New study supports link between Omega-3 supplementation and reduction in depression

According to the World Health Organization, depression is a major cause of disease burden worldwide, affecting an estimated 350 million people.

According to the National Institutes of Mental Health, in 2014, an estimated 15.7 million adults aged 18 or older in the United States had at least one major depressive episode in the past year. 

A new meta-analysis published in Translational Psychiatry supports the link between intake of EPA and DHA omega-3 fatty acids, the kind found in fish, and reduction in major depressive disorder (MDD).

The meta-analysis includes 13 studies with 1233 participants and, according to the authors, showed a benefit for EPA and DHA comparable to effects reported in meta-analyses of antidepressants. 

The present meta-analysis observed a beneficial overall effect of omega-3 PUFA supplementation in patients with MDD according to diagnostic criteria, which seemed larger in studies that supplemented higher doses of EPA and included patients taking antidepressants. Future precision/personalized medicine trials should establish whether possible interactions between EPA and antidepressants could provide targets to improve antidepressant response and its prediction. Nevertheless, potential long-term biochemical side effects of high-dosed add-on EPA supplementation should be carefully monitored.

According to the study's lead author Dr. RJT Mocking, Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands, "This new meta-analysis nuances earlier research on the importance of long chain omega-3s in MDD."

 

Article courtesy medical news today

Refugees at Much Greater Risk of Psychotic Disorders

Refugees are at much greater risk of developing a psychotic disorder, such as schizophrenia, compared to non-refugee migrants from the same regions, according to a new study by a team of researchers at Karolinska Institutet in Sweden and the University College London (UCL).

Since World War II, the world has not seen so many displaced people, asylum seekers, and refugees as there are today. While it is well-known that refugees are at an increased risk of mental health problems, such as post traumatic stress disorder (PTSD), anxiety, and depression, little is known about their risk of psychosis.

For the study, the researchers set out to compare the risk of schizophrenia and other non-affective psychotic disorders in refugees to people in two other groups: the general Swedish population (those born to two Swedish parents) and non-refugee migrants from four major refugee generating regions (the Middle East and north Africa, sub-Saharan Africa, Asia, Eastern Europe, and Russia).

Using national register data, the investigators examined more than 1.3 million people in Sweden, and tracked diagnoses of non-affective psychotic disorders among the population. On a per capita basis, Sweden has granted more refugee applications than any other well-developed country, and in 2011, 12 percent of the total immigrant population were refugees.

The findings revealed that refugees granted asylum were on average 66 percent more likely to develop schizophrenia or another non-affective psychotic disorder than non-refugee migrants. In addition, they were up to 3.6 times more likely to do so than the Swedish-born population. The increased rates of psychosis in refugees was significant for all areas of origin except sub-Saharan Africa, for whom rates in refugees and migrants were similarly high.

One possible explanation is “that a larger proportion of sub-Saharan Africa immigrants will have been exposed to deleterious psychosocial adversities before emigration, irrespective of refugee status,” suggest the authors. It’s also possible that “post-migratory factors, such as discrimination, racism, and social exclusion” may explain these high rates.

Overall, they say “our findings are consistent with the hypothesis that increased risk of non-affective psychotic disorders among immigrants is due to a higher frequency of exposure to social adversity before migration, including the effects of war, violence, or persecution.”

The researchers add that the findings emphasize “the need to take the early signs and symptoms of psychosis into account in refugee populations, as part of any clinical mental health service responses to the current global humanitarian crises.”

Article courtesy of psych central news

Can a heartburn drug cause cognitive problems?

A new study has shed light on one of the long-term effects of proton pump inhibitors (PPIs). These drugs are commonly used to treat gastroesophageal reflux disease (GERD), heartburn, and peptic ulcers. PPIs (omeprazole, lansoprazole, esomeprazole, pantoprazole, and others) help reduce the amount of stomach acid made by glands in the lining of the stomach.

Research published online on February 15 in JAMA Neurology showed that there may be an association between chronic use of PPIs and an increased risk of dementia. Experts compared prescription PPI intake and diagnosis of dementia among approximately 74,000 adults ages 75 and older. In the study, chronic PPI use was defined as at least one prescription every three months in an 18-month window. The most common PPIs in use were omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium). All participants were free of dementia at the study’s beginning. Yet, after the eight-year follow-up, chronic PPI users had a 44% increased risk of dementia compared with those who did not take any medication. Men were at a slightly higher risk than women. Occasional users of PPIs had a much lower risk.

Putting the results in perspective

The researchers were quick to stress that this study only provided a statistical association between PPI use and risk of dementia, and that taking PPIs does not automatically mean you will get dementia. However, the study continues the ongoing discussion about the impact of long-term medication use, according to Dr. Houman Javedan, clinical director of inpatient geriatrics at Harvard-affiliated Brigham and Women’s Hospital. “Older adults take more medications as they age, and often continue them long after they are still necessary,” he says. “They either get used to taking it, and do not think to ask their doctor if they should stop, or they are afraid of what might happen if they do.”

Many older adults also take multiple drugs at one time, a situation known as polypharmacy. In fact, an estimated 44% of men and 57% of women older than age 65 take five or more medications; 12% of both men and women in this age group take 10 or more. “How different drugs interact with each other, and what the consequences of long-term use are, continues to be explored by scientists, as the researchers tried to do in this case with PPIs,” says Dr. Javedan.

It is not clear how PPIs might make a person more vulnerable to dementia. Evidence suggests parts of the drug may cross the blood–brain barrier, which becomes more porous as a person ages, and interact with brain enzymes. In initial animal studies, PPIs were shown to increase levels of beta amyloid in the brains of mice, and higher amounts of this protein have been linked to dementia and Alzheimer’s disease. Other research has shown a possible connection between chronic PPI use and vitamin B₁₂ deficiencies, as well as an increased risk of osteoporosis. “There still may be other mechanisms at work that are unknown,” says Dr. Javedan. “But this study raises the question whether chronic PPI usage is safe, especially among the older population.”

What you should do if you take PPIs

If you currently take PPIs every day, or have for more than 18 months, you should consult with your doctor about whether to continue at your current dosage, Dr. Javedan suggests. “You only may need it when you have symptoms and not endlessly.”

Article courtesy of Harvard health publications

8 ways to quell the fire of heartburn

Heartburn is a common problem. It's caused by the backwash of stomach acid into the esophagus, the tube connecting the mouth and stomach. This is formally called gastroesophageal reflux disease (GERD). More than just a minor discomfort, heartburn can significantly reduce quality of life. "Heartburn can cause damage to the esophagus and even increase the risk of cancer if ignored and untreated," says Dr. William Kormos, editor in chief of Harvard Men's Health Watch and a primary care physician at Massachusetts General Hospital.

These eight steps can help ease heartburn.

1.      Eat in a heartburn-smart way. Large meals put pressure on the muscle that normally helps keep stomach contents from backing up into the esophagus. The more you eat, the longer it takes for the stomach to empty, which contributes to reflux. Try smaller, more frequent meals — and don't wolf down your food.

2.      Avoid late-night eating. Having a meal or snack within three hours of lying down to sleep can worsen reflux, causing heartburn. Leave enough time for the stomach to clear out.

3.      Don't exercise right after meals. Give your stomach time to empty; wait a couple of hours. But don't just lie down either, which will worsen reflux.

4.      Sleep on an incline. Raising your torso up a bit with a wedge-shaped cushion may ease nighttime heartburn. Wedges are available from medical supply companies and some home goods stores. Don't just prop your head and shoulders up with regular pillows — doing so can actually increase pressure on the stomach by curling you up at the waist.

5.      Identify and avoid foods associated with heartburn. Common offenders include fatty foods, spicy foods, tomatoes, garlic, milk, coffee, tea, cola, peppermint, and chocolate. Carbonated beverages cause belching, which also causes reflux.

6.      Chew sugarless gum after a meal. Chewing gum promotes salivation, which helps neutralize acid, soothes the esophagus, and washes acid back down to the stomach. But avoid peppermint-flavored gum, which may trigger heartburn more than other flavors.

7.      Rule out medication side effects. Ask your doctor or pharmacist whether any of the medications you take might cause pain resembling heartburn or contribute to reflux.

8.      Lose weight if you need to. Being overweight puts more pressure on the stomach and pushes stomach contents into the esophagus. The tight-fitting clothing and belts that come with weight gain may also be a factor. 

Article courtesy of Harvard health news

Breaking Down Symptoms of Bipolar Disorder: Mania

 Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. 

The manic phase of bipolar disease is characterized by intense euphoria or irritability and high energy. To be diagnosed as a manic episode, you have to experience three of the listed symptoms, or four for irritability. Each of these can be fleshed out extensively, but here’s a simple breakdown:

1 “Inflated self-esteem or grandiosity”
Grandiosity is an inflamed sense of superiority. You become self-involved, thinking you’re the best and the brightest, even when there isn’t really evidence to back it up. Anger is not uncommon if anyone contradicts you. If psychosis or delusions occur, you might think you’re in a relationship with a famous person or that you are president or a god.

2 “Decreased need for sleep”
It’s important to note that this does not mean the same thing as insomnia or just not being able to sleep. During a manic episode you may feel fully rested and energetic after only a few hours of sleep. Staying up for days at a time is not uncommon.

3 “More talkative than usual or pressure to keep talking”
This comes into play if you’re not typically chatty and suddenly finding yourself talking non-stop or striking up conversations with strangers at the grocery store. The pressure to keep talking is your brain telling you that you need to keep speaking even if you don’t know what to say. You may become loud or interrupt frequently. If you’re irritable you may decide it’s a good time to rant at your boss in front of all of your co-workers.

4 “Flight of ideas or subjective experience that thoughts are racing.”
Your thoughts are moving faster than you can process them. You may jump from one idea to another in half a second. When you combine this with being more talkative, you may stop making sense if what you’re saying is trying to keep up with what you’re thinking.

5 “Distractibility”
This one is fairly straightforward. Instead of focusing on the task at hand or on the person who is speaking to you, you flip your focus from what’s going on across the room to the mustard stain on the person’s shirt .

6 “Increase in goal-directed activity.”
You suddenly decide you’re going to run in a marathon next week when you’ve never even owned a pair of running shoes. It could also be something less extreme like cleaning the entire house and rearranging all of the furniture. You may decide to do all of these things at once yet do nothing to actually reach these goals. Some goals may involve work projects or relationships.

7 “Excessive involvement in activities that have a high potential for painful consequences”
Typically, this symptom is characterized as “risky behaviour,” which is a little vague. When experiencing mania, risk-taking rises to a whole new level. We’re talking spending hundreds or thousands of dollars because you suddenly decided you needed a room full of fish tanks. Maybe your sex drive goes into hyper drive and you decide to have an affair with several different people. Perhaps you just get in the car and drive until the gas runs out. Then just get out and keep walking. There is no end to the list of ideas that sound fantastic when you’re manic.

These are only a few examples of what can happen during mania. Eventually, it ends, and you have to face the consequences. The best thing to do is keep track of your behaviour and call your doctor if anything starts changing.

Article courtesy of LaRae LaBouff, Psych central