolar disorder is valid

Earlier today, I asked the FDA to respond to a statement made by Harvard child psychiatrist Janet Wozniak, wherein the doctor claimed that the FDA accepted the validity of the hotly-debated child bipolar disorder. That was news to me, since the diagnosis does not exist in the DSM and many child psychiatrists such as Jack McClellan and Larry Diller, both affiliated with major medical schools, even claim that the child bipolar diagnosis is not real. From FDA spokeswoman Sandy Walsh comes the following reply: "I just heard from Dr. Tom Laughren, head of psychiatry products. He said that Dr. Wozniak is correct. The FDA does accept the validity of pediatric bipolar disorder, as evidenced by our issuing Written Requests for pediatric studies for this disorder and approving both Risperdal and Abilify for use in pediatric bipolar disorder." I'll likely be talking with Laughgren in the next few days so he can explain how it is that a disorder that doesn't exist in the DSM and doesn't exist in the minds of experts in the field actually can exist in the minds of the FDA. Stay tuned. (Source: Furious Seasons)

Controversial harvard child psychiatrist claims fda affirms child bipolar disorder

There was a recent op-ed in the Boston Globe by an emeritus Harvard med school professor criticizing the many financial conflicts of the group of child psychiatrists headed by Joseph Biederman. Among other things, he pounded on the meds given to children for the alleged child bipolar disorder. Now, Janet Wozniak, a Harvard child psych doc and one of the Biederman clan, defends the use of meds in kids and makes an interesting claim about the FDA, in a letter to the paper that appears today. "The FDA approvals of Risperdal and Abilify for this purpose not only suggest that at the proper dose, these atypical antipsychotic medications are safe and effective for use as indicated, but affirm that the FDA accepts the validity of pediatric bipolar disorder and the need to treat it." The approvals she refers to are both within the last year or so. What's weird is her claim that the FDA accepts the validity of pediatric bipolar disorder since the alleged disorder does not appear in the DSM-IV and it seems a bit of a stretch to suggest that drug approvals mean that the FDA has validated a condition that is not accepted by the central diagnostic manual for psychiatry. I've queried the FDA to learn its view on this matter, but have not heard back yet. Wozniak also states the following: "When patients suffer, and available treatments are lacking, it is the job of experts to innovate and explore new options for hope....Families faced with the anguish and disruption of bipolar disorder need reassurance that steady progress is being made in understanding and treating this complex diagnosis." Last year, Wozniak described her fellow child bipolar disorder propagandists as working in "uncharted water." Now they are the harbingers of hope. I guess when you are at Harvard you get to break out all the heroic metaphors to describe yourself. (Source: Furious Seasons)

Can a Computer Replace a Therapist?

It’s an intriguing question, and one that entrepreneurs and researchers continually look at as progress is made with artificial intelligence and the increasing accessibility of the Internet — can an online computer program be used as effectively with a family doctor as with a psychologist?

The fact is, most people with a mental health disorder don’t usually seek out a mental health professional at first. Instead, they contact their family physician or general practitioner (GP). The problem is that while GPs are really good at narrowing down what a problem is likely to be and treating most common and non life-threatening medical concerns, they are not mental health experts. So their ability is somewhat limited when it comes to ongoing treatment of such a concern — they can prescribe an antidepressant and listen to your complaints for 5 or 10 minutes, but after that, you’re on your own.

Most GPs recognize this limitation and make the appropriate referral to a psychiatrist or psychologist or the like for followup.

But some researchers in Australia wondered whether a self-help computer program coupled with seeing a GP could compete with the same program being used with a psychologist. The participants in the study suffered from panic disorder (with many also suffering from agoraphobia).

Except that the researchers, for reasons unclear, stacked the deck at the onset of the study. They allowed the group of people seeing the GP to see the GP face-to-face over the course of the treatment. Instead of allowing the same for the psychologists, they limited contact to the psychologists by email only.

The other confound in this particular study was that the same psychologists that were used to treat patients were also used to assess the amount of panic in participants in both the psychologist-treatment group and the GP-treatment group. That’s a general no-no in research.

The results were not surprising:

In this study, Panic Online [the online treatment computer program] (whether supported by eTherapists or face-to-face GPs) led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity, agoraphobia avoidance, and quality of life. Improvements were maintained at follow-up[…]

I say “not surprising” because as usual with research that has no control group, you’re only showing what hundreds of other studies have shown — that any type of treatment is usually better than no treatment at all. The individual attention given to a person by another human being (and other nonspecific factors) have a huge therapeutic effect in and of themselves. If you had them sitting in front of a computer reading about panic disorder (or heck, reading a book about panic disorder), it may have provided for the same positive effects as long as the person also communicated with a GP or psychologist on a regular basis.

For both groups, only half the participants were panic-free at the end of treatment. Meaning that, as with many treatments available today, this treatment regimen is only somewhat effective. Half the people trying it will still have panic attacks at the end of treatment.

Significantly, more people dropped out of treatment in the GP group than in the virtual psychologist group. That suggests that even a virtual psychologist trumps a real life general practitioner, probably because the psychologist has far more extensive training in the cognitive behavioral techniques used and emphasized in this treatment program… And perhaps because the psychologist got into the field to help people with these kinds of problems, while that is not generally the case with most GPs.

What this study clearly illustrates is that yes, you could get away with people only seeing a GP and using some sort of online program as a supplement, but that you still won’t get comparable treatment outcomes than if you used that program with a trained mental health professional. The answer from this research suggest not in burdening GPs with additional treatment efforts when they are already strained for time and energy, but to instead encourage people to seek out alternative treatment modalities that best fit with their lifestyle (e.g., online therapy, for one).

Reference:

Shandley K, Austin DW, Klein B, Pier C, Schattner P, Pierce D, Wade V. (2008). Therapist-assisted, Internet-based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists?. J Med Internet Research, 19;10(2):e14.

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