TDCS Effective in Bipolar Depression

February 28, 2018 · Posted in Potential Treatments · Comment 

tDCSA 2017 study in the journal JAMA Psychiatry reports that transcranial direct current stimulation (tDCS) is an effective add-on treatment for bipolar depression. In the study by researcher Bernardo Sampaio-Junior and colleagues, 59 patients taking medication for bipolar disorder and experiencing a depressive episode were randomized to receive either 10 daily half-hour sessions of tDCS (and then one every two weeks) or an inactive sham stimulation.

TDCS is a painless form of neurostimulation in which electrodes applied to the scalp provide a steady, low current of electricity that modulates neuron activity. Sampaio-Junior describes its low cost, portability and ease of use as some of its benefits. This is the first randomized, sham-controlled study of tDCS in bipolar disorder.

After six weeks of treatment, patients who received real tDCS treatment showed significantly more improvement in their depression than those who received the inactive sham stimulation. In the active group, 67.6% showed sustained response compared to 30.4% in the inactive group. TDCS was well tolerated, with skin redness at the application site the only side effect that was more common in the active group than in the sham group. Mood switching rates were similar across the two groups.

The research was completed as part of the Bipolar Depression Electrical Treatment Trial (BETTER) taking place in Brazil. The group of participants was 68% female with a mean age of 45.9 years. Sixty-one percent of participants had bipolar I disorder while the remainder had been diagnosed with bipolar II.

In Danish Study, Higher Trace Levels of Lithium in Drinking Water in Certain Regions Do Not Seem to Prevent Bipolar Disorder

February 21, 2018 · Posted in Potential Treatments · Comment 

man drinking water

Previous studies have found that trace levels of lithium that occur naturally in the drinking water of certain regions are associated with lower rates suicide. Preliminary studies have also shown that lithium in drinking water is associated with lower dementia rates. The trace levels seen in drinking water are many hundreds of times lower than clinical doses of lithium prescribed for bipolar disorder, but they vary greatly according to locality.

A new study by researcher Lars Kessing and colleagues investigated whether chronic exposure to lithium in drinking water might protect against bipolar disorder, but found no evidence that this is the case in Denmark.

In an article published in the journal Bipolar Disorders in 2017, Kessing and colleagues describe findings from their analysis of data on 14,820 patients with a diagnosis of mania or bipolar disorder and (for each participant with bipolar disorder) 10 other age- and gender-matched control participants totaling 140,311. The researchers were able to look longitudinally at the participants’ exposure to trace levels of lithium in drinking water based on their municipalities of residence.

The investigators hoped to find evidence that greater exposure to lithium was associated with lower rates of bipolar disorder. Kessing and colleagues concluded that trace lithium levels higher than those in Denmark might be needed to find such a result.

Editor’s Note: Clinical studies of lithium treatment for children at high risk for bipolar disorder could help clarify whether even conventional therapeutic levels of lithium could reduce or delay the appearance of bipolar disorder.

Naturally Occurring Lithium in Texas Drinking Water Reduced Alzheimer’s Mortality Rates

February 19, 2018 · Posted in Potential Treatments · Comment 

woman drinking water

Several studies have found that trace levels of lithium that naturally occur in the drinking water of certain regions are associated with reductions in dementia compared to regions with less lithium in the water. The latest such study found that higher trace levels of lithium in certain Texas counties were associated with less mortality from Alzheimer’s disease compared to Texas counties with lower levels of lithium in the water.

The research by Val Andrew Fajardo and colleagues was published in the Journal of Alzheimer’s Disease in 2017. Fajardo’s team obtained 6,180 water samples from 234 of Texas’ 254 counties. They also calculated that there was an increase in the Alzheimer’s mortality rate from the period 2000–2006 to the period 2009–2015. However, regions with higher trace levels of lithium were negatively correlated with this increase, suggesting that the lithium in the water had a protective effect on people in those counties.

The researchers controlled for gender, race, education, rural living, and air pollution. Physical inactivity, obesity, and type 2 diabetes seemed to be confounding factors. Obesity and type 2 diabetes were positively correlated with Alzheimer’s mortality and negatively correlated with lithium levels in drinking water, meaning that it is possible that lithium also protects against these conditions.

Lithium in Drinking Water May Reduce Dementia

February 16, 2018 · Posted in Potential Treatments · Comment 

New research suggests that higher trace levels of lithium in drinking water can reduce dementia rates in the general population. In a 2017 article in the Archives of General Psychiatry, researcher Lars Kessing and colleagues compared data on 73,731 patients in Denmark with a diagnosis of dementia to 733,653 control participants without this diagnosis between the years 1970 and 2013. They were able to match the data to recorded levels of trace lithium in the drinking water in participants’ municipalities of residence.

Lithium levels in the water ranged from 0.6 micrograms per liter to 30.7 micrograms per liter in 151 different locations throughout Denmark. Compared to those exposed to 2.0 to 5.0 micrograms of lithium per liter of water, those exposed to more than 15.0 micrograms per liter had a lower incidence rate of dementia. However, those exposed to 5.1 to 10.0 micrograms per liter had a higher incidence of dementia. The same relationship was also found between lithium exposure levels and both Alzheimer’s disease and vascular dementia.

The lithium levels in the water were approximately 10,000 to 300 times lower than typical clinical doses (typically 900–1500mg/day, which produce concentrations ranging from 0.6 to 1.2 meq/L in patients’ blood). The minute exposures to lithium in the drinking water occurred over decades in the Danish study, and suggest that there may be long-term positive effects to chronic lifetime exposure to very low lithium levels.

These data follow others regarding exposure to trace lithium. In 2011, researcher Orestes V. Forlenza and colleagues reported in the British Journal of Psychiatry that low dose lithium (150–600mg/day) over a period of one year decreased the progression of mild cognitive impairment compared to placebo, while researcher Marielza Andrade Nunes and colleagues reported in the journal Current Alzheimer’s Research in 2013 that an even smaller dose (0.3mg/day) over a period of 15 months slowed the progression of Alzheimer’s dementia. Thus, low or microscopic doses consumed over long periods could slow cognitive deterioration.

Exercise May Protect Against Breast Cancer

February 9, 2018 · Posted in Potential Treatments · Comment 

walkingEpidemiological evidence suggests that exercise reduces breast cancer rates and rates of breast cancer recurrence. However, it is not well understood why this is true.

Exercise that is intense enough to increase the heartrate and induce heavy breathing can increase the hormone epinephrine in the blood. A 2017 article by researcher Christine Dethlefson and colleagues in the journal Cancer Research reported that this elevated level of epinephrine in the blood of breast cancer patients after one intense exercise session stopped their breast cancer cells from growing in vitro and reduced tumor growth by half.

Senior author Pernille Hojman told Reuters that while exercise could not be expected to replace anti-cancer treatments, it is a great supportive strategy that has the added benefits of increasing patients’ quality of life and sense of empowerment.

The study looked at human breast cancer tumor cells in test tubes, and the same type of tumor cells implanted into mice. Only 45 percent of the mice implanted with the cancer cells collected after vigorous exercise developed tumors, compared to 90 percent of the mice who received cancer cells collected before exercise or with no exercise.

Exercise May Improve Memory

February 7, 2018 · Posted in Potential Treatments · Comment 

exerciseA recent study suggests that exercising vigorously 20 minutes per day may improve “interference memory,” a type of memory that involves reconciling new learning with information one already knows. (Sometimes older information “interferes” with new learning.) In a 2017 article in the Journal of Cognitive Neuroscience, researcher Jennifer Heisz and colleagues report that performance on a high-interference memory task improved when participants engaged in 20-minute daily sessions of interval training for six weeks.

Heisz and colleagues compared three groups of students: one did interval training, another did both interval training and cognitive training, and a control group did no special training. Both exercise groups performed better on the high-interference memory task than the control group. Those who exercised also had higher levels of brain-derived neurotrophic factor (BDNF), which promotes the growth of new synapses and is crucial for long-term memory.

The researchers suggest that this finding could be useful to seniors facing memory deficits, since only six weeks of exercise improved memory performance. Interference memory tends to decline with age.

Previous research has linked aerobic exercise to better academic performance.

In Rats, Weight-Loss Drug Lorcaserin Reduces Opiate Use

February 5, 2018 · Posted in Potential Treatments · Comment 

rat investigating pills

The serotonin 5HT-2c agonist drug lorcaserin (Belviq) was approved by the US Food and Drug Administration in 2012 for the treatment of obesity and weight-related conditions (such as high blood pressure, type 2 diabetes, or high cholesterol) in adults. A 2017 article by researcher Harshini Neelakantan and colleagues in the journal ACS Chemical Neuroscience reports that in rats, lorcaserin may also reduce opiate use.

The rats had been self-administering the opiate oxycodone. After receiving lorcaserin, the rats were less likely to consume oxycodone and less likely to seek it out. The rats were also less responsive to cues that had previously led them to consume oxycodone, such as lights or sounds that occurred when oxycodone was available.

Serotonin 5HT-2c receptors both regulate psychostimulant reward in the brain and play a role in reactivity to cues like the lights and sounds the rats associated with oxycodone. Lorcaserin’s effect on these serotonin receptors explains how it could reduce the rats’ drug use.

Clinical trials are expected to examine whether lorcaserin can reduce opiate use in humans in addition to assisting with weight loss.

Grape Extract May Improve Cognition

January 31, 2018 · Posted in Potential Treatments · Comment 

Polyphenolic compounds in colored fruits and vegetables are thought to improve memory and cognition. Extracts from Vitis vinifera, the grape species that includes almost all well-known varieties of wine, have been found to have many beneficial effects: antioxidant, antibacterial, anti-inflammatory, anticancer, antidiabetic effects, in addition to protective effects on skin, the heart, the liver, and neurons.

For about a decade, researchers have known that polyphenolic compounds from grapes could improve cognitive impairment and reduce neuropathological lesions in the brain in animals with a model of Alzheimer’s disease. New research suggests that the same compounds that protect the plant against damage, fungus, or UV rays may also protect the human brain against damage.

Researchers led by Gioacchino Calapai tested a trademarked nutritional supplement called Cognigrape, which includes extracts from Vitis vinifera, in healthy adults between the ages of 55 and 75 in Italy. One group of 57 participants received 250mg of Cognigrape per day while the other group of 54 received placebo once a day for twelve weeks. Several weeks after the supplementation period, the group taking Cognigrape showed significant improvement in cognitive function compared to baseline and compared to the group taking placebo. The Cognigrape group also showed significant reductions in depression symptoms, improvements in somatic symptoms, and improvements in attention, language, immediate memory, and delayed memory. This is the first study to find an improvement in cognitive performance in humans after supplementation with a Vitis vinifera extract.

The study by Calapai and colleagues was published in the journal Frontiers in Pharmacology in 2017.

A New Treatment for Disruptive Mood Dysregulation

December 26, 2017 · Posted in Potential Treatments · Comment 

disruptive boy

The 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, included a new diagnosis of disruptive mood dysregulation disorder. Children with persistent, severe temper outbursts and irritable or angry moods that are out of proportion to circumstances may be diagnosed with the disorder. However, there is not much specificity to the diagnosis and few treatment studies have been done to help clinicians and parents determine how to manage symptoms of the disorder.

A poster presented at the 2017 Psych Congress reported that a medication protocol consisting of an anticonvulsant drug to stabilize moods and temper outbursts and a dopamine agonist to reduce irritability, impulsivity, and concentration problems reduced rates of re-hospitalization. The retrospective study by researchers D. Matthews and G. Matthews included 91 children and adolescents who were prescribed the anticonvulsant oxcarbazepine and the dopamine agonist amantadine following hospitalization for severe aggression, mood instability, and impulsivity. Those who stuck to the regimen with minimal changes for one year had an 8% re-hospitalization rate compared to a 26% re-hospitalization rate among those who discontinued the regimen or substituted other drugs.

Editor’s Note: Oxcarbazepine has a long-acting preparation, Oxtellar, that can be given all at night.

Amantadine (Symmetrel) not only is a dopamine agonist used for Parkinson’s disease, but is also an antiviral and a blocker of glutamate NMDA channels. It stabilizes the closed state of the NMDA channel.

Simvastatin Looks Promising in Treatment of Negative Symptoms of Schizophrenia

December 20, 2017 · Posted in Potential Treatments · Comment 

simvastatin

The statin drug simvastatin (Zocor) enhances the effects of risperidone on negative symptoms of schizophrenia, according to a 2017 article by Soode Tajik-Esmaeeli and colleagues in the journal International Clinical Psychopharmacology.

In the 8-week study, 40 mg/day of simvastatin enhanced the effects of 4–6 mg/day of the antipsychotic risperidone on negative symptoms of schizophrenia, such as apathy and withdrawal, but not positive symptoms such as hallucinations or delusions.

Other statins, lovastatin and pravastatin, have not had a similar effect, possibly because they do not cross the blood-brain barrier as easily as simvastatin does.

Simvastatin has other benefits as well. Like all statins it decreases lipid levels, reducing cardiovascular disease. People with schizophrenia and bipolar disorder are at especially high risk for cardiovascular disease.

Simvastatin also decreases inflammation (lowering IL-1 alpha and TNF-beta levels) and may be neuroprotective, as it increases brain-derived neurotrophic factor (BDNF), a protein that protects neurons and is important for learning and memory. Inflammation is increasingly implicated in schizophrenia and bipolar disorder.

There is also some evidence that statins can prevent depressions over long-term follow-up. Studies in women without depression and men who had recently had heart attacks both showed that those taking statins had a lower rate of future depression than those not taking statins.

Editor’s Note: These findings suggest a potential 5-fold benefit to simvastatin: 1) It reduces negative symptoms in schizophrenia. 2) It reduces inflammation. 3) It increases BDNF. 4) It decreases cardiovascular disease risk by lowering lipid levels. 5) It may prevent future depressions.

Other approaches to augmenting schizophrenia treatment include nutritional supplements vitamin D3 and folate. Patients with psychosis often have vitamin D deficits. Folate supplements can reduce homocysteine, which has been linked to cognitive deficits in schizophrenia.

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