MENTAL HEALTH
Novel MRI technique improves the lasting effects of treatment for severe depression
A major clinical trial has shown that by using MRI and tracking to guide the delivery of magnetic stimulation to the brains of people with severe depression, patients will see their symptoms ease for at least six months, which could vastly improve their quality of life.
The results of the trial, published in Nature Medicine, found that on average, participants showed substantial improvements in the severity of their depression, anxiety and thinking with better function and quality of life over 26 weeks with MRI neuronavigated Transcranial Magnetic Simulation (TMS). This was a substantial increase on the previous reported improvements lasting only 1-3 months.
The BRIGhTMIND randomised controlled trial was led by experts at the University of Nottingham, hosted by Nottinghamshire Healthcare NHS Foundation Trust, and was funded by a National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership. It involved five centres across England (Nottingham, Camden and Islington, Newcastle, Northampton and Oldham).
Transcranial Magnetic Simulation (TMS)
TMS is an outpatient treatment where people have powerful magnetic pulses delivered to the left side of their head just in front of the temporal area of the scalp. The person is conscious and has 20 sessions over a four-to-six-week period. The method has been used since the 1980s to treat people with severe depression, but by targeting the precise area of the brain where stimulation is thought to be helpful, we now have evidence for a more longer lasting benefit of this treatment.
Major depression is the leading cause of disability lost years worldwide (WHO, 2017), and suicide from depression is the biggest killer in people aged between 15-49. Antidepressants and therapy delivered as first or second-line treatments help two thirds of people with depression, but the remaining third have treatment resistant depression (TRD). This is defined as a lack of response to two courses of antidepressants.
The aim of the trial was to look at whether the effects of using TMS could be extended to at least six months, which would mean that patients with TRD who respond to the treatment might only require one to two courses of treatment each year to remain relatively well and free from symptoms of depression.
Neuronavigation
The trial, which is the first of its size in the world to look at outcomes at six months, suggest this might be achieved using functional MRI with TMS to define the exact area of the brain to hit. MRI is not normally used to deliver this treatment.
The team used neuronavigation, a computerised tracking system using light to deliver the TMS, which is a way of precisely pinpointing the area of stimulation so that the same area is targeted at all 20 treatment sessions.
Richard Morriss, Professor of Psychiatry in the School of Medicine and Lead for the Centre for Mood Disorders at the Institute of Mental Health at the University of Nottingham, said: “Ideally when people come for a TMS session, they would sit in the exact same place, but this is rarely going to happen. This method uses light from both ear lobes and the top of the nose to measure the stimulation point from the first time a patient has the treatment. The MRI personalises the site of stimulation and then neuronavigation makes sure the same site is being stimulated at each treatment session. This reduces the variability in stimulation at each session. Since the magnetic pulse can be focused, there are usually only minor short-lasting side-effects, and the person can return to their daily activities immediately on return from the hospital.”
A total of 255 participants took part in the trial, all completing 20 TMS sessions. Patients already in specialist mental health services were recruited, and both Primary Care trusts and GPs were approached, with all participants having to be referred by their GP to take part.
Substantial improvement in quality of life
Over two thirds of participants responded to the treatment, with a third showing 50% improvement in terms of their symptoms and a fifth managing to move into remission and stay there.
“Given these patients are people who have not responded to two previous treatment attempts and have been ill for an average of 7 years, to get such a significant response rate and a fifth who have a sustained response is really encouraging,” said Professor Morriss.
He adds: “Patients who responded to the treatment could stay relatively well compared to how they were previously, with as little as one or two treatments a year. The changes we saw were substantial, not only in reducing their depression symptoms, but they were large enough to improve concentration, memory, anxiety and subsequently their quality of life. The results have already persuaded three NHS Mental Health Trusts, including Nottinghamshire Healthcare NHS Foundation Trust, to routinely offer new TMS services for treatment resistant depression.”
One of the participants of the trial said: “It has been a privilege to work alongside the research and clinical teams and feel that you are making an important contribution to such a groundbreaking study from a patient perspective. The next challenge is to make transcranial magnetic stimulation a standard and universally available treatment option for difficult to treat depression."
Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “Once again, high quality research funded by NIHR and MRC is making a step change in improving health and care services. It’s brilliant to see three UK mental health trusts are now routinely offering TMS to patients following robust evidence from this study.
“These are important findings showing this novel technique can hugely benefit patients with severe depression which has not responded to other treatments."
JOURNAL
Nature Medicine
METHOD OF RESEARCH
Randomized controlled/clinical trial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial
ARTICLE PUBLICATION DATE
16-Jan-2024
For people with migraine, feelings of stigma may impact disability, quality of life
Study finds that nearly one-third of people with migraine experienced related stigma
Peer-Reviewed PublicationMINNEAPOLIS – Migraine can impact many aspects of a person’s life, but less is known about how feelings of stigma about the disease affect quality of life. For people with migraine, these feelings of stigma were linked to more disability, increased disease burden and reduced quality of life, according to new research published in the January 17, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“Stigma is common where the disease is not readily apparent to others, and there is indication that it could be especially relevant for those living with migraine,” said study author Robert Evan Shapiro, MD, PhD, of the University of Vermont and Fellow of the American Academy of Neurology. “This stigma may arise when a person with migraine recognizes negative stereotypes about the disease and experiences shame for having the disease, fear of experiencing stigma from others, or other negative emotions.”
For the study, researchers looked at 59,001 people with migraine with an average age of 41. Among all participants, 41% reported experiencing four or more headache days per month on average.
Participants answered 12 questions to assess two types of stigma: whether they felt others viewed migraine being used for secondary gain and whether they felt others were minimizing the burden of migraine. Questions included “How often have you felt that others viewed your migraine as a way to get attention?” “… as something that made things difficult for your co-workers or supervisor?” and “…with a lack of understanding of the pain and other symptoms?”
Researchers found that 32% of the participants experienced migraine-related stigma often or very often.
To assess migraine-related disability, participants reported the number of days they missed or had reduced productivity at work, home or social events over the previous three months. High scores on migraine-related stigma were linked with moderate to severe disability. Three-quarters of those who experienced stigma often or very often had moderate to severe disability, compared to 19% of those who never experienced stigma.
They also took a test assessing migraine-specific quality of life, which looked at the impact of migraine on social and work-related activities over the previous four weeks. Scores ranged from zero to 100 with higher scores meaning higher quality of life. Researchers found that those who experienced the highest rates of migraine-related stigma scored far lower in these tests, with an average score of 35 compared to those who did not experience stigma with an average score of 69.
The results remained the same after researchers adjusted for other factors that could affect disability and quality of life, such as age, employment status, other medical conditions and frequency of migraines.
They also found that the amount of stigma experienced increased with migraine severity. Those with 8-14 headache days or more than 15 monthly headache days were far more likely to report at least one form of stigma with 42% and 48%, respectively, compared to those with less than four monthly headache days with 26%.
“The social context of migraine may have a greater impact on quality of life than the number of monthly headache days,” said Shapiro. “However, it is possible that connecting with others with migraine may help decrease migraine-related stigma and stereotypes. More studies are needed to explore the mechanisms that link stigma to health outcomes.”
A limitation of the study was that participants self-reported their migraines, based on a questionnaire or a diagnosis from a health care provider, and they may not have remembered all the information accurately.
The study was funded by Eli Lilly & Company, the maker of medications to treat migraine. Dr. Shapiro serves as a consultant for Eli Lilly.
Learn more about migraine at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, X, and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, X, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
Therapy versus medication: comparing treatments for depression in heart disease
Cedars-Sinai study shows behavioral activation therapy as effective as antidepressant medications for treatment of depression in heart failure patients
New research by investigators from the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai shows that behavioral activation therapy is as effective as antidepressant medications in treating symptoms of depression in patients with heart failure.
Heart failure affects nearly 6 million adults in the United States, and approximately 50% of heart failure patients experience symptoms of depression along with their condition. Past studies show patients with heart failure and depression have lower cardiac function, more emergency department visits and hospital admissions, higher caregiver burden, and poorer quality of life compared with patients with heart failure who are not depressed.
“The most important finding here is that patients experiencing depression have a choice in terms of their treatment between therapy or medications,” said Waguih W. IsHak, MD, vice chair of Education and Research in the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai and first author of the study. “Patients who prefer not to be on medication can do behavioral activation therapy with similar results.”
The study, which was published in the peer-reviewed journal JAMA Network Open, followed more than 400 patients over the course of a year. Half of the study participants received antidepressant medication management to treat depression symptoms while the other half participated in behavioral activation psychotherapy, an evidence-based treatment for depression that promotes engagement in activities a patient finds enjoyable.
Investigators say there was no statistically significant difference between the effectiveness of the two methods, with each patient group experiencing a more than 50% reduction in the severity of depressive symptoms.
Study participants randomized to receive behavioral activation therapy worked with a therapist to develop a personalized list of activities that bring them joy and fulfillment, including having lunch with a friend, taking a walk, volunteering, listening to their favorite music—among other options—on a regularly scheduled basis. The treatment focused on increasing the level of enjoyable and rewarding activities the patient was doing every week for 12 weeks, and then incorporating them into their regular activity schedule.
Patients who received psychotherapy intervention showed a slight improvement in their physical and mental health-related quality of life, a secondary outcome monitored by the study. They also had fewer emergency department visits and spent fewer days hospitalized during the course of the study compared with the patients who were randomized to receive antidepressant medications.
“This study, which was conducted in a real-world setting, demonstrates that it is entirely feasible to incorporate psychiatric treatment into specialty medical care. Integrating psychiatric treatment into medical care is an effective way to reduce stigma, increase access and improve outcomes for people who struggle with mental health problems alongside their chronic medical conditions,” said Itai Danovitch, MD, MBA, chair of the Department of Psychiatry and Behavioral Neurosciences and a study co-author. “Most people who suffer from depression do not receive effective treatment. It is critical that we increase screening for psychiatric conditions and ensure that patients have access to high-quality and effective mental health care.”
Other Cedars-Sinai authors involved in the study are Michele A. Hamilton, MD; Samuel Korouri, BA; Marcio A. Diniz, PhD; James Mirocha, MS; Rebecca Hedrick, MD; Robert Chernoff, PhD; Jeanne T. Black, PhD; Harriet Aronow, PhD; Brigitte Vanle, MD, PhD; Jonathan Dang, MD; Gabriel Edwards, MD; Tarneem Darwish, MD; Gabrielle Messineo, LCSW; Stacy Collier, RN; Mia Pasini, RN; John G. Harold, MD; and Brennan Spiegel, MD, MSHS. Additional authors include Kaleab K. Tessema, MD, PhD; Michael K. Ong, MD; and Kenneth Wells, MD.
Funding: The study by was funded by the Patient-Centered Outcome Research Institute (PCORI) (award No.: 2017C2-7716; paid to Cedars-Sinai Medical Center).
JOURNAL
JAMA Network Open
ARTICLE TITLE
Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure
ARTICLE PUBLICATION DATE
17-Jan-2024
Comparative effectiveness of psychotherapy vs antidepressants for depression in heart failure
JAMA Network Open
Peer-Reviewed PublicationAbout The Study: In this comparative effectiveness trial of behavioral activation psychotherapy (BA) and antidepressant medication management (MEDS) in 416 patients with heart failure experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical health-related quality of life, fewer emergency department visits, and fewer days hospitalized. The study findings suggest that patients with heart failure could be given the choice between BA or MEDS to ameliorate depression.
Authors: Waguih William IsHak, M.D., of Cedars-Sinai Medical Center in Los Angeles, is the corresponding author.
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(doi:10.1001/jamanetworkopen.2023.52094)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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JOURNAL
JAMA Network Open
Study reveals key factors in surgeons' opioid prescribing patterns
Social determinants and access to mental health services are significant factors that can impact prescription rates
Key takeaways
- Decreasing trend in opioid prescriptions: There was a notable nationwide reduction in opioid prescriptions after surgery from 2013 to 2017, reflecting a shift in the medical community's approach to pain management.
- Social determinants affect opioid prescription rates: At the county level, lower median population age, higher education levels, insufficient sleep, higher health care costs, fewer mental health providers, and higher uninsured rates are linked to higher opioid prescription rates.
- No direct correlation with opioid-related deaths: The study found no direct geographic correlation between opioid prescriptions by surgeons and opioid-related deaths, suggesting other factors might contribute more significantly to the opioid epidemic.
CHICAGO (January 16, 2024): Researchers revealed new insights into the patterns and predictors of opioid prescribing after surgery in a comprehensive county-level study across the United States. The research results, which offer a detailed look at how various social and healthcare factors influence opioid prescribing, are published in the Journal of the American College of Surgeons (JACS).
Using data from the 2013-2017 Medicare Part D database, the researchers found:
- The average number of opioid prescriptions per beneficiary (OPBs) decreased from 1.08 in 2013 to 0.87 in 2017.
- There were several factors associated with a higher OPB, including a younger population, higher education levels, and higher healthcare costs.
- Counties with fewer mental health providers and higher uninsured rates also saw higher OPBs.
“In our study, we were surprised by the variance in opioid prescription rates across different states,” said Apostolos Gaitanidis, MD, co-lead author of the study. Dr. Gaitanidis was a research fellow in the division of trauma, emergency surgery, and surgical critical care at Massachusetts General Hospital, Boston, at the time the research was conducted. He worked under the supervision of Haytham Kaafarani, MD, MPH, FACS. Dr. Kaafarani is an associate professor of surgery at Harvard Medical School.
For instance, in West Virginia, where the opioid epidemic was notably rampant, the authors observed fewer opioid prescriptions by surgeons compared to states like Louisiana, Alabama, and Missouri, which were not as heavily affected by the epidemic, Dr. Gaitanidis added.
“This raises important questions about the role of different medical specialties in the opioid crisis,” he said. “It's a common assumption to associate high opioid prescriptions with surgical practices. However, our findings suggest that the reality is more complex and that the issue may not be predominantly with surgical prescriptions.”
Notably, the authors found higher OPBs in counties with higher uninsured rates and reduced access to mental health services, suggesting that decreased access to health care and mental health services may significantly impact patterns of opioid prescribing after surgery.
“It is likely that in counties with restricted health care access, due to higher health care costs, lack of insurance coverage, and decreased availability of mental health providers, patients may receive more postoperative opioids as they might not be able to easily obtain additional opioid pills should they need to, or, more likely, that the higher opioid prescribing is masking an unaddressed overall health and mental health burden in this patient population,” the authors wrote.
Counties with higher education levels, which often host major hospitals and referral centers, might see higher opioid prescriptions due to a larger influx of complex cases. On the contrary, better healthcare quality on a county level was associated with a greater drop in OPB over time, according to Dr. Gaitanidis.
The findings highlight the need for a comprehensive approach to addressing pain management and the opioid epidemic, particularly focusing on enhancing mental health services and health care accessibility, the authors noted.
One limitation to this study is not knowing if a prescription initially made in one county was then diverted to another county or state.
Areas for further study, according to the researchers, include using data from private insurance companies, which capture a younger patient population, and analyzing OPBs for specialties other than surgery. Additional data after 2017 could be analyzed to see if these patterns persist or change, reflecting the continued cultural evolution among surgeons prescribing opioids.
Study coauthors are Ander Dorken Gallastegi, MD; Inge van Erp, BS; Anthony Gebran, MD; George C. Velmahos, MD, PhD, FACS; and Haytham M. A. Kaafarani, MD, MPH, FACS.
The study is published as an article in press on the JACS website.
Citation: Nationwide, County-Level Analysis of the Patterns, Trends and System-Level Predictors of Opioid Prescribing in Surgery in the US: Social Determinants and Access to Mental Health Services Matter. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000000920
# # #
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
CONTACT:
Sheila Evans | 312-202-5386
Dan Hamilton | 312-202-5328
Email: pressinquiry@facs.org
JOURNAL
Journal of the American College of Surgeons
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Nationwide, County-Level Analysis of the Patterns, Trends and System-Level Predictors of Opioid Prescribing in Surgery in the US: Social Determinants and Access to Mental Health Services Matter
ARTICLE PUBLICATION DATE
16-Jan-2024
US heart disease deaths linked with substance use rose 4% per year between 1999-2019
Alcohol was a factor in 65% of the deaths from CVD, followed by opioids, cocaine and other illicit drugs, finds new study in Journal of the American Heart Association
Research Highlights:
- Despite drops in overall cardiovascular disease deaths from 1999-2019, cardiovascular disease deaths in which substance use was cited as a contributing factor increased an average of 4% per year, with the death rate accelerating to 6.2% from 2012-2019.
- Prominent increases in cardiovascular deaths associated with substance use were most notable among women, American Indian or Alaskan individuals, younger individuals, rural area residents and users of cannabis and psychostimulants.
- Identifying high-risk groups is crucial for prioritizing preventive measures to reduce substance use linked with cardiovascular disease deaths, particularly in high-risk populations.
Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, Jan. 10, 2024
DALLAS, Jan. 10, 2024 — Cardiovascular disease deaths involving substance use rose an average of 4% per year from 1999 to 2019, despite a drop in overall cardiovascular disease deaths, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
“The study results were generally consistent with what we see in our clinic while caring for patients with cardiovascular disease,” said study senior author Dmitry Abramov, M.D., a cardiologist and associate professor of medicine at Loma Linda University Health in Loma Linda, California.
“Although alcohol and opioids were the substances most associated with cardiovascular deaths, the increases in cardiovascular deaths related to stimulants (predominantly amphetamines) during the study period were particularly prominent,” he continued. “This highlights both the ongoing risk of common substances, including alcohol and opioids, and also demonstrates the need to tackle amphetamines as a substance whose contribution to CVD deaths is growing more rapidly.”
The researchers reviewed publicly available data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to investigate death trends related to substance use from 1999 and 2019. The WONDER database aggregates death certificate data across the U.S. from the National Vital Statistics System.
The analysis found:
- The overall rate of substance use-related cardiovascular deaths increased from 9.9 per 100,000 population in 1999 to 21.4 per 100,000 population in 2019, representing an average annual increase of 4%.
- Increases in substance use-related average annual percent changes were noted across all subgroups and were pronounced among women (4.8%); American Indian or Alaskan individuals (5.4%); younger adults, ages 25-59 (5.3%); people living in rural areas (5%); people who used cannabis (12.7%) and psychostimulants (16.8%).
- 65% of cardiovascular disease deaths were related to alcohol, followed by opioids (13.7%), cocaine (9.8%), stimulants (6.5%), sedatives (4.1%) and cannabis (0.5%).
- The highest rate of change was noted among adults ages 25-39 (5.3%), followed by adults ages 55-69 (4.9%).
- The age-adjusted death rate was 15.2 per 100,000 in adults living in non-metropolitan/rural areas, 22.5 per 100,000 in men; and 37.7 per 100,000 in American Indian or Alaska Native adults.
“We were surprised to see significant increases among individuals ages 25 to 39, compared to other age groups and among people in certain racial and ethnic groups, including white adults and American Indian/Alaska Native adults. Identifying high-risk groups will be crucial for prioritizing preventive measures to reduce substance use-related cardiovascular disease deaths,” Abramov said.
“In addition, while the rates of cardiovascular disease mortality related to substance use were higher in men than women, women demonstrated larger increases during the study period. Data from prior studies have found notable increases in substance use among women over the last 20 years, and women may face unique societal risks that may contribute to the increases noted in our study,” he said. “These sex-based differences, in addition to the differences by race and ethnicity, age and living in an urban or rural community, require additional research.”
Study background and details:
- Data from the CDC WONDER database from 199-2019 included 636,572 substance use-related cardiovascular deaths. Of these, 75.6% were among men, and 70.6% of the individuals were non-Hispanic white people.
- Smoking/tobacco use was not included as a form of substance use in this study.
- The increases in substance use found in rural areas have been connected to socioeconomic vulnerabilities, access to health care and substance abuse treatment differences and will require further evaluation, the researchers noted.
The study’s limitations included that causes of death noted on death certificates may have some miscoding errors, therefore, it would affect the data analysis since deaths attributable to cardiovascular disease were the original data source. In addition, the authors did not have information regarding cardiovascular disease risk factors, family histories of cardiovascular disease or initial measurements of other health conditions (such as high blood pressure and/or Type 2 diabetes diagnosis), as this information is not included in the WONDER database.
“We would like to see additional public health efforts to support comprehensive evaluation and management of substance use in the U.S. that includes clinician and patient education, as well as attention to socioeconomic factors that contribute to substance use,” Abramov said. “Such efforts are critical in reversing the trends in CVD deaths associated with substance use and will hopefully lead to further reduction in the overall burden of heart disease and stroke.”
Co-authors, disclosures and funding sources are listed in the manuscript.
Studies published in the American Heart Association’s scientific journals are peer reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.
Additional Resources:
- Multimedia is available on the right column of release link.
- After January 10, view the manuscript online.
- American Heart Association Report: Heart Disease and Stroke Statistics: 2023 Update (January 2023)
- AHA news release: American Indian and Alaska Native adults had higher rate of premature heart attack deaths (November 2023)
- AHA scientific statement news release: Heart health is sub-optimal among American Indian/Alaska Native women, supports needed (May 2023)
- AHA news release: Rates of premature heart attack death vary by sex, race and region in the U.S. (December 2021)
- AHA news release: U.S. CVD death rate drops overall, county-level data signals ongoing regional disparities (May 2021)
- Follow AHA/ASA news on X (formerly known as Twitter) @HeartNews
- Follow news from the Journal of the American Heart Association @JAHA_AHA
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JOURNAL
Journal of the American Heart Association
ARTICLE TITLE
Temporal Trends in Substance Use and Cardiovascular Disease–Related Mortality in the United States
Therapy against spider fear can also reduce fear of heights
Psychology
Peer-Reviewed PublicationIMAGE:
ONCE ONE FEAR HAS BEEN CONQUERED, THIS CAN ALSO HAVE AN EFFECT ON OTHER FEARS.
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CREDIT: © RUB, KRAMER
A number of anxiety disorders are co-morbid
“Anxiety rarely comes alone,” says Iris Kodzaga, lead author of the study. “Patients who suffer from one fear often subsequently develop another.” The most effective treatment method is exposure: By confronting the fear-inducing situations or stimuli under psychotherapeutic supervision, patients learn to overcome their fear.
“It was long assumed that if a person had multiple fears, they would require multiple exposure therapies tailored to their specific fear,” explains Kodzaga. The Bochum-based team is now challenging this assumption. The researchers measured fear of spiders and heights in 50 test subjects before and after exposure therapy targeting spider fear. Measures included subjective data from specific questionnaires for fear of spiders and heights. In addition, the researchers collected quantitative behavioral measures, such as how close the participants dared to approach the spiders or how far they could climb a high church tower.
Therapy methods could become more universal
Exposure therapy for spider fear not only reduced the fear of spiders, but also the fear of heights. A significant effect emerged in both the subjective and behavioral measures: Fear of heights decreased by an average of 15 percent as a result of exposure to spiders.
“The discovery that exposure to spiders also reduces fear of heights opens up new perspectives for the efficient treatment of phobias,” says Iris Kodzaga. “It could mean that we can rethink therapeutic approaches and possibly develop more universal methods.”
How exactly this effect is transferred from one fear to another is still unclear. “The effect can’t be fully explained by associative learning processes. The generalization effect might be due to an increase in self-efficacy as a result of exposure therapy,” says the researcher. “But perhaps there is also a common denominator between fear of spiders and fear of heights that’s not obvious. We’ll need to conduct follow-up studies to find out more.”
JOURNAL
Translational Psychiatry
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Generalization of Beneficial Exposure Effects to Untreated Stimuli from Another Fear Category
Do symptoms of post-traumatic stress disorder facilitate substance use as a coping method among children after a natural disaster?
In a survey-based study of 3rd to 12th grade students in Puerto Rico after 2017’s Hurricane Maria, certain symptoms of post-traumatic stress disorder (PTSD) were linked with a higher risk of using drugs or alcohol.
The study, which is published in the Journal of Traumatic Stress, included 91,732 youths who completed a survey 5–9 months after Hurricane Maria made landfall in Puerto Rico. Associations between PTSD symptoms and substance use were examined using a network conceptualization, which views disorders as stemming from interactions between symptoms. This approach identified irritable behavior and angry outburst symptoms of PTSD as being associated with the greatest risk for coping through substance use after a natural disaster. This association was more pronounced among youths who did not have a supportive caregiver, friend, or teacher/counselor in their life.
Two PTSD symptom clusters were identified: 1) arousal and reactivity, negative alterations in cognition and mood, and substance use; and 2) avoidance and intrusion. Sleep disturbance and physiological reactivity to trauma reminders were identified as important bridge symptoms connecting these clusters. These findings suggest that interventions targeting sleep and physiological reactivity to trauma reminders after a natural disaster may be effective in disrupting the interaction between PTSD symptoms that maintain this disorder among youths.
“The current global climate crisis makes disaster inevitable in Puerto Rico, which can have a lasting impact on the lives of youths and the broader community,” said corresponding author Alejandro Luis Vázquez, PhD, of the University of Tennessee. “While it is useful to identify individual-level risk factors to guide triage intervention efforts, there is a need to address colonialist policies that have denied adequate investment and aid following natural disasters in Puerto Rico, which limits available support services and negatively impacts the mental health of youths.”
URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/jts.23008
Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.
About the Journal
Journal of Traumatic Stress is an interdisciplinary forum for the publication of peer-reviewed original papers on biopsychosocial aspects of trauma. Papers focus on theoretical formulations, research, treatment, prevention education/training, and legal and policy concerns. It is the official publication of the International Society for Traumatic Stress Studies (ISTSS).
About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.
JOURNAL
Journal of Traumatic Stress
ARTICLE TITLE
A network analysis of Hurricane Maria related traumatic stress and substance use among Puerto Rican youth
ARTICLE PUBLICATION DATE
10-Jan-2024
E-cigarettes help more tobacco smokers quit than traditional nicotine replacement
UMass Amherst researcher leads annual analysis of smoking cessation studies
IMAGE:
PUBLIC HEALTH RESEARCHER JAMIE HARTMANN-BOYCE IS AN ASSISTANT PROFESSOR AT THE UMASS AMHERST SCHOOL OF PUBLIC HEALTH AND HEALTH SCIENCES.
view moreCREDIT: UMASS AMHERST
Nicotine e-cigarettes are more effective in helping people quit smoking than conventional nicotine-replacement therapy (NRT), according to the latest Cochrane review co-led by a University of Massachusetts Amherst public health and health policy researcher.
The review of studies published on the Cochrane Database of Systematic Reviews found high certainty evidence that e-cigarettes, which allow users to “vape” nicotine instead of smoke it, lead to better chances of quitting smoking than patches, gums, lozenges or other traditional NRT.
“In England, quite different from the rest of the world, e-cigarettes have been embraced by public health agencies as a tool to help people reduce the harm from smoking,” says Jamie Hartmann-Boyce, assistant professor of health policy and promotion in the School of Public Health and Health Sciences.
Worldwide, smoking is the leading cause of preventable disease and death, resulting in more than seven million deaths per year. “Most of the adults in the U.S. who smoke want to quit but many find it really difficult to do so,” says Hartmann-Boyce, who conducted research at the University of Oxford in England before joining UMass Amherst earlier this year. “We need a range of evidence-based options for people to use to quit smoking, as some people will try many different ways of quitting before finding one that works for them.”
Hartmann-Boyce, a Cochrane editor, is senior author of the review, which included 88 studies and more than 27,235 participants – an addition of 10 studies since the last update in 2022. Most of the studies analyzed took place in the U.S., United Kingdom or Italy.
E-cigarettes do not burn tobacco but rather heat liquids with nicotine and flavorings, allowing users to inhale a vapor that contains nicotine rather than inhale tobacco smoke. With conventional cigarettes, people who smoke are exposed to a complex mix of chemicals that are known to cause diseases.
“We have very clear evidence that, though not risk free, nicotine e-cigarettes are substantially less harmful than smoking,” Hartmann-Boyce says. “Some people who haven’t had success in the past with other quit aids have found e-cigarettes have helped them.”
The analysis found that for every 100 people using nicotine e-cigarettes to stop smoking, eight to 10 would be expected to successfully stop, compared with six of 100 people using traditional nicotine-replacement therapy, and with four of 100 trying to quit with no support or behavioral support only.
The regular review of smoking cessation studies continues to offer strong evidence that can inform public health policies and strategies, offering people who smoke better tools to quit for good. Hartmann-Boyce emphasizes that the public health message is a nuanced and complex one, especially in the U.S.
While those who don’t smoke tobacco should avoid the use of e-cigarettes for their potential negative health effects, Hartmann-Boyce says, some people who smoke can improve their health and reduce their risks by quitting tobacco with the help of e-cigarettes.
“Not everything is either entirely harmful or beneficial,” Hartmann-Boyce says. “Different things can have different impacts on different populations. Evidence shows that nicotine e-cigarettes can help people quit smoking, and that people who don’t smoke shouldn’t use e-cigarettes.”
She compares the tobacco smoking vs. e-cigarette scenario to treatment for a substance-use disorder involving opioids. “We’re not going to prescribe methadone to people who aren’t addicted to opioids,” Hartmann-Boyce says. “But for people addicted to opioids, we recognize that methadone is a helpful thing.”
The U.S. Food and Drug Administration (FDA), which regulates e-cigarettes, has approved seven different medicationsthat have been shown to help adults quit smoking. E-cigarettes are not one of them. Earlier this year, in an update on the FDA’s tobacco program, FDA commissioner Dr. Robert Califf stated, “While certain e-cigarettes may help adult smokers transition completely away from, or significantly reduce their use of more harmful combusted cigarettes, the law’s public health standard balances that potential with the known and substantial risk with regard to youth appeal, uptake and use of these highly addictive products.”
JOURNAL
Cochrane Database of Systematic Reviews
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Latest Cochrane Review finds high certainty evidence that nicotine e-cigarettes are more effective than traditional nicotine-replacement therapy (NRT) in helping people quit smoking
ARTICLE PUBLICATION DATE
8-Jan-2024
Virginia Tech researchers find drugs used to treat Type 2 diabetes reduce alcohol cravings, use in individuals with obesity
Fralin Biomedical Research Institute study analyzed social media posts and self-reported experiences among patients who use drugs such as Ozempic, Wegovy, and Mounjaro
Peer-Reviewed PublicationIMAGE:
WARREN BICKEL, DIRECTOR OF THE ADDICTION RECOVERY AND RESEARCH CENTER AT THE FRALIN BIOMEDICAL RESEARCH INSTITUTE, LED A STUDY OF INDIVIDUALS WITH OBESITY POSTING ON SOCIAL MEDIA AND REPORTING THE USE OF SEMAGLUTIDE AND TIRZEPATIDE DECREASED CRAVINGS AND REDUCED ALCOHOL CONSUMPTION
view moreCREDIT: CLAYTON METZ/VIRGINIA TECH
In social media posts on the community network Reddit, users reported reduced cravings for alcohol when taking drugs intended to treat Type 2 diabetes and obesity.
Across a number of threads — with titles such as “Did scientists accidentally invent an anti-addiction drug?” and “I don't know if this is a side effect but ... Mounjaro makes me drink less!!!!!” — users reported a changing relationship with beer, wine, and liquor.
An analysis of those posts, together with a remote study of individuals with obesity who reported using semaglutide and tirzepatide, found that the drugs decreased cravings and reduced alcohol consumption, according to a study by Virginia Tech researchers published Nov. 28 in Scientific Reports.
“These findings add to a growing literature that these medications may curb dangerous drinking habits,” said Warren Bickel, Virginia Tech Carilion Behavioral Health Research Professor at the Fralin Biomedical Research Institute at VTC and corresponding author.
What they did
Scientists with the Fralin Biomedical Research Institute’s Addiction Recovery Research Center combined two different studies to build on existing research, including studies that showed the drugs were effective in reducing alcohol consumption in animal models.
The first was an analysis of more than 68,000 Reddit posts from 2009-23 that included terms linked to GLP-1 approved medications. Semaglutide is a GLP-1 agonist, a class of drugs that reduce blood sugar and energy intake by mimicking the actions of hormones released after eating.
Among the keywords included in the search were Mounjaro, Wegovy, Ozempic, and Trulicity. After cleaning the resulting data — such as eliminating comments with fewer than 100 characters — the set was narrowed to 33,609 posts from 14,595 unique users. The study was unique in using Reddit to analyze the reported experience of thousands of users.
On examining alcohol-related discussions, researchers found that 962 individuals made 1,580 alcohol-related posts. Of those, 71.7 percent addressed reduced cravings, reduced usage, and other negative effects due to drinking.
In a second study, 153 participants who self-reported having obesity were recruited from various social media platforms. Roughly a third of these participants represented the control group, a third were taking either a semaglutide injection or tablet, and a third were using tirzepatide.
Participants on semaglutide or tirzepatide reported drinking significantly fewer drinks, on average, than those in the control group who were not on any medication for diabetes or weight loss. In addition, researchers found that both the average number of drinks and the odds of binge drinking were found to be significantly lower.
Results also found that the stimulative and sedative effects of alcohol intoxication are reduced when taking these medications. “Participants reported drinking less, experienced fewer effects of alcohol when they did drink it, and decreased odds of binge drinking,” said Alexandra DiFeliceantonio, assistant professor at Fralin Biomedical Research Institute and one of the study’s co-authors.
Researchers believe theirs is the first published report following tirezepatide, sold under the brand name Mounjaro, which was approved in 2022 and is used for treatment of Type 2 diabetes and weight loss.
Why this matters
Case studies and reports in the popular press hint at the drugs’ unexpected side effect of reducing addictive behaviors, including the desire to consume alcohol.
The U.S. Food and Drug Administration has approved only three medications to treat alcohol use disorder: disulfiram, naltrexone, and acamprosate. They have shown only modest success, have poor compliance, and are underprescribed.
The authors suggest further randomized controlled trials to explore the therapeutic potential of GLP-1 agonists and GIP/GLP-1 combination drugs to treat alcohol use disorder, which affects 5.9 percent of individuals in the United States ages 12 and older. In addition, the participants identified as mostly white and female, and further studies in more diverse populations are needed to examine sex and race differences.
“Although evidence supporting the use of these medications for alcohol use disorder is growing, the field still needs to learn considerably more about them, particularly in identifying the underlying mechanisms. We plan to contribute to that effort,” Bickel said.
The drugs are a promising development in the study of alcohol use disorder. Data from the National Survey on Drug Use and Health indicate 15.7 million people in the United States meet the criteria for the chronic, relapsing brain disorder that is a significant contributor to global mortality yet remains one of the most undertreated conditions, Bickel said.
JOURNAL
Scientific Reports
METHOD OF RESEARCH
Content analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Semaglutide and Tirzepatide reduce alcohol consumption in individuals with obesity
COI STATEMENT
Although the following activities/relationships do not create a conflict of interest pertaining to this manuscript, in the interest of full disclosure, Dr. Bickel would like to report the following: W. K. Bickel is a principal of HealthSim, LLC; BEAM Diagnostics, Inc.; and Red 5 Group, LLC. In addition, he serves on the scientific advisory board for Ria Health; and serves as a consultant for Lumanity. All other authors declare no potential conflict of interest.
For Black adolescents, feeling connected to school has long-lasting mental health benefits
Students who reported higher levels of school connectedness showed lower levels of aggressive behaviors and depression six years later, Rutgers researchers find
School connectedness – the degree to which students feel part of their school community – influences more than grades. For Black students, it’s a protective factor against depression and aggressive behavior later in life, according to a Rutgers University-New Brunswick study.
“Our data provide fairly strong evidence for the idea that the experiences Black adolescents have in their school impacts their long-term mental health,” said Adrian Gale, an assistant professor in the Rutgers School of Social Work, and lead author of the study published in the Journal of Youth and Adolescence.
Researchers have long understood the benefits of school connectedness for youth well-being and physical health outcomes. But most research into the topic has been focused on White adolescents, with limited research exploring the relationship among Black youth, Gale said.
To address this gap, Gale and Lenna Nepomnyaschy, an associate professor in the Rutgers School of Social Work, analyzed longitudinal data from the Future of Families and Child Wellbeing Study (FFCWS), a population-based birth cohort study following children born in large United States cities between 1998 and 2000.
From the total cohort of nearly 5,000 children included in the FFCWS, Gale and Nepomnyaschy identified 1,688 who self-identified as Black or African American, were interviewed at ages 9 and 15, and whose primary caregivers were interviewed at the 15-year follow-up.
At age 9, participants were asked about their connectedness to schools. Participants were asked to rate the frequency they felt “part of your school, close to people at your school, happy to be at your school, and safe at school.” Six years later, caregivers were asked about their children’s propensity for aggressive behaviors, and youth reported their experiences of depression.
Using these data as inputs, the researchers then used linear regression models to control for variables that could influence the association between school connectedness, depression and aggressive behaviors. Covariates included family characteristics, mother’s education, neighborhood characteristics and perceived neighborhood disorder – such as the presence of garbage.
Even with this “rich set of child, parent, family, neighborhood and school-district characteristics that could potentially confound the associations between school connectedness and mental health,” the researchers said they found evidence that early school connectedness may reduce depressive symptoms and aggressive behaviors later in life. The association was strongest for girls.
“These findings demonstrate that when Black children felt connected to their school at age 9, they had fewer depressive symptoms and less aggressive behavior issues as adolescents,” Gale said. “Simply put, when Black kids feel closely tied to their school, their mental health benefits.”
Gale said these findings have implications for school districts nationwide and should be viewed as more evidence to support increased school funding.
“School connectedness, no matter how it's defined, is about the relationships people in school have with one another,” he said. “The extent that you can improve the quality of those individual relationships – with funding for smaller classes, for example – is what will lead to improved school connectedness and better student outcomes.”
JOURNAL
Journal of Youth and Adolescence
SUBJECT OF RESEARCH
People
Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders
NIH-supported findings suggest the need to expand definitions of addiction treatment success beyond abstinence
Reducing stimulant use was associated with significant improvement in measures of health and recovery among people with stimulant use disorder, even if they did not achieve total abstinence. This finding is according to an analysis of data from 13 randomized clinical trials of treatments for stimulant use disorders involving methamphetamine and cocaine. Historically, total abstinence has been the standard goal of treatment for substance use disorders, however, these findings support the growing recognition that a more nuanced perspective on measuring treatment success may be beneficial.
The study, published in Addiction, was led by scientists at the Johns Hopkins Bloomberg School of Public Health, Baltimore, in collaboration with researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.
Researchers found that transitioning from high use (five or more days a month) to lower use (one to four days a month) was associated with lower levels of drug craving, depression, and other drug-related challenges compared to no change in use. These results suggest that reduction in use of methamphetamine or cocaine, in addition to abstinence, is a meaningful surrogate or intermediate clinical outcome in medication development for stimulant addiction. Unlike other substance use disorders, such as opioid use disorder or alcohol use disorder, there are currently no U.S. Food and Drug Administration-approved pharmacological treatments for stimulant use disorders.
“These findings align with an evolving understanding in the field of addiction, affirming that abstinence should be neither the sole aim nor only valid outcome of treatment,” said NIDA Director Nora Volkow, M.D. “Embracing measures of success in addiction treatment beyond abstinence supports more individualized approaches to recovery, and may lead to the approval of a wider range of medications that can improve the lives of people with substance use disorders.”
Temporary returns to use after periods of abstinence are part of many recovery journeys, and relying exclusively on abstinence as an outcome in previous clinical trials may have masked beneficial effects of treatment. To help address this research gap, investigators analyzed data from previous clinical trials to study the effects of transitioning to reduced drug use or abstinence on a broad range of health measures. Researchers analyzed data from 13 randomized clinical trials evaluating the impact of potential pharmacological medications for stimulant use disorders, which included more than 2,000 individuals seeking treatment for cocaine or methamphetamine use disorders at facilities across the United States. The trials were of varying duration and were undertaken from 2001 to 2017.
Researchers compared “no reduced use,” “reduced use,” and “abstinence” in association with multiple health outcomes, such as severity of drug-related symptoms, craving, and depression. The study found that more participants reduced the frequency of primary drug use (18%) than achieved abstinence (14%). While abstinence was associated with the greatest clinical improvement, reduced use was significantly associated with multiple measures of improvements in psychosocial functioning at the end of the trials, such as a 60% decrease in craving for the primary drug, 41% decrease in drug-seeking behaviors, and a 40% decrease in depression severity, compared to the beginning of the trial.
These findings suggest that improvements in health and functioning can occur with reduced use and should be considered in the development and approval of treatments for substance use disorders. Research on alcohol use disorder has shown similar results, with studies finding that transitioning from high-risk to low-risk drinking is associated with functional improvement and fewer mental and general health consequences caused by alcohol. As a result, a reduced number of heavy drinking days is already recognized as a meaningful clinical outcome in medication development for alcohol use disorder.
“With addiction, the field has historically acknowledged only the benefits of abstinence, missing opportunities to celebrate and measure the positive impacts of reduced substance use,” said Mehdi Farokhina, M.D., M.P.H., a staff scientist in the NIDA Intramural Research Program, and author on the paper. “This study provides evidence that reducing the overall use of drugs is important and clinically meaningful. This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”
The authors note that the study did not include behavioral treatment trials, which were too varied to harmonize their data. In addition, the study featured only people who enrolled in clinical trials, which could limit generalizability. Additional research is needed to understand the potential clinical benefits of reduced drug use, along with other harm reduction-based indicators of clinical improvement in real-world populations. The authors highlight that the findings of this study should encourage researchers to re-evaluate treatment outcome measures in their studies and consider non-abstinence treatment outcomes in the development of new medications for the treatment of stimulant use disorders. The authors also write that these new findings need to be replicated in other contexts with additional substance use disorders such as opioid use disorder.
“By promoting an understanding of addiction as a treatable disorder with multifaceted causes, society can work towards providing better support, resources, and care for individuals on their way to recovery,” said Masoumeh Aminesmaeili, M.D., lead author of the paper. “This approach is not only compassionate, but also clinically valid in addressing the complex nature of addiction.”
For more information on substance and mental health treatment programs in your area, call the free and confidential National Helpline 1-800-662-HELP (4357) or visit www.FindTreatment.gov.
Reference: M Aminesmaeili, et al. Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials. Addiction. DOI: 10.1111/add.16409 (2024).
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About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit https://www.nida.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/.
About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by the continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide.
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JOURNAL
Addiction
ARTICLE TITLE
Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials
ARTICLE PUBLICATION DATE
10-Jan-2024
