Probiotic Supplementation in Pregnancy Reduces the Risk of Anxiety and Depression

Though the evidence of the role of diet and the gut in the development of psychological disorders is established and growing, the majority of the research has either been epidemiological (observations of large groups of people – these do not show causality) or animals trials (show the mechanisms but might not completely translate to humans). At the end of all of these papers the authors remark that more high-quality human trials are required to draw firmer conclusions. Earlier in the year we had the publication of the SMILES Trial, a study that showed a cause and effect relationship between poor diet and depression and now a new paper provides more good evidence of the role of probiotics and the gut microbiome on mental health. Even more interesting is that this was not even the main aim of the research.

Researchers in New Zealand set up a trial to see whether giving pregnant women probiotics would affect their children’s risk of developing eczema. Eczema is an inflammatory skin condition and the gut microbiome plays an essential role in regulating inflammation. A baby’s gut microbiome is seeded at birth during its transit through the birth canal, or from skin contact after delivery by caesarean section. In the study 423 pregnant women were randomly assigned to two groups. One group received a daily supplement of a strain of bacteria called Lactobacillus rhamnosus (HN001). The other group received an identical looking/tasting placebo. The women took the supplement/placebo from the moment they enrolled until their child was born, and from birth until 6 months if the mother was breastfeeding. Information about the women’s mental state was taken at baseline (14-16 weeks pregnant), when the child was 6 months and 12 months old. They found a strong effect of the probiotic. The women who had taken the supplement (and none of the women knew whether they were taking the active supplement or the placebo) were much less likely to experience depression and anxiety after the birth of their children.  

The researchers report that between 10%-15% of women experience post-partum (post-natal) depression, which can impair the development of a strong bond between mother and infant, creating psychological and physical health risks for both. Medication options for breastfeeding women are limited because of the risk that the medication would be ingested by the baby in breast milk. In addition, it is practically difficult for women to access psychological or psychosocial interventions on top of the demands of a new baby. Further, some women feel reluctant to ask for help because they feel ashamed or guilty that they should feel so unhappy following the birth of their baby. Clearly then, the development of accessible and effective treatments is essential. There are many questions still to be answered about what a probiotic treatment might look like. This trial looked at only one strain and it might be that others of a combination are important too. We also need to know how long treatment should last and what the dose should be. But this well-designed study adds to the evidence of the role and importance of gut health in mental health and of taking the health of the whole body in to consideration when looking to treat mental health problems.

Reference

Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. DOI: 10.1016/j.ebiom.2017.09.013

Exercise (Walking) Increases Effectiveness of CBT in Reducing Depression and Suicidal Thoughts

Depression is now the leading cause of global disease burden. This means that depression is a greater cause of loss of quality of life and days without illness than other illnesses such as heart disease and type 2 diabetes. This week the Mental Health Foundation published a report indicating that only 13% of people in the UK report living with good mental health. More than ever we need to find ways to support mental wellness and increase the efficacy of standard treatment.

I have reported elsewhere research indicating the beneficial effects of physical exercise on mental health. Exercise improves brain function in a number of ways including increasing blood flow to the brain, promoting the growth of new brain cells and increasing levels of serotonin and dopamine, neurotransmitters associated with good mood and satisfaction. A new study compared the effectiveness of Cognitive Behavioural Therapy (CBT), a recognised effective treatment for depression, against a combined treatment package of exercise and CBT for treating depression. In this Iranian study 54 (70 started, 16 dropped out) sedentary people with mild to moderate depression were assigned to either a combined CBT and exercise group or a CBT only group. The CBT was delivered in groups of 4-6 people, one 90-minutes session per week for 12 weeks. Interestingly, and importantly, the exercise was not strenuous or high-impact. It involved:

• 5 minutes of warm up flexibility exercises
• 5 minutes of clapping and light movements
• 20 minutes walking at moderate intensity
• 5 minutes cool down and deep breathing.

This was repeated three times per week for 12 weeks in the evening.

The authors conclude that both groups saw improvements in their depression and reduced suicidal thoughts. However, the combined CBT and exercise group also improved their daily functioning and the combined treatment was superior than CBT alone at reducing depression and suicidal thoughts.

Using exercise as an adjunct to traditional therapy provides a low-cost, safe, easily accessible way to improve the effectiveness of standard treatment that has the added benefit of improving physical health too. This work adds further support to the importance approaching mental health from a whole-body perspective.

Reference

Abdollahi, A., LeBouthillier, D. M., Najafi, M., Asmundson, G. J. G., Hosseinian, S., Shahidi, S., Carlbring, P., Kalhori, A., Sadeghi, H. & Jalili, M. (2017). Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression. Journal of Affective Disorders, https://doi.org/10.1016/j.jad.2017.05.012

Dietary Intervention for Depression – The SMILES Trial

I have reported on epidemiological studies that show a relationship between a consistently healthy diet and depression in the general population and in women. This research has been correlational; it shows that there is a relationship but cannot say that what causes what. It could be that depressed people are more likely to eat a poor diet. All that changed recently with the publication of a randomised controlled trial of the use of diet as a treatment of depression; The ‘SMILES’ Trial.

The 67 participants in this 12-week Australian study were depressed adults who had a clinically defined poor diet. A poor diet was one that was low in fibre, fruit and vegetables and lean protein, and high in sweets, salty snack foods and processed meats. Some participants were receiving treatment in the form of medication, talking therapy or both.

Participants were randomly assigned to either a nutritional intervention group or a befriending control group. In the intervention group the participants had seven one-hour sessions with a registered nutritionist who provided them with personalised nutritional advice, meal plans, and coached them around goal setting and motivation to help them to stick to the nutritional recommendations. They were encouraged to eat (servings in brackets):

• Whole grains (5–8 servings per day)
• Vegetables (6 per day);
•  Fruit (3 per day),
• Legumes/beans (3–4 per week);
• Low-fat and unsweetened dairy foods (2–3 per day);
• Raw and unsalted nuts (1 per day);
• Fish (at least 2 per week);
• Lean red meats (3–4 per week);
• Chicken (2–3 per week);
• Eggs (up to 6 per week); and
• Olive oil (3 tablespoons per day).

In addition, participants were encouraged to reduce their intake of “‘extras’ foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). Red or white wine consumption beyond 2 standard drinks per day and all other alcohol (e.g. spirits, beer) were included within the ‘extras’ food group. Individuals were advised to select red wine preferably and only drink with meals.” Those in the social support/befriending group had seven one-hour meetings with a trained professional who talked to them about neutral. Anxiety, depression and general mood were assessed at the beginning and end of the study, along with biometric and anthropometric data such as weight, waist circumference, fasting blood glucose and cholesterol.

People in the dietary intervention group were four times more likely to be in remission at the end of 12 weeks than those in the befriending group. They also had reduced severity of anxiety symptoms. There was no change in BMI, blood glucose, cholesterol or physical activity within or between the groups.

The NNT in the SMILES Trial was four. This compares favourably to common antidepressant medication which can vary from 5-16, which is still considered effective particularly in relation to the high global rates of depression. The authors also make the point that that this nutritional intervention would also have positive outcomes for other problems that are commonly associated with depression such as heart disease, type 2 diabetes and obesity. Crucially, the researchers also looked at the affordability of the diet and found that, on average, people adhering to the diet spent $26 less per week on food and drink than they were at the start of the study.

Of course, this was a small study and it will both interesting and exciting to see the trial replicated with more participants from different ethnic backgrounds. However, it is also, I think, hugely important. It is the first study that demonstrates a direct influence of diet on depression. Depressed people who improved their diet felt better. The upshot is that improving diet in line with general guidelines had a significantly positive effect on depression. The benefit of this kind of intervention is that there are no waiting lists or side-effects, and it doesn’t have to be expensive. We eat several times a day and this research shows us that each meal provides us with a valuable opportunity to make a difference to how we feel.

Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, M., Dean, O.M. Hodge, A. M. & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the “SMILES” trial). BMC Medicine, 15, 23. http://doi.org/10.1186/s12916-017-0791-y

Effect of Probiotics on Central Nervous System Functions in Animals and Humans: A Systematic Review

Many by now will be familiar with the term ‘friendly bacteria’, referring to the vast population of bacteria in the digestive tract. This population of microbes (the microbiome) play an important role in maintaining our digestive health and many people consume yogurt and other fermented milk drinks to promote gut health. Increasingly research is showing us that the gut microbiome has a significant effect on our mental as well as physical health.

To gain a better overview of the current status of research in this area a systemic review of random controlled trials was conducted and published in the Journal of Neurogastroenterology & Motility. The researchers reviewed 25 animal and 15 human trials. Of the studies involving human participants just over half described significant effects of probiotics on central nervous system function and an intake of probiotics for four weeks appeared to be the threshold for noticeable effects. In the human trials the most common bacterial strains tested were Bifidobacterium longum, B. breve, B. infantis, Lactobacillus helveticus, L. rhamnosus, L. plantarum, and L. casei, all of which are present in fermented foods such as yogurt, kefir and traditional (unpasteurised) sauerkraut.

Looking at both the animal models and human trials the results of this review indicated that probiotics were an effective intervention for a range of mental health disorders including anxiety, depression, Obsessive Compulsive Disorder (OCD) and memory function. A number of potential mechanisms were identified:

• Reduced cortisol (stress hormone) levels

• Reduced inflammation.

• Improved immune function

It is also feasible that some of the known metabolites of the microbiome such as GABA, an inhibitory neurotransmitter, might play a role either via the vagus nerve or more directly by crossing the blood-brain barrier. Whilst the review is generally positive the researchers called for further studies to be conducted with human participants in order to be able to draw firmer conclusions on the promising role of probiotics on mental diseases.

Reference:

Wang, H., Lee, I., Braun, C. & Enck, P. (2016). Effect of Probiotics on Central Nervous System Functions in Animals and Humans: A Systematic Review. Journal of Neurogastroenterology & Motility, 22, 589-605.

Poor Diet Associated with Increased Risk of Depression in Women

The Whitehall II Study is a large, longitudinal study following the health and wellness of over 10,000 British civil servants between the ages of 35 and 80. Recruitment started in 1985 and follow-up is ongoing. Whilst the study primarily releases data on the relationship between physical health and socioeconomic status the enormous amount of data collected is often shared with and analysed by international researchers interested in other aspects of health and lifestyle. A paper published in Clinical Psychological Science reviewed the Whitehall data looking at the relationship between diet and depression. They were curious as to whether the inflammatory potential of a person’s diet had any bearing on their risk of developing the illness.

Inflammation is they way that the body responds to physical illness and injury and is also associated with lifestyle factors such as chronic stress and poor diet. The Dietary Inflammatory Index (DII) is a reliable assessment of how likely certain foods are to promote inflammation in the body. Broadly, processed foods increase inflammation while whole foods, fruits, vegetables, nuts and oily fish reduce it. A higher score on the DII is linked to higher markers of inflammation in the body.

In this analysis the researchers looked at the available dietary information and depression status of 4246 people over a period of five years. They were interested in what they have called ‘recurrent depression’ - people who had depression at the start and again at the end of this five-year period. (They did not look at whether the depression was ongoing during this period or whether it had gone in to remission at any point.) Alongside diet they looked at other health-related factors such as level of exercise, smoking status, alcohol consumption, obesity, heart disease, diabetes and stroke. 

The researchers found that women with high scores on the Dietary Inflammatory Index were significantly much more likely to develop recurrent depression, and this effect was independent of other health factors. This is similar to the results of the large Spanish 'SUN Project' that showed that healthy (anti-inflammatory) diets were linked to a reduced risk of depression in men and women. The authors comment that these results support the growing body of research in to the relationship between diet, inflammation and depression. 

Reference

Akbaraly, T. N., Kerlau, C., Wyart, M., Chevallier, N., Ndiaye, L., Schivappa, N., Hébert, J. R., Kivimäki, M. (2016). Dietary Inflammatory Index and Recurrence of Depressive Symptoms: Results From the Whitehall II Study. Clinical Psychological Science, first published on August 8, 2016 doi:10.1177/2167702616645777

The Role of Emotion Suppression in Chronic Fatigue Syndrome

Last month a report on the possible biological mechanisms underlying Chronic Fatigue Syndrome (CFS) generated a lot of interest on social media so I thought I would follow that up with a new study that discusses the psychological and emotional processes of the disorder.

This study from researchers at King’s College London looked at the relationship between emotional suppression and fatigue in CFS. Patients recruited from two specialist CFS services (and healthy controls) were required to watch a distressing film clip. Half of the group were told that they could deal with the emotions from watching the film in any way that they liked and the other half were told that they had to suppress their emotional responses. All were monitored for signs of distress by video-tape and skin conductivity.

Before watching the video participants completed a questionnaire about their beliefs about emotions. This scale is designed to uncover whether people hold unhelpful beliefs, for example that showing emotions is a sign of weakness, that it is important to keep up a brave face or that others will think less of you for expressing your true feelings. Participants also completed a measure of depression and anxiety. After watching the clip participants were asked how fatigued the felt.

The results showed that participants with CFS experienced higher rates of distress but were less likely to express them, even when they were allowed to. This study indicates that this is partly due to self-held beliefs by the CFS group that expression of emotion is unacceptable. Interestingly, all participants in the suppression condition experienced higher levels of anxiety at the end of watching the film.

The researchers also showed an important relationship between emotional suppression and fatigue. When emotions were suppressed the distress didn’t go away but showed up in the body, and this increased physiological distress was associated with higher rates of fatigue. In short: the more suppression the more fatigue.

In addition, people in the CFS group were so efficient at hiding their feelings that observers found it difficult to tell if they were suffering. In the real world this makes it harder for individuals to access support and increases the likelihood of being overwhelmed and isolated.

This paper is important for individuals and professionals dealing with CFS. It highlights the importance of addressing the beliefs about emotions as a way of relieving the symptoms of the syndrome. Psychotherapy and mindfulness-based treatments are an effective way of helping people to stop supressing their emotions and learn how to accept, process and manage them providing hope for the 250,000 people with CFS in the UK.

Rimes, K. A., Ashcroft, J., Bryan, L., & Chalder, T. (2016). Emotional Suppression in Chronic Fatigue Syndrome: Experimental Study. Health Psychology. Advance online publication. http://dx.doi.org/10.1037/hea000034

Mental Health Awareness Week – Special Focus on Depression (Probiotics)

Just last week the NHS reported a study stating that there was insufficient evidence that probiotics were beneficial for healthy people. The trials analysed so far had not been well enough designed to be sure.

“Given the limitations of the studies – including the variety of probiotics examined – it is not possible to conclude with certainty that all probiotics are ineffective.

Absence of good-quality evidence is not evidence of there being no effect. Better-designed studies may yet find some benefit from taking probiotics.”

However, there is certainly some good evidence that particular probiotics do have a beneficial effect on depression, particularly where that depression is associated with cellular inflammation. Inflammation is the body’s immune response to illness or injury; the swelling around a cut or a bruise is part of this process. But inflammation also happens within and around the cell in response to other non-injury factors such as poor diet, prolonged stress or an imbalance of bacteria in the gut. Inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease are commonly associated with psychological and behavioural changes such as lack of energy or interest, loss of appetite, loss of appetite; and depression. This consistent relationship between inflammation and depression has led to the inflammation theory of depression; that is to say that for some sufferers inflammation may be contributing to the severity of their depressive symptoms.

A well-designed study of petrochemical workers published in 2015 showed that probiotic yogurt and supplements significantly improved scores of depression and anxiety. I have reported elsewhere that probiotics have been shown to alleviate the negative thoughts associated with low mood. A more recent controlled study showed that eight weeks of probiotic supplementation was associated with a significant reduction on depression scores in patients with a diagnosis of Major Depressive Disorder. It is thought that part of the mechanism underlying this effect are the by-products of the bacteria’s metabolism. When breaking down food in the gut (particularly fibre) gut bacteria produce a number of metabolites, many of them beneficial to the human body such as vitamin K and some B vitamins. They also produce short-chain fatty acids. One of these, butyric acid, in a potent anti-inflammatory. It also forms part of a neurotransmitter called GABA, which has a calming, tranquilizing effect on the brain.

There are a lot of probiotic products on the market and it can be difficult to know which is likely to be the most effective. There is very good research data supporting the anti-inflammatory properties of a highly concentrated probiotic supplement called VSL#3 in a number of different diseases. Whilst not necessarily a recommendation, this is the product that I use as well as ensuring regular consumption of fermented and high fibre foods.

http://www.nhs.uk/news/2016/05May/Pages/No-evidence-probiotics-are-beneficial-for-healthy-adults.aspx

Mohammadi, A. A., Jazayeri, S., Khosravi-Darani, K., Mohammadpour, N., Asemi, Z., Adab, Z., Djalali, M., Tehrai-Doost, M., Hosseini, M. & Eghtesadi, S. (2015). The effects of probiotics on mental health and hypothalamic–pituitary–adrenal axis: A randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutritional Neuroscience. Published online April 16th.

Laura Steenbergen, Roberta Sellaro, Saskia van Hemert, Jos A. Bosch, and Lorenza S. Colzato. 2015. A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain, Behavior, and Immunity, 48, 258-264.

Akkasheh, G., Kashani-Poor, Z., Tajabadi-Ebrahimi, M., Jafari, P., Akbari, H., Taghizadeh, M., Memarzadeh, M. R., Asemi, Z., & Esmaillzadeh, A. (2016). Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition, 32, 315-20.

D'Mello, C., Ronaghan, N., Zaheer, R., Dicay, M., Le, T., MacNaughton, W. K., Surrette, M. G. & Swain, M. G. (2015) Probiotics Improve Inflammation-Associated Sickness Behavior by Altering Communication between the Peripheral Immune System and the Brain. Journal of Neuroscience, 35, 10821-18030.

Mariman, R., Tielen, F., Koning, F. & Nagelkerken, L. (2014). The probiotic mixture VSL#3 dampens LPS-induced chemokine expression in human dendritic cells by inhibition of STAT-1 phosphorylation. PLoS One, 9: e11567.

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

Mental Health Awareness Week – Special Focus on Depression (Mindfulness)

Yoga, Meditation & Mindfulness

Mindfulness meditation - the skill of paying attention without judgement – has been a feature of some religious and cultural traditions for centuries. Over the last 30 years psychology has been interested in how this ancient practice might have beneficial effects on our modern lives. Mindfulness mediation really came to public attention in 2011 when a study at Harvard University showed that eight weeks of mindfulness practice was able to reshape the brain’s structure, improving function in the areas associated with memory, empathy and stress. More recently, a study published in the journal Neural Plasticity used functional MRI to demonstrate the nature of meditation-induced brain changes and showed that meditation was able to significantly reduce the participants’ depression scores; participants who at the start of the study were identified as depressed had scores below the cut-off for diagnosis by the end of the intervention, a near 50% reduction in symptoms in eight weeks. Earlier, researchers at the University of Bologna compared the efficacy of mindfulness-based therapy to a matched psychoeducation programme. The mindfulness-based intervention yielded significantly greater improvement in depression scores.

The practice of yoga has a strong mindfulness component, requiring practitioners to focus on the position of their bodies, their breathing as well as any thoughts or emotions they become aware of during the practice. The case for yoga and meditation as a useful tool in tackling depression is strong and growing. A randomised control trial comparing yoga to walking found that yoga was more effective at improving mood (and decreasing anxiety). A recent study published in Depression and Anxiety found that yoga had a significantly beneficial effect on depression scores compared to standard treatment alone, and that it also improved overall wellbeing. In another recent trial a consistent yoga practice was associated with better outcomes and recovery from Post-Traumatic Stress Disorder and depression.

Both yoga and mindfulness/meditation have health benefits beyond a sense of calm. As well as reducing the severity of depressive symptoms they can increase levels of brain chemicals that promote the growth of new brain cells, reduce levels of stress hormones, increase concentration and reduce anxiety. Yoga also comes with the added physical advantages of increased strength, balance and flexibility, all of which are important in slowing the process of aging. Both yoga and mindfulness are practices whose benefits are accumulative, requiring regular application for the best results. As with physical exercise, it is best to start with shorter, manageable efforts and build up to a longer regular practice. When introducing my own clients to mindfulness I recommend starting with just one minute a day first thing in the morning, before they can get distracted. Mindfulness practice is also helpful before bed as it can help to ease you into a restful sleep. There are free apps, such as Headspace, and online tutorials and guided meditations that can be useful to get you started as well a number of taught courses and books. Those interested in giving it a try might find this video from Martin Boroson an easy introduction.

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research, 191(1), 36–43. http://doi.org/10.1016/j.pscychresns.2010.08.006

Yang, C.-C., Barrós-Loscertales, A., Pinazo, D., Ventura-Campos, N., Borchardt, V., Bustamante, J.-C., … Walter, M. (2016). State and Training Effects of Mindfulness Meditation on Brain Networks Reflect Neuronal Mechanisms of Its Antidepressant Effect. Neural Plasticity, 2016, 9504642. http://doi.org/10.1155/2016/9504642    

Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., … Jensen, J. E. (2010). Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study. Journal of Alternative and Complementary Medicine, 16(11), 1145–1152. http://doi.org/10.1089/acm.2010.0007

de Manincor, M., Bensoussan, A., Smith, C. A., Barr, K., Schweickle, M., Donoghoe, L.-L., Bourchier, S. and Fahey, P. (2016). Individualized yoga for reducing depression and anxiey, and improving well-being: A randomized controlled trial. Depression and Anxiety. doi: 10.1002/da.22502

Rhodes, A., Spinazzola, J. & van der Kolk, B. (2016). Yoga for adult women with chronic PTSD: A long-term follow—up study. The Journal of Alternative and Complementary Medicine, 22, 189-196. doi:10.1089/acm.2014.0407.

Chiesa, A., Castagner, V., Andrisano, C., Serretti, A., Mandelli, L., Porcelli, S. & Giommi, F. (2015). Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment. Psychiatry Research, 226, 474 – 483.

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine

Mental Health Awareness Week – Special Focus on Depression (Heat)

Hot off the press is some brand new research in to the role of heat on alleviating the symptoms of depression. Turkish baths, saunas and sweat lodges have been a feature of cultures all over the world for hundreds of years. Full body heat has been used for therapeutic and sacred purposes by indigenous peoples across North America, Scandinavia, Central and South America, Central Europe where they are known to create a sense of relaxation. More recently research into the hormetic effects of heat on the body have uncovered many more health benefits. Hormesis is the term used to describe the beneficial effects of stress on the body. The most commonly understood example of this is exercise; the process of applying manageable stress to the body, by lifting weights for example, compels the body to respond by becoming stronger. Similarly, heat stress can activate biological pathways linked to improved health, longevity and neurogenesis (the formation of new brain cells).

In this paper the authors sought to clarify an earlier observation that a single session of infrared heat exposure reduced depression for five days post-treatment. Conducted over two years the participants in this current study all had a very high depression scores on a standard symptoms scale but were not taking any antidepressant medication. Participants were randomly allocated to one of two conditions: either one session of full body infrared heat treatment or one session of a placebo treatment; an identical set up just without sufficient heat to significantly raise core body temperature. The sham condition was so convincing that the majority of the people who received it believed they were receiving the real treatment. At the end of the intervention participants were reassessed at 1, 2 and 3 days, and 1, 2, 4 and 6 weeks after by assessors who did not know whether the participant had had the real or the sham treatment. Remarkably the participants who had received just one session of heat treatment showed significantly reduced depression scores up to six weeks after treatment and experienced only mild and short-lived side effects (such as dry mouth, headache or sweating). Though small, this study builds on previous research that showed a significant reduction in depression following heat treatment as well, of course, as the established therapeutic use of heat in many cultures.

Whole body heat treatment has the potential to be a powerful, safe, fast-acting and long-lasting treatment for depression. It means that a visit to the gym (see yesterday’s post) followed by a few minutes in the sauna could have tremendous positive effects on mood and depressive symptoms.

Janssen CW, Lowry CA, Mehl MR, et al. Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Published online May 12, 2016. doi:10.1001/jamapsychiatry.2016.1031.

Hanusch, K. U., Janssen, C. H., Billheimer, D., Jenkins, I., Spurgeon, E., Lowry, C. A.  & Raison, C. L. (2013). Whole-body hyperthermia for the treatment of major depression: associations with thermoregulatory cooling. American Journal of Psychiatry, 170, 802-804.

Koltyn, K. F., Robins, H. I., Schmitt, C. L., Cohen, J. D. & Morgan, W. P. Changes in mood state following whole-body hyperthermia. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 8, 305-307 (1992).

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. 

Mental Health Awareness Week – Special Focus on Depression (Exercise)

Many people will have heard that there are mood benefits of exercise. This is often linked to the ‘runners high’; the body’s release of endorphins and other ‘feel good’ chemicals during and just after exercise. There are also other neurological benefits of exercise that are linked to improved mood and wellbeing. For example, aerobic exercise increases the production of a protein called Brain Derived Neurotrophic Factor (BDNF). BDNF promotes the growth of new brain cells and is associated with improved memory, executive function and mood. Several studies and meta-analyses have demonstrated a positive effect of exercise on the symptoms of depression that are comparable to psychotherapy and antidepressant medication, and a new meta-analysis published last month, looking specifically at Quality of Life (QoL) adds to this body of research. QoL differs from illness symptoms in that it relates to a more global sense of wellbeing or satisfaction with life including where one perceives oneself to be in relation to peers or cultural expectations.

In this review the researchers collated exercise trials that assessed QoL in people with a diagnosis of Major Depressive Disorder (MDD). All trials included in this review had to include a non-exercise control group so that the effect of exercise could be established (as opposed to some other factor). The results indicated that moderate aerobic exercise, performed three times per week (the average across the studies) was associated with improved overall QoL for people with MDD. In addition, there were specific improvements in the psychological domain. The psychological domain (compared to the physical and social domains) has been shown have the greatest effect on overall QoL in long-term illness. There was no change in QoL in the non-exercising (control) groups. The authors state that exercise can be used as an effective treatment strategy for depression especially since antidepressant medication alone tends not to improve QoL even when depressive symptoms improve.

The evidence for the benefits of exercise in treating depression is robust and established. Regular exercisers have up to 30% reduced risk of developing the illness.  Of course, the experience of depression can make it difficult to find the motivation to exercise in the first place. For some people it may be important to start with smaller exercise goals such as a five minute walk three times a week to help build a sense of achievement and consistency. Walking with a friend or a group could potentially enhance the social domain of QoL as well as helping you to stay committed. Exercise can be a very effective, accessible, low-cost, low-risk (of side effects) weapon in the arsenal against depression.

Schuch, F. B., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P. B. & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response. Psychiatry Research, 241, 47-54.

Arnold, R., Ranchor, A. V., Sanderman, R., Kempen, G. I., Ormel, J. & Suurmeijer, T. P. (2004). The relative contributions of domains of quality of life to overall quality of life for different chronic diseases. Quality of Life Research, 13, 883-896.

http://www.nhs.uk/Livewell/fitness/Pages/Whybeactive.aspx

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

Mental Health Awareness Week – Special Focus on Depression (Omega-3)

Depression, or more technically Major Depressive Disorder (MDD), is a common and growing mental health concern, currently affecting 350 million people worldwide, making it one of the leading causes of global disability. Many people will be familiar with the symptoms of depression; low mood, loss of interest and enjoyment, disturbed sleep, change in appetite, low self-worth and fatigue, among others. This constellation of symptoms can rob sufferers of meaning from life, impair relationships and in severe cases lead to suicidal and self-harming thoughts and behaviours. Anybody who feels they might be experiencing these symptoms is strongly encouraged to talk to their GP about their symptoms and available treatments. Depression can be a very isolating experience but help is available and you are entitled to it.

A number of treatments have been shown to effectively treat depression including Cognitive Behavioural Therapy and Psychodynamic Psychotherapy. Anti-depressant medication can also be helpful if well tolerated, though side effects can be problematic for a number of patients. Recent research has started to identify other factors that can influence mood disorders or enhance the effectiveness of treatments. This week I will be presenting the latest research on lifestyle interventions that have been shown to alleviate the symptoms of depression.

The first in the series is the promising research on the efficacy of omega-3 fats in the reduction of severity of depressive symptoms. I have mentioned elsewhere the results of a meta-analysis showing that these fats have positive effects on depression. A new meta-analysis published in March this year builds on these results and addresses some of the limitations of previous papers.

In this latest analysis published in the journal Translational Psychiatry researchers reviewed the pooled results of over 1200 patients with a diagnosis of MDD. They found a significant beneficial effect of omega-3 supplementation on the depressive symptoms of MDD, comparable to the effects of anti-depressant medication. In particular, studies that included higher doses of the specific omega-3 eicosapentaenoic acid (EPA) showed the most benefit. Omega-3 supplementation also appeared to improve the effectiveness of antidepressant medication. The authors speculate that this effect might be mediated by EPA’s known anti-inflammatory action, though more research is needed to confirm this hypothesis. They also note that the long-term effects of high-dose omega-3 supplementation have not been fully analysed and should be before any clinical recommendations can be made.

The safest way to ensure you are getting enough omega-3 is through your diet. EPA is found primarily in oily fish such as mackerel, herring, trout, salmon and sardines. The body is able to convert it from the essential fat alpha-linolenic acid (ALA) but not very efficiently and only in small amounts; it is much more easily absorbed from marine sources. The NHS recommends that a healthy diet should include at least one serving of oily fish per week but the most recent National Diet and Nutrition Survey published by Public Health England showed that Britons are not consuming anywhere close to the recommended amounts. The research is encouraging but there is still work to be done. Until then trying to eat the recommended amounts of oily fish could be a useful adjunct to prescribed treatment.

Mocking, R. J. T., Harmsen, I., Assies, J., Koeter, M. W. J, Ruhé, H. G. & Schene, A. H. (2016). Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Translational Psychiatry, 6, e756; doi:10.1038/tp.2016.29

http://www.nhs.uk/Livewell/Goodfood/Pages/fish-shellfish.aspx

https://www.bda.uk.com/foodfacts/omega3.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/310997/NDNS_Y1_to_4_UK_report_Executive_summary.pdf

https://www.sciencedaily.com/releases/2016/04/160426091725.htm

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern.

Short-Term Psychodynamic Psychotherapy Effective at Reducing Depressive Symptoms and Inflammatory Markers

Depression is rapidly becoming the leading cause of disease burden (negative effects on quality of life) in the world. Psychologists and biologists have been trying to understand the underlying mechanisms of depression for a long time, wondering whether it is mainly biological or psychological in nature; a disease of the body or of the mind? My clinical experience is that it can be either or both, which is why a thorough assessment is essential. For some people the roots of their depression lie in difficult early circumstances, abusive relationships or a traumatic event. For others there may be a genetic predisposition to the illness, it ‘runs in the family’, or some other physiological factor.

Several studies have demonstrated a relationship between inflammation in the body and depression. Inflammation is your body’s response to illness or infection and can be activated by a number of factors such as poor diet, underlying illness and chronic stress. Many studies have illustrated that the higher the degree of inflammation in the body the more severe the depressive symptoms and vice versa. The consistency of this finding has led to the ‘Inflammatory Hypothesis of Depression’, proposing that inflammation is the driving force in depression in many people, and that it can increase symptom severity in those already dealing with low mood.

In a trial thought to be the first of its kind researchers from Brazil and the USA looked at the levels of inflammation in patients' blood as well as the severity of their depression before and after 16 standard (50 minutes) sessions of psychotherapy (plus an extra two for data collection). The result demonstrated a relationship between the levels of markers for inflammation and the severity of symptoms such that after psychotherapy treatment patients were less depressed and their inflammation had reduced. Previous research had looked at the ways that medication and CBT could reduce inflammation but this was the first study to look at the role of psychodynamic psychotherapy and the results are interesting enough to warrant further research.

The implications are powerful because, as the upward trend of depression continues, it will become increasingly important to find effective and low-cost treatments for the illness. This study suggests that patients could potentially gain relief from their mild or moderate depression in as little as four months and without the side-effects associated with medication.

Silva, G. D. G. d., Wiener, C. D., Barbosa, L. B., Araujo, J. M. G., Molina, M. L., Martin, P. S., Oses, J. P., Jansen, K., Souza, L. D. d. M. & Silva, R. A. d. (2016). Pro-inflammatory cytokines and psychotherapy in depression: Results from a randomised clinical trial. Journal of Psychiatric Research, 75, 57-64. 

Healthy Diet Linked to Reduced Risk of Depression

In 2015 a large Spanish study reported results showing that improvements in diet reduced a person's likelihood of developing depression. Similarly, a new correlation study of Iranian adults (average age 36 years) has demonstrated a statistically significant relationship between healthy diet and reduced rates of depression. The researchers assessed the diet and lifestyle of over 3000 people - looking at their eating habits, weight, BMI, smoking status and levels of psychological distress - and compared them against measures for anxiety and depression. They found that non-smokers were less likely to be anxious than smokers and those with healthier diets were 29% less inclined to be depressed than those with poor diets. Further research is required to understand the predictive features of these results.

Saneei, P., Esmaillzadeh, A., Keshteli, A. H., Reza Roohafza, H., Afshar, H., Feizi, A. & Adibi, P. (2016). Combined healthy lifestyle is inversely associated with psychological disorders in adults. PLoS One. DOI: 10.1371/journal.pone.0146888

Omega-3 Fats Are Effective Treatment for Depression – Meta Analysis

The varied literature on the effects of omega-3 supplementation on depression can throw up conflicting results depending on the structure and size of the individual studies. Some researchers will look at the components of omega-3s together, some separately; some for two weeks and some for two months. In order to arrive at a coherent answer to the questions of the role of omega-3 fats on depression a group of Italian researchers conducted a meta-analysis. They pooled the studies conducted on patients with a diagnosis of major depressive disorder (MDD) and those who exhibited depressive symptoms but who did not have a clinical diagnosis. The average length of treatment with fish oils was 16 weeks. The analysis revealed a significantly positive effect of fish oils (particularly EPA) in alleviating symptoms in both patients with MDD and those without a diagnosis showing that these essential fats are an effective treatment for primary depression. 

Grosso, G., Pajak, A., Marventano, S., Castellano, S., Galvano, F., Bucolo, C., Drago, F. & Caraci, F. (2014). Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One, 9 (5), e96905. ECollection.

Healthy Diets Reduce Risk of Depression

A large (15,000 participants) Spanish study has shown that diets high in nutrients are linked to a reduced risk of depression. This study has generated a lot of interest not only because of the large cohort size, which makes the results more generalisable, but because it is thought to be the first to follow healthy individuals and track, over 10 years, those who went on to develop illness and disease.

The researchers looked at three diets:

• Mediterranean Diet – characterised by the consumption of vegetables, legumes, fruits and nuts, cereals, fish and seafood; low intake of meat and dairy products, and moderate alcohol intake.

• Vegetarian Dietary Pattern – a kind of ‘flexitarian’ diet that promotes eating plant foods (including potatoes) most of the time but allowing for a little meat

• Healthy Eating Index- promotes eating larger amounts of vegetables, fruits, whole-grain bread, nuts, beans and pulses, omega 3s and unsaturated fats, and smaller amounts of sugar-sweetened beverages and fruit juice, red/processed meat, trans fats, and alcohol.

As part of the study the researchers also looked at activity levels, BMI, health history and vitamin supplementation, and the analysis was controlled for a number of variables including age, sex and smoking status.

For the statistical analysis the levels of adherence were split in to five groups (quintiles). So on a scale of 1-5, those in group 1 ate the least healthy diets while those in group 5 were paragons of healthy eating. The results showed that those in groups 2-5 had a 25-30% reduced risk of developing depression than those in group 1. Interestingly, there was a plateau in this effect once the respondents had moderately good diets. The researchers believed this to be due to a threshold effect; once you are consuming adequate amounts of a nutrient there is no additional benefit of consuming larger quantities of it.

The researches did not highlight any individual food or nutrient as being particularly important or protective. In fact they pointed out in their discussion the inconclusive results from other studies that looked at the relationship between individual nutrients (vitamins, minerals or fats) and depression. However, this and other studies have demonstrated the strong relationship between the quality of the overall diet and risk of depression. It is likely that it is the interaction of different compounds from various foods that offers most protection not just to depression but to overall health. 

Reference

Sánchez-Villegas, A., Henríquez-Sánchez, P., Ruiz-Canela, M., Lahortiga, F., Molero, P., Toledo, E., & Martínez-González, M. (2015). A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project. BMC Medicine, 13, 197-197.