Research Update November 2017:
From the NAMI Illinois State Conference
by Hugh Brady
One of the best sessions at the NAMI Illinois State Conference in October was a research report by Dr. John Zajecka, a psychiatrist and researcher in the Department of Psychiatry at Rush University. He is particularly interested in depression and bipolar disorder and his presentation was full of interesting, and in some cases amazing, new developments in the field. Here are some highlights:
• Depression and bipolar disorder and the number one cause of disability worldwide.
• But depression is one of the most treatable illnesses in all of medicine. In one study 80% of patients who stayed in treatment saw significant or complete remission of symptoms.
• There is lots of overlap between the various mental illness diagnoses. So instead of rigid boxes which patients are assigned to, definitions need to be fluid.
• BDNF, brain derived neurotropic factor, helps neurons grow, and lack of BDNF contributes to mental illnesses. Antidepressants have been shown to increase levels of BDNF.
• It is well known that stress increases symptoms of mental illness. Stress leads to increases of the hormone cortisol which in turn lowers BDNF levels.
• Vagus nerve stimulation has been shown to be an effective treatment for depression and will soon be approved for that purpose by the FDA.
• Genetic testing can now reveal how quickly the body metabolizes various medications. So if one person metabolizes their antidepressant very quickly a higher dose will be needed to be effective. But if their body metabolizes the medication slowly, then smaller doses will be sufficient.
• Studies are also under way to use activation brain scans to predict who will respond to which medication. This, in conjunction with genetic testing, will help prevent the trial and error approach that doctors often have to take when prescribing medications
• Newer is not necessarily better. One of the most effective medications in treating mental illnesses is lithium, which has been used for this purpose for a long time. It even seems to have a preventive effect. Areas of the world that have high levels of lithium in the drinking water appear to have lower incidences of mental illnesses.
• There is a lot of data that supports the use of the drug ketamine in treating depression. It works almost instantly, and has been shown to increase neurogenesis, the growth of new neurons. Studies are underway to determine effective dose levels and how long a single treatment lasts. Currently ketamine must be delivered by injection, but work is under way to develop a ketamine nasal spray which may be as effective and much easier to administer. Unfortunately, the drug is also used by some as a recreational drug and it has street value, so research is proceeding with caution.
• Mindfulness therapies are very effective at treating depression and bipolar disorder and over time have been shown to change the wiring of a person’s brain.
As I mentioned, Dr Zajecka’s talk was very interesting. He said he loves NAMI and was excited to be able to present these findings to us. In fact some of the slides in his presentation had typos on them because he said he kept adding new slides, and even added some the morning of his presentation.
The slides should be on the NAMI Illinois website shortly.