Health Workers At-home exercise may help reduce depression symptoms, burnout, and absenteeism in healthcare workers, according to a new study. The randomized clinical trial followed 288 healthcare workers over 12 weeks and found a reduction in depressive symptoms among participants who exercised for 80 minutes per week with an application-based program. Adherence to the program decreased to 23% of participants by the end of the study, however. When combined with institutional support, "this is one solution that an individual can take to support themselves a little bit better," study author Eli Puterman, PhD, Canada Research Chair in Physical Activity and Health and associate professor of kinesiology at the University of British Columbia in Vancouver, told Medscape Medical News. Improved Mental Health 6 tips to improve mental health | STEPS Group Australia During the COVID-19 pandemic, healthcare workers faced many new challenges and stressors. Concern about burnout and absenteeism among health workers also rose during this period and motivated the study. The pandemic likely exacerbated and revealed the extent of mental health concerns in the workforce, said Puterman. "There was already a lot of burnout. There was a lot of stress, a lot of sick leave. I think the pandemic really brought these issues to light, and it just made them worse as well," he added. The study participants had notably higher baseline depression scores than the prepandemic averages. Between April and July 2022, the investigators recruited nearly 300 healthcare workers with low activity levels from an urban healthcare organization in British Columbia. They assigned participants to an intervention or control group for the 12-week study. The intervention group was asked to complete four 20-minute exercise sessions each week using apps that guided users in yoga, running, barre, and body weight interval training. The control group was placed on a wait list and received the apps at the end of the study. The study population was racially and ethnically diverse, and there was a greater level of participation from nurses, who constitute a large part of the workforce. Roughly 85% of participants were women. By the end of the 12 weeks, the investigators found a small to medium reduction in depressive symptoms (effect size [ES], −0.41), measured with the Center for Epidemiological Studies Depression Scale. Smaller, but still significant, effects were seen as early as 4 weeks into the study. The investigators also found significant improvements among participants following the exercise program in symptoms of burnout, including cynicism (ES, −0.33) and emotional exhaustion (ES, −0.39), as well as absenteeism (r = 0.15). Application-Based The investigators designed the study with an at-home, application-based program through the Down Dog suite of exercise apps. This approach provided a low-cost option that was convenient during the height of the pandemic when gyms and other exercise facilities were closed. "There's an ease to at-home exercise that fulfills that need," said Puterman. From an institutional perspective, app subscriptions are also more cost-effective than expensive gym memberships, for example. In the future, Puterman hopes to extend the study to more health workers across British Columbia and assess whether exercise interventions can help reduce healthcare expenditure. Exercise apps may not be suitable for everyone, though. In the first week of the trial, about half of the participants completed the full 80 minutes of exercise with the apps. At week 12, that adherence dropped to less than a quarter of participants. The low adherence at the end of the trial was "eye opening" for Puterman, who said that it demonstrated the importance of support mechanisms for maintaining good exercise habits. By contrast, one of his previous studies maintained greater adherence, which Puterman attributed to weekly phone calls to check in with participants. "Timely, Relevant, Interesting" Commenting on the study for Medscape, David Gratzer, MD, a physician and attending psychiatrist at the Centre for Addiction and Mental Health in Toronto, said that it is a well-designed investigation of a low-cost and highly scalable intervention for an increasingly relevant issue. Gratzer was not involved in the research. "Research on burnout and a practical, real-world intervention is not only interesting from a literature perspective, it's also highly relevant across North America," said Gratzer. He summarized the study as "timely, relevant, interesting." Gratzer noted that the low adherence is a limitation of the study. "It's not a cure-all or a panacea for all burnout," he said. Rather, it may provide one possible low-cost option for some healthcare workers struggling with burnout and depressive symptoms. Puterman hopes that institutions and governments will invest more in improving healthcare workers' access to a range of mental health resources, adding that "there is a move in the right direction." The study was supported by the Kinesiology Equipment and Research Accelerator Fund at the University of British Columbia's School of Kinesiology. Puterman and Gratzer reported no relevant financial relationships.

Some of my girlfriends that have been on medications for mood disorders for most of their adult lives are faced with the dilemma of discontinuing medications during pregnancy. A Swedish study found that discontinuing antidepressant medication during pregnancy (but not before) is associated with an apparent increased risk of psychiatric emergency compared to continuing treatment throughout pregnancy. Taking medications during pregnancy has risks and benefits. Read the information below from Mayo Clinic to learn more: Why is treatment for depression during pregnancy important? If you have untreated depression, you might not seek prenatal care or eat the healthy foods you and your baby need. Having major depression during pregnancy is associated with an increased risk of premature birth, low birth weight, decreased fetal growth and other problems for the baby. Unstable depression during pregnancy also increases the risk of postpartum depression and difficulty bonding with your baby. Are antidepressants an option during pregnancy? Yes. A decision to use antidepressants during pregnancy, in addition to counseling, is based on the balance between risks and benefits. The biggest concern is typically the risk of birth defects from exposure to antidepressants. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. However, some antidepressants are associated with a higher risk of complications for your baby. Talking to your health care provider about your symptoms and medication options can help you make an informed decision. If you use antidepressants during pregnancy, your health care provider will try to minimize your baby's exposure to the medication. This can be done by prescribing a single medication at the lowest effective dose, particularly during the first trimester. Keep in mind that psychotherapy also is an effective treatment for mild to moderate depression. Which antidepressants are considered OK during pregnancy? Generally, these antidepressants are an option during pregnancy: Certain selective serotonin reuptake inhibitors (SSRIs).SSRIs are generally considered an option during pregnancy, including citalopram (Celexa) and sertraline (Zoloft). Potential complications include maternal weight changes and premature birth. Most studies show that SSRIs aren't associated with birth defects. However, paroxetine (Paxil) might be associated with a small increased risk of a fetal heart defect and is generally discouraged during pregnancy. Serotonin and norepinephrine reuptake inhibitors (SNRIs).SNRIs also are considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR). Bupropion (Forfivo XL, Wellbutrin SR). Although bupropion isn't generally considered a first line treatment for depression during pregnancy, it might be an option for women who haven't responded to other medications. Research suggests that taking bupropion during pregnancy might be associated with miscarriage or heart defects. Tricyclic antidepressants. This class of medications includes nortriptyline (Pamelor) and desipramine (Norpramin). Although tricyclic antidepressants aren't generally considered a first line or second line treatment, they might be an option for women who haven't responded to other medications. The tricyclic antidepressant clomipramine (Anafranil) might be associated with fetal birth defects, including heart defects. Are there any other risks for the baby? If you take antidepressants during the last trimester of pregnancy, your baby might have temporary signs and symptoms of quitting the drug — such as jitters, irritability, poor feeding and respiratory distress — for up to a month after birth. However, there's no evidence that discontinuing or tapering dosages near the end of pregnancy reduces the risk of these symptoms for your newborn. In addition, changing your treatment might increase the risk of a relapse postpartum, especially for severe depression. The connection between antidepressant use during pregnancy and the risk of autism and attention-deficit/hyperactivity disorder in offspring remains unclear. But most studies have shown that the risk is very small, and some studies have shown no risk at all. Further research is needed. A new study also suggests a link between use of antidepressants during pregnancy, specifically venlafaxine and amitriptyline, and an increased risk of gestational diabetes. More research is needed. Should I switch medications? The decision to continue or change your antidepressant medication will be based on the stability of your mood disorder. Talk to your health care provider. Concerns about potential risks must be weighed against the possibility that a different drug could fail and cause a depression relapse. What's the bottom line? If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Deciding how to treat depression during pregnancy isn't easy. The risks and benefits of taking medication during pregnancy must be weighed carefully. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health. Source: Psychiatric Times

Adult ADHD is a condition that is often underappreciated in older adults, with less than half being diagnosed and many never receiving treatment. Negative consequences can include job loss, suppressed income levels, low educational attainment, and difficulty maintaining relationships. Primary care physicians or family medicine clinicians are often best placed to diagnose ADHD in older adults, but they may struggle to distinguish ADHD symptoms from other conditions of aging such as mild cognitive impairment. Although no formal US guidelines exist on diagnosis of adult ADHD, adults usually present with symptoms such as chronic forgetfulness, distractibility, or procrastination. Hyperactivity is more internalized as a feeling of internal restlessness in this age group, rather than the more visible hyper behavior seen in children. To assess the possibility of ADHD, clinicians can use a six-item screening test or a longer 18-item screening tool developed by the World Health Organization. To make an ADHD diagnosis definitively, a patient needs to report sustained difficulties in at least two aspects of life: work, home, or social situations, and indicate that these troubles began before age 12. Undiagnosed adults may develop coping mechanisms without being aware of them, such as avoiding socializing, being overly punctual, studying in a cold basement, having structured checklists, and finding ways to work without paper. ADHD symptoms result from brain differences of disordered self-regulation and executive functioning, and people with ADHD need to learn to think and act differently. On average, three-fourths of adults with ADHD never receive an accurate diagnosis or effective treatment, despite having the condition since childhood. Over their lifetimes, undiagnosed adults may develop coping mechanisms and compensations, some more helpful than others, without being aware of why they are doing so. Some coping mechanisms may look like obsessive-compulsive behaviors, but the difference between true OCD and ADHD is that true OCD is a more complex condition that requires a combination of medication and lifestyle changes.

The brain and body are intimately connected in health and illness. Three Aspects of Health and Healing: The Biopsychosocial Model in Medicine KEY POINTS Common illnesses have psychological and social components that combine with biology to cause disease. Biopsychosocial Model: Definition & Example The biopsychosocial model approaches illness in a multifactorial way. Biopsychosocial Model George Engel was the pioneer of the biopsychosocial model of disease. Engel’s model included the biological, psychological, and social dimensions of an individuals's life. The belief that the mind and body are separate entities makes no sense, right? If I cut off your head, could you continue to live? Of course not! But, for a few brilliant philosophers and early physicians, the mind and body were thought of as distinct entities for centuries. However, we now know many illnesses are significantly impacted not only by biological factors but by psychological and social factors as well. For example, untreated depression is an independent risk factor for cardiovascular disease. Anxiety can cause gastrointestinal illness. Stressful home or work environments can initiate or exacerbate the symptoms of autoimmune disorders. To successfully treat these disorders, a more holistic approach to illness management was conceptualized by some early pioneers in medicine. In the decades that followed, this would evolve into the biopsychosocial model. In the 19th and 20th centuries, as medicine advanced, greater emphasis was placed on cellular mechanisms of disease. When Pasteur and Koch made their discoveries about the role of bacteria in disease, they laid the groundwork for the principle that for every disease, there is a single specific cause. As a result, mental or emotional factors took a less prominent role. George Engel, the most prominent pioneer of the biopsychosocial model of disease, was born into a prominent medical family in 1913. He was greatly influenced by his uncle Manny, a famous physician who treated an elite clientele. George was also influenced by his mother but in a different way. Mrs. Engel was described as “dramatic” and suffered from multiple physical complaints that were out of proportion to any physical findings. She was diagnosed as a “hysteric” because no biological basis could be found for her many physical symptoms. In modern terms, she most likely had an illness that would be classified as psychosomatic, a term later made famous by her son. As an adult, George reflected, “She was an influence on my life with which I struggled—that it be my destiny to solve the problems Uncle Manny could not.” During his extensive career, George’s focus remained on trying to understand how psychological phenomena could influence physiology. The principles of Engel’s model included the biological, psychological, and social dimensions of an individual’s life and the perception that individuals suffer as a whole, not as isolated organs. Physicians, therefore, should use a holistic approach regarding illness, including the patient’s emotional state as well as their environment. How Is the Biopsychosocial Model of Illness Used Today? The biopsychosocial (BPS) model of wellness and medicine examines how biological, psychological, and social elements impact health and disease. The BPS model stresses the interconnectedness of these factors. The causes of common illnesses such as heart disease and cancer have psychological and social components that combine with biology to cause illness. For example, it is estimated that 30 percent of cancers are associated with tobacco use, and diet accounts for a proportion of digestive tract cancers. So, the biological factor may be a family predisposition to cancer, but if you smoke, that risk adds to your genetic loading. Similarly, if your family has a risk for gastrointestinal cancers and you eat a diet high in processed foods, red meat, and sugar, your risk increases overall. On the other hand, understanding the various psychological and social risk factors for disease can help mitigate your genetic inheritance. For example, heart disease risks are increased by factors such as hypertension, smoking, high cholesterol, and type A personality traits. Learning to modify these risks can help offset the generic risk. As an example, the biopsychosocial model was used to develop new treatment approaches for patients living with chronic pain, which affects approximately 50 million Americans. Traditionally, pain research focused on sensory modalities, and neurological transmissions were identified only on a biological level. In other words, the experience of pain was conveyed directly from your skin to your brain without consideration of psychological or social factors. This was called the reductionist or biomedical view of pain. Your nervous system is composed of two major parts or subdivisions, the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS includes the brain and spinal cord. The brain is the body’s control center. The PNS is a vast network of nerves that are linked to the brain and the spinal cord. The gate control theory of pain was formulated in 1965 by a neurobiologist and a psychologist who proposed that spinal nerves act as gates that either allow pain to reach the brain, or close these gates and prevent pain messages from getting through. This theory helped researchers understand how individuals experience different types of pain and develop strategies for treatment. So, what influences your perception of pain? Emotions: Negative emotions like anxiety, depression, and chronic stress can increase pain. Once you’re in the cycle of depression and pain, it can be difficult to know whether your depression is making your pain worse, or whether your pain is worsening your depression Brain disorders: Your brain is the processing center for pain, so if part of the brain isn’t working correctly, you might not process pain in a healthy way. People with schizophrenia, for example, often don’t perceive pain in the same way as those without this disorder. Stronger signals: An old wife’s tale suggests if you hurt yourself, you should rub the affected spot. This is a great example of “closing the gates” of pain. When your brain perceives a secondary stronger signal coming in, it doesn’t pay as much attention to the first painful signal. My dentist demonstrated this to me one day when I needed a novocaine shot to have her work on my teeth. She was able to give me the shot without causing any pain because she put pressure on the inside of my cheek for a few minutes before inserting the needle loaded with anesthetic. Drug use: Prescription medications as well as illegal drug use affect the way your body processes and perceives painful stimuli. Opioids, which are often prescribed for pain, have a strong “gate-closing” effect—usually. However, overusing opioids can cause a rebound effect and lead to increased sensitivity to pain over time. Central sensitization: People with chronic pain often experience heightened pain responses to nearly everything. If you live with chronic pain daily, your nervous system develops an abnormal response to everyday stimuli. For example, clothing may hurt, and walking may be too painful to bear. In other words, things that seem innocuous and theoretically shouldn’t be perceived as painful, are the reality for those with conditions like rheumatoid arthritis or fibromyalgia. In these disorders, the body’s gates are left wide open and often require medical assistance to shut again. There are other proven differences in how individuals perceive and respond to pain. Devising a “one size fits all” approach simply would not, and does not, work effectively. As the biopsychosocial model evolved and spread through the scientific and medical communities, it became increasingly apparent that managing chronic pain through solely biological pathways was a dead end. This new approach offered valuable additional avenues for pain management that diversified the number of treatment providers capable of managing chronic pain and led to breakthrough clinical approaches with better outcomes. Understanding these factors is critical to providing a successful treatment plan for those with chronic pain. For example, nutritional education, assessment, and treatment for sleep disturbance, and learning to moderate alcohol use can all improve the experience of pain for

Anger is an emotion characterized by antagonism toward someone or something you feel has deliberately done you wrong. Anger can be a good thing. It can give you a way to express negative feelings, for example, or motivate you to find solutions to problems. But excessive anger can cause problems. Anger is learned behavior; and so is hatred.

Senior Psychiatrist Harmed By Antidepressants | An Interview with Peter Gordon Dr. Peter Gordon: “Over 25 years ago, my son had just been born, I was sitting my membership exam for the Royal College of Psychiatrists . . . and I wasn’t sleeping well — young baby, disturbed nights, I’ve always been a little on the anxious side, I was distressed. I went to my GP in rural Aberdeenshire, which is quite remote in Scotland, and my GP recommended that I start an antidepressant for what, she explained to me — and I knew this, because I was studying psychiatry at the time — was social anxiety disorder. And a new drug was being widely marketed at that time, widely promoted, really across the Western world, and that drug was paroxetine — Paxil, Seroxat. At this time in Scotland we had what was called a ‘Defeat Depression’ campaign — and it later transpired this five-year campaign was almost entirely sponsored by the pharmaceutical industry — and it was to try and tackle ‘low rates of diagnosis of depression’ and ‘make sure a treatable condition was treated.’ And a major part of that, and what I told my patients and what I was taught on a daily basis — and some senior psychiatrists today try and make out this wasn’t the case — but certainly in Scotland every single week that I went to education I was taught about the chemical imbalance, and the drug reps that came along to those meetings — it was all about 5-HT. So I thought it was perfectly safe for me to take an antidepressant for anxiety. And I took it and I probably felt a little bit better, not hugely — I wasn’t depressed, I was just anxious and not sleeping. But probably about three or four months in . . . I just stopped it because I thought it wasn’t making much difference. And the next day I felt hellish. I felt nausea, flooding, I’d slept poorly, I felt flu-like, I had buzzing in my head, I’m a keen gardener and I couldn’t work in the garden, I couldn’t sit down, I was restless. I thought, What’s going on here? And I said to my wife, I wonder, why am I feeling like this? Do you think it could have a relationship to the fact that I’ve just stopped my Seroxat, my Paxil? And that was the beginning of my discovery. And to cut a long story short, it’s been absolute hell ever since then trying to get off this medication that I was told I wouldn’t find dependence-forming. And not only was it hell, over probably the vast majority of my career right up until the end, many of my psychiatrist colleagues — good folk, nice folk that liked me — they didn’t believe me. They wouldn’t say it outright, but they would say things [like], ‘Oh, this is recurrence of Peter’s illness,’ and I would say to them, ‘Well I started this for anxiety, I didn’t have these states of mind and physical symptoms before this.’ These states were brought about from protracted withdrawal, however slowly I tried to get off this damn stuff . . . I tried everything . . . I must have tried about four or five times to come off it gradually, and eventually I got off it using liquid. It probably took me at least a year; I felt hellish but I got off the stuff. But in the course of the last few months, physically, I was feeling terrible, mentally, I was feeling terrible and I was getting lower and lower mood . . . So in 2005, this changed my life for good. My children were then wee — a wee daughter at kindergarten, a son at primary school. And I knew my mood was slipping, and I became suicidal. I wasn’t sleeping, I wasn’t eating, I was restless, I was agitated, I felt flu-like, I thought I was never going to get better. And then I became suicidal [and] ended up in a psychiatric hospital . . . [for] about three or four months. I tried to end my life. I was given multiple different psychiatric drugs to treat my depression, which — I was depressed, but — you can ask my wife, everybody who knows me — I’ve never had anything like this, it was directly related to the withdrawal from paroxetine. And then eventually I was getting ECT . . . the ECT, it was like a sledgehammer. So it certainly got rid of some of my worst feelings at the time. But as a result of the ECT I really don’t remember anything of — very little of — 2005, and that’s a mixed blessing. It’s good I don’t remember what I put my family through, but it’s also sad because my children were then wee, and you don’t really relive your family life again. So eventually with ECT I got to a sort of level state; it took me another seven or eight months before I got back to work. Eventually as an outpatient I insisted to my psychiatrist, ‘Look, I think the only thing you can do is’ — because at that time they tried me on different antidepressants, I can’t even remember which ones in combination — but eventually I said, ‘I think you should put me back on my Seroxat.’ And that’s 2005. So here I am 17 years later, I’m still on the stuff. And people have said, Oh Peter, why don’t you just try and withdraw slowly with tapering strips, and I have very seriously thought about that. And I’ve even heard some people say, Oh Peter, you don’t have balls, you know, you can get off this stuff. And well maybe they’re right, but I kind of believe life is — I only live life once, it’s fairly short, and I’m terrified, absolutely terrified — I can cope with much heartache myself, [but] I’m terrified of putting my family through what I put them through before. So to cut a long story short, here I am in 2023 still on this paroxetine that I was told was not dependent-forming and I shouldn’t be ashamed of taking. 20:19 The narrative in psychiatry has been very powerfully controlled by a fairly small group that’s had a wide influence on the rest of us. And here I’m not just blaming the pharmaceutical industry, certainly not. I actually blame more the medical, the healthcare system for just slavish — for rather not questioning enough of what we’re doing here, and not explaining to people that — people look for quick fixes, we all do, for suffering; nobody wants to suffer, so we want a quick fix . . . But in any intervention there could be a range from positive outcomes to negative outcomes and usually a whole host of in-between. So why has — antidepressants in particular, but not just them, antipsychotics and other drugs — why has it become so polarized? And I think partly that’s because these narrative controllers are very defensive. 22:25 I think there is plenty of evidence out there to show that the investment of money, the relationship of the pharmaceutical industry and medical prescribing — not just in psychiatry — can lead to worse outcomes because the interests of the company are put before the interests of the patient. 33:03 There is a small group of what I call the narrative controllers who have been career-long paid opinion leaders for the pharmaceutical industry and have been there ten, 20, 30, 40 years. Many of them are coming up to their retirement and they are still ‘educating.’ And there is no way of finding out how much they may have been paid in recent weeks, in previous months, previous years, or as a career. And I think the scale of payments could be massive. 46:23 What I saw on social media… I was briefly on it, probably 2014 for about six months, and at first I thought it’s great because it’s a leveler, it levels out people who are in high positions of power and you can say things that they don’t want you to ask them. [But] I quickly realized how nasty it can be . . . there’s some very senior members of the Royal College of Psychiatrists for example, and I’m sure it’s the same in America and Canada and Australia, who are extremely nasty, and get away with some of what if it was in the clinic would be the most unprofessional behavior. And it goes with a blind eye by the Royal College of Psychiatrists.” Dr. Josef Witt-Doerring: “There seems to be very little appetite for a conversation that doesn’t say ‘Antidepressant save lives,’ you know. As soon as you start talking about the risks of them I see people labeled as being ‘dangerous’ or ‘harmful’ or ‘pill shaming’ or, you know, ‘dissuading people from getting the help that they seek’ and . . . there’s this intimidation. And it was definitely something that I felt kind of subtly throughout my training, and then maybe a little bit more loudly when I saw people I really admired talk about these things, people like David Healy, and I look at what happened to him…”

CONFERENCE REPORTER Investigators found in a recent study that esketamine nasal spray for treatment-resistant depression (TRD) results in greater work productivity loss (WPL) improvements and cost savings in comparison to quetiapine extended-release treatment. They shared these results in a poster presentation at Psych Congress 2023. The poster presentation, titled “Costs Associated With Work Productivity Loss of Patients With Treatment-Resistant Depression Treated With Esketamine Nasal Spray Versus Quetiapine Extended Release: ESCAPE-TRD Subgroup Analysis,” described some of the results from the ESCAPE-TRD trial,1 a long-term comparison of esketamine nasal spray and quetiapine extended-release in combination with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in patients with treatment-resistant major depressive disorder (MDD).2 TRD poses considerable direct and indirect cost burdens to employers in the United States,1 with recent research finding that disproportionate health care costs and unemployment rates are associated with TRD.3 As such, the investigators sought to determine which treatment—esketamine nasal spray or quetiapine extended-release treatment—would result in the greatest cost savings and improvements in WPL.1 To explore this, the investigators evaluated WPL among adults with TRD who were receiving esketamine nasal spray versus those who were receiving quetiapine extended-release treatment per US label dosing. The participants were randomized to receive either esketamine nasal spray (56/84 mg) or quetiapine extended-release treatment (150 to 300 mg) in combination with an ongoing SSRI or SNRI.1 The investigators assessed WPL using Work Productivity and Activity Impairment (WPAI) scores among the participants who were employed. The mean change in WPL versus baseline and mean differences (MD) between the esketamine nasal spray and quetiapine extended-release groups were reported at weeks 8 through 32 post-baseline using mixed models for repeated measurements. Per-patient indirect cost savings were estimated using mean US$2021 weekly wages from the US Bureau of Labor Statistics.1 Upon evaluation at baseline, total WPL was 77.0% in the esketamine nasal spray group (N=150) and 72.5% in the quetiapine extended-release treatment group (N=151).1 Upon evaluation at week 8, total WPL had decreased from baseline by 30.3% and 17.3% in the esketamine nasal spray and quetiapine extended-release treatment groups (MD=13.0%;95% confidence interval [CI]:6.3%-19.8%), resulting in respective weekly cost savings of $363 and $207 in the esketamine nasal spray and quetiapine extended-release treatment groups (MD=$156; 95%CI:$76-$237).1 Upon evaluation at week 32, total WPL had decreased from baseline by 45.3% and 32.5% in the esketamine nasal spray and quetiapine extended-release treatment groups (MD=12.7%; 95%CI:4.7%-20.7%), with respective weekly cost savings of $543 and $390 (MD=$153; 95%CI:$57-$250).1 “Among employed adults with TRD, [esketamine nasal spray] treatment was associated with significantly larger improvements in WPL and related costs compared to [quetiapine extended-release treatment], suggesting benefits from a patient wellbeing and employer perspective,” the investigators concluded. The research outlined in this poster presentation was contributed by Amanda Teeple, MPH, of Janssen Scientific Affairs, LLC, and colleagues from Janssen, Analysis Group Inc, and Right Solutions Mental Health, LLC.

Patients who suffered childhood or adolescent anxiety and those who were born to parents with bipolar disorder are at an increased risk for developing bipolar disorder in adulthood. A systematic review published in the journal Bipolar Disorder found evidence that the presence of anxiety disorders in childhood or adolescence increases patient risk for developing bipolar disorder (BD) later in life. Investigators from King’s College London searched publication databases through September 2022 for longitudinal studies examining BD risk. A total of 16 studies comprising 21 reports with a total sample size of 2,433,761 study participants recruited from 10 countries were included in this review. The studies included patients who experienced anxiety in childhood or adolescence, as well as patients born to parents with bipolar disorder who also experienced early-life anxiety. One study with 10 years of follow-up data for patients aged 14 to 24 years reported that the presence of obsessive-compulsive disorder and specific phobia increased the risk for BD onset by 590% and 120%, respectively. In addition, the study found a significant link between separation anxiety disorder and the later development of BD in a subsample of patients aged 14 to 17 years. The study included 4 years of follow-up data and reported that separation anxiety increased the risk for BD by 7-fold. In addition, a study that employed a machine-learning approach using data from a large birth cohort reported that a diagnosis of suicidality, followed by generalized anxiety disorder by the age of 18 years were the first- and second-best predictors for BD risk, respectively. "[T]his review suggests that anxiety in childhood or adolescence increases the risk of later bipolar disorder and may represent a clinically useful marker of vulnerability to major mood disorders in bipolar offspring." In a study that assessed patients with hypomania spectrum episodes at ages 16 and 17 years, researchers found that the risk for developing BD at 15 years follow-up was associated with the presence of either a panic disorder or generalized anxiety disorder, either of which would increase BD risk by 12-fold.

Summary Over two years into the COVID-19 pandemic, many people continue to grapple with worsened mental health associated with the prolonged impact of the pandemic, including social distancing, income loss, and death and illness. In 2020, 33% of all nonelderly adults reported having a mental illness or substance use disorder. Drug overdose deaths have increased over time – particularly during the pandemic – and these increases have disproportionately affected people of color. Following a period of increases, suicide deaths slowed in 2019 and 2020, although they have increased faster among people of color than White people. Drawing on a series of recent KFF analyses, this brief presents five key findings on mental health and substance use concerns by race/ethnicity. It finds: Five Key Findings on Mental Health and Substance Use Disorders by Race/Ethnicity Rates of death by suicide are rising faster among people of color compared to their White counterparts. The recent rise in deaths associated with drug overdoses has disproportionately affected people of color. Overall rates of mental illness and substance use disorder are lower for people of color compared to White people but may be underdiagnosed among people of color. People of color have experienced worsening mental health during the pandemic. People of color face disproportionate barriers to accessing mental health care. Rapidly rising rates of deaths by suicide and drug overdose among people of color, along with disproportionate impacts of the COVID-19 pandemic, further underscore inequities in access to mental health care and treatment and highlight the importance of centering equity in diagnostics, care, and treatment. Key Findings Rates of death by suicide are rising faster among people of color compared to their White counterparts. Between 2010 and 2020, Black and American Indian or Alaska Native (AIAN) people experienced the largest increases in rates of death by suicide (Figure 1). AIAN and White people continue to experience the highest rates of deaths by suicide compared to all other racial and ethnic groups (23.9 and 16.8 per 100,000 in 2020, respectively). However, people of color are experiencing the largest increases in rates of death by suicide. AIAN and Black people experienced the largest absolute increases in suicide death rates (7.0 and 2.3 percentage points, respectively) from 2010 to 2020 (Figure 1). Moreover, Black and Hispanic people had larger percentage increases in their suicide death rates compared to White people over the same period (at 43% and 27%, respectively, compared to 12%). Between 2010 and 2020, suicide-related death rates among adolescents more than doubled for Asian adolescents and nearly doubled for Black and Hispanic adolescents (Figure 1). However, similar to the overall population data, AIAN adolescents accounted for the highest rates of deaths by suicide, over three times higher than White adolescents (22.7 vs. 6.3 per 100,000). In contrast, Black, Hispanic, and Asian adolescents had lower rates of suicide deaths compared to their White peers. Suicide remains the second leading cause of death among adolescents overall. The recent rise in deaths associated with drug overdoses has disproportionately affected people of color. Drug overdose death rates increased across all racial and ethnic groups in recent years, but these increases were larger for people of color compared to their White counterparts. Reflecting these increases, drug overdose death rates among Black people surpassed rates of White people by 2020 (35.4 versus 32.8 per 100,000) (Figure 2). However, AIAN people continued to experience the highest rates of drug overdose deaths (41.9 per 100,000 in 2020) compared with all other racial and ethnic groups. Among adolescents, deaths due to drug overdose nearly doubled in 2020 and disproportionately affected adolescents of color. Further, it is possible that deaths by suicide are being undercounted due to misclassifications as drug overdose deaths. Fentanyl-related deaths, which have accounted for many drug overdose deaths during the pandemic, may be disproportionately affecting Black communities. White people continue to account for the largest share of deaths due to drug overdose, but people of color are accounting for a growing share of these deaths over time. Between 2015 and 2020, the share of drug overdose deaths among White people fell, while at the same time the shares of these deaths among Black and Hispanic people rose. As a result of this increase, Black people accounted for a disproportionate share of drug overdose deaths relative to their share of the total population in 2020 (17% vs. 13%) (Figure 3). Similarly, reflecting an increase in deaths over the period, Hispanic adolescents accounted for a disproportionate share of drug overdose deaths relative to their share of the population as of 2020 (30% vs. 25%). These recent trends are contributing to emerging disparities in drug overdose deaths among some people of color, which may worsen if they continue. Full article - Source: Kaiser Family Foundation

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home. If you or someone you know needs support now, call or text 988,or chat 988lifeline.org Depression symptoms can vary from mild to severe and can include: Feeling sad or having a depressed mood Loss of interest or pleasure in activities once enjoyed Changes in appetite — weight loss or gain unrelated to dieting Trouble sleeping or sleeping too much Loss of energy or increased fatigue Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others) Feeling worthless or guilty Difficulty thinking, concentrating or making decisions Thoughts of death or suicide Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression. Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes. Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings) have depression. Depression Is Different From Sadness or Grief/Bereavement The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.” But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways: In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks. In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common. In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression. Grief and depression can co-exist. For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression. Distinguishing between grief and depression is important and can assist people in getting the help, support or treatment they need. Risk Factors for Depression Depression can affect anyone—even a person who appears to live in relatively ideal circumstances. Several factors can play a role in depression: Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression. Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life. Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression. Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression. How Is Depression Treated? Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms. Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms). The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action. Medication Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression. Antidepressants may produce some improvement within the first week or two of use yet full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects. Psychiatrists usually recommend that patients continue to take medication for six or more months after the symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk. Psychotherapy Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the problem solving in the present. CBT helps a person to recognize distorted/negative thinking with the goal of changing thoughts and behaviors to respond to challenges in a more positive manner. Psychotherapy may involve only the individual, but it can include others. For example, family or couples therapy can help address issues within these close relationships. Group therapy brings people with similar illnesses together in a supportive environment, and can assist the participant to learn how others cope in similar situations. Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions. Electroconvulsive Therapy (ECT) ECT is a medical treatment that has been most commonly reserved for patients with severe major depression who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant. ECT has been used since the 1940s, and many years of research have led to major improvements and the recognition of its effectiveness as a mainstream rather than a "last resort" treatment. Short and long term use can lead to permanent memory issues. Self-help and Coping There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression. Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing your mental health needs. Support Groups: Depression and Bipolar Support Alliance National Alliance on Mental Illness Related Conditions Peripartum depression (previously postpartum depression) Seasonal depression (Also called seasonal affective disorder) Bipolar disorders Persistent depressive disorder (previously dysthymia) (description below) Premenstrual dysphoric disorder (description below) Disruptive mood dysregulation disorder (description below) Premenstrual Dysphoric Disorder (PMDD) PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. A woman with PMDD has severe symptoms of depression, irritability, and tension about a week before menstruation begins. Common symptoms include mood swings, irritability or anger, depressed mood, and marked anxiety or tension. Other symptoms may include decreased interest in usual activities, difficulty concentrating, lack of energy or easy fatigue, changes in appetite with specific food cravings, trouble sleeping or sleeping too much, or a sense of being overwhelmed or out of control. Physical symptoms may include breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. These symptoms begin a week to 10 days before the start of menstruation and improve or stop around the onset of menses. The symptoms lead to significant distress and problems with regular functioning or social interactions. For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual cycles during the past year and must have an adverse effect on work or social functioning. Premenstrual dysphoric disorder is estimated to affect between 1.8% to 5.8% of menstruating women every year. PMDD can be treated with antidepressants, birth control pills, or nutritional supplements. Diet and lifestyle changes, such as reducing caffeine and alcohol, getting enough sleep and exercise, and practicing relaxations techniques, can help. Premenstrual syndrome (PMS) is similar to PMDD in that symptoms occur seven to 10 days before a woman’s period begins. However, PMS involves fewer and less severe symptoms than PMDD. Disruptive Mood Dysregulation Disorder Disruptive mood dysregulation disorder is a condition that occurs in children and youth ages 6 to 18. It involves a chronic and severe irritability resulting in severe and frequent temper outbursts. The temper outbursts can be verbal or can involve behavior such as physical aggression toward people or property. These outbursts are significantly out of proportion to the situation and are not consistent with the child’s developmental age. They must occur frequently (three or more times per week on average) and typically in response to frustration. In between the outbursts, the child’s mood is persistently irritable or angry most of the day, nearly every day. This mood is noticeable by others, such as parents, teachers, and peers. In order for a diagnosis of disruptive mood dysregulation disorder to be made, symptoms must be present for at least one year in at least two settings (such as at home, at school, with peers) and the condition must begin before age 10. Disruptive mood dysregulation disorder is much more common in males than females. It may occur along with other disorders, including major depressive, attention-deficit/hyperactivity, anxiety, and conduct disorders. Disruptive mood dysregulation disorder can have a significant impact on the child’s ability to function and a significant impact on the family. Chronic, severe irritability and temper outbursts can disrupt family life, make it difficult for the child/youth to make or keep friendships, and cause difficulties at school. Treatment typically involves psychotherapy (cognitive behavior therapy) and/or medications. Persistent Depressive Disorder A person with persistent depressive disorder (previously referred to as dysthymic disorder) has a depressed mood for most of the day, for more days than not, for at least two years. In children and adolescents, the mood can be irritable or depressed, and must continue for at least one year. In addition to depressed mood, symptoms include: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness Persistent depressive disorder often begins in childhood, adolescence, or early adulthood and affects an estimated 0.5% of adults in the United States every year. Individuals with persistent depressive disorder often describe their mood as sad or “down in the dumps.” Because these symptoms have become a part of the individual’s day-to-day experience, they may not seek help, just assuming that “I’ve always been this way.” The symptoms cause significant distress or difficulty in work, social activities, or other important areas of functioning. While the impact of persistent depressive disorder on work, relationships and daily life can vary widely, its effects can be as great as or greater than those of major depressive disorder. A major depressive episode may precede the onset of persistent depressive disorder but may also arise during (and be superimposed on) a previous diagnosis of persistent depressive disorder. Source: Diagnostics Statistical Manual Version 5 - Treatment Review (DSM5-TR)

Positive childhood experiences are associated with reduced risk for fair or poor adult physical health and mental health issues. HealthDay News — Positive childhood experiences (PCEs) are independently associated with reduced risks for fair or poor adult health and adult mental health problems, according to a study published online June 20 in Pediatrics. Cher X. Huang, M.D., from the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues examined the associations between PCE score and adult self-rated health or condition diagnosis, with and without adjustment for adverse childhood experiences (ACEs). The researchers found that compared with adults with zero to two PCEs, those with five to six PCEs had 75 and 74 percent of the risk for fair/poor overall health and for any psychiatric diagnosis, respectively, independent of ACEs. The annual hazard of developing any adult psychiatric or physical condition was lower in association with reporting five to six PCEs and higher with reporting three or more ACEs in survival analysis models accounting for PCEs and ACEs (hazard ratios, 0.84 and 1.42, respectively). “Our findings suggest that PCEs play a role in enhancing health resilience, promoting healthy outcomes while also protecting from poor mental and physical health conditions,” the authors write. Full Article

Children aged 12 to 17 years were more likely to have received any mental health treatment than those aged 5 to 11 years. HealthDay News — In 2023, 14.9 percent of children aged 5 to 17 years received mental health treatment, according to a June data brief published by the U.S. Centers for Disease Control and Prevention National Center for Health Statistics. Benjamin Zablotsky, Ph.D., and Amanda E. Ng, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, used data from the 2023 National Health Interview Survey to describe the percentage of children aged 5 to 17 years who received mental health treatment in the past 12 months. The researchers found that children aged 12 to 17 years were more likely to have received any mental health treatment (including prescription medication and counseling or therapy) in the past 12 months compared with children aged 5 to 11 years (18.9 versus 11.3 percent). In the past 12 months, boys were more likely than girls to have taken prescription medication for their mental health (9.0 versus 7.3 percent). Compared with children in other race and Hispanic-origin groups, Asian non-Hispanic children were least likely to have received any mental health treatment in the past 12 months. The percentage of children who received any mental health treatment increased as the level of urbanization decreased. “In 2023, 14.9 percent of children aged 5 to 17 years in the United States received mental health treatment in the past 12 months,” the authors write. “About 8 percent of children took prescription medication for their mental health, and 11.5 percent of children received counseling or therapy from a mental health professional.” Full Article