|News & Information for May 18-19, 2019
★ Genetic theory of depression collapses: hundreds of studies falsified
In 1996, a group of European researchers found that a certain gene, called SLC6A4, might influence a person’s risk of depression. It was a blockbuster discovery at the time. The team found that a less active version of the gene was more common among 454 people who had mood disorders than in 570 who did not. In theory, anyone who had this particular gene variant could be at higher risk for depression, and that finding, they said, might help in diagnosing such disorders, assessing suicidal behavior, or even predicting a person’s response to antidepressants. […]
But a new study—the biggest and most comprehensive of its kind yet—shows that this seemingly sturdy mountain of research is actually a house of cards, built on nonexistent foundations. […] Using data from large groups of volunteers, ranging from 62,000 to 443,000 people, the team checked if any versions of these genes were more common among people with depression. “We didn’t find a smidge of evidence,” says Matthew Keller, who led the project. […] “This should be a real cautionary tale,” Keller adds. “How on Earth could we have spent 20 years and hundreds of millions of dollars studying pure noise?”
“What bothers me isn’t just that people said [the gene] mattered and it didn’t,” wrote the psychiatrist Scott Alexander in a widely shared blog post. “It’s that we built whole imaginary edifices on top of this idea of [it] mattering.” Researchers studied how SLC6A4 affects emotion centers in the brain, how its influence varies in different countries and demographics, and how it interacts with other genes. It’s as if they’d been “describing the life cycle of unicorns, what unicorns eat, all the different subspecies of unicorn, which cuts of unicorn meat are tastiest, and a blow-by-blow account of a wrestling match between unicorns and Bigfoot,” Alexander wrote.
Ian’s thoughts: Given that the gene in question, SLC6A4, is “responsible for getting a chemical called serotonin into brain cells,” this result seems to also undermine the serotonin theory of depression. If variance in serotonin causes variance in depression, then variance in the gene controlling for serotonin would be a likely candidate for affecting depression. But it seems not. So after a 23-year unicorn chase, it might be time to check our premises.
Protesters demonstrate in Montreal against the use of electric shock therapy in psychiatry
Demonstrators rallied in Montreal Saturday to denounce the use of electric shock therapy, also known as electroconvulsive therapy (ECT), to treat psychiatric disorders.
The treatment, as described by the Mayo Clinic, involves sending small electric currents through the brain to trigger a brief seizure and change the patient’s brain chemistry. It is a procedure which is done under general anesthesia. Pare-chocs, the group organizing the protest, is calling for an end to the practice. In Quebec, the group contends that 11,000 ECT treatments were administered in 2017, up by 1,000 over the previous year. […] “We see that the rates in different places in Quebec are going up and we are against electroshock because it causes potential damage to the brain. We have other things that work well without causing damage, so we are here to denounce that situation.”
Dementia: New WHO prevention guidelines evaluate 12 risk factors
Millions of people around the world have a form of dementia, but scientists are still unsure exactly what causes this condition. Nevertheless, newly published prevention guidelines from the World Health Organization evaluate 12 risk factors and offer advice on how to tackle them. […] Earlier this week, the World Health Organization (WHO) published a new set of guidelines — downloadable from their website — that seek to advise governments, policymakers, and healthcare providers on how best to tackle dementia prevention.
How Smartphones Sabotage Your Brain’s Ability to Focus
Our phones give us instant gratification. But there’s a cost: loss of attention and productivity. WSJ’s Daniela Hernandez goes on a quest to understand the science of distractions and what you can do stay be more focused and productive.
Extrapyramidal symptoms from antipsychotics differ with age
Patient age is significantly associated with the type of extrapyramidal symptoms that stem from antipsychotic use, according to a study presented during a poster session at the American Psychiatric Association’s annual meeting. “Antipsychotic medications are widely used to treat a growing number of mental health disorders. However, their utility may be limited by the potential to cause serious movement adverse reactions,” wrote poster presenter Areef S. Kassam, MD, and coauthor Elizabeth Cunningham, DO. “Akathisia, dystonia, parkinsonism, and tardive dyskinesia (collectively known as extrapyramidal symptoms or EPS) are associated with reduced social and occupational functioning, negative patient attitudes toward treatment, and nonadherence to pharmacotherapy.” […] The study revealed a significant association with age and EPS type: patients with akathisia and dystonia tended to be younger, while patients with parkinsonism and tardive dyskinesia tended to be older, according to the poster abstract. In addition, the investigation showed patients with tardive dyskinesia had a greater average body mass index (BMI) and were more likely to be female.
Concomitant use of lithium and antipsychotics may be neurotoxic
Concomitant use of lithium and antipsychotics, particularly haloperidol, may be associated with neurotoxicity in some patients, and should therefore be carefully monitored, according to research presented at the American Psychiatric Association Annual Meeting, held May 18-22, 2019, in San Francisco, California.1 […] “The simultaneous use of lithium with antipsychotics, especially the high potency ones like haloperidol, should be either avoided or monitored very cautiously. Blood levels of both lithium and the antipsychotic must be checked regularly and any potential symptoms or signs of neurotoxicity should be looked for carefully,” concluded the case study authors.
Potential pitfalls of using antidepressants for anxiety disorders
Clinicians should consider their long-term strategy before initiating antidepressants in patients with anxiety disorders, researchers urged at the American Psychiatric Association’s annual meeting, warning of high relapse rates and hazards of later discontinuation. […] Dr. Batelaan outlined a systematic review and meta-analysis the group did, which was published in the BMJ in 2017. It summarized results from 28 studies, with follow-up periods of 8 to 52 weeks, and a total of more than 5000 patients. It found that more than one-third of patients (36.4%) relapsed within the follow-up period. Other research has shown most such relapses take place within the first few months after discontinuation. […] “I think we should inform our patients at the beginning of the treatment about all of these issues. We should tell them that there are high relapse rates,” Dr. Scholten said. “We should inform patients that it’s not always easy for people to discontinue their antidepressants… We should also inform people that treatment is not always guaranteed for a long-lasting effect, even for CBT.”
Naltrexone XR May Be Associated With Dysphoria, Suicide Ideation
Monthly injections of naltrexone extended-release (naltrexone XR) may induce a dysphoric state and suicidal ideation in some patients, according to a case study presented at the American Psychiatric Association Annual Meeting, held May 18-22, 2019, in San Francisco, California. These adverse effects underscore the need for clinicians to give patients an oral test dose of naltrexone XR before initiating treatment. Researchers described the case of a woman aged 36 with opioid dependence who presented with severe anxiety, suicidal ideation, and dysphoria following an initial naltrexone injection. […] “In this era of the opioid epidemic, the use of naltrexone XR will only increase given its success in assisting with abstinence from opioids. Clinicians should be aware of the need to administer an oral test dose, as well as educate and be vigilant of the existence and time course of potential adverse reactions, including dysphoria and even suicidal ideation,” concluded the authors of the case study.