HILARY SOJDAK, MSN, APRN, PMHNP
Hilary Sojdak is an Advanced Registered Nurse Practitioner, with American Nurse Credentialing Center (ANCC) board certification as a Psychiatric Mental Health Nurse Practitioner. She is a joint-owner of Psychiatric Associates of Southwest Florida with Robert Pollack, MD. She graduated with distinction in 2011 with her Master’s of Science in Nursing from the State University of New York Upstate Medical University in Syracuse New York. She began her career in psychiatric nursing as a registered nurse in 2001, and has been in practice as an ARNP since 2011; originally in New York State and transferring to Florida in 2015. Her memberships include American Psychiatric Nurses Association (APNA) and Omicron Alpha Sigma Theta Tau International Honor Society of Nursing: Region 11, Chapter #359. https://www.linkedin.com/in/hilary-sojdak-msn-aprn-pmhnp-822124a1
Position: Patient Account Liaison
Brenda Sluder is PASWFL’s clinic manager and provides excellent leadership and coordination of the practice’s administrative and financial/billing operations. She strives to maintain the highest level of client satisfaction and staff morale by serving as a liaison between the client and provider. She is usually the first point of contact with outside referral sources, insurance networks, and potential clients. She plays and integral and positive role in the client experience by making everyone feel welcome from the moment they first contact the office.
Brenda is originally from Minnesota and has been serving the psychiatric community of SWFL for the past 10 years. She was previously the Office Manager with Brenda L. Keefer, MD of Psychiatric Center of Florida until Dr. Keefer’s retirement in 2016.
Position: Practice Manager
Sonya is originally from Maine and has lived in the Fort Myers area with her family for 26 years. She has many years’ experience as a practice manager for small to medium size practices and had heavy involvement with organizational growth, accounting, physician outreach programs, customization of practice management and electronic health records software and served as internal IT person. As Practice Manager at PASWFL, Sonya is responsible for accounting, physician outreach, office management and is regularly involved in marketing strategy as well.
Shelley Butler, MSN, APRN, PMHNP-BC, NP-C
Shelley is double board certified in psychiatric/mental health and family practice with over 30 years in the medical profession. She received her Master of Science as a Family Nurse Practitioner from South University in Tampa, graduating with honors. She completed her Post Master’s Family Psychiatric-Mental Health Nurse Practitioner fellowship at Anderson University in South Carolina, graduating with high honors. She received her Bachelor of Science in Nursing at the University of South Florida in Tampa.
Shelley is a compassionate provider that practices by the Golden Rule, treating everyone as she would her own family. She provides a safe, trusting, caring environment where patients feel comfortable being themselves and sharing their experiences without judgement. She works collaboratively with patients and families in developing their treatment plans and providing them with the skills they need to build successful lives.
Her personal interests include spending time with her children, family and friends. Her hobbies include the beach, sports, traveling and local events.
Psychiatric Mental Health Nurse Practitioner, American Nurses Credentialing Center
Family Nurse Practitioner, American Academy of Nurse Practitioners
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Wearing a face mask: ● Cover your nose, mouth, and chin to make a tight seal aroundyour face with a face mask when in public and when aroundpeople who do not live in your household● Avoid touching the mask with your hands● Wash cloth masks after use, or dispose of used masks safelyHandwashing● Wash your hands frequently during the day for at least 20seconds (sing the “Happy Birthday” song twice)● If soap and water are not available, you may clean the entiresurface of your hands with hand sanitizer that contains at least60% alcohol● Avoid touching your eyes, nose, and mouthSocial distancing● Stay at least 6 feet (2 arms’ lengths) away fromother people in public in both indoor andoutdoor spaces. A mask must be worn inaddition to social distancing. Contact Your Healthcare Provider If: ● You develop a fever, cough, and/or shortness of breath, loss oftaste or smell● You have been exposed to someone who has tested positive forCOVID-19 Additional Suggestions: ● Remain active by walking or riding a bike for at least 30 to 60minutes a day. Avoid activities that require close contact orsharing equipment with others● Practice meditation to relieve stress● Get adequate sleep● Consult your family physician regarding […]
The Centers for Disease Control and Prevention (CDC) recently released a statement that face masks do in fact offer protection to the wearer in addition to helping prevent the transmission of COVID-19. Initially, it was thought that masks only prevented individuals from spreading the virus to others, but new research shows that exposure from infectious droplets is lowered through the filtration of masks. This filtration increases with face masks that have multiple layers of fabrics and higher thread counts, according to the CDC. The organization also encourages individuals to reduce the spread of the coronavirus by continuing to social distance and maintain proper hygiene like washing your hands. This news comes amid a surge in coronavirus cases across the United States, with the number of hospitalizations due to COVID-19 rising by almost 50% in the last two weeks. Now, restrictions are tightening again on businesses and public gatherings and new mask mandates are being issued in states like Iowa that did not have requirements around mask-wearing before. With demand growing for face masks yet again, now is an excellent time to stock up on new ones. Here is our expert advice on the best face masks you can buy right now based on our own testing and research. The best face masks you can buy right […]
As communities continue to navigate the impending flu season amid the ongoing COVID-19 pandemic, it is vital that patients take preventive measures to minimize their risk and limit exposure to SARS-CoV-2, often referred to as the novel coronavirus. Following proper precautions can decrease a person’s chances of being infected or spreading the deadly virus. With the U.S. surpassing the tragic milestone of 200,000 COVID-19 deaths, here are some coronavirus tips that physicians wish patients would follow to mitigate the spread. Wear a maskThere has been a turning point in the U.S., with many states mandating the wearing of masks to curb the spread of COVID-19. However, misinformation and mixed signals about masks continue to circulate. This has threatened to drown out the growing body of evidence that shows wearing masks can help fight SARS-CoV-2. Physicians want to clear up those misunderstandings to get everyone to #MaskUp.Learn more with the AMA about coronavirus masking in public. Watch your distancePhysical distancing “is the No.1 one way to prevent transmission,” said Hannah Kirking, MD, medical epidemiologist for the Division of Viral Diseases at the Centers for Disease Control and Prevention (CDC). “The person-to-person transmission is essentially when someone talks or speaks or coughs, they create little droplets, and that […]
Researchers at Yale and elsewhere previously identified a host of genetic risk factors that help explain why some veterans are especially susceptible to the debilitating symptoms of post-traumatic stress disorder (PTSD). A new Yale-led study published Sept. 30 in the journal Biological Psychiatry has now identified a social factor that can mitigate these genetic risks: the ability to form loving and trusting relationships with others. The study is one of the first to explore the role of nurture as well as nature in its investigation of the biological basis of PTSD. “We exist in a context. We are more than our genes,” said Yale’s Robert H. Pietrzak, associate professor of psychiatry and public health, and senior author of the study. Pietrzak is also director of the Translational Psychiatric Epidemiology Laboratory of the U.S. Department of Veterans Affairs National Center for PTSD. Like many genetic studies on mental disorders such as depression, anxiety, and schizophrenia, PTSD studies have revealed numerous genetic risk factors that contribute to the severity of the disorder. For instance, a previous study of more than 165,000 U.S. military veterans led by Yale’s Joel Gelernter, the Foundations Fund Professor of Psychiatry and professor of genetics and of neuroscience, found variants in eight separate […]
Dear Valued Patient, Thank you for choosing my practice and allowing me to be your healthcare professional. I look forward to being of service and helping you reach your greatest health potential. I wanted to let you k now about an exciting addition to my practice. My greatest goal as your physician is to provide you with healthy alternative choices that will enhance your health and well-being. I am pleased to present BioTE® Bio-Identical Hormone Pellet Therapy for womenand men. I decided BioTE® was the right choice for my patients because restoring and balancing ones hormones makes a significant difference in the quality of life BioTE® is safe and effective with no harmful side effects. If you have any of the following symptoms you may be a candidate for BioTE® hormone therapy. DepressionExtreme FatigueDifficulty SleepingLow LibidoMemory Loss,Mental Fog, ConfusionJoint Pain,Night Sweats & Hot Flashes If you’re looking for the following benefits you may want to consider BioTE® hormone therapy. Reduce Risk of Breast CancerReduce Risk of Heart Disease, Osteoporosis and Alzheimer’sIncrease EnergyIncrease Lean Muscle and Bone MassLose Belly Fat Are you a candidate for natural hormone balancing? Would you like to improve your life, health and sense of well-being? Would […]
In a recent article in the Wall Street Journal, it was noted that psychologists and psychiatrists are bracing for rising rates of Post-traumatic Stress Disorder (PTSD). PTSD is defined as a disorder that occurs after a person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. The symptoms range from intrusive thoughts, avoidance behaviors, negative changes in cognition and mood, and a state of hyperarousal and decrease function. Treatments have ranged from cognitive focus to the use of pharmacotherapy. We now have some new developments in the treatment that we will address below. PTSD has been with us for many years, and its treatment parallels the advances in medical science. When PTSD was treated in the mid-1970s, the primary focus was the use of group therapies and anti-depressant and anti-anxiety medications. Successes were minimal and the suffering was great. Fortunately, with better understanding of the neurobiology along with better science, we now have newer modalities that can help quiet the pain of PTSD symprtoms. In a recent conference, an fMRI (Functional MRI) was taken and demonstrated several areas of the brain involved in PTSD. These would be the Anterior Cingulate Gyrus and […]
The Food and Drug Administration wants updated boxed warnings on benzodiazepines to reflect the “serious” risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions associated with these medications. “The current prescribing information for benzodiazepines does not provide adequate warnings about these serious risks and harms associated with these medicines so they may be prescribed and used inappropriately,” the FDA said in a safety communication. The FDA also wants revisions to the patient medication guides for benzodiazepines to help educate patients and caregivers about these risks. “While benzodiazepines are important therapies for many Americans, they are also commonly abused and misused, often together with opioid pain relievers and other medicines, alcohol, and illicit drugs,” FDA Commissioner Stephen M. Hahn, MD, said in a statement. “We are taking measures and requiring new labeling information to help health care professionals and patients better understand that, while benzodiazepines have many treatment benefits, they also carry with them an increased risk of abuse, misuse, addiction, and dependence,” said Dr. Hahn. Ninety-two million prescriptions in 2019 Benzodiazepines are widely used to treat anxiety, insomnia, seizures, and other conditions, often for extended periods of time. According to the FDA, in 2019, an estimated 92 million benzodiazepine prescriptions were dispensed […]
Millions of individuals are impacted by hormone imbalance every day. From fatigue, and weight gain to severe mood changes, and low libido, many are left with feelings of discomfort, unaware of how they may help alleviate these common issues. Psychiatric Associates of Southwest Florida in Fort Myers, FL specializes in addressing these and other early indicators of aging through precision, personalized patient care plans that optimize hormones and extend patient healthspan. As a Certified BioTE® Provider, Psychiatric Associates of Southwest Florida is proud to offer BioTE Medical’s method of hormone therapy in their Fort Myers, FL office. With more than 1.7 million insertions performed, BioTE Medical’s method of bioidentical hormone replacement therapy (BHRT) may help men and women experiencing hormone imbalance. Contact Psychiatric Associates of Southwest Florida to schedule an evaluation and learn how restoring hormones to their optimal level may address specific health concerns. [See Us on BioTE]
The AMA recently launched the #MaskUp campaign to normalize mask wearing in the fight against COVID-19. “COVID-19 respects no geographic, demographic or ideological boundaries, and unfortunately it shows no signs of going away any time soon,” AMA President Susan R. Bailey, MD, said in a press release. “Make masks part of your daily wardrobe and regular routine. By wearing a cloth mask, practicing physical distancing, and regularly washing our hands, we can all prevent the spread of COVID-19.” The #MaskUp campaign aims to promote discussions on social media, address FAQs on masks, dispell myths on “common misconceptions and misinformation” about masks and provide ways that people stop the spread of the virus. Last month, the Council of Medical Specialty Societies called for a nationwide mask-wearing mandate. The American Hospital Association, American Nurses Association and Infectious Diseases Society of America have also urged Americans to wear masks. “Masks work. Masks save lives,” Bailey said. “Do your part. Mask up!” Currently, the CDC recommends all people older than 2 years except those with trouble breathing or who cannot remove a face covering without help, to wear a cloth face covering in public or when around non-household members.
BY LI COHEN JULY 16, 2020 / 5:31 PM / CBS NEWS By 2022, people experiencing a mental health crisis will be able to connect with someone who can help faster than ever. The Federal Communications Commission voted Thursday to designate 988 as the new nationwide emergency number that will connect callers 24/7 to the National Suicide Prevention Lifeline. [Read the Full Article Here]
In a 12-hospital health care system, universal masking was associated with lower rates of testing positive for SARS-CoV-2 in health care workers, according to a research letter published in JAMA. [Read the Original Post Here]
The Expert Starting Point For Your Mental Health™ We’ve learned that genetics plays a powerful role in your mental health. Genomind® Mental Health Map™ is a breakthrough innovation designed to help you understand your genetic predispositions so that you can take more informed action to improve your mental well-being. A Breakthrough Innovation in Mental Health and Wellness Genomind® Mental Health Map™ provides information about your genetic predispositions toward traits across 7 Core Genetic Mental Health Capabilities™ including: Stress and Anxiety, Mood, Focus and Memory, Habits and Substance Use, Sleep, Social Behavior, and Eating Behavior. The test involves collecting a sample with a simple cheek swab that you can take at home. From your sample 38 gene variants that impact your mental health and wellness are analyzed in our highly accredited CLIA, CAP and NYSDOH certified lab. You will receive your results within a few days. 7 In-Depth, Interactive Mental Health Reports Each report is based on one of the 7 Core Genetic Mental Health Capabilities™ Your reports will identify genetic predispositions you may have, detail the neuroscience driving your behavior, and provide actionable insights and resources from our highly experienced mental health experts. Everything you need to start forming better […]
Countries with early interest in face mask use had milder COVID-19 infection rates, according to a letter-to-the-editor published in the American Journal of Respiratory and Critical Care Medicine. Researchers with the Chinese University of Hong Kong reported findings from an analysis of how public interest in face masks, based on Google Trends relative search volume data, may have affected the severity of COVID-19 infection and potentially contained the outbreak in 42 countries around the world. “There is a clear dichotomous pattern, with regions having an early awareness and interest in face masks having milder outbreaks of COVID-19, and vice-versa,” Sunny H. Wong, MBChB, DPhil, FRCPE, FRCPath, FHKCP, FHKAM, associate professor in the department of medicine and therapeutics at the Chinese University of Hong Kong, and colleagues wrote. “Our results support that face masks can slow the spread of COVID-19.” To gauge public interest in face masks, Wong and colleagues retrieved Google Trends relative search volume data on the topic “surgical mask” and COVID-19 global incidence data from January 2020 to May 2020. Wong and colleagues observed a “divergent pattern” of Google Trends relative search volume values for “surgical mask” during the timeline of COVID-19, showing peak relative search volume values in some regions early in the COVID-19 […]
PTSD Awareness Month Each June, we mark PTSD Awareness Month. It is a time to bring together people and programs across the country to spread awareness about PTSD—what it is and how to treat it—to help improve the lives of trauma survivors. This year—during a global pandemic that has created significant challenges for so many people—PTSD Awareness Month comes at a time of increased public attention to how racism affects people of color. PTSD and Racial Minorities Racial minorities are more likely than whites to have PTSD. One explanation for these differences may be that racial minorities have more frequent exposure than whites to some types of traumatic events. For example, racial minorities are more likely to live in areas with higher rates of community violence. But higher risk of being exposed to a traumatic event only partially explains the racial differences in PTSD prevalence. Additional factors are involved, including those that could affect recovery, such as the ongoing stresses of poverty and limited access to mental health care. PTSD and Racial Discrimination Racial discrimination is associated with worse physical and mental health and poorer quality of life. Growing evidence also points to experiences with racial discrimination as a factor […]
PASWFL has offered telehealth services for years and we pride ourselves on running a modern and technologically advanced practice. When the COVID-19 pandemic broke out, demand for telehealth appointments sky-rocketed and we were relieved to have had some of the infrastructure already in place. Our Patients are Loving Virtual Mental Health Appointments It’s been a couple months since the pandemic first broke out in our area and we’re pleased to report that for the most part our patients are loving the new method of appointment. Some unexpected benefits of offering appointments virtually have emerged and it’s these benefits that make us confident that we’ll continue offering telehealth appointments even after the pandemic dies down. 10 Unexpected Benefits of Telepsychiatry Telehealth saves both the doctor and the patient time.Telehealth saves time and prevents stress from driving.Patients don’t have to leave the comfort of their own home. They can sit in a more comfortable environment which can have a positive impact on how comfortable they feel sharing/speaking with their treatment provider.Access to other family members for input on the appointment (if necessary) is easier to arrange.Services can be rendered in full: consultation, diagnosis, prescriptions etc.Technology allows for smooth appointments and the ability […]
The Pandemic Environment is taking a Toll on People’s Mental Health The outbreak of the novel Coronavirus (COVID-19) can cause feelings of uncertainty and anxiety for many people. Unfortunately, for those suffering from mental illnesses, these feelings might become intensified and in some cases crippling. This is why our PASWFL team remains committed to offering essential psychiatric care during this challenging time which includes in-office visits for Ketamine and TMS Therapy as well as safe and convenient telehealth appointments for those who aren’t able to leave home. Our Patients in Florida are appreciating the Benefits of Telehealth Appointments During a pandemic like COVID-19, telehealth allows us to better respond to the needs of patients in our community who aren’t able to leave home to receive the care they need. It helps bridge the gap between our physicians and patients by allowing patients to meet with providers from the comfort of their homes. Please know that your safety and health are a top priority for our team. PASWFL’s telehealth program is designed to provide the highest caliber of care for our patients via virtual appointments. And, as with our in-office services, PASWFL accepts most commercial insurance including Medicare and Tricare. Telehealth Services Offered: TelepsychiatryTelepsychotherapyOnline […]
Your Physical and Mental Safety is Our Top Priority at PASWFL Depression is a potentially life threatening illness and we are here to continue offering access to care. That being said, we believe it is important to care for our patients in the safest way possible so we have implemented precautions to make sure our practice is as safe as possible for our patients. Our office is still offering the TMS and Ketamine treatments by appointment.Therapy and medication assessment visits are still taking place either in the office or by telepsychiatry. We have expanded our waiting room so there is a minimum of 6 feet between each chair. If patients would rather wait in their cars for their visits that is fine and we will notify them by text. As a medical practice, we generally have high standards for cleanliness and sanitization. Still, during this pandemic we have implemented extra precautions to ensure surfaces, treatment rooms and implements are pristine. We feel that mental health is a vital need that requires treatment and we are doing the best we can to serve our patients. To inquire about our IV Ketamine infusions, our TMS treatment, our psychiatry appointments or our telepsychiatry services, please […]
What does being sick with COVID-19 look like compared with a cold or the flu? Check what types of symptoms show up for each illness and how often in the chart below. NOTE: If you have not been to a country or area with an outbreak of COVID-19 or have not had contact with someone who has, the Centers for Disease Control and Prevention says the risk of getting the disease is low.
Our world is plagued by an epidemic. By a disease that shows no mercy. The demons known as addiction and depression are very real. And they have claimed far too many of those we love, far soonerthan they should have left us. Those still with us are fighting a battle they wage every day oftheir lives keeping those demons at bay. It’s up to us to show them that they aren’t alone. That they have nothing to be ashamed of. That we understand and we will fight with them and for them. NATIONAL ADDICTION HOTLINE: 1-800-662-4357 NATIONAL SUICIDE PREVENTION LIFELINE: 1-800-273-8255 INTERNATIONAL HELP RESOURCES [Read the Original Publication Here]
For years, ADHD has been considered a disorder of kids and younger adults. Now, doctors are realizing older people have it too—and it’s sometimes mistaken for dementia. Many seniors get diagnosed with conditions like dementia or heart disease. Not Timothy McMichael. At the age of 60, he was diagnosed with a condition most often associated with school children: attention-deficit hyperactivity disorder. He started taking a low dose of a stimulant about a year-and-a-half ago and says his attentiveness and concentration at work have never been better. “I’ve been fairly successful in my life and career, and did not think of ADHD as an adult thing,” says Mr. McMichael, a 61-year-old Leonardtown, Md., resident and engineer for the Department of Defense. “But I had spent the last 40 years coming up with coping mechanisms.” Like many older people diagnosed with ADHD for the first time, Mr. McMichael didn’t consider the condition until his then-11-year-old son went through the diagnosis and treatment process about five years ago. He recognized many of the symptoms and struggles of his son and raised the issue with his son’s psychiatrist, David Goodman. Dr. Goodman, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University […]
Tanya Albert Henry – Contributing News Writer American Medical Association In a win for physicians and their patients, a federal court blocked a Trump Administration-backed conscience rights rule the AMA and other medical associations opposed in an amicus brief because the change would “radically disrupt medical care and endanger the health and lives of patients.” In a 147-page ruling, a judge in the U.S. District Court of the Southern District of New York vacated the entire Department of Health and Human Services’ (HHS) “Protecting Statutory Conscience Rights in Health Care” rule that was supposed to take effect Nov. 22. Judge Paul Engelmayer called the rule that would have expanded health care workers ability to refuse to provide care because of religious or moral reasons “arbitrary and capricious.” (The U.S. District Court for the Northern District of California Judge William Alsup also vacated the rule in a separate November ruling.) Engelmayer’s ruling in State of New York et al. v. Department of Health and Human Services said the department didn’t have rule-making authority to make the substantive changes it attempted to make and that the rule conflicted with other federal laws, including the Emergency Medical Treatment and Labor Act (EMTALA) and Title VII, which […]
In January of 2011 Dr. Bob Pollack opened his office at 6804 Porto Fino Circle, Suite 1 in Fort Myers Florida. He, along with Julie Kuhns, LCSW, began serving the people of Fort Myers. Dr. Pollack had a long career in Psychiatry with a multitude of accomplishments. His intent was to have a small, quiet practice and enjoy his relocation to the area. He was wrong. Beginning in 2011 he introduced the following advanced psychiatric services which have grown in popularity tremendously: • Genomic Testing• Transcranial Magnetic Stimulation• Ketamine Infusions• Theta Burst Stimulation• QEEG All of these innovations make use of more scientific knowledge and techniques to enhance the quality of the treatments that are offered to patients. With the addition of each new treatment, PASWFL has also had to make space for new equipment, new staff to operate the equipment and new patients who are interested in advanced psychiatric treatments. Since 2011 all of this has been conducted in the same 2000 square foot office space consisting of 4 offices and a waiting room. All of these treatments were administered in the office and all on an outpatient basis. Evidently, PASWFL has grown significantly since 2011 and as this […]
Let’s face it: we’re all stressed these days. In fact, recent polls show just how stressed out Americans are over things like politics, work, finances … the list goes on and on. It seems like we’ve adopted a new work culture where the 8-hour workday is a thing of the past. People are working 9 or 10-hour days, skipping vacation time, and slowly losing sight of priorities outside of work. With jam-packed schedules and 24/7 connection through technology, it’s easy to understand why Americans are so stressed. The problem is that chronic stress can affect your mental and physical health. So, how can you manage stress in today’s world where people wear stress like a badge of honor? Understanding Stress To start, it’s important to realize there are different types of stress in life. In many ways, stress can be a normal part of life. You might feel stressed about an upcoming deadline or major life event and that’s OK. Sometimes, this type of stress stems from excitement and anticipation and can even work as a motivator. However, chronic stress is the type of stress that lingers even after the event or deadline passes. You might feel anxious and overwhelmed […]
Ketamine, Similar Compounds Emerging as Mood Disorder Treatments Sanjay J. Mathew, MD, vice chair for research at Baylor College of Medicine and staff physician at the Michael E. Debakey VA Medical Center in Houston, Texas, has long been interested in the brain’s glutamate system and how it could be manipulated with substances such as ketamine to treat conditions including depression and suicidal ideation. At this year’s Psych Congress, Dr. Mathew, who is also director of Baylor’s mood and anxiety disorders program, will share the top 5 things that mental health clinicians should know about therapy with ketamine and the esketamine nasal spray newly approved by the US Food and Drug Administration (FDA). Below, he discusses his research into ketamine, how it works in the body, ongoing research into the compound, and similar agents that are in development. Q: How did you first become involved with research into glutamatergic agents such as ketamine? A: I‘ve been involved ever since my faculty position at Mount Sinai [School of Medicine], where we were interested in the glutamate system broadly for its potential impact in neuroplasticity and we were studying agents such as riluzole, which is approved in amyotrophic lateral sclerosis (ALS), and repurposing it for depression and generalized […]
Every day last week, approximately 122 people in the United States took their lives by suicide. This week, as we recognize World Suicide Prevention Day, it’s more important than ever to help spread awareness that can save lives. The tragedy of suicide is stealing loved ones-leaving behind family and friends to navigate the tragedy of loss, emptiness, and despair. Untreated mental illnesses are often the cause of suicide. Unfortunately, the stigma surrounding mental health leaves many feeling in the dark with nowhere to turn. This is why we need to do more as a society to help end the stigma and move forward in compassion and understanding. Because depression is more than just having a bad day and it’s not just something people can shake off. Depression can be debilitating. It can interfere with every aspect of your life…making it hard to function each day. In fact, depression is currently the leading cause of disability and poor health worldwide. And, with an estimated 1 in 6 Americans affected by the darkness of depression, it’s time to put the spotlight on treatments that help people get better. The darkness of depression is something that affects an estimated 1 in 6 Americans. […]
Handan Gunduz-Bruce, M.D., Christopher Silber, M.D., Inder Kaul, M.D., Anthony J. Rothschild, M.D., Robert Riesenberg, M.D., Abdul J. Sankoh, Ph.D., Haihong Li, Ph.D., Robert Lasser, M.D., Charles F. Zorumski, M.D., David R. Rubinow, M.D., Steven M. Paul, M.D., Jeffrey Jonas, M.D., et al. Abstract BACKGROUND Altered neurotransmission of γ-aminobutyric acid (GABA) has been implicated in the pathogenesis of depression. Whether SAGE-217, an oral, positive allosteric modulator of GABA type A receptors, is effective and safe for the treatment of major depressive disorder is unknown. METHODS In this double-blind, phase 2 trial, we enrolled patients with major depression and randomly assigned them in a 1:1 ratio to receive 30 mg of SAGE-217 or placebo once daily. The primary end point was the change from baseline to day 15 in the score on the 17-item Hamilton Depression Rating Scale (HAM-D; scores range from 0 to 52, with higher scores indicating more severe depression). Secondary efficacy end points, which were assessed on days 2 through 8 and on days 15, 21, 28, 35, and 42, included changes from baseline in scores on additional depression and anxiety scales, a reduction from baseline of more than 50% in the HAM-D score, a HAM-D score of 7 or lower, and a Clinical Global Impression of Improvement score of […]
Major depressive disorder (MDD) is commonly observed in medical settings, with a prevalence of up to 14% compared with 2% to 4% in the general population.1 Various studies have found rates of 12% to 18% in patients with diabetes, 15% to 23% in those with coronary heart disease, 23% to 54% in patients with multiple sclerosis (MS), and 18% to 85% in patients with chronic pain.1,2 Some findings suggest that depression may result from the pathophysiology of medical illness (such as inflammatory cytokines involved in chronic pain) or from medications such as corticosteroids. In many cases, the link between MDD and medical illness appears to be bidirectional, as with diabetes. Studies have demonstrated that the relative risk of developing diabetes is 2.23 among patients with MDD, and the risk of developing MDD is twice as high among patients with vs without diabetes.3,4 Related Articles Telemedicine Interventions May Improve Comorbid Pain, Mood SymptomsGreater Subjective Well-Being Associated With Longer, Healthier LivesCAM Therapies Evaluated for the Treatment of Clinical Depression A similar relationship has been observed between MS and depression.5 It is known that “MS causes depression and depression worsens MS, and depression is one of the various risk factors that must align in order to develop MS,” Adam Kaplin, MD, PhD, […]
The Washington Post (8/5, Wan, Bever) reports that according to research, mental illness is not to blame for America’s mass shootings. In a 2018 report of active shooters, the FBI “found that 25 percent of active shooters had been diagnosed with a mental illness. And of those diagnosed, only three shooters had been diagnosed with a psychotic disorder.” Similarly, “in a 2015 study that examined 235 people who committed or tried to commit mass killings, only 22 percent could be considered” as having a mental illness. In addition, “a 2004 report conducted by the Secret Service and the Education Department found that only 12 percent of perpetrators in more than three dozen school shootings showed an interest in violent video games.” The AP (8/5, Johnson) reports experts say that “Trump’s focus on ‘mentally ill monsters’ oversimplifies the role of mental illness in public mass shootings and downplays the ease with which Americans can get firearms, experts said.” Mental health experts “repeated what they have said after previous mass shootings: Most people with mental illness are not violent, they are far more likely to be victims of violent crime than perpetrators, and access to firearms is a big part of the problem.” The AP adds […]
Frequent use of sleep medications appears to be associated with increased long-term risk of dementia, particularly among older white adults, according to research presented at the Alzheimer’s Association International Conference in Los Angeles this week. “Based on our findings, we recommend that clinicians make more effort to be aware of their patients’ sleep problems including use of sleep aids,” said lead study author Yue Leng, Ph.D., of the University of California, San Francisco, in a press release. Leng and colleagues studied 3,068 black and white community-dwelling older adults aged 70 to 79 years who did not have dementia and were enrolled in the Health, Aging, and Body Composition study. At the beginning of the study, the participants were asked to rate their use of “sleeping pills or other medication” to help them sleep using the following responses: “never,” “rarely (once a month or less),” “sometimes (2 to 4 times per month),” “often (5 to 15 times per month),” or “almost always (16 to 30 times per month).” A total of 147 (4.8%) participants reported taking sleep medications “sometimes,” and 172 (5.6%) reported “often” or “almost always.” A total of 34 black participants (2.7%) and 138 white participants (7.7%) reported taking sleep […]
Anxiety is a common comorbidity among drug-naive individuals with first-episode major depressive disorder, according to cross-sectional study data published in the Journal of Affective Disorders. Patients were recruited from the psychiatric department of a general hospital in Taiyuan, China. Drug-naive individuals receiving outpatient care and reporting first-episode major depressive disorder were eligible for inclusion. Demographic and clinical data, including past suicide attempt and psychotic symptoms, were assessed during the study visit. The Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were used to grade depressive and anxiety symptoms, respectively. Regression analyses were performed to identify predictors of comorbid anxiety in this population. A total of 1718 patients were recruited, among whom 1130 (65.8%) were women. The mean age of participants was 34.87±12.43 years. Patients reported a mean depressive episode duration of 6.31±4.73 months, with a range of 5 to 28 months. Anxiety symptoms were observed in 80.3% of the general sample, with 67.6% and 12.7% of the total cohort experiencing mild to moderate and moderate to severe symptoms, respectively. Compared with patients without anxiety, patients with anxiety were more likely to report prior suicide attempt (24.3% vs 3.3%) and psychotic symptoms (12.3% vs 0.3%; both P <.001). Patients with anxiety also had higher […]
A study published this week in Depression & Anxiety suggests that among patients with cancer who are prescribed antidepressants, those who take the medication may live longer than those who are non-adherent. Patients with cancer are known to have higher rates of depression than the general public—a factor that may reduce adherence to cancer treatment and increase their risk of death. The findings “add to the pressing need to encourage adherence to [antidepressants] among cancer patients,” wrote Gal Shoval, M.D., of the Geha Mental Health Center in Tel Aviv, Israel, and colleagues. To examine the relationship between antidepressant adherence and mortality in people with cancer, Shoval and colleagues analyzed the medical records of patients with cancer who had at least one prescription for an antidepressant between January 2008 and January 2012. Patients were followed from the time of initial antidepressant prescription until death or the end of the four-year study. Patients were categorized into one of four adherence groups: Nonadherent if adherence was below 20%, poor adherence for those with 20% to 50% adherence, moderate adherence for those with 50% to 80% adherence, and good adherence for those with adherence above 80%. Of the 42,075 patients included in the analysis, 28.9% were nonadherent, […]
Baby boomers match seniors in the use of benzodiazepines, while misuse is most common in those aged 18 to 25. Over 30 million U.S. adults took benzodiazepines in the past year, including 5.3 million who misused the medication, according to a study posted December 17, 2018, in Psychiatric Services in Advance. The findings, which were based on an analysis of data collected as part of a national survey in 2015 and 2016, suggest that annual benzodiazepine use among U.S. adults may be more than double estimates based on data collected in 2013 and 2014. The findings also point to those most likely to take the medication without a prescription or in greater amounts or over longer periods of time than prescribed. In the study, researchers analyzed data about adults age 18 and older who participated in the National Survey on Drug Use and Health (NSDUH) in 2015 and 2016. The data were extrapolated for the U.S. population. The annual NSDUH asks participants about substance use, mental health, and more. Overall, 30.6 million adults, or 12.6 percent, used benzodiazepines in the previous year. Other studies such as the 2013-2014 National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey suggested […]
Treatment-resistant depression can be a frustrating challenge for doctor and patient alike. The trial-and-error process of trying different medications and treatments to see what alleviates patients’ depression symptoms can feel like a “shot in the dark” approach. According to Ann McDonald, former editor of the Harvard Mental Health Letter, in her blog post on the Harvard Health Blog, only about a third of patients who are diagnosed with major depressive disorder (MDD) find a medication that works for them on the first try. “When the first medication doesn’t adequately relieve symptoms, next step options include taking a new drug along with the first, or switching to another drug. With time and persistence, nearly seven in 10 adults with major depression eventually find a treatment that works. Of course, that also means that the remaining one-third of people with major depression cannot achieve remission even after trying multiple options.” The Mayo Clinic says: “If you’ve already tried an antidepressant and it didn’t work, don’t lose hope. You and your doctor simply may not have found the right dose, medication or combination of medications that works for you.” One way to find out this information is through pharmacogenomic testing, which analyzes your genes and tells your doctor what might […]
INTRODUCTION Fibromyalgia is a chronic pain disorder that is often difficult to treat. Effective interventions include a number of nonpharmacologic and pharmacologic therapies that are often provided in combination. Patients with fibromyalgia generally respond best to a multidisciplinary, individualized treatment program that incorporates the primary treating clinician and other healthcare providers, including physical medicine, rehabilitation, and mental health specialists . The treatment of fibromyalgia in adults who are not responsive to initial therapies will be reviewed here. The initial treatment and prognosis of fibromyalgia in adults; the pathogenesis, clinical manifestations, diagnosis, and differential diagnosis of fibromyalgia; and fibromyalgia in children and adolescents are discussed separately. (See “Initial treatment of fibromyalgia in adults” and “Pathogenesis of fibromyalgia” and “Clinical manifestations and diagnosis of fibromyalgia in adults” and “Differential diagnosis of fibromyalgia” and “Fibromyalgia in children and adolescents: Clinical manifestations and diagnosis”.) OVERVIEW OF TREATMENTTreatment of fibromyalgia is directed at reducing the major symptoms of this disorder, including chronic widespread pain, fatigue, insomnia, and cognitive dysfunction [2-4]. A variety of modalities are employed, using a stepwise approach (table 1). (See “Clinical manifestations and diagnosis of fibromyalgia in adults”.) Initial therapy — Our initial approach to the treatment of patients with fibromyalgia is discussed in detail separately. (See “Initial treatment of fibromyalgia in adults”.) [Read the […]
Post Traumatic Stress Disorder is a psychiatric disorder that is a direct consequence of experiencing trauma. Experiencing war, working in emergency response areas, sexual, emotional or physical abuse, a threat of death, even childhood neglect can cause changes in the brain. Also, if the traumatic event did not happen to you directly and you were a witness, you can experience PTSD. Traumatic events can make changes to the brain. In time post-trauma can change how the person interacts with themselves and others. In post trauma, one’s ability to be present becomes altered for themselves or others. Some people have a heightened sense of alertness or hyper-vigilance; other symptoms include intrusive memories, irritability/anger, or poor impulse control. PTSD and depression are linked. Often alcohol, drugs or food can offer temporary relief from intrusive thoughts or numb heightened emotions associated with PTSD. At Psychiatric Associates of Southwest Florida, we are treating PTSD from a multidiscipline approach. When food becomes the go-to source for self-soothing, to calm the heightened emotions, it does two things. First, most foods that have the right amount of sugar, fat, and salt (known in the food industry as the “bliss point”) serve to fuel the brain into a false […]
The use of higher-than-recommended doses of zolpidem was commonly seen in women not previously treated with the drug, according to results from a study published in the Journal of Clinical Psychiatry. Researchers conducted a retrospective cohort study of 139,525 people who had never been treated with zolpidem and were prescribed the drug from January 1, 2013, to June 3, 2014. Cohort data were obtained from a national pharmacy health administration database used by the Veterans Health Administration. High-dose zolpidem use was defined as more than 5 mg per day for women or 10 mg per day for men. The dosing definition was based on a safety warning released by the US Food and Drug Administration in 2013. After statistical analysis, the researchers found that 0.4% of men (n=122,659) and 41.1% of women (n=16,866) were prescribed high-dose zolpidem therapy. In addition, they reported that substance abuse or dependence was associated with high-dose therapy in women (odds ratio, 1.20; P <.001). Related Articles FDA to Review Lemborexant NDA for Treatment of InsomniaInsomnia in Late Pregnancy Associated With Perinatal AnxietyCan Acupuncture Improve Sleep for Veterans With Traumatic Brain Injury and PTSD? “The high prevalence of high-dose use in women is due in part to the change […]
Heart attack, conceptual computer illustration. Mild depression was a long-term independent predictor of death in patients after acute myocardial infarction (AMI), per cohort study data published in Heart, Lung and Circulation. Investigators conducted a 25-year follow-up of men who were recruited after AMI to participate in a randomized controlled trial in the 1980s. The initial trial investigated the impact of high intensity exercise on physical and psychological health; depression was assessed at baseline using the Beck Depression Inventory. Sociodemographic information, cardiovascular risk factors, and severity of AMI were also captured at baseline. During the 25-year follow-up period, investigators used the Australian National Death Index to determine mortality status of patients after their index AMI. Cox proportional-hazards modeling was used to assess the relationship between depression severity and all-cause mortality at 5, 10, 15, 20, and 25 years post-AMI. Related Articles Pharmacotherapy May Reduce Depressive Symptoms After Traumatic Brain InjuryDepression Associated With Polygenic Risk for Major Depression, Bipolar Disorder, and SchizophreniaPostnatal Paternal Depression Associated With Depression in Girls The final analysis cohort comprised 185 men, mean age 54.15 (8.54). Per the Beck Depression Inventory, 114 patients (60.4%) had low to no depression, 47 (25.2%) had mild depression, and 27 (14.3%) had moderate to severe […]
With well over two dozen traditional antidepressants available in the US, and an ever-growing list of other psychotropic compounds with apparent antidepressant properties, pharmacological options for treating clinical depression today are broad and vast. However, recent findings suggest that the magnitude of efficacy for most antidepressants compared with placebo may be more modest than previously thought.1Most depressed patients do not respond fully to a first antidepressant trial, and with each consequent trial, there is less chance of symptom remission.2 About one-third of patients receiving long-term treatment report persistent moderate-to-severe depression.3 Hence, there remains more than a little room for improvement. Since the late 1950s, the traditional view of treating depression has focused on the role of monoamines (serotonin, norepinephrine, and dopamine) as the main targets for medications. Newer treatments are looking beyond effects on monoamines as potential strategies to leverage depressive symptoms. A major challenge for progress in novel pharmacotherapies has been our lack of a full understanding about the causes of depression. Advances in functional neuroimaging and genetic markers have begun to shed new light on brain regions and pathways associated with aberrant neural functioning in depression, but not in ways that have led to treatments aimed at remedying its pathogenesis. […]
Abstract Depression is a common chronic psychiatric disorder that is also often co-morbid with numerous neurological and immune diseases. Accumulating evidence indicates that disturbances of neuroplasticity occur with depression, including reductions of hippocampal neurogenesis and cortical synaptogenesis. Improper trophic support stemming from stressor-induced reductions of growth factors, most notably brain derived neurotrophic factor (BDNF), likely drives such aberrant neuroplasticity. We posit that psychological and immune stressors can interact upon a vulnerable genetic background to promote depression by disturbing BDNF and neuroplastic processes. Furthermore, the chronic and commonly relapsing nature of depression is suggested to stem from “faulty wiring” of emotional circuits driven by neuroplastic aberrations. The present review considers depression in such terms and attempts to integrate the available evidence indicating that the efficacy of current and “next wave” antidepressant treatments, whether used alone or in combination, is at least partially tied to their ability to modulate neuroplasticity. We particularly focus on the N-methyl-D-aspartate (NMDA) antagonist, ketamine, which already has well documented rapid antidepressant effects, and the trophic cytokine, erythropoietin (EPO), which we propose as a potential adjunctive antidepressant agent. [Read the Full Article Here]
By Alan Mozes HealthDay Reporter THURSDAY, Dec. 27, 2018 (HealthDay News) — Teens who are often bullied may be left with shrinkage in key parts of their brain, increasing their risk for mental illness, European researchers report. They said such shrinkage eventually appears to create a growing sense of anxiety, even after taking into account the possible onset of other mental health concerns, such as stress and/or depression. “We don’t know how early in life these brain changes begin,” said study author Erin Burke Quinlan. “But the earlier bullying is identified, and the sooner it can be dealt with, the better.” Her team analyzed brain scans of nearly 700 14- to 19-year-olds in England, Ireland, France and Germany. The teens were part of a long-term project called IMAGEN that is studying adolescent brain development and mental health. “We found that the relationship between chronic peer victimization — an umbrella term that includes bullying — relates to the development of anxiety partly via changes in the volume of brain structures,” Quinlan said. She’s an IMAGEN project coordinator at the Center for Population Neuroscience and Precision Medicine at King’s College London. Researchers aren’t sure if the bullied teens’ brain shrinkage is permanent […]
For 50 years, pharmacological treatment approaches in MDD have focused on targeting monoamine receptors in the hopes of reducing symptoms. While conventional therapies have helped many, the STAR*D trial* revealed that as many as a third of patients may not achieve remission despite treatment with traditional antidepressants.¹,² Dr Rakesh Jain, clinical professor of psychiatry at Texas Tech University School of Medicine, discusses the estimated 5 million patients who aren’t reaching remission despite multiple treatment attempts in a video available on ConnectingMDD.com. THE LIKELIHOOD OF REMISSION DROPS TO 14% AFTER A SECOND TREATMENT FAILURE* In the STAR*D trial, 37% of patients reached remission after the first-line treatment step with an oral antidepressant.1 The chances for remission dropped substantially after 2 treatment attempts, even with augmentation strategies.1 WITHOUT REMISSION, THE BURDEN OF MDD GROWS REFERENCES Rush AJ, et al. Am J Psychiatry. 2006;163:1905-1917. The National Institute of Mental Health. Major depression among adults. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Updated November 2017. Accessed April 6, 2018. Uher R, et al. Depress Anxiety. 2014;(31):459-471. Feldman RL, et al. J Med Econ. 2013;16(1):62-74.
Key Points Question What are the trends across adulterated dietary supplements associated with a warning released by the US Food and Drug Administration from 2007 through 2016? Findings In this quality improvement study, analysis of the US Food and Drug Administration warnings from 2007 through 2016 showed that unapproved pharmaceutical ingredients were identified in 776 dietary supplements, and these products were commonly marketed for sexual enhancement, weight loss, or muscle building. The most common adulterants were sildenafil for sexual enhancement supplements, sibutramine for weight loss supplements, and synthetic steroids or steroid-like ingredients for muscle building supplements, with 157 products (20.2%) containing more than 1 unapproved ingredient. Meaning Potentially harmful active pharmaceuticals continue to be identified in over-the-counter dietary supplements. Abstract Importance Over half of adults in the United States report consuming dietary supplements. The US Food and Drug Administration (FDA) has warned of numerous dietary supplements containing undeclared, unapproved pharmaceutical ingredients. These FDA warnings have not been comprehensively analyzed for recent years. Objective To summarize trends across adulterated (containing unapproved ingredients) dietary supplements associated with a warning released by the FDA from 2007 through 2016. Design, Setting, and Participants In this quality improvement study, data were extracted from the FDA’s Center for Drug Evaluation and Research, […]
On April 25th 2018 the American Psychiatric Association published the following criticism of genomic testing emphasizing their skepticism towards psychiatrists who are using genetic testing to make informed decisions about diagnosis and treatment. An abstract of their statement reads: Evidence Does Not Support Commercial Rush Of DNA Tests Designed To Inform Decisions Regarding Patients’ Psychiatric Medications, Review Indicates. STAT (9/28, Robbins) reported that “several dozen companies” are now “probing patients’ DNA in search of insights to help inform decisions about what psychiatry medications patients should take,” and are even “touting applications for depression, bipolar disorder, attention deficit hyperactivity disorder, and post-traumatic stress disorder.” Now, “some top psychiatrists say the evidence doesn’t support the commercial rush.” In fact, in a review published online April 25 in the American Journal of Psychiatry, “a task force of the American Psychiatric Association’s research council concluded that such genetic testing is not ready for prime time in their field.” The members of the task force wrote, “Although some of the preliminary published data sound promising…there is insufficient evidence to support widespread use of combinatorial pharmacogenetic decision support tools at this point in time.” To read their full statement please visit this link. […]
WHY AREN’T SOME PATIENTS WITH MDD REACHING REMISSION? For more than 50 years, major depressive disorder (MDD) pharmacological treatment approaches have focused on increasing the level of monoamine neurotransmitters in the brain, with the hope of reducing symptoms.1 And while conventional antidepressants have helped most, the STAR*D trial* found that one-third of patients didn’t achieve remission after multiple treatment attempts.2 What’s missing? BEYOND NEUROTRANSMITTERS: SYNAPTIC CONNECTIONS One emerging theory suggests that MDD may be linked to impaired synaptic connections in areas of the brain that regulate mood.3,4 The hypothesis points to an intriguing possibility: If synaptic connections are disrupted in MDD, can this synaptic impairment be improved?5 SYNAPTIC CONNECTIVITY: THE GLUTAMATE HYPOTHESIS Scientists are honing in on the role of glutamate, a major excitatory neurotransmitter that helps regulate synaptic connectivity.6 A burst of glutamate may initiate pathways that are believed to be involved in the strengthening and formation of new synaptic connections.5 As research advances, a deeper understanding of MDD is within reach. Watch THIS video or visit Janssen Pharmaceuticals Inc. to learn more.
Impaired Synaptic Connections Research increasingly links impaired synaptic connections with MDD.1 Synaptic connections are constantly remodeled, created, and lost as a result of new experiences, emotions, learning, and memory.1 However, this synaptic plasticity may be impaired in patients with MDD.2 In a study published in Nature Medicine, researchers found a significantly lower number of synapses in key regions of post-mortem brains from patients who suffered from MDD compared to healthy subjects3 Preclinical studies show that chronic stress not only causes dendritic spines to atrophy and contract, but also reduces the number of synapses2,4 The impairment appears to be centered in the prefrontal cortex and hippocampus, which are areas of the brain involved in regulating mood and information processing5 Other brain regions that are affected include the amygdala, nucleus accumbens, and orbitofrontal cortex4 Structural and Functional Brain Changes are Associated with MDD The findings on synaptic impairment add to the evidence that MDD is associated with structural and functional abnormalities in the brain, as previously seen by neuroimaging studies. Again, the most consistent alterations are observed in the prefrontal cortex and hippocampus, where reduced gray matter volume is associated with more severe depression. Impaired synaptic plasticity within these and other brain regions may reduce the number […]
Glutamate neurotransmission is an active area of research in major depressive disorder (MDD).1 Much of this interest revolves around glutamate’s role in regulating synaptic connectivity, one of several pathways that may strengthen and initiate the formation of new synaptic connections.1 As research advances, a deeper understanding of MDD is within reach. Watch our video featuring Dr Samuel Wilkinson, Assistant Director at the Yale Depression Research Program, discussing the hypothesized roles of synaptic connections and glutamate signaling in MDD. Discovered as a neurotransmitter after serotonin and other monoamines, glutamate neurotransmission is an active area of research in MDD.1 Much of this interest revolves around glutamate’s role in regulating synaptic connectivity, one of several pathways that may strengthen and initiate the formation of new synaptic connections.1 HOW GLUTAMATE SIGNALING WORKS As part of a complex balancing act, glutamate signaling is tightly controlled by either inhibitory or excitatory proteins2 Once a burst of glutamate is released, the signal activates post-synaptic receptors3 These receptors then trigger downstream pathways that influence dendritic spine density, synaptic formation, and synaptic connectivity4 Glutamate signaling is one of several pathways that are being studied in MDD5 BDNF: Brain-derived neurotrophic factor Ca2+: Calcium ions TrkB: Tropomyosin-related kinase B Dendritic spines: Principal sites of synapses in […]
Significance Identifying biological targets in major depressive disorder (MDD) is a critical step for development of effective mechanism-based medications. The epigenetic agent acetyl-L-carnitine (LAC) has rapid and enduring antidepressant-like effects in LAC-deficient rodents. Here, we found that LAC levels were decreased in patients with MDD versus age- and sex-matched healthy controls in two independent study centers. In subsequent exploratory analyses, the degree of LAC deficiency reflected both the severity and age of onset of MDD. Furthermore, the lowest LAC levels were found in patients with treatment-resistant depression, whereby history of emotional neglect and being female predicted decreased LAC levels. These translational findings suggest that LAC may serve as a candidate biomarker to help the diagnosis of a clinical endophenotype of MDD. Abstract The lack of biomarkers to identify target populations greatly limits the promise of precision medicine for major depressive disorder (MDD), a primary cause of ill health and disability. The endogenously produced molecule acetyl-L-carnitine (LAC) is critical for hippocampal function and several behavioral domains. In rodents with depressive-like traits, LAC levels are markedly decreased and signal abnormal hippocampal glutamatergic function and dendritic plasticity. LAC supplementation induces rapid and lasting antidepressant-like effects via epigenetic mechanisms of histone acetylation. This mechanistic […]
June 12, 2018 Key Points Question How frequently do US adults use prescription medications with depression as a potential adverse effect and is use of these medications associated with concurrent depression? Findings In this cross-sectional US population-based survey study conducted between 2005 and 2014, the estimated overall prevalence of US adults using medications with depression as a potential adverse effect was 37.2%. The adjusted percentage of adults with concurrent depression was higher among those using more concurrent medications (eg, estimated 15% for ≥3 medications). Meaning Use of prescription medications that have depression as a potential adverse effect was common and associated with greater likelihood of concurrent depression. Abstract Importance Prescription medications are increasingly used among adults in the United States and many have a potential for causing depression. Objectives To characterize use of prescription medications with depression as a potential adverse effect and to assess associations between their use and concurrent depression. Design, Setting, and Participants Five 2-year cycles (2005-2006 through 2013-2014) of the National Health and Nutrition Examination Survey, representative cross-sectional surveys of US adults aged 18 years or older, were analyzed for use of medications with depression as a potential adverse effect. Multivariable logistic regression examined associations between use of these medications and concurrent depression. Analyses […]
The CBS Evening News (6/7, story 3, 3:05, Glor) reported, “The CDC put out an alarming report today on suicide. Nearly 45,000 Americans took their lives in 2016. That is more than car accidents or opioid overdoses.” On ABC World News Tonight (6/7, story 7, 1:40, Muir), ABC News correspondent Gio Benitez said that “the CDC is reporting that suicide rates have increased by 25 percent over two decades.” NBC Nightly News (6/7, story 9, 0:30, Holt) reported that the CDC’s report “shows a dramatic rise in suicide rise in half the states across the US more than 30 percent from 1999 to 2016.” The New York Times (6/7, Carey, Subscription Publication) reports suicide rates increased in all states but Nevada between 1999 and 2016, according to a report from the Centers for Disease Control and Prevention. The report “found that slightly more than half of people who had” died by suicide “did not have any known mental health condition.” The Washington Post (6/7, Nutt) reports that Anne Schuchat, MD, the CDC’s principal deputy director, said, “The data are disturbing. The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.” Joshua Gordon, MD, PhD, the director of the National […]
Healing Then and Now With Music Therapeutic uses of music date back to antiquity. Healing shrines in Ancient Greece housed both hymn specialists and physicians. Native American tribes chanted, danced, and played drums to heal illness. And early Christian priests used hymns to ease pain in the sick. Today, scientific studies confirm what the ancients seemed to know inherently: that music can be medicinal. The Ancient Greeks: Musical Wisdom Hippocrates advocated a “healthy mind in a healthy body,” which included mental health care and art therapy. Music and drama were used to treat illness and improve behavior in his time. The notion was that healing the soul through music would also heal the body, with specific applications. The sounds of the flute and harp, for instance, were a treatment for gout. What Is Music Therapy? A Contemporary Definition Today, music therapy aims to influence both emotion and physiology. Music therapy is an established allied healthcare profession that entails a therapeutic relationship between a patient and a board-certified music therapist. Treatment techniques are designed to achieve functional changes in mood, brain, and behavior. Imaging Studies: The Brain Dances to Music Music modifies brainwaves, a phenomenon that can be seen through functional […]
Question: How do effects of genetics and rearing each contribute to the transmission of risk for major depression from parents to children? Findings: In this population register–based study of 2 269 552 offspring of intact, adoptive, not-lived-with father, stepfather, and triparental families from the general Swedish population, the effects of genes and rearing were approximately equal for parent-offspring resemblance for major depression. Genetic and rearing effects acted additively on offspring risk for major depression. Meaning: Genetic and rearing effects are important in the cross-generational transmission of major depression. Importance Twin studies have assessed sibling resemblance for major depression (MD) but cannot address sources of resemblance across generations. Objective To clarify the relative importance of genetic and rearing effects on the parent-offspring resemblance for MD. Design This Swedish population register–based study examined parents and children from the following 5 family types: intact (2 041 816 offspring), adoptive (14 104 offspring), not-lived-with (NLW) father (116 601 offspring), stepfather (67 826 offspring), and triparental (29 205 offspring). The 5 family types permitted quantification of parent-offspring resemblance for genes plus rearing, genes-only, and rearing-only associations. Treated MD was assessed from national primary care, specialist care, and inpatient registries. Data were collected from January 1, 1960, through […]
John Foster, like many who have served our country, has dealt with the lasting effects of war, especially post-traumatic stress disorder (PTSD). The 38-year-old says a genetic test, ordered by his doctor, helped guide his treatment plan and allowed him to get better, faster. The Orlando, Florida, resident was a combat medic and served two tours of duty in Iraq. He says the first tour, in 2004 and 2005, left him with no problems…or so he thought. It was during the second tour, in 2006 and 2007, when his issues developed. This is when the Army extended tours as a part of the troop surge. During John’s deployment, 11 members of his unit were killed in the deadliest year of the war on terror. Foster’s PTSD has required both inpatient and outpatient treatment. Through the years, he’s dealt with the frustration of discovering that many psychiatric drugs don’t work for him: at one point taking as many as 13 different medications a day. “My doctor, Dr. Robert Pollack, was able to adjust my meds and recommend supplements to more effectively help me deal with the situation…the Genecept Assay® was key for me to help unlock the personal information that I needed […]
Published Thursday 26 October 2017 By Tim Newman Fact checked by Jasmin Collier According to a recent study, although treating major depressive disorder has benefits in the short-term, over a longer period of time, it may make the condition worse. Major depressive disorder is a serious, debilitating mental illness. In the United States, it affects more than 16.1 million people over the age of 18. Although its prevalence is high, it is still a difficult condition to treat. Treatments include medications such as selective serotonin re-uptake inhibitors and talking therapies, such as cognitive therapy. No case of depression is the same, and often, individuals receive a range of treatments across their lifetime. How well the treatment of depression works has come under scrutiny over recent years, and the debate is by no means over. The latest study, published in the journal Psychotherapy and Psychosomatics, adds another dimension to this ongoing conversation. Clinical Treatment Compared with Community Individuals with major depressive disorder who receive medication or cognitive therapy often see a reduction in their depressive symptoms and experience significantly longer times before relapse. But over the longer-term, the picture is less clear. This is primarily because studies generally only run for […]
Patrice Wendling August 03, 2017 MURRAY, UT — Depression and coronary artery disease are known to walk hand in hand, but a new study suggests that depression any time after a diagnosis of CAD is the strongest predictor of death. Among 24,137 patients identified with significant CAD, a new depression diagnosis was associated with a twofold higher risk of all-cause death after multivariable adjustment, the investigators reported in the European Heart Journal Quality of Care and Clinical Outcomes. “It was stronger than any follow-up events, stronger than diabetes, stronger than smoking, sex, prior diagnosis of high blood pressure or depression, and even whether they had a heart attack,” lead author Dr Heidi T May (Intermountain Heart Institute, Murray, UT) told theheart.org | Medscape Cardiology. “I thought it would be a significant predictor, but I didn’t anticipate it would be the strongest. “I would think most people would find that amazing.” She said the results emphasize the need for continual depression screening among all CAD patients, but an accompanying editorial notes that recommendations by the American Heart Association (AHA) for routine screening in patients with heart disease have been met with some opposition, in large part because of a lack of studies showing a survival benefit with depression treatment. “Given the […]
PASWFL’s New Treatments for Depression Showcased on ABC TV Show PASWFL was featured on Out and About Southwest Florida. We had a chance to film and take photos of our beautiful facility as well as discuss the different treatment options we’re proud to offer people in Southwest Florida and surrounding communities. Check out the video tour of our office below: And more images of our comfortable treatment rooms:
When should you, the prescriber, conclude that your patient with depression is “treatment resistant,” and thereby eligible for alternative non-pharmacological interventions—such as vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS)? There are multiple ways that the failure to agree on a standardized definition of treatment-resistant depression (TRD) impacts the clinical care of patients who do not respond to multiple medication trials. In an article appearing in the January 2017 issue of JAMA Psychiatry, Charles Conway, M.D., Mark George, M.D., and Harold Sackheim, Ph.D., wrote that the lack of a consensus definition around what constitutes TRD “limits the ability to do comparative treatment research, to understand the biological underpinnings of TRD, and produces ambiguous medical insurance coverage issues.” Drawing on data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, they proposed a definition for TRD: failure to respond to two trials of an antidepressant prescribed at an adequate dose for an adequate duration of time. Conway, a professor of psychiatry and director of the Treatment Resistant Depression and Neurostimulation Clinic at Washington University, St. Louis, said that in the absence of a consensus definition of TRD, patients often receive multiple trials of medication. “Our experience has been that […]
Ketamine makes #7 on Dr. Axe’s Top 10 Medical Innovations to Watch Out for in 2017 list! “7. Ketamine for Treatment-Resistant Depression More than 15 millions Americans over the age of 18 suffer from depression — that’s 6.7 percent of the adult population. (8) And while there are some natural remedies and prescription medications available, for nearly one-third of depressed patients, they don’t work. Unfortunately, for about 43,000 people, the answer becomes suicide. The medical world believes there is new hope in ketamine for these extreme, treatment-resistant cases. For the last few years, the animal tranquilizer and sometimes-party drug has been studied and trialled as a treatment for major depression when other options have been exhausted, and the results are promising. Of course, I am an advocate for natural depression treatment and improving mood and brain structure through food and exercise, but in some cases, even that fails to work. Numerous studies have found that ketamine is extremely effective in treating major depression, sometimes as quickly as in 24 hours after just one dose. (9) Serial ketamine infusions seem to be even more effective at treating the mental disease. (10) It works by targeting and inhibiting NMDA receptors in nerve cells. Thanks to […]
A fascinating article in The Atlantic that tells the story of a neuroscientist on a mission to change how the brain and immune system handle stress. Her work shows tremendous promise for the use of ketamine in treating PTSD and stress-related mental illness. [Read the Article Here]
An interesting article on the wide range of symptoms used to diagnose depression: “the standard rating scales used by healthcare professionals and researchers to diagnose this disease often differ in the symptoms they list, perhaps explaining why a one-size-fits-all treatment has to date been so ineffective.” [Read Full Article Here]
When you’re depressed, literally and figuratively stuck in a dark place, with no desire to get out and experience the world, it feels like time is inching by. Seconds feel like minutes, minutes feel like hours, and hours feel like days. Apparently, though, it’s not just a feeling. It’s a very real perception of time. New research from psychologists at the Johannes Gutenberg University of Mainz in Germany shows that depressed people actually experience time differently than healthy individuals. The scientists analyzed the results of 16 different studies examining 433 depressed subjects and 485 non-depressed control subjects. For the first part of the study, subjects were surveyed on their perception of time. “Psychiatrists and psychologists in hospitals and private practices repeatedly report that depressed patients feel that time only creeps forward slowly or is passing in slow motion,” reported study author Dr. Daniel Oberfeld-Twistel. The results of the meta-analysis confirmed that this is indeed the case. Then, for the second part of the study, they asked the subjects to subjectively estimate the length of a movie in minutes, press a button for five seconds, or identify the length of different sounds. In this case, the results obtained from the depressed […]
Learn about how this former NFL football player tackled his depression when traditional drug treatments failed