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Friday, 29 September 2017
Health services must stop leaving older people behind
How Ketamine Acts on the Brain
Ketamine is a medication mainly used for starting and maintaining anesthesia although it has also been used to provide rapid relief of treatment resistant depression.
The ability to rapidly stabilize severely depressed patients has been demonstrated in several studies and has led researchers to search for the exact mechanism by which ketamine works.
The effort is important as ketamine is sometimes illicitly used for its psychedelic properties and could also impede memory and other brain functions.
The multiple actions of ketamine has spurred scientists to identify new drugs that would safely replicate its antidepressant response without the unwanted side effects.
Now, emerging research from University of Texas (UT) Southwestern Medical Center scientists has identified a key protein that helps trigger ketamine’s rapid antidepressant effects in the brain. This is a crucial step to developing alternative treatments to the controversial drug being dispensed in a growing number of clinics across the country.
Researchers from the Peter O’Donnell Jr. Brain Institute have now answered a question vital to guiding future research: What proteins in the brain does ketamine target to achieve its effects?
As Dr. Lisa Monteggia, Professor of Neuroscience at UT Southwestern’s O’Donnell Brain Institute states:
Now that we have a target in place, we can study the pathway and develop drugs that safely induce the antidepressant effect.
The study published in Nature shows that ketamine blocks a protein responsible for a range of normal brain functions. The blocking of the N-methyl-D-aspartate (NMDA) receptor creates the initial antidepressant reaction, and a metabolite of ketamine is responsible for extending the duration of the effect.
The blocking of the receptor also induces many of ketamine’s hallucinogenic responses. The drug—used for decades as an anesthetic—can distort the senses and impair coordination.
But if taken with proper medical care, ketamine may help severely depressed or suicidal patients in need of a quick, effective treatment, Dr. Monteggia said.
Studies have shown ketamine can stabilize patients within a couple of hours, compared to other antidepressants that often take a few weeks to produce a response—if a response is induced at all.
As explained by Dr. Monteggia:
Patients are demanding ketamine, and they are willing to take the risk of potential side effects just to feel better. This demand is overriding all the questions we still have about ketamine. How often can you have an infusion? How long can it last? There are a lot of aspects regarding how ketamine acts that are still unclear.
Researchers will work to answer these questions as they plan two clinical trials with ketamine, including an effort to administer the drug through a nasal spray as opposed to intravenous infusions.
The results of these trials will have major implications for the millions of depressed patients seeking help, in particular those who have yet to find a medication that works.
A major national study UT Southwestern led more than a decade ago (STAR*D) yielded insight into the prevalence of the problem: Up to a third of depressed patients don’t improve upon taking their first medication, and about 40% of people who start taking antidepressants stop taking them within three months.
Ketamine, due to the potential side effects, is mainly being explored as a treatment only after other antidepressants have failed. But for patients on the brink of giving up, waiting weeks to months to find the right therapy may not be an option.
Dr. Monteggia touches on expected future developments, where:
Ketamine opens the door to understanding how to achieve rapid action and to stabilize people quickly. Because the (NMDA) receptor that is the target of ketamine is not involved in how other classical serotonin-based antidepressants work, our study opens up a new avenue of drug discovery.
This guest article originally appeared on PsychCentral.com: Researchers Learn How Ketamine Acts on the Brain by Rick Nauert PhD.
References
Suzuki, K., Nosyreva, E., Hunt, K., Kavalali, E., & Monteggia, L. (2017). Effects of a ketamine metabolite on synaptic NMDAR function. Nature, 546(7659), E1-E3. Doi: 10.1038/nature22084
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Ketamine for Rapid Treatment of Depression
A team of researchers funded by the National Institutes of Health (NIH) recently discovered why the drug ketamine may act as a rapid antidepressant.
Ketamine is best known as an illicit, psychedelic club drug. Often referred to as “Special K” or a “horse tranquilizer” by the media, it has been around since the 1960s and is a staple anesthetic in emergency rooms and burn centers. In the last 10 years, studies have shown that it can reverse — sometimes within hours or even minutes — the kind of severe, suicidal depression that traditional antidepressants can’t treat.
Researchers writing in the August 2010 issue of Archives of General Psychiatry reported that people in a small study who had treatment-resistant bipolar disorder experienced relief from depression symptoms in as little as 40 minutes after getting an intravenous dose of ketamine. Eighteen of these people had previously been unsuccessfully treated with at least one antidepressant medication and a mood stabilizer; the average number of medications they had tried unsuccessfully was seven. Within 40 minutes, 9 of 16 (56 percent) of the participants receiving ketamine had at least a 50 percent reduction in symptoms, and 2 of 16 (13 percent) had full remission and became symptom-free. The response lasted an average of about a week.
In a small 2006 NIMH study, one of the first to look at ketamine for depression, 18 treatment-resistant, depressed (unipolar) patients were randomly selected to receive either a single intravenous dose of ketamine or a placebo. Depression symptoms improved within one day in 71 percent of those who were given ketamine, and 29 percent of the patients became nearly symptom-free in a day. Thirty-five percent of patients who received ketamine still showed benefits seven days later.
In the most recent study published online in the journal Nature in May 2016, researchers discovered that a chemical byproduct, or metabolite, is created as the body breaks down ketamine. The metabolite reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine.
As put by Carlos Zarate, MD, of the National Institute of Mental Health (NIMH), and a study coauthor and pioneer of research using ketamine to treat depression:
This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments. By using a team approach, researchers were able to reverse-engineer ketamine’s workings from the clinic to the lab to pinpoint what makes it so unique.”
In response to the Nature report, Sara Solovitch of The Washington Post wrote that:
experts are calling [ketamine] the most significant advance in mental health in more than half a century.
She reported that many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.
It all sounds too good to be true, right?
The Drawbacks of Ketamine
The predominant drawback of ketamine is the lack of data.
There haven’t been enough clinical trials on the drug to assure its safety, and there’s a lack of information on the long-term effects of its use.
Ketamine’s effects are also short-lived. To be used as an effective antidepressant, it would need to be administered regularly, which leads to concerns about addiction, tolerance, and, again, long-term effects. The data that we do have on long-term use comes from people who have taken ketamine recreationally, as well as those who have used it to treat chronic pain.
One 2014 study published in the British Journal of Clinical Pharmacology included among possible side effects, psychedelic symptoms (hallucinations and panic attacks), nausea, cardiovascular stimulation, memory defects, and bladder and renal complications.
Still, the drug holds promise for uncovering new ways of treating depression and offers hope for the most severe and complicated mood disorders that baffle psychiatrists today.
Richard J. Hodes, MD, director of the National Institute on Aging, commented on the most recent NIH study and the importance of furthering the research:
Unraveling the mechanism mediating ketamine’s antidepressant activity is an important step in the process of drug development. New approaches are critical for the treatment of depression, especially for older adults and for patients who do not respond to current medications.
Join Project Hope & Beyond, the new depression community.
This guest article appeared on PsychCentral.com: Ketamine: A Miracle Drug for Depression? and was originally posted on Sanity Break at Everyday Health by Therese J. Borchard.
References
Diazgranados, N., Ibrahim, L., Brutsche, N., Newberg, A., Kronstein, P., & Khalife, S. et al. (2010). A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression. Archives Of General Psychiatry, 67(8), 793. DOI: archgenpsychiatry.2010.90.
Zanos, P., Moaddel, R., Morris, P., Georgiou, P., Fischell, J., & Elmer, G. et al. (2016). NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature, 533(7604), 481-486. DOI: 10.1038/nature17998.
Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., & Luckenbaugh, D. et al. (2006). A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Archives Of General Psychiatry, 63(8), 856. DOI: 10.1001/archpsyc.63.8.856.
via Brain Blogger Read More Here..Older Age, Dementia, and Circadian Rhythms
It is common knowledge that sleep patterns change with age. Older people tend to sleep less, their sleep can be shallow and fragmented. Often they sleep very little at night, spending few hours in bed during the daytime. The problem becomes serious in older people suffering from dementia, especially from the caretaker’s perspective.
Researchers discovered several brain processes that influence these sleeping pattern changes. One particularly interesting finding from this research (which may also inform approaches for addressing the problem) is the finding that light exposure has serious effects on the circadian rhythm in the elderly.
Our visual sensory system performs two major tasks: the gathering and processing of visual information (the visual response), and the control of the biological clock that regulates the production of several important hormones (the non-visual response). The majority of living organisms have a non-visual response to the day-night cycle, where body functions adjust to specific periods within a 24 hour day (circadian cycle).
Circadian rhythms regulate the sleep-wake cycle, body temperature, hormone release (e.g., melatonin and cortisol), and gene expression. Circadian rhythms are not set in stone and have to be fine-tuned to the actual experience of the timing and duration of day and night, which are subject to seasonal changes and geographic location. The importance of synchronized circadian regulation is obvious if we consider the physiological and behavioral disruptions caused by jet lag.
In 2005, our eyes were discovered to have a specific photosensitive cell type named intrinsically photosensitive retinal ganglion cells (ipRGCs) that are primarily involved in the regulation of circadian rhythms. These cells are sensitive to a broad range of wavelengths with maximal light absorption at blue light wavelengths of around 480 nm. It is believed that ipRGCs are tuned to the dominant wavelength of light at twilight. During twilight (i.e., at dawn and dusk) the sun is close to the horizon and there is a relative enrichment of ‘blue’ light in the dome of the sky because of the preferential scattering of short wavelengths of light passing obliquely through the atmosphere.
The signals from ipRGCs are processed in the suprachiasmatic nucleus in the anterior hypothalamus that is considered the key circadian pacemaker in the brain. The suprachiasmatic nucleus regulates the release of melatonin, a hormone crucial to the regulation of sleep and wakefulness, with blue light stimulating the most powerful changes in the melatonin secretion rhythm.
Visual and non-visual systems respond differently to the quantity of light and timing of light exposure. The quantity of polychromatic white light necessary to activate the non-visual circadian system is at least two orders of magnitude greater than the amount that activates the visual system. The reaction time of two systems is also different: while the visual system responds to a light stimulus very quickly (in milliseconds), the duration of light exposure needed to affect the circadian system can take minutes. The effects of light on the circadian system depends on the infusion of melatonin into the bloodstream, increasing the response time.
How circadian rhythms get affected with advanced age?
Our sensitivity to light stimuli reduces with the age. Multiple studies demonstrate that neuronal activity in the suprachiasmatic nucleus is reduced in the elderly, especially after the age of 80, and circadian rhythm amplitude is also reduced after the age of 50. This means that the intensity of the response of the non-visual system to light stimuli is reduced, sometimes very substantially. The direct consequence of this muted response is the lack of proper regulation and adjustment of circadian rhythms to the day/night cycle. Disturbances in circadian rhythms leading to poor sleep in older adults can be the result of dysfunctional circadian pathways or a pathway that cannot process light information with as much fidelity.
The first stage of phototransduction (when light signals are converted into neural signals) is negatively affected in older people: older adults have reduced optical transmission at short wavelengths that are maximally effective for the regulation of circadian system (i.e., blue light).
Older adults also tend to lead a more sedentary indoor lifestyle, with less access to bright light during the day, potentially increasing the risk for circadian disruption.
It is well-established that visual task performance improves with increased light levels, regardless of age. However, the need for light for visual task performance increases with age due to age-related losses in retinal illumination. These losses are reasonably uniform over time, with a 10% loss per ten years of aging. Thus, a ninety-year-old would require ten times the light of a 10-year-old for similar photoreception. The effect on circadian rhythmicity is further exacerbated with age because the shorter violet and blue wavelengths (400–500 nm) are most affected by yellowing of the aging eye.
It is also worth keeping in mind that older people often have reduced eyesight, suffer from blurred vision, and may have age-related eye diseases such as glaucoma, cataracts, macular degeneration, and other conditions.
How circadian rhythms get affected in neurological conditions?
Neurodegeneration caused by Alzheimer’s disease and similar conditions may affect multiple parts of the brain, including the parts involved in regulation of circadian rhythms. In Alzheimer’s disease, the suprachiasmatic nucleus deteriorates, contributing to alterations in circadian rhythms. This deterioration exacerbates the age-related loss of neuronal activity in the nucleus. Sleep disturbances, agitated behaviour, and depression are very common in people suffering from dementia.
What can be done to counteract these negative changes?
Bright light therapy has emerged as one of the most harmless and effective approaches to manage sleep disturbances in elderly people and patients with dementia.
Researchers have demonstrated that increased exposure to bright light may increase the amplitude of circadian rhythms, i.e., clearly enhances the intensity of the response to daily 24-hour cycles. Bright light exposure during the morning or evenings may help in consolidating circadian rhythms. Additionally, increased exposure to blue light may be beneficial, as photoreceptors in ipRGCs are more easily activated at these wavelengths.
The points above were incorporated into the development of a number of experimental light therapies aimed at stimulating the normal functioning of the non-visual system in the elderly and people with Alzheimer’s disease and dementia.
Light therapy may be delivered in a variety of ways, such as using a light box placed approximately one meter away from the participants at a height within their visual field; a headworn light visor; ceiling mounted light fixtures; or naturalistic light therapy—known as dawn-dusk simulation—that mimics outdoor twilight transitions.
Published research data suggests that circadian rhythm disturbances may be reversed by stimulation of the suprachiasmatic nucleus with light. Clinical research has shown that light therapy can consolidate rest and activity patterns in people with dementia.
There is a diverse choice of various electric light sources these days, and with proper selection, a balanced and circadian-effective lighting regime can be achieved in spaces with insufficient daylight illumination. The spectral characteristics and intensity of electric lights should be adjusted to the time of the day. Currently, the LED Luminaire™ is being developed that auto-tunes interior lighting to mimic the full spectrum of natural daylight throughout the day, with characteristics that can be “tuned” for older adults. This would provide quality illumination for visual tasks and help synchronize biological rhythms for better health, cognitive ability, and performance.
References
Abraha, I., Rimland, J. M., Trotta, F. M., Dellaquila, G., Cruz-Jentoft, A., Petrovic, M., Gudmundsson, A., Soiza, R., O’Mahony, D., Guatita, A., & Cherubini, A. (2017). Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open, 7(3). doi: 10.1136/bmjopen-2016-012759
Dimitriou, T., & Tsolaki, M. (2017). Evaluation of the efficacy of randomized controlled trials of sensory stimulation interventions for sleeping disturbances in patients with dementia: a systematic review. Clinical Interventions in Aging, Volume 12, 543-548. doi: 10.2147/cia.s115397
Duffy, J. F., & Czeisler, C. A. (2009). Effect of Light on Human Circadian Physiology. Sleep Medicine Clinics, 4(2), 165-177. doi: 10.1016/j.jsmc.2009.01.004
Ellis EV et al. Chronobioengineering indoor lighting to enhance facilities for ageing and Alzheimer’s disorder. Intelligent Buildings International, 2013b Vol. 5, No. S1, 48–60. Ellis, E. V., Gonzalez, E. W., & Mceachron, D. L. (2013). Chronobioengineering indoor lighting to enhance facilities for ageing and Alzheimers disorder. Intelligent Buildings International, 5(Sup1), 48-60. doi: 10.1080/17508975.2013.807764
Figueiro, M. G. (2017). Light, sleep and circadian rhythms in older adults with Alzheimers disease and related dementias. Neurodegenerative Disease Management, 7(2), 119-145. doi: 10.2217/nmt-2016-0060
Hanford N, Figueiro M. (2013). Light Therapy and Alzheimer’s Disease and Related Dementia: Past, Present, and Future. Journal of Alzheimer’s Disease, 33(4), 913-922. doi: 10.3233/JAD-2012-121645
Weldemichael, D. A., & Grossberg, G. T. (2010). Circadian Rhythm Disturbances in Patients with Alzheimers Disease: A Review. International Journal of Alzheimers Disease, 2010, 1-9. doi: 10.4061/2010/716453
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Ketamine for Rapid Treatment of Depression
A team of researchers funded by the National Institutes of Health (NIH) recently discovered why the drug ketamine may act as a rapid antidepressant.
Ketamine is best known as an illicit, psychedelic club drug. Often referred to as “Special K” or a “horse tranquilizer” by the media, it has been around since the 1960s and is a staple anesthetic in emergency rooms and burn centers. In the last 10 years, studies have shown that it can reverse — sometimes within hours or even minutes — the kind of severe, suicidal depression that traditional antidepressants can’t treat.
Researchers writing in the August 2010 issue of Archives of General Psychiatry reported that people in a small study who had treatment-resistant bipolar disorder experienced relief from depression symptoms in as little as 40 minutes after getting an intravenous dose of ketamine. Eighteen of these people had previously been unsuccessfully treated with at least one antidepressant medication and a mood stabilizer; the average number of medications they had tried unsuccessfully was seven. Within 40 minutes, 9 of 16 (56 percent) of the participants receiving ketamine had at least a 50 percent reduction in symptoms, and 2 of 16 (13 percent) had full remission and became symptom-free. The response lasted an average of about a week.
In a small 2006 NIMH study, one of the first to look at ketamine for depression, 18 treatment-resistant, depressed (unipolar) patients were randomly selected to receive either a single intravenous dose of ketamine or a placebo. Depression symptoms improved within one day in 71 percent of those who were given ketamine, and 29 percent of the patients became nearly symptom-free in a day. Thirty-five percent of patients who received ketamine still showed benefits seven days later.
In the most recent study published online in the journal Nature in May 2016, researchers discovered that a chemical byproduct, or metabolite, is created as the body breaks down ketamine. The metabolite reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine.
As put by Carlos Zarate, MD, of the National Institute of Mental Health (NIMH), and a study coauthor and pioneer of research using ketamine to treat depression:
This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments. By using a team approach, researchers were able to reverse-engineer ketamine’s workings from the clinic to the lab to pinpoint what makes it so unique.”
In response to the Nature report, Sara Solovitch of The Washington Post wrote that:
experts are calling [ketamine] the most significant advance in mental health in more than half a century.
She reported that many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.
It all sounds too good to be true, right?
The Drawbacks of Ketamine
The predominant drawback of ketamine is the lack of data.
There haven’t been enough clinical trials on the drug to assure its safety, and there’s a lack of information on the long-term effects of its use.
Ketamine’s effects are also short-lived. To be used as an effective antidepressant, it would need to be administered regularly, which leads to concerns about addiction, tolerance, and, again, long-term effects. The data that we do have on long-term use comes from people who have taken ketamine recreationally, as well as those who have used it to treat chronic pain.
One 2014 study published in the British Journal of Clinical Pharmacology included among possible side effects, psychedelic symptoms (hallucinations and panic attacks), nausea, cardiovascular stimulation, memory defects, and bladder and renal complications.
Still, the drug holds promise for uncovering new ways of treating depression and offers hope for the most severe and complicated mood disorders that baffle psychiatrists today.
Richard J. Hodes, MD, director of the National Institute on Aging, commented on the most recent NIH study and the importance of furthering the research:
Unraveling the mechanism mediating ketamine’s antidepressant activity is an important step in the process of drug development. New approaches are critical for the treatment of depression, especially for older adults and for patients who do not respond to current medications.
Join Project Hope & Beyond, the new depression community.
This guest article appeared on PsychCentral.com: Ketamine: A Miracle Drug for Depression? and was originally posted on Sanity Break at Everyday Health by Therese J. Borchard.
References
Diazgranados, N., Ibrahim, L., Brutsche, N., Newberg, A., Kronstein, P., & Khalife, S. et al. (2010). A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression. Archives Of General Psychiatry, 67(8), 793. DOI: archgenpsychiatry.2010.90.
Zanos, P., Moaddel, R., Morris, P., Georgiou, P., Fischell, J., & Elmer, G. et al. (2016). NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature, 533(7604), 481-486. DOI: 10.1038/nature17998.
Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., & Luckenbaugh, D. et al. (2006). A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Archives Of General Psychiatry, 63(8), 856. DOI: 10.1001/archpsyc.63.8.856.
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Monday, 25 September 2017
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Think of walking to work or cleaning as low-cost preventive medicine
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Mosquito controls with AGO bucket traps, Autocidal Gravid Ovitrap (AGO), tested by CDC
AGO traps are available for purchase online from Springstar. Two traps cost $75, free shipping: https://www.springstar.net/collections/mosquitoes/products/ago
The Autocidal Gravid Ovitrap (AGO trap), was developed by the Center for Disease Control (CDC) and has been proven to reduce populations of Aedes mosquitoes by over 80%. It is effective for the mosquitoes that transmit Zika, dengue, chikungunya, and yellow fever. No pesticides or pheromones required. Just add water and a little hay.
From Springstar website: "The Trap-N-Kill® Autocidal Gravid Ovitrap is an 18 liter black bucket fitted with a “capture chamber” on the top. The capture chamber allows you to swap out the sticky board without having to pull off the whole lid. Twist the top half of the chamber and you'll have access to where the sticky board rests. The bucket itself is filled with water up to a specific depth that is controlled by a series of slots which are machined into the bucket sides. Gravid female Aedes mosquitoes are attracted to the hay-infused standing water and seek to lay their eggs on a hard surface right at the water line.
They try to do that by entering the capture chamber through the top screen. They can get through that screen with ease but other critters, like squirrels or birds can't. The capture chamber, a cylinder, contains a replaceable glue board that covers the entire inside portion of the cylinder. The mosquitoes cannot get to the water surface because the bottom screen is made of a finer mesh than the top one -- too fine for a mosquito to get through. As they keep trying to get to the water, they tire and may need to rest. When they choose to rest on the glue surface, that will be their final resting place, so to speak.
No pesticides or pheromones required. Just add water and some grass clippings or hay."
The "stickies" are the sticky issue here, as the replacements are not readily available for purchase. Pest management company Catchmaster lists "AGO Trap Replacement Glue Boards" on its website but there is no link to purchase them online.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631065/
https://www.nbcnews.com/storyline/zika-virus-outbreak/low-tech-trap-might-help-fight-zika-virus-outbreaks-cdc-n571501
https://stacks.cdc.gov/view/cdc/21081
http://www.miamiherald.com/news/nation-world/world/americas/article130514329.html
http://mosquito.ifas.ufl.edu/Workshop/Documents/Dengue_Workshop_Introductory_Talks.pdf
Saturday, 23 September 2017
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Friday, 22 September 2017
For Men, Fitness Can Often Last a Lifetime
Activities enjoyed when younger are often continued, but lots of men take up walking as they age
Source: HealthDay via Exercise and Physical Fitness New Links: MedlinePlus RSS Feed Read More Here..