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How insulin resistance can lead to depression

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Stanford Medicine scientists have found that insulin resistance can increase the risk of developing major depressive disorder. The results of the study were published in the American Journal of Psychiatry. “If you are insulin resistant, your risk of developing major depressive disorder is twice that of someone who is not insulin resistant, even if you’ve never experienced depression before,” said Natalie Rasgon, MD, PhD, Professor of Psychiatry and Behavioral Sciences.

The WHO estimates that almost 5% of adults suffer from depression. Symptoms include incessant sadness, despair, sluggishness, trouble sleeping, and loss of appetite.

Also read: How I recognized OCD and what impact it had on my life

Some factors that contribute to this deeply debilitating disease – such as childhood trauma, the loss of a loved one, or the stress of the COVID-19 pandemic – we cannot prevent. But insulin resistance is preventable: it can be reduced or eliminated through diet, exercise and, if necessary, medication.

Rasgon shares lead authorship of the study with Brenda Penninx, MD, PhD, Professor of Psychiatric Epidemiology at the Medical Center of the University of Amsterdam. The study’s lead author is Kathleen Watson, PhD, a postdoctoral fellow in Rasgon’s group.

Studies have confirmed that at least 1 in 3 of us walk around with insulin resistance – often without knowing it. The condition is not caused by an inadequate ability of the pancreas to secrete insulin into the bloodstream, as is the case with type 1 diabetes, but rather by the decreased ability of cells throughout the body to obey this hormone’s command.

The job of insulin is to tell our cells that it is time for them to process the glucose that floods our blood from our food intake, its production in our liver, or both. Every cell in the body uses glucose as fuel, and each of these cells has receptors on their surface that, when bound to insulin, signal the cell to take in the precious source of energy.

But an increasing proportion of the world’s population is insulin resistant for a variety of reasons, including their insulin receptors that don’t bind properly to insulin, excessive caloric intake, sedentary lifestyle, stress, and lack of sleep. Eventually, their blood sugar levels become chronically high.

Once these levels stay above a certain threshold, the diagnosis is type 2 diabetes, a treatable but incurable disease that can lead to cardiovascular and cerebrovascular disease, neuropathy, kidney disease, limb amputation, and other unhealthy outcomes.

Associations between insulin resistance and several mental disorders have already been established. For example, about 40 percent of patients who suffer from mood disorders have been shown to be insulin resistant, Rasgon said. But these assessments are based on cross-sectional studies – snapshots of populations at a single point in time.

The question of whether one event was the cause or the result of the other – or whether both were the results of a different causal factor – is best clarified by longitudinal studies that people can typically track over years or even decades to determine which event occurred first.

Also Read: How Reflection Can Accelerate Growth

As part of a cross-institutional collaboration within the Rasgon research network, founded in 2015, the scientists received data from an ongoing longitudinal study in which more than 3,000 participants were closely observed in order to get to know the causes and consequences of depression: the Dutch study on depression and anxiety.

Rasgon is Stanford’s lead investigator and Penninx is the lead investigator. “The Dutch study, with its meticulous monitoring of a large test population for nine years and still growing, presented us with a great opportunity,” said Watson.

The Stanford team analyzed data from 601 men and women who served as controls for the Dutch study. At the time of their enrollment, they had never suffered from depression or anxiety. Their median age was 41 years. The team measured three proxies of insulin resistance: fasting blood sugar levels, waist circumference, and the ratio of circulating triglyceride levels to that of circulating high-density lipoprotein – or HDL, known as “good” cholesterol.

They examined the data to see if those who were diagnosed with insulin resistance were at an increased nine-year risk of developing major depressive disorder. The answer to all three measures was yes: they found that a moderate increase in insulin resistance, as measured by the triglyceride-to-HDL ratio, was associated with an 89 percent increase in new cases of major depressive disorders.

Similarly, every two-inch increase in belly fat was associated with an 11 percent higher rate of depression, and an increase in fasting plasma glucose of 18 milligrams per deciliter of blood was associated with a 37 percent higher rate of depression. “Some subjects were already insulin resistant at the start of the study – there was no way of knowing when they first became insulin resistant,” said Watson. “We wanted to be more specific about how quickly the connection started,” added Watson.

The researchers therefore limited the next phase of their analysis to the approximately 400 test subjects who not only had never experienced significant depression, but also showed no signs of insulin resistance at the start of the study. However, within the first two years of the study, nearly 100 of these participants became insulin resistant. The researchers compared the likelihood of this group of developing major depressive disorder within the next seven years with that of participants who had not become insulin resistant after two years.

Also read: Pressure is a privilege, believes soccer player Ashutosh Mehta

While the number of participants was too small to determine statistical significance for waist circumference and triglyceride-to-HDL ratio, the fasting glucose results were not only statistically significant – meaning they were not incidental – but Also clinically meaningful – that is, important enough to worry: Those who developed prediabetes within the first two years of the study were at 2.66 times the risk of major depression after the nine-year follow-up up compared to those who received normal fasting glucose test results. had the two year point.

Bottom line: Insulin resistance is a strong risk factor for serious problems, including not only type 2 diabetes but also depression. “It is time providers took into account the metabolic status of patients with mood disorders and vice versa by assessing mood in patients with metabolic disorders such as obesity and high blood pressure,” said Rasgon. “To prevent depression, doctors should check their patients’ insulin sensitivity. These tests are readily available in laboratories around the world and they are inexpensive. In the end, we can curb the development of lifelong debilitating diseases, ”concluded Rasgon.

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Open up about barriers rural residents face in getting help for mental health

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We’re tight-lipped in the farmland. To suffer in silence seems to be the way we have been taught. But I think we need to acknowledge and address our problems. October 10th was World Mental Health Day and gave me a nudge. It’s okay to admit that we’re not okay. Write it down on a health questionnaire. Tell your doctor. Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you.

Mental health is important for everyone, whether in cities or in the country. Photo by Kallie Coates / Grand Vale Creative LLC

In the city or in the country, we are alike when it comes to mental suffering and stigma. The difference is that those of us in non-urban areas face three additional mental health challenges. According to the Rural Health Information Hub, these challenges include:

  • Accessibility: “Rural residents often travel long distances to use services, are less likely to have psychiatric insurance and are less likely to recognize an illness,” says RHIhub. Personally, I’m insured, but if I keep an appointment I’ll take two to four hours off from work to attend. There have been instances where I’ve taken a full day off to do a 200-mile round-trip for a counseling appointment. Not all rural residents can change this schedule. Telemedicine options have been expanded by the pandemic. I hope telemedicine continues to improve mental health accessibility.
  • Availability: I love rural clinics and support them with routine health care. However, at the moment I have no possibility of psychological support in a rural health clinic. According to RHIhub, “there is a chronic shortage of mental health professionals and mental health providers are more likely to practice in urban centers.” I called an expert I had seen years ago after a new appointment and was told they were six would book up to a year for new dates. At first, I had empathy for the person who had to answer the phone and make appointments. Next, I thought of those in the mental health services industry who are unable to get in touch with everyone who wants to see them. We need more experts. I still want to see this professionally and personally. I will wait for your appointment. I will also see another professional on video sooner.
  • Acceptance: The first time I wrote about mental health in this column, I received feedback from someone who felt they knew me enough in real life to comment and say I had the mental health issues or the reality Not really familiar with the effects of mental illness is a family disease. She was wrong. I usually don’t stick with the haters or negative feedback, but it did for a while. Then came a person who personally thanked them for talking about mental health. Don’t let this stop you from seeking professional mental health help. “The stigma of needing or receiving psychiatric care and the limited selection of trained professionals who work in rural areas create barriers to care,” says RHIhub. We can break down barriers by saying that it is okay to seek psychological help for you or your loved ones.

Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you, says Katie Pinke.  Erin Brown / Grand Vale Creative

Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you, says Katie Pinke. Erin Brown / Grand Vale Creative

We are all affected by mental health problems. Unless you have any mental health problems or severe mental illness, you know someone who is. Add in a global health pandemic and we’re more isolated now than we were two years ago. Don’t be silent about mental health or serious mental illness. When someone confides in you, help them get in touch with professional help. Listen more than talk. Showing up with your presence is a difference maker.

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You are not alone. You are needed. You are loved. Your presence is a crucial part of someone’s community. I made a deliberate decision not to let the waves of fear swallow me up that I sometimes feel. I fight it with a network of support. I also know that a healthy lifestyle, regular exercise, fresh air, quiet time in my beliefs, and a few things for myself that I enjoy have positive effects on my mental health.

Caring for our mental health is just as important as caring for our physical health. Let’s start by breaking down the rural mental health barriers of availability, accessibility, and acceptance by seeking the help we need regardless of the travel time, waiting time for appointments, or the stigma we need to overcome.

To read more of Katie Pinke’s The Pinke Post columns, click here.

Pinke is the editor and managing director of Agweek. You can reach her at kpinke@agweek.com or connect with her on Twitter @katpinke.

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Facebook should modify algorithms to make social media safer for teens

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Talk to a pediatrician and we will tell you: We are going through a mental crisis in teenagers. The pandemic has brought school closings and stay-at-home restrictions that resulted in social isolation among youth. With more than 721,000 COVID-19 deaths across the country, many teens know a deceased person personally and in some cases have even lost a parent.

Unsurprisingly, pediatricians like us are at the forefront of caring for more than twice as many teenagers struggling with depression, anxiety, and eating disorders.

With this in mind, social media giant Facebook – owner of Instagram, a platform used by more than half of teenagers in the United States – plays a key role. Amid these rising and unprecedented rates of mental illness among teenagers, will Facebook be part of the problem or the solution?

Instagram and eating disorders

Whistleblower and former Facebook product manager Frances Haugen recently testified before Congress that internal research by the company showed that Instagram may have worsened the mental health of young people. In these studies, teenage girls reported feeling worse about their bodies on Instagram, increasing eating disorders, and having thoughts of suicide more often.

We’ve seen examples of this at our own eating disorders clinic, where teenagers often tell us Instagram exposes them to posts that perpetuate unrealistic body shapes and share harmful diet tips.

Facebook’s internal research confirms a 2018 study by the Pew Research Center that shows 1 in 4 teenagers say social media negatively affects their lives because they experience bullying and harassment, unrealistic views about their lives Develop colleagues and get distracted from spending too much time online.

Again, these are concerns we often hear from teenagers in our practice. Such issues are likely to be compounded among teenagers who spend more time on social media, which is particularly worrying given that nearly 90% of teenagers who visit Instagram and other platforms do so several times a day.

This time of immense control presents Facebook with a pivotal opportunity to support, rather than hurt, teenage mental health. Legislators have proposed stepping in and regulating the platform, and as pediatricians we are inclined to support these measures if they are aimed at improving the health and wellbeing of teenagers. However, despite regulation, social media is likely to play a permanent role in teenage lives for years to come. Facebook should seize this moment to take action to clearly improve and support teenage mental health.

Larry Strauss:A teacher’s question: Social media harms my students, but do technical executives even care?

Perhaps most importantly, Facebook and other social media companies should reinforce healthy messages. In the same study by the Pew Research Center, 1 in 3 teenagers reported that social media had a positive impact on their lives, most often because it helped them connect with others or find important information.

However, algorithms in Facebook and Instagram – which are kept secret from public scrutiny – are based on how many people like, share and comment. This approach encourages bombastic, misleading, and unhealthy posts.

We need health-oriented algorithms

Instead, social media companies could specifically curate and actively promote messages about health and wellbeing. Numerous pediatric influencers (e.g. @teenhealthdoc, specialist in youth health in New York) already offer evidence-based advice and health information for adolescents and their families on Instagram and other platforms. Facebook could set up an advisory board of clinicians to assess the quality of influencers’ posts, offer health care providers a review (with the invaluable “blue check mark” that shows a user is authentic and remarkable), and make their posts accessible to a youthful audience do.

Social media companies should also encourage young people to post accurate, health-promoting content themselves.

Tom Kistenmacher:Facebook Revelations: Social Media Strengthened Our Voices, But Impaired Our Hearing

This approach would require Facebook to change its algorithms, which the company is likely to resist unless regulation enforced. Social media companies have come under constant fire for being too late to respond to misleading or harmful posts, which contributes to bad press and negative regulatory attention.

We claim that Facebook should be proactive in its approach and promote high quality content that is interesting to teens. Done right – with an infusion of creativity, thoughtful design, and humor – positive, health-promoting posts can receive a tremendous number of likes, shares, and comments, but may need to be actively promoted amid the negative messages currently prevailing. Realizing that it has a duty to block misinformation about COVID-19, Facebook must take similar steps to protect teenagers’ mental health.

Facebook can also help facilitate moderation in the use of its platforms among teenagers. The current business models of social media companies are driven by the persistent, compulsive use of their products and the advertising revenue they generate. In his credit, Facebook has imposed advertising restrictions on teenagers.

The company should build on this by helping teenagers put their smartphones down. To reduce screen time, Apple introduced Screen Time, an iPhone and iPad integration that allows parents to limit the time teens spend using social media apps. However, workarounds are easy to find for teenagers. Facebook should introduce its own functionality that would allow parents to limit teenagers’ use of its platforms.

We will address the after-effects of COVIC-19 on teenage mental health in the years to come. The reality is that while many of us pediatricians would like to remove social media from the lives of our teenage patients altogether, Instagram and other popular platforms are going nowhere. Social media companies wield tremendous power over young people. You should use it to empower – not hinder – the hard work we frontline pediatricians do to fight mental illness.

Dr. Scott Hadland is the Chief Medical Officer of Adolescent Medicine at MassGeneral Hospital for Children and Harvard Medical School (@DrScottHadland on Twitter and Instagram). Dr. Kathryn Brigham is the medical director of the Teenage Eating Disorders Program at MassGeneral Hospital for Children and Harvard Medical School.

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Study finds a downward trend in buprenorphine misuse among U.S. adults with opioid use disorder

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Data from a nationwide representative survey shows that in 2019, nearly three-quarters of US adults who used buprenorphine had not abused the drug in the past 12 months. In addition, buprenorphine abuse among people with opioid use disorder declined between 2015 and 2019, although the number of people receiving buprenorphine treatment increased. The study, published today on the JAMA Network Open, was conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Centers for Disease Control and Prevention.

Buprenorphine is an FDA-approved drug used to treat opioid use disorders and to relieve severe pain. Buprenorphine, used to treat opioid use disorders, works by partially activating opioid receptors in the brain, which can help reduce opioid cravings, withdrawal, and general use of other opioids.

In 2020, more than 93,000 people lost their lives to drug overdoses, with 75% of those deaths being caused by an opioid. In 2019, however, fewer than 18% of people with last year’s opioid use disorder were receiving medication to treat their addiction, in part because of stigma and barriers to accessing those medications. To prescribe buprenorphine for the treatment of opioid use disorders, doctors must do so as part of a certified opioid treatment program or submit a letter of intent to the federal government, and the number of patients they can treat at the same time is limited. Only a small fraction of doctors are authorized to treat an opioid use disorder with buprenorphine, and even fewer prescribe the drug.

Quality medical practice requires the provision of safe and effective treatments for health conditions, including substance use disorders. This includes providing life-saving drugs to people with an opioid use disorder. This study provides further evidence of the need for expanded access to proven treatment approaches such as buprenorphine therapy, despite the remaining stigma and prejudice that persists in people with addiction and the drugs used to treat them. “

Nora D. Volkow, MD, NIDA director

In April 2021, the U.S. Department of Health released updated guidelines for buprenorphine practice to expand access to treatment for opioid use disorders. However, barriers to the use of this treatment persist, including doctor’s discomfort in treating patients with opioid use disorder, the lack of adequate insurance coverage, and concerns about the risks of distraction, abuse, and overdose. Abuse is defined as patients taking medication in a manner not recommended by one doctor and may include consuming someone else’s prescription medication or taking their own prescriptions in larger quantities, more frequent doses, or for a longer duration than directed.

To better understand buprenorphine use and abuse, researchers analyzed data on prescription opioid use and abuse, including buprenorphine, from the National Surveys on Drug Use and Health (NSDUH) 2015-2019. The NSDUH is conducted annually by the Department of Substance Abuse and Mental Health. It provides representative data on prescription opioid use, abuse, opioid use disorder, and motivation for recent abuse in the civil, non-institutionalized US population nationwide.

The researchers found that nearly three-quarters of US adults who reported using buprenorphine in 2019 had not abused buprenorphine in the past 12 months. In total, an estimated 1.7 million people reported taking buprenorphine as prescribed in the past year, compared to 700,000 people who reported using the drug. In addition, the proportion of patients with opioid use disorder who have abused buprenorphine has tended to decline over the study period, although the number of patients who received buprenorphine treatment has increased recently.

Importantly, in adults with an opioid use disorder, the most common reasons for recent buprenorphine abuse were “because I am addicted to opioids” (27.3%), suggesting that people are using buprenorphine over the counter for self-treatment of cravings and withdrawal may have symptoms related to an opioid use disorder and “to relieve physical pain” (20.5%). In addition, adults who took buprenorphine were less likely to have buprenorphine abuse among those who received drug treatment than those who did not. Taken together, these results illustrate the urgent need to expand access to buprenorphine treatment, as receiving treatment can help reduce buprenorphine abuse. In addition, strategies need to be developed to further monitor and reduce buprenorphine abuse.

The study also found that people who did not receive drug treatment and those who lived in rural areas were more likely to abuse drugs. However, other factors, such as belonging to a racial / ethnic minority or living in poverty, did not influence buprenorphine abuse. The study authors suggested that addressing the current opioid crisis should improve both the access to and quality of buprenorphine treatment for people with opioid use disorder.

“Three-quarters of adults taking buprenorphine do not abuse the drug,” said Wilson Compton, MD, MPE, NIDA associate director and lead author on the study. “Many people with opioid use disorder need help, and as clinicians we need to treat their condition. Use disorder can access this life-saving drug.”

Source:

National Health Institute

Journal reference:

Han, B., et al. (2021) Trends and Characteristics of Buprenorphine Abuse Among Adults in the United States. JAMA network open. doi.org/10.1001/jamanetworkopen.2021.29409.

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