Category Archives: Mental Health

Sensory Over-Responsivity and ADHD

Sensory Over-Responsivity and ADHD: Differentiating Using Electrodermal Responses, Cortisol, and Anxiety – Free full-text /PMC2885866/Mar 2010

This study describes a symptom of ADHD, sensory over-responsivity (SOR), that also seems prevalent with EDS: oversensitivity, both physical and emotional.

Deficits in sensory modulation have been linked clinically with impaired attention, arousal, and impulsivity for years, but a clear understanding of the relationship between sensory modulation disorders and attention deficit hyperactivity disorder (ADHD) has proven elusive.”

The phrase “deficit in sensory modulation” describes what I feel when I can’t tune out anything going on around me and get snagged on every feeling passing through me. It’s very hard to make my feelings “shut up and behave.”  Continue reading

Physical Activity and Brain Health – Part 1

Physical Activity and Brain Health – free full-text PMC6770965/ – Genes (Basel).  Sep 2019

Physical activity (PA) has been central in the life of our species for most of its history, and thus shaped our physiology during evolution. However, only recently the health consequences of a sedentary lifestyle, and of highly energetic diets, are becoming clear.

It has been also acknowledged that lifestyle and diet can induce epigenetic modifications which modify chromatin structure and gene expression, thus causing even heritable metabolic outcomes.

About 50 years ago, scientists first learned that genetics has another layer, epigenetics. It matters not just what your genes are, but also on whether they are turned on or off.  Continue reading

Augmentation Strategies for Treatment-Resistant Depression

An Evidence-Based Approach to Augmentation and Combination Strategies for Treatment-Resistant Depression – free full-text /PMC2958866/Psychiatry (Edgmont). 2006 Jul;

This long paper explores all kinds of other medications that can be used in addition to the usual antidepressants. I experimented with countless medications over several decades and now operate on a cocktail of antidepressants (SNRI’s and tricyclics), mood stabilizers, and supplementary hormones (estrogen, thyroid, neurosteroids).

I’m still depressed at least half the time, but the suicidal impulses have quieted since I got my anxiety under better control using pregnenolone (and Lyrica, which also has anti-anxiety properties).

This paper is a review article that collects and synthesizes up-to-date information about the practice of augmenting and combining medications in regards to treatment-resistant major depressive disorder.  Continue reading

Neurosteroids for Anxiety Disorders

Neuroactive Steroid Levels in Patients With Generalized Anxiety DisorderThe Journal of Neuropsychiatry and Clinical Neurosciences – 2001

Anxiety isn’t just a state of mind, it’ s physical state of the body too.

Several neurotransmittersystems have been suspected to play a role in the pathophysiology of GAD [generalized anxiety disorder].  Various lines of research suggest dysregulation of the gamma-aminobutyric acid (GABA A )/ benzodiazepine (BZ) receptor complex.

These findings include decreased numbers and sensitivities of BZ receptors in patients with GAD and successful pharmacologic treatment of GAD with agents that target the GABA A / BZ receptor (e.g., benzodiazepines).   Continue reading

Anxiety Disorders Linked to Mitochondria

Anxiety Disorders Linked to Disturbances in the Cells’ Powerhouses [Mitochondria]  19-Sep-2019 1 Newswise

The powerhouse of the cell, the mitochondria, provides energy for cellular functions. But those activities can become disturbed when chronic stress leads to anxiety symptoms in mice and humans. Iiris Hovatta of the University of Helsinki and colleagues report these findings in a new study published 26th September in PLOS Genetics.

Chronic stress due to stressful life events, such as divorce, unemployment, loss of a loved one and war, are a major risk factor for developing panic attacks and anxiety disorders. 

This is not only proven, but also intuitively true, as we know from our own lives, once beset by chronic pain.  Continue reading

Military Sees Frustrating Trend as Suicides Spike

Military Sees Frustrating Trend as Suicides SpikeBy Lolita C. Baldor – Sep 2019

Military suicides have surged to a record high among active duty troops, continuing a deadly trend that Pentagon officials say is frustrating and they are struggling to counter.

The difficulties involved in identifying service members with possible problems and finding ways to prevent suicides were underscored earlier this month when the Navy reported that three crew members who served on the USS George H.W. Bush took their own lives within a week.

The number of suicides across the military increased from 511 in 2017 to 541 in 2018.

“Our numbers are not moving in the right direction,” said Elizabeth Van Winkle, director of the Pentagon’s office of force resiliency. She said that most of the military rates are comparable to civilians, but added, “that’s hardly comforting.”

Military and defense leaders expressed dismay and a resolve to do more to increase resilience in the force, train service members how to handle stress better and encourage troops to seek help when they need it.

Van Winkle said the military is also looking at increasing efforts to train troops on the safe storage of firearms and medication.

…recognizing service members who may be struggling or at risk of taking their own lives is very difficult, and that sometimes suicide is a sudden, impulsive decision with little warning. They said it’s difficult to identify reasons for suicide because there are so many stresses that could contribute.

They also acknowledged that service members are reluctant to come forward and seek help, because they worry that it could affect promotions or security clearances

This year for the first time, the Pentagon included statistics for suicides by military spouses and dependents. Van Winkle said the most recent numbers available were for 2017, but officials are working to get better at collecting family data.

According to the report, there were 186 families that had suicides — 123 were spouses and 63 were dependents between the ages of 12 and 23.

Fear and Anxiety: A Two-System Framework

Using Neuroscience to Help Understand Fear and Anxiety: A Two-System Framework. – PubMed – NCBI – Am J Psychiatry. Nov 2016

This makes sense to me because my anxiety isn’t specific like fear is. When I’m anxious, whatever I’m thinking about makes my stomach clench with dread, but when I’m afraid, I fear a specific situation.

Tremendous progress has been made in basic neuroscience in recent decades. One area that has been especially successful is research on how the brain detects and responds to threats.

Such studies have demonstrated comparable patterns of brain-behavior relationships underlying threat processing across a range of mammalian species, including humans.

This would seem to be an ideal body of information for advancing our understanding of disorders in which altered threat processing is a key factor, namely, fear and anxiety disorders.

But research on threat processing has not led to significant improvements in clinical practice.

The authors propose that in order to take advantage of this progress for clinical gain, a conceptual reframing is needed.

Key to this conceptual change is recognition of a distinction between circuits underlying two classes of responses elicited by threats:

1) behavioral responses and accompanying physiological changes in the brain and body and

2) conscious feeling states reflected in self-reports of fear and anxiety.

This distinction leads to a “two systems” view of fear and anxiety.

The authors argue that failure to recognize and consistently emphasize this distinction has impeded progress in understanding fear and anxiety disorders and hindered attempts to develop more effective pharmaceutical and psychological treatments. The two-system view suggests a new way forward.

Circuitry for Fearful Feelings, Behavior Untangled in Anxiety Disorders PubMed – NCBI – Sep 2016 • Science Update

An “incorrect” assumption that fear and anxiety are mediated in the brain by a single “fear circuit” has stalled progress in developing better treatments for anxiety disorders, argue two leading experts. Designing future research based on a “two-system” framework holds promise for improving treatment outcomes, say Daniel Pine, M.D.

Neuroscience advances in understanding how the brain detects and responds to threat have failed to translate into significantly improved treatments because the field has been led astray by a simplistic notion of a “fear system,” contend Pine and LeDoux.

For example, hopes that medications that lessen rodents’ stress reactivity might help people feel less fearful or anxious often haven’t borne out.

It seems absurd to try modeling disorders that stem from human brain function, like anxiety, depression, or addiction, in rodents. Chronic pain cannot be modeled in animals if it really is a biopsychosocial disorder as many claim.

They can’t say “psychological and sociological factors greatly influence pain perception” and then cite pain studies that were done on animals.

Rather, the authors point to mounting evidence that such subjective feeling states are mediated via different circuitry than defensive behaviors. The former via higher order processing in the cortex – and the latter via the amygdala and related centers, mostly deeper in the brain.

Fear and anxiety describe conscious subjective feeling states; defensive reactions refer to rapidly-deployed behaviors or physiological responses.

Fear denotes feelings associated with an imminent threat, anxiety feelings associated with an uncertain or more distant source of harm.

For example, the amygdala, often colloquially dubbed the brain’s “fear center,” in fact unconsciously detects and responds to imminent threats and contributes to fear only indirectly.

States like fear and anxiety instead arise from areas of the cortex associated with higher order thinking processes and language in people, only some of which occur in other animals.

It’s hard to imagine a rat with anxiety about how they’re going to pay for retirement, or how they’re going to find affordable housing. Yet these are precisely the kinds of thoughts that can trigger my anxiety.

If feelings of fear or anxiety are not products of circuits that control defensive behavior, studies of defensive behavior in animals will be of limited value in finding medications that can relieve feelings of fear and anxiety in people,” observe the authors, who note that making such distinctions will help in the design of more realistic translational studies.

the experience of fear and anxiety is rooted in cortical changes in thinking, attention and memory, some “anxiolytic” effects might result from “general emotional blunting” or “impaired cognitive processing,” they add.

Improving treatments will require a more exact understanding of how treatments work. With this knowledge and the two-systems perspective, existing treatments might be adapted to work better. Brain imaging biomarkers might help tailor treatments to target circuit dysfunctions of specific patients.

The absurd trashing of antidepressants

Why the constant trashing of antidepressants is absurd – Vasco M Barreto | Aeon Essays

I was first prescribed antidepressants in 2000. Ever since, I have been on and off these drugs, mostly because the idea of taking them made me uncomfortable.

It was a mixture of guilt, probably not unlike the guilt some athletes must feel for taking a prohibited doping substance; shame for needing a pill that had such a profound impact on my behaviour; and frustration with the recurrent episodes of depression that would bring me back to the antidepressants I would then quickly abandon.

I broke this cycle when my daughters were born and I realised that it would be irresponsible to stop treatment because being a good father meant having a stable mood.   Continue reading

The Diagnosis and Treatment of Anxiety Disorders

The Diagnosis and Treatment of Anxiety Disorders – free full-text /PMC6206399/ Sep 2018 

Background

Anxiety disorders are the most common type of mental illness in Europe, with a 12-month prevalence of 14% among persons aged 14 to 65.

Their onset is usually in adolescence or early adulthood. The affected patients often develop further mental or somatic illnesses (sequential comorbidity).

Methods

This review is based on pertinent publications retrieved by a selective search in PubMed.   Continue reading

Neurosteroids: Endogenous Role in Human Brian

Neurosteroids: Endogenous Role in the Human Brian and Therapeutic Potentials – free full-text /PMC3139029/ – July 2011

This chapter provides an overview of neurosteroids, especially their impact on the brain, sex differences and therapeutic potentials.

Neurosteroids are synthesized within the brain and rapidly modulate neuronal excitability. Neurosteroids such as allopregnanolone are positive allosteric modulators of GABA-A receptors with powerful antiseizure activity in diverse animal models.

Neurosteroids increase both synaptic and tonic inhibition. They are endogenous regulators of seizure susceptibility, anxiety and stress.

This is exactly the kind of information I was looking for: a potential new treatment for the anxiety that has tormented me for decades.  Continue reading