TIME Mental Illness

Depression Is a Risk Factor for Dementia, New Research Says

The two have been linked before, but the new study says depression may be an independent risk factor for the disease

The link between depression and dementia is puzzling for researchers. Many studies have noticed a correlation between the two diseases and a 2013 review of 23 studies of about 50,000 older men and women reported that older adults suffering from depression were more than twice as likely to develop dementia and 65% more likely to develop Alzheimer’s. But these have often only been associations. The newest study, published Wednesday in the journal Neurology, takes it further. The researchers believe that their findings, while not definitive, show that depression is in fact an independent risk factor for dementia — and not the other way around.

Researchers looked at 1,764 people with no memory problems around age 77 and followed them for about eight years. They discovered that people with mild cognitive decline as well as people with dementia were likely to have higher levels of depression symptoms before they were diagnosed, and that having these symptoms was associated with a greater decline in memory. Depression symptoms, the researchers estimated, accounted for 4.4% of the difference in memory decline that could not be caused by brain damage.

The reasons for the link between the two diseases are more unclear. Some research suggests that people with depression may have high levels of hormones that interfere with the region of the brain responsible for learning and memory aptitude. Gary Kaplan, an osteopath who runs the Kaplan Center for Integrative Medicine, as well as a handful of other researchers, has another theory: that inflammation caused by hyperreactivity of immune cells can hinder blood flow to — and impact neural pathways in — the brain.

Kaplan, who was not involved in this research, views depression as a symptom of inflammation in the nervous system, and not a disease in itself. “Depression is manageable,” says Kaplan. “We can modify risk for depression by lowering neuroinflammation. And these findings are completely consistent with depression as an inflammatory disease.”

It’s also possible that depression adds stress to the brain, and that can play a role in its deterioration.

If it was possible that treating depression could curb dementia risk, that would be game changing, medically speaking. That hasn’t been proved yet, but it’s an active area of research. The Mayo Clinic recommends that patients opt for treatments that are safe for both issues — for instance, taking antidepressants for depression, though “these medications may not be as effective at treating depression with Alzheimer’s as they are at treating depression alone,” they write. Kaplan thinks treating depression can be done with practices like meditation and getting more sleep — activities thought to calm the brain and improve overall brain health.

If the new research is right, finding new ways to treat depression may have an impact on dementia risk — even if it’s small.

TIME Mental Health/Psychology

The Part of Your Brain That Senses Dread Has Been Discovered

This tiny part of your brain tracks bad experiences

A tiny part of the brain can keep track of your expectations about negative experiences—and predict when you will react to an event—researchers at University College London say.

The brain structure, known as the habenula, activates in response to negative events such as electric shocks, and they may help people learn from bad experiences.

The findings, published in Proceedings of the National Academy of Sciences, marks the first time this association has been proven in humans. Earlier studies showed that the habenula causes animals to avoid negative stimuli by suppressing dopamine, a brain chemical that drives motivation.

In this study, investigators showed 23 people random sequences of pictures followed by a set of good or bad outcomes (an electric shock, losing money, winning money, or neutral). The volunteers were asked to occasionally press a button to show they were paying attention, and researchers scanned their brains for habenula activity using a functional magnetic resonance imaging (fMRI) scanner. Images were taken at high resolution because the habenula is so small—half the size of a pea.

When people saw pictures associated with painful electric shocks, the habenula activated, while it did not for pictures that predicted winning money.

“Fascinatingly, people were slower to press the button when the picture was associated with getting shocked, even though their response had no bearing on the outcome,” lead author Rebecca Lawson from the University College London Institute of Cognitive Neuroscience, said in a statement. “Furthermore, the slower people responded, the more reliably their habenula tracked associations with shocks. This demonstrates a crucial link between the habenula and motivated behavior, which may be the result of dopamine suppression.”

The study also showed that the habenula responds more the worse an experience is predicted to be. For example, researchers said the habenula responds much more strongly when an electric shock is certain than when it is unlikely to happen. This means that your brain can tell how bad an event will be before it occurs.

The habenula has been linked to depression, and this study shows how it could play a part in symptoms such low motivation, focusing on negative experiences and pessimism in general. Researchers said that understanding the habenula could potentially help them develop new ways of treating depression.

MONEY Careers

Make Sure a Friend’s Unemployment Doesn’t Ruin Your Friendship

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Melissa Ross—Getty Images/Flickr Open

Millennials and new college grads still face a tough job market, and that can create strains in your social circle. Follow this script to keep everyone happy.

You and your best friend graduated from the same college and moved to the same city at the same time. But while you landed a promising entry-level position, your friend’s been out of work for months. Even though you know that shouldn’t affect your relationship, you’re starting to feel that the two of you are drifting apart. Or maybe you’re simply sick of hearing yourself repeat the same chirpy platitudes (“I’m sure something will come up!”).

As millennials and new grads enter the job market together, one friend’s unemployment can easily become a point of tension. Landing a position is an uphill battle for some young job seekers. The unemployment rate for 20- to 24-year-olds stood at 10.5% in June. Although that number has been on the decline, it’s still higher than the overall unemployment rate of 6.1%

“This mirrors a lot of other life-stage issues, whether it’s getting married or getting pregnant. One person is moving forward, and the other one is stuck,” says Ken Clark, a certified financial planner and psychotherapist.

The good news? You can take steps to ensure that your relationship doesn’t crumble as your friend scrambles for a job. No matter how long this stretch of unemployment lasts, here’s what you can say (or not say) to preserve your friendship.

YOU SAY: “A couple of people are coming to my place for happy hour this week—want to join?”

While your friend looks for work he or she may pull away from you or your group of friends. It’s normal—many people are embarrassed and reluctant to spend money on socializing when they’re unemployed. But if you notice your friend hasn’t been around much, try to draw him or her back into your social circle.

“A sensitive friend should take a leadership role among their circle of friends,” says Clark.

If your group of friends tends to spend a lot of money at bars or eating out, subtly push for a change. Invite a close group over for drinks at your place, or suggest a half-price movie or a free concert you can all attend. If spending time together doesn’t mean spending money, your unemployed friend may find it easier to join in.

“People have a tendency to self-isolate when they’re trying to be careful with their money,” says Amanda Clayman, a financial therapist and author of financial behavior blog The Good, the Bad and the Money. “Go above and beyond in terms of making offers to your friend.”

YOU DON’T SAY: “How’s the job hunt going this week?”

Avoid the impulse to dig for details on the job search. Trust that you’ll hear when a major development comes up.

“Stuff doesn’t change that much in a week,” says Clark. “If you’re asking more than once a month, it’s too much.”

That said, don’t stop checking in. Retreating from your friend could cause him or her to become even more isolated.

“Your presence and availability is huge for someone who’s hurting,” says Maggie Baker, a psychologist specializing in money and relationships. “The worst thing you can do is pull away.”

YOU SAY: “I could really use a running partner tomorrow.”

Be aware that unemployment can quickly give way to depression. Exercise is an easy, natural way to shake the blues. Invite your friend out for a brisk walk or run with you. It’ll give you two time to talk one-on-one and help your friend re-energize.

“Physical exercise outside is both beneficial and free,” says Clark. “You’re helping elevate her mood, decreasing anxiety, and building your relationship.”

YOU DON’T SAY: “I can give you feedback on your résumé if you’d like.”

You might want to offer to help edit your friend’s résumé or forward job listings that seem relevant. Tread lightly. Your offers could backfire if they come off as condescending.

“Just having a job doesn’t make you an expert on résumés,” says Clayman. “Don’t presume that you have the solution.”

Instead, make a gentle, broad offer to help in any way you can. Beyond that, let your friend’s reaction guide you.

“Usually if people are scrambling to find whatever work they can, they put off a very strong signal. If you aren’t seeing them ask for help, better safe than sorry.”

Read more Face to Face columns:

 

 

TIME Diet/Nutrition

Stressful Days Can Slow Your Metabolism, Study Says

Denny's waitress Tahmina Najemyar delivers free Grand Slam breakfasts to customers on February 3, 2009 in Emeryville, California.
Denny's waitress Tahmina Najemyar delivers free Grand Slam breakfasts to customers on February 3, 2009 in Emeryville, California. Justin Sullivan—Getty Images

Why you shouldn't reward yourself with a donut after a long day

You might think that on a high-intensity stressful day would cause you to burn more calories, but research shows you’d likely be wrong.

Women who ate a high-fat meal after they were stressed burned calories more slowly, according to a new study.

Our bodies metabolize slower under stress, but the types of food we crave when we are stressed or depressed tend to be very high in fat and sugar. New research published in the journal Biological Psychiatry suggests how that combination of factors could result in significant weight gain.

Researchers from Ohio State University’s Wexner Medical Center interviewed 58 women about stressors they experienced the day before, such as arguments with spouses or trouble with kids, before giving them a meal of eggs, turkey sausage, biscuits and gravy containing 930 calories and 60 grams of fat.

The women then wore masks which were able to measure their metabolism by calculating inhaled and exhaled airflow of oxygen and carbon dioxide. The researchers also measured the women’s blood sugar, triglycerides (cholesterol), insulin and the stress hormone cortisol.

The researchers found that women who reported being stressed out during the prior 24 hours burned 104 fewer calories than the women who were not stressed. That effect could add up to 11 extra pounds gained over a year of stress-eating, they concluded.

The women who were stressed had higher levels of insulin, which contributes to how the body stores fat, and can slow down the process of metabolizing calories into energy. If fat is not burned, it’s stored on the body. Previous research shows a similar effect in men.

It’s important to note that while stress can lead to overeating, that is not what this research showed. The women in the study were fed high-fat meals as part of the design of the study; they did not choose those foods on their own. Regardless, this adds to a large body of research suggesting the importance of reducing stress and adhering to a healthy diet.

 

TIME Depression

No, Antidepressants During Pregnancy Don’t Harm Babies’ Hearts

Silhouette of Pregnancy
Getty Images

The latest study finds no significant increase in heart malformations in babies whose moms used antidepressants during pregnancy

That should reassure the 8% to 13% of women who take antidepressants while expecting. Concerns about the risks of the drugs, primarily selective serotonin reuptake inhibitors (SSRIs), on the developing fetus prompted the Food and Drug Administration in 2005 to add warnings about the risk of heart defects in babies born to moms taking antidepressants. While studies have shown up to a three-fold increase risk in some congenital heart abnormalities associated with antidepressants, doctors couldn’t be entirely sure the higher risk wasn’t due purely to chance. Now, the New England Journal of Medicine reports that may indeed be the case, thank to the work of Krista Huybrechts, in the division of pharmacoepidemiology at Brigham and Women’s Hospital and Harvard Medical School, and her colleagues.

In their analysis involving 949,504 pregnant women, 64,389 of whom used antidepressants during the first trimester, the rate of heart defects in newborns was similar between the groups. “Based on our study, there is no evidence to support a substantial increased risk of cardiac malformations overall,” she says.

She and her team specifically focused on adjusting for potential confounding factors that could explain the heart malformations, such as age, how many children the women had had, diabetes, hypertension and use of psychotropic medications. Even after accounting for these effects, they found no strong association between antidepressant use and heart defects.

While the findings should be reassuring for expectant mothers who take antidepressants, Huybrechts says that “heart defects are one factor in a whole range of potential risks” associated with the drugs. Some studies hint, for example, that the medications may contribute to hypertension in newborns, as well as other adverse health conditions. “The study provides quite solid evidence of the low risk in terms of cardiac malformations, but the treatment decision should consider the whole range of other potential adverse outcomes,” Huybrechts says. “[Decisions also need to consider] potential risk of not treating women who are severely depressed and required pharmacologic interventions. It’s one piece of the puzzle but definitely not the whole answer.”

TIME Depression

The Latest About Antidepressants and Weight Gain

Scientists compare antidepressants to see which result in the most and least amount of weight gain

A common complaint among patients on antidepressants is that their drugs cause them to gain weight. It’s not fully understood why this happens, or which are the worst offenders, but a new study published in the journal JAMA Psychiatry tried to figure it out by comparing a variety of drugs prescribed for anxiety and depression.

The researchers looked at the electronic medical records of 22,610 adults on antidepressants and compared their reported weight gain over a year. They used the antidepressant citalopram (Celexa) as the control.

The worst offenders in regards to weight gain were mirtazapine (Remeron) and paroxetine hydrochloride (Paxil). The drugs with the lowest the rate of weight gain were bupropion (Wellbutrin), amitriptyline (Elavil), and nortriptyline (Pamelor). The researchers found that among many SSRIs, like escitalopram (Lexapro), there wasn’t a great difference in weight changes.

Exactly why antidepressants cause some people to put on a few pounds is not fully understood. One possible reason is that the antidepressants interfere with the neurotransmitter serotonin which has a role in controlling and regulating appetite. Doctors also know that some people lose their appetite when they are depressed while other people get hungrier. It’s possible that changes in weight are actually reversals in the weight status of the individuals when they were feeling anxious and depressed. “The mechanism is complicated, and we don’t completely understand it,” says study author Dr. Roy Perlis of the Center for Experimental Drugs and Diagnostics, Psychiatric and Neurodevelopmental Genetics Unit at Massachusetts General Hospital.

One of the take-aways from their findings is that if there’s weight gain from antidepressants, it’s typically modest and gradual. “People care a lot about weight gain,” says Perlis. “I think the two questions I hear the most are ‘Is this going to affect my sexual functioning?’ and ‘Is this going to make me gain weight?'”

Perlis says understanding the effects antidepressants have on weight gain is important for patient-doctor conversations about what’s working. Some patients may feel very uncomfortable with the extra pounds, but may feel uneasy telling their doctors that that is the true reason they are unsatisfied; some may even stop taking their medications.

“We don’t want people to be scared away from treatment,” says Perlis. “We hope this study provides reassurance.”

TIME PTSD

Here’s What Happens To The Mind After 5 Years of Captivity

Captured US Solider
Sgt. Bowe Bergdahl in an undated image provided by the U.S. Army. U.S. Army/AP

Sgt. Bowe Bergdahl has a lot of healing to do after five years of captivity. The physical scars may fade, but the emotional ones can sometimes be too deep to heal completely

U.S. Army Sergeant Bowe Bergdahl, the last known American POW, was finally returned home over the weekend after five years held in captivity in Afghanistan. Since Bergdahl’s return, curious details have emerged about his mental state before and after capture. And it all begs the question: What does five years in captivity do to the human mind?

Bergdahl’s repatriation is going to be a challenge, and piecing together the psychologically and physically broken veteran is a delicate process. After all, an abduction is the ultimate exchange of power, spurring the start of a complicated relationship based on both deep distrust and reliance, say experts. “He’s to some degree merged with those who held him,” says Brian Engdahl, professor of PTSD Research and Neuroscience at the University of Minnesota. “He was totally dependent on them for food, shelter, clothing. It can reduce a person to a weak state where their entire life revolves around how their captors are treating them.” A morsel of food becomes a generous gift, only to be withheld at the next feeding.

Many POWs find physical and mental strength by relying on their fellow captured soldiers, but Bergdahl was alone. Speculation about whether he suffered from Stockholm Syndrome—the phenomenon where captives identify with their captors—are not unwarranted, though so far evidence hasn’t suggested this to be true.

Studies of POWs from the Korean War show that the psychological injuries from captivity stem from two types of trauma. The first is physical and usually short-term, caused by malnutrition and injury. The more persisting trauma is, of course, psychological. At Landstuhl Regional Medical Center in Germany, which treats U.S. vets from Afghanistan and Iraq, Bergdahl is likely being tested for depression, anxiety, and PTSD, says Engdahl. “Beyond that, he could be feeling deep guilt, shame, bewilderment, and a lost sense of identity,” says Engdahl. If his English is poor, as has been reported, it’s likely from lack of speaking.

Once home, psychological challenges won’t likely abate overnight, says Barbara Rothbaum, the associate vice chair of clinical research in the department of psychiatry at Emory School of Medicine. “But even if the trauma is over, it’s not really over,” she says. POWs often experience flashbacks, and will wake up in the middle of the night thinking they are still in captivity. Many victims become avoidant and don’t want to talk about their experience because they are afraid it will trigger memories, she says. It’s one of the reasons many will forgo treatment.

“I’ve had veterans tell me they were drunk for a year,” says Rothbaum. But avoidance is one of the worst ways to deal with the harsh return, and Rothbaum’s research has shown that talking about experiences early can actually help prevent the onset of PTSD.

“People want to avoid talking about the worst parts, the most shameful, the most embarrassing,” says Rothbaum. “But it will help.”

TIME

Why Some People Get Depressed And Others Get Resilient

New research in mice show certain neurons in the brain may determine whether someone is depressed or resilient

Some people thrive under stress and tight deadlines, and others become crippled with defeat. A team of scientists looked to mice to find biological answers for these different responses and found the reason my lie deep in the brain.

The area of the brain called the medial prefrontal cortex (mPFC) is known to be involved in the regulation of emotions and behavior, and can become highly activated in people who are depressed. Researchers have long wanted to know whether hyperactivity in mPFC causes depression or if the activity in that part of the brain is a result of something else (and thus not the cause of depression). To test this, they looked at mice and were able to pinpoint the specific neurons involved with stress. Like humans, when mice are depressed, the mPFC neurons become activated. The very same neurons were weak among mice who appeared not to be bothered by added stress.

To see whether the activated mPFC was indeed causing depression in mice, the scientists engineered them with neurological conditions associated with depression. Interestingly, the mice that were once resilient became depressed and helpless, suggesting that the neuron interference was in fact causing these symptoms. The findings were published in The Journal of Neuroscience.

The researchers believe these findings support the use of a depression treatment called deep brain stimulation (DBS), which targets these very neurons. Understanding what areas of the brain are impacted by depression not only helps in the creation of better antidepressants, but the creation of therapies that do not involve drugs. Besides DBS, treatments that use magnets on the brain like transcranial magnetic stimulation (TMS) have proven successful, and another recent study showed that oxytocin is effective in regulating mood and benefiting mental disorders like depression and anxiety.

Of course, since the research is only looking at mice, it’s still preliminary, but it provides further evidence for different targeting treatments.

TIME Smoking

The Weird Link Between E-Cigarettes and Mental Health Disorders

US-HEALTH-TOBACCO-E CIGARETTE
This September 25, 2013 photo illustration taken in Washington, DC, shows a woman smoking a "Blu" e-cigarette (electronical cigarette). PAUL J. RICHARDS—AFP/Getty Images

A new study finds elevated rates of depression, anxiety and other mental disorders among users of e-cigarettes

A new study has found that people suffering from depression, anxiety and other mental disorders are more than twice as likely to spark up an e-cigarette and three times as likely to “vape” regularly than those without a history of mental issues.

Researchers at the University of California, San Diego drew their findings from an extensive survey of American smoking habits. Among 10,041 respondents, 14.8% of individuals suffering from mental health disorders said they had tried an e-cigarette, compared with 6.6% of individuals who had no self-reported history of mental disorders.

The e-smokers’ elevated rates of mental disorders reflected the elevated rates of mental illness among smokers in general. The authors note that by some estimates, people suffering from mental disorders buy upwards of 50 percent of cigarettes sold in the U.S. annually.

Many respondents said they switched to e-cigarettes as a gateway to quitting. The FDA has not yet approved e-cigarettes as a quitting aide.

“People with mental health conditions have largely been forgotten in the war on smoking,” study author Sharon Cummins said in a university press release. “But because they are high consumers of cigarettes, they have the most to gain or lose from the e-cigarette phenomenon.”

The study will run in the May 13 issue of Tobacco Control.

TIME Depression

Doctors Treat Depression With Brain Magnets

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SCIEPRO—Getty Images/Brand X

What to do when the drugs don't work

Meghan McGill was a freshman in college when she was diagnosed with depression. She lost interest in reading and dancing, two of her favorite activities, and eventually missed so many classes that she was disqualified from her university. Six years later, when she was 28, she finally saw a psychiatrist who put her on Prozac. That didn’t help either. “I lost a lot of jobs because I couldn’t call into work,” she says.

McGill’s experience is a familiar one for many patients with depression; more than one in 10 Americans take antidepressants according to the Center for Disease Control—and almost 15% of all women. But 20-40% of people cannot tolerate the side effects or do not benefit from antidepressants.

That’s why doctors are encouraged by a bizarre and novel treatment called transcranial magnetic stimulation (TMS), in which magnets (yes, magnets) are administered to alleviate depression. This strange strategies may provide a way to finally bring relief to patients like McGill, who don’t respond to antidepressant medications or who prefer non-drug treatments for their depression.

Last week, scientists presented their latest success with TMS at the 167th American Psychiatric Association Annual Meeting in New York City. TMS was approved by the FDA in 2008 for the treatment of depression and unlike electroconvulsive therapy (ECT), which uses electrical currents to stimulate the brain to treat serious mental illness like bipolar disorder, TMS does not spur seizures.

The researchers, led by Dr. Mark Demitrack, the chief medical officer of Neuronetics, Inc. and Dr. Kit Simpson of Medical University of South Carolina, studied 306 patients with major depressive disorder who were treated with a TMS device called the NeuroStar TMS Therapy®. (Neurostar was the first TMS therapy on the market, and in 2013, the FDA approved another TMS device called Brainsway.) After one year, people who received six weeks of daily TMS, which targeted the mood regions of the brain, 53% reported no or mild depression. After a comparable period of time, only 38% of people on antidepressants reported the same benefit.

“I think TMS is a very valuable addition to our treatment,” says Dr. Amit Anand, the vice chair for at the Center for Behavioral Health at Cleveland Clinic. Anand was not involved in the research. “It’s a way to treat depression directly, with few side effects. Other research has shown only a small percentage of people respond to it, but I think if even a quarter of those people respond, it’s a benefit.”

Dr. Anand says the Cleveland Clinic will soon be offering the service, which he sees as an option that lies somewhere between antidepressants and ECT. “I think it’s best for people who cannot tolerate antidepressants due to side effects,” he says. “It is does give people hope, but I think expectations should be realistic.”

Dr. Demitrack says TMS comes in when doctors and patients are looking for a second option. “The next option would be the addition of another medication, or they might be recommended to receive Electroconvulsive therapy (ECT), which is more invasive and complicated.” Instead, they could try TMS.

In TMS therapy, a large magnet is put to the left side of the patient’s head. Magnetic pulses are thought to stimulate areas of the patient’s brain that are underactive and are involved in mood regulation. The patient is awake and alert the entire time. The are few side effects other than occasional headaches.

TMS, however, is $998 more expensive than drug therapy, but since it’s a limited-time treatment, the company argues it in two years it is more affordable than additional rounds of drug therapy. Insurance companies are starting to pay for the treatment. (The study was conducted by and for the medical device company, Neuronetics, Inc.)

For now, Dr. Demitrack says TMS is only being studied in patients who don’t respond to antidepressants, and not as a first line therapy. Though, he says he could so how one day patients might prefer it as a first line treatment, even though it’s logistically more difficult than drugs. The American Psychiatric Association does not have an official statement on TMS, but it notes that meta-analyses have discovered relatively small to moderate benefits from TMS.

Encouraging results may help more patients like McGill to finally free themselves from their worst depressive symptoms. “At the second week of treatment, I was suddenly singing to the radio in my car,” she says. “I realized how very different I felt. I just thought, Wow.”

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