A couple of Medical snippets
June 5, 2017 at 5:55 am
(This post was last modified: June 5, 2017 at 5:56 am by brewer.)
Interesting that they are looking at psychedelics/LSD closer.
Reviews of Note: A Future for Psychedelic Psychiatry?
Peter Roy-Byrne, MD Reviewing Liechti ME., Neuropsychopharmacology 2017 Apr 27;
Two reviews lay the groundwork for understanding the issues of potential therapeutic use of psychedelics in psychiatry, challenges in research, and possible future directions.
The current interest in the psychological and possible therapeutic effects of psychedelic drugs has been accompanied by controlled investigations. Two review articles now examine nascent research into psychedelic drugs, including the putative benefits of LSD, psilocybin, and ayahuasca.
One article is organized as a point–counterpoint focusing on psilocybin and ayahuasca. First, Carhart-Harris reviews three controlled and five observational studies (3 in cancer patients) examining these drugs' safety and effects on anxiety, depression, obsessive-compulsive disorder, and substance use disorders, showing potentially long-lasting benefits after single doses and only limited adverse effects. Then, Goodwin, a senior psychopharmacologist with more-tempered enthusiasm, highlights difficulties in blinding, flaws in generalizing from cancer patients, and biases in subjective outcomes. In the end, the authors agree on the usefulness of studies focusing on treatment-resistant depression, multidose designs, and clarification of the optimal environment for the experience (how much psychotherapy should be provided).
Liechti reviews five placebo-controlled studies of LSD administered to healthy people and one placebo-controlled, crossover study in 11 anxious cancer patients. The studies document subjective, possibly long-term anxiolytic effects. Brain-imaging data link LSD to reduced amygdala reactivity to fearful faces, reduced connection between normally connected brain areas, and enhanced connections between areas more usually separable and dissociated. These findings might provide a basis for understanding how LSD and other psychedelics could cause more durable changes in a subject's perspective via a kind of “corrective emotional experience.”
Comment
This field is still in its infancy. Although use of these substances in nonresearch settings seems wildly premature and possibly dangerous, it seems foolish not to conduct well-designed research studies to explore their potential therapeutic use in individuals afflicted with disabling, distressing, and treatment-refractory mood and anxiety symptoms.
And a debbie downer.
Depression and Dementia are Associated, But How?
reviewing Almeida OP et al. Transl Psychiatry 2017 May 2.
A 14-year, community-based study suggests that men's late-life depressive symptoms can herald and may be part of subsequent dementia and that antidepressant treatment at depression diagnosis doesn't avert dementia.
Associations between depression and subsequent dementia have been widely reported, but how these conditions are connected remains unclear. Using an Australian data-linkage system, researchers followed 4922 men, initially without clinically meaningful cognitive impairment, from 2001–2004 through June 2015 (baseline age range, 71–89).
At an average follow-up of 9 years, 18% of men received dementia diagnoses (determined by hospital codes), and 38% died dementia-free. Based on baseline hospital codes, self-reported depression histories, and a patient-completed geriatric-depression scale, adjusted risk estimates (sub-hazard ratios [SHRs]) for subsequent diagnoses of dementia were 1.3 among men who had ever been depressed and 1.5 among those with baseline depression. Risks for later dementia were linearly associated with baseline depression symptom severity (SHRs: questionable depressive symptoms, 1.2; mild-moderate symptoms, 1.7; severe symptoms, 2.1). SHR was 2.6 for subsequent dementia risk in those who were depressed at baseline and taking antidepressants. Antidepressant use at baseline did not reduce subsequent dementia risk. Individuals depressed at baseline were at highest risk for dementia within the next 5 years (SHR, 2.7), after which the risk fell considerably.
COMMENT
Within the limitations imposed by use of hospital codes, registry data, and self-report depression scales, these findings suggest two intriguing possibilities. First, the elevated risk for dementia within 5 years of diagnosed late-life depression (with subsequent fall-off of risk) might indicate that the depressive symptoms are prodromal of an unrecognized early dementing process. Second, antidepressants in late-life depression might confer no protective antidementia effects. Additional studies to clarify these possibilities are necessary. Nevertheless, regardless of whether dementia is in the offing, clinicians will want to alleviate suffering by actively treating depressive episodes in elderly patients.
Reviews of Note: A Future for Psychedelic Psychiatry?
Peter Roy-Byrne, MD Reviewing Liechti ME., Neuropsychopharmacology 2017 Apr 27;
Two reviews lay the groundwork for understanding the issues of potential therapeutic use of psychedelics in psychiatry, challenges in research, and possible future directions.
The current interest in the psychological and possible therapeutic effects of psychedelic drugs has been accompanied by controlled investigations. Two review articles now examine nascent research into psychedelic drugs, including the putative benefits of LSD, psilocybin, and ayahuasca.
One article is organized as a point–counterpoint focusing on psilocybin and ayahuasca. First, Carhart-Harris reviews three controlled and five observational studies (3 in cancer patients) examining these drugs' safety and effects on anxiety, depression, obsessive-compulsive disorder, and substance use disorders, showing potentially long-lasting benefits after single doses and only limited adverse effects. Then, Goodwin, a senior psychopharmacologist with more-tempered enthusiasm, highlights difficulties in blinding, flaws in generalizing from cancer patients, and biases in subjective outcomes. In the end, the authors agree on the usefulness of studies focusing on treatment-resistant depression, multidose designs, and clarification of the optimal environment for the experience (how much psychotherapy should be provided).
Liechti reviews five placebo-controlled studies of LSD administered to healthy people and one placebo-controlled, crossover study in 11 anxious cancer patients. The studies document subjective, possibly long-term anxiolytic effects. Brain-imaging data link LSD to reduced amygdala reactivity to fearful faces, reduced connection between normally connected brain areas, and enhanced connections between areas more usually separable and dissociated. These findings might provide a basis for understanding how LSD and other psychedelics could cause more durable changes in a subject's perspective via a kind of “corrective emotional experience.”
Comment
This field is still in its infancy. Although use of these substances in nonresearch settings seems wildly premature and possibly dangerous, it seems foolish not to conduct well-designed research studies to explore their potential therapeutic use in individuals afflicted with disabling, distressing, and treatment-refractory mood and anxiety symptoms.
And a debbie downer.
Depression and Dementia are Associated, But How?
reviewing Almeida OP et al. Transl Psychiatry 2017 May 2.
A 14-year, community-based study suggests that men's late-life depressive symptoms can herald and may be part of subsequent dementia and that antidepressant treatment at depression diagnosis doesn't avert dementia.
Associations between depression and subsequent dementia have been widely reported, but how these conditions are connected remains unclear. Using an Australian data-linkage system, researchers followed 4922 men, initially without clinically meaningful cognitive impairment, from 2001–2004 through June 2015 (baseline age range, 71–89).
At an average follow-up of 9 years, 18% of men received dementia diagnoses (determined by hospital codes), and 38% died dementia-free. Based on baseline hospital codes, self-reported depression histories, and a patient-completed geriatric-depression scale, adjusted risk estimates (sub-hazard ratios [SHRs]) for subsequent diagnoses of dementia were 1.3 among men who had ever been depressed and 1.5 among those with baseline depression. Risks for later dementia were linearly associated with baseline depression symptom severity (SHRs: questionable depressive symptoms, 1.2; mild-moderate symptoms, 1.7; severe symptoms, 2.1). SHR was 2.6 for subsequent dementia risk in those who were depressed at baseline and taking antidepressants. Antidepressant use at baseline did not reduce subsequent dementia risk. Individuals depressed at baseline were at highest risk for dementia within the next 5 years (SHR, 2.7), after which the risk fell considerably.
COMMENT
Within the limitations imposed by use of hospital codes, registry data, and self-report depression scales, these findings suggest two intriguing possibilities. First, the elevated risk for dementia within 5 years of diagnosed late-life depression (with subsequent fall-off of risk) might indicate that the depressive symptoms are prodromal of an unrecognized early dementing process. Second, antidepressants in late-life depression might confer no protective antidementia effects. Additional studies to clarify these possibilities are necessary. Nevertheless, regardless of whether dementia is in the offing, clinicians will want to alleviate suffering by actively treating depressive episodes in elderly patients.
Being told you're delusional does not necessarily mean you're mental.
