Lithium and longevity?

Seems like a long shot since we still don't know how lithium works in the body, but according to Science Daily:

Nematode worms treated with lithium show a 46 percent increase in lifespan, raising the tantalizing question of whether humans taking the mood affecting drug are also taking an anti-aging medication.

Lithium is a medication that has been used to treat bipolar disorder for over 50 years. We still don't really know how it works, despite numerous studies and hypotheses.

The study above, by Buck Institute's Gordon J. Lithgow, PhD hypothesize that the process of normal aging in humans is intrinsically linked to the onset of neurodegenerative disease. They are studying hundreds of compounds for their anti-aging properties, and in the case of lithium, exploring the neuroprotective effects of lithium.

I hope they find their Fountain of Youth, but more importantly, there better be ethicists around who can wisely implement the use of it.

Online health records, brought to you by Google or Microsoft

The idea of online health records is not surprising, but definitely not reassuring.

From Computerworld:

Less than two weeks after Microsoft Corp. announced plans to support online personal health information records, Google unveiled plans to follow suit.

Marissa Mayer, Google's vice president of search products and user experience, said Wednesday here at the Web 2.0 Summit that Google plans to support the "storage and movement" of people's health records.

...Google became interested in the personal health record market as it watched Hurricane Katrina take aim at the Gulf Coast and all the paper-based records stored in various medical offices and hospitals in the region. "In that moment, it was too late for us to mobilize," Mayer said. "It doesn't make sense to generate this volume of information on paper. It should be something that is digital. People should have control over their own records."

I'm definitely mixed about this. Your personal health records should be something you have access to, and probably even have copies of. Having a copy of x-rays, MRI images, and other objective data could be very useful information for your new health care provider. What worries me is the confidentiality of these records if they become hackable and findable on the internet, and all the fraud that this could propagate. Medicare fraud is already a pretty uncontrolled problem. NPR has a wonderful segment on this.

Here's what I found most striking about the article:

Medicare fraud has now become a favorite career path of many former drug dealers. The FBI has interviewed drug dealers and asked them why they're moving from cocaine to wheelchairs and walkers.

Why the Shift? Malcolm Sparrow of Harvard's Kennedy School of Government says former drug dealers give three reasons.

"There's more money, there's much less chance of being caught and if I do get caught, I'll be treated like a white-collar criminal, not like a drug dealer," Sparrow says. There's also a fourth reason: They're less likely to be killed in a drive-by shooting.

If there was some secure, untamperable way to have access to these records, it could definitely help the health care industry save money by not needing to run the same tests over and over every time a patient goes to a new provider. Of course, there would also need to be some way to guarantee this data does not get into the wrong hands, which is much harder to do. I hear about stolen laptops with employee or customer data almost daily. Fortunately, credit card numbers, bank accounts, and even social security numbers can be changed with effort. How much worse would it be if that laptop also contained your medical files?

The Depression Report

Left: Summary table from the Depression Report

According to SAMHSA, 7% of full time workers have clinical depression. They interviewed 107,000, using questionnaires based on DSM-IV depression criteria to determine episodes of major depression in the last year.

Here's the study.

Summary:

Combined data from 2004 to 2006 indicate ... highest rates of past year MDE among full-time workers aged 18 to 64 were found in the personal care and service occupations (10.8 percent) and the food preparation and serving related occupations (10.3 percent)
l The highest rates of past year MDE among female full-time workers aged 18 to 64 were found in the food preparation and serving related occupations (14.8 percent), and the highest rates among male full-time workers aged 18 to 64 were found in the arts, design, entertainment, sports, and media occupations (6.7 percent)

The study concludes that depression results in a loss of revenue estimated at $30-44 billion annually.

Drug companies shaping medical literature 'behind the scenes'

From Science Daily:

Drug companies control or shape multiple steps in the research, analysis, writing, and publication of a large proportion of the medical literature, and they do so behind the scenes, according to a policy paper recently published in PLoS Medicine.

The essay can be found at: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040286

They talk about ghost writers, who in turn end up 'ghost managing' the studies that the prescribing population depend on for information about medications.
Drug companies hire medical education and communication companies (MECCs) to help produce and place company-funded articles in medical journals, says Dr Sismondo. These articles are "managed," he says, because those MECCs "shape the eventual message conveyed by the article or by a suite of articles."

To demonstrate this, he tracked studies of zoloft (sertaline), an antidepressant manufactured by Pfizer.

His analysis suggests that between 18% and 40% of the literature on this drug published between 1998 and 2000 was ghost managed by a single MECC acting on behalf of the drug's manufacturer. Ghost managed studies, says the author, "affect medical opinion, practice and ultimately, patients," says Dr. Sismondo. "I suspect that most researchers -- even those participating in the system -- don't have a good sense of the extent to which this happens."

Creepy to think that an unknown amount of information that we as clinicians rely on may have been secretly planted there by the drug companies.

Balance enhancing ear implant

Pic: Della Santina holding multichannel vestibular prosthesis.

Scientists at the Vestibular Neuroengineering Laboratory at Johns Hopkins University are developing a vestibular prosthesis.

They have tested the concept on chincillas with some success. Usable human versions may still be years away, but the proof of concept is promising.

More from the John Hopkins University Gazette:

In its report in the June edition of the journal I.E.E.E. Transactions on Biomedical Engineering, the Johns Hopkins team showed that a matchbox-size prototype device, weighing less than three ounces, effectively mimics the workings of the inner ear's three semicircular canals by sensing head rotation and transmitting that information to the brain.
Adapting the design of cochlear implants...researchers constructed a circuit that could measure and transmit 3-D balance information to the brain through multiple electrodes connected to the vestibular nerve.
The device...consists of a head- mounted battery-operated box containing the sensors, which are positioned outside the head so that the sensors are parallel to the animal's actual semicircular canals, where head rotation is normally sensed. The sensors are connected to a microprocessor and up to eight electrodes surgically implanted in the inner ear and separately connected to nerve endings. Each electrode can act as one information channel.
Della Santina says that people disabled by loss of vestibular sensation often feel chronically off balance and lose the ability to keep the eyes steadily pointed at an object when they move their head, "seeing the world like the wobbly image on a shaky handheld video camera."
... this is the first implantable device made with multiple sensors and channels of processing that can measure and encode head rotation in all directions.
Each of the three sensors... can measure the speed of head rotation about one of three axes, or directional planes.

Increased suicide rate coincides with decreased antidepressant use?

So goes the headline. It's very difficult to determine causality for this sort of thing (ie. we can't conclude that decreased antidepressant use caused increase in suicides, since there are many other factors that lead someone to suicide), but there definitely seems to be a correlation that has been measured from multiple studies.

I'm just relieved that the study data support the current practice standards of using antidepressants for the depressed and suicidal (bipolar disorder is separate, and antidepressants are NOT recommended is those cases).

From sfgate:
In 2003 and 2004, the FDA issued a series of warnings that clinical trials had detected an increase in suicidal thinking among children and adolescents taking a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), compared with those given sugar pills. In late 2004, the agency called for a "black box" warning on the drugs to call attention to the potential risk, and expanded it last December to include young adults.
The warnings led to a broad decline in SSRI prescriptions for all patients younger than 60, Gibbons said. Prescription rates continued to rise among those older than 60, and this was the only group in which suicides dropped between 2003 and 2004, his study found.
The study included the Netherlands, which saw a 22 percent decrease in antidepressant use between 2003 and 2005. The suicide rate among youngsters there increased 49 percent in that period.
Previous studies have shown that U.S. suicide rates are lower in counties where antidepressant use is higher, and a study in July of more than 200,000 depressed veterans found that those taking an antidepressant had one-third the risk of suicide than those who were not.

A good breakfast can help control your blood sugar all day!

From Science Daily:

"It is known that a carbohydrate-rich breakfast with low GI [glycemic index] can moderate increases in blood sugar after lunch. But my results show that low GI in combination with the right amount of so-called indigestible carbohydrates, that is, dietary fiber and resistant starch, can keep the blood-sugar level low for up to ten hours, which means until after dinner," says Anne Nilsson, a doctoral student at the Unit for Applied Nutrition and Food Chemistry and author of the dissertation.
Experiments also showed that the blood sugar increase following breakfast can be moderated in a similar way by eating the right grain products the night before.

Additionally, eating the 'right' grains can help decrease metabolic syndrome. This researcher also studied mental acuity and blood sugar levels after meals.

It turned out that subjects who had eaten low GI breakfasts could concentrate better and had a better working memory (a type of short-term memory) than the other group. These experiments also showed that healthy individuals with low glucose tolerance, that is with high rises in blood sugar than average following a meal, generally performed less well. "The findings indicate that people with great fluctuations in their levels of blood sugar run a greater risk of having a generally lower cognitive ability," says Anne Nilsson.

Apparently, the indigestible carbohydrates are the key to feeding the bacteria in the large intestine. This in turn ferments the carbohydrates into usable compenents like short chain fatty acids:

Anne Nilsson's studies show that components produced in the process of fermentation can enter the blood and favorably affect the regulation of blood sugar and the feeling of satiety, and they can help alleviate inflammatory conditions in the body, which in turn can entail a reduced risk of diabetes and cardiovascular diseases.

Magnetic brain scans to diagnose common brain diseases in 60 seconds

From Science Daily:

By comparing the patterns of tiny magnetic charges in healthy brains to those afflicted with common diseases such as Alzheimer's, the team has been able to identify the patterns commonly associated with these debilitating diseases [multiple sclerosis, Alzheimer's and schizophrenia].

How?

A process called magnetoencephalography (MEG), a non-invasive measurement of magnetic fields in the brain, has been used to examine a total of 142 volunteers during tests which last between 45-60 seconds. The team first studied 52 volunteers to find patterns of neural activity that could identify all the different illnesses. They then tested a further 46 patients to see whether the patterns found from the first group could accurately diagnose disease within a second group. Here, many of the predictors found from the first set of participants also correctly diagnosed more than 90% of subjects in the second sample.

The theory?

All behavior and cognition in the brain involves networks of nerves continuously interacting--these interactions occur on a millisecond by millisecond basis. The MEG has 248 sensors that record the interactions in the brain on a millisecond by millisecond basis, much faster than current methods of evaluation such as the functional magnetic resonance imaging (fMRI), which takes seconds to record. The measurements they recorded represent the workings of tens of thousands of brain cells.

Wow. I hope it works out, this would be an awesome tool for diagnosing, and thereby helping us choose treatments for some difficult to treat diseases.

Depressed brains are just wired differently

From Science Daily:

In what may be the first study to use brain imaging to look at the neural circuits involved in emotional control in patients with depression, researchers at the University of Wisconsin-Madison have found that brains of people with clinical depression react very differently than those of healthy people when trying to cope with negative situations.

Apparently, non-depressed people were much better at regulating their negative emotions than depressed people. In depressed people, the harder they worked, the worse they got.
In their words:

In nondepressed individuals, high levels of regulatory activity correlated with low activity in the emotional response centers - in effect, the healthy subjects' efforts successfully quelled their emotional responses. In depressed patients, however, high levels of activity in the amygdala and other emotional centers persisted despite intense activity in the regulatory regions.
This finding suggests that healthy people are able to effectively regulate their negative emotions through conscious effort, but that the necessary neural circuits are dysfunctional in many patients with depression, the researchers say. The difference becomes even more pronounced the harder the patients try.

What does this mean? Some depressed people may not get better from cognitive therapy. If thinking about something gets someone too worked up, there will need to be other ways of helping them to get better.

I wonder how depressed people successfully managed on antidepressants would do in this study?

Free online neuropsychopharmacology textbook

The American College of Neuropsychopharmacology has just released a free, online neuropharmacology textbook in .pdf format. At 134 chapters, it is broken up into 13 sections, and huge.

SECTION 1: NEUROTRANSMITTER AND SIGNAL TRANSDUCTION
SECTION 2: EMERGING METHODS IN MOLECULAR BIOLOGY AND GENETICS
SECTION 3: EMERGING IMAGING TECHNOLOGIES AND THEIR APPLICATION TO PSYCHIATRIC RESEARCH
SECTION 4: DRUG DISCOVERY AND EVALUATION
SECTION 5: DISORDERS OF DEVELOPMENT
SECTION 6: SCHIZOPHRENIA AND RELATED DISORDERS
SECTION 7: ANXIETY AND STRESS DISORDERS
SECTION 8: AFFECTIVE DISORDERS
SECTION 9: ALZHEIMER AND OTHER DEMENTIAS
SECTION 10: SUBSTANCE USE DISORDERS
SECTION 11: IMPULSIVE AND COMPULSIVE DISORDERS
SECTION 12: MOVEMENT DISORDERS AND PAROXYSMAL DISORDERS
SECTION 13: CHRONOBIOLOGY AND SLEEP DISORDERS

Another benefit of mental and physical exercise: Decreasing schizophrenia symptoms?

As if we didn't already have enough reasons to exerise our minds and bodies.

From physorg:

Dr Anthony Hannan, along with Dr Caitlin McOmish, Emma Burrows and colleagues, characterised a genetically altered mouse and discovered that it had schizophrenia-like behaviours, including learning and memory problems, the inability to process complex information, and abnormal responses to particular sensory stimuli.
The scientists found the mouse’s condition significantly improved by simply giving them enhanced mental and physical exercise – putting running wheels in their cages, plus interesting items to smell, see and touch.
Not only did the mouse’s schizophrenia-like symptoms ease through this environmental enrichment, but a specific chemical transmitter pathway found to be abnormal in the cerebral cortex of the mice was selectively rescued.

This makes sense, since we know that schizophrenia is influenced by both genetic and environmental factors. For identical twins (twins with identical DNA), if one twin is schizophrenic, the other twin has a 50% chance of also becoming schizophrenic.

'Stay awake' pill for treating bipolar depression?

Modafinil is a pill marketed for helping'alertness' and reducing 'excessive daytime sleepiness.' It is used for treating narcolepsy, and has off label uses in the treatment of ADHD.

From physorg:

A preliminary study of 85 patients with bipolar disorder shows that a drug used to treat patients with sleep disorders might also control the depressive symptoms associated with bipolar disorder. At least 44 percent of the participants in the study reported improved symptoms, a noteworthy improvement for a disorder in which new treatments are needed, according to the study’s author, Mark Frye, M.D., director of the Mayo Clinic Mood Disorders Clinic and Research Program.

Since there is a paucity of effective treatments for bipolar depression, anything that is clinically proven to be helpful would be very welcome.

Bipolar Disorder Phenome Database

From Science Daily:

A novel, free, public online database opening this week should greatly speed efforts to find genes linked to increase risk of bipolar disorder. The Bipolar Disorder Phenome Database--a joint project of Johns Hopkins Psychiatry and the National Institute of Mental Health--is the first of its kind, offering detailed descriptions of symptoms and course of disease on more than 5,000 people with bipolar illness, a mood disorder commonly marked by alternating bouts of depression and manic or overexcited behavior.

It's wonderful to see more researchers sharing information in this way. Having access to information is a vital part of research.

They have named their particular branch of research BioinforMOODics.

Drugs in the News

A short summary of interesting articles about drugs and medications in the last few days.

Lithium may promote bone healing: Researchers have described a novel molecular pathway that may have a critical role in bone healing and have suggested that lithium, which affects this pathway, has the potential to improve fracture healing.

Pigeon population control with birth control pills: Happening in Hollywood = Over the next few months a birth control product called OvoControl P, which interferes with egg development, will be placed in bird food in new rooftop feeders.

Marijuana's lung damage: Smoking a single joint of cannabis has the same impact on breathing capacity as up to five cigarettes, according to a New Zealand study published on Monday in a specialist British journal, Thorax.

Maternal smoking bad for baby's blood pressure: Smoking during pregnancy may raise newborn babies' blood pressure, a new Dutch study shows...Babies born to mothers who smoked during pregnancy had an average systolic blood pressure (the first number in a blood pressure reading) that was 5.4 points higher than that of babies whose mothers hadn't smoked or been exposed to secondhand smoke during pregnancy.

Marijuana increases risk of psychosis

Sounds like the data finds a correlation between marijuana and psychosis, but no provable explanations for why this is the case, or whether the marijuana use actually causes the psychosis.

From physorg:

Zammit and colleagues from the University of Bristol, Imperial College and Cambridge University examined 35 studies that tracked tens of thousands of people for periods ranging from one year to 27 years to examine the effect of marijuana on mental health.
They looked for psychotic illnesses as well as cognitive disorders including delusions and hallucinations, bipolar disorder, depression, anxiety, neuroses and suicidal tendencies. They found that people who used marijuana had roughly a 40 percent higher chance of developing a psychotic disorder later in life. The overall risk remains very low.
"The strongest case is that there are consistencies across all of the studies," and that the link was seen only with psychoses - not anxiety, depression or other mental health problems, he said.

Predicting risk of sudden infant death syndrome (SIDS) with hearing tests?

Sounds like a very strange connection, but the preliminary data is intriguing.

The current study is by Dr. Daniel D. Rubens of Children's Hospital and Regional Medical Center in Seattle. His new theory:

It is known that the inner ear contains tiny hairs that are involved in both hearing and vestibular function. Rubens proposes that vestibular hair cells are important in transmitting information to the brain regarding carbon dioxide levels in the blood. He postulates that injury to these cells will disrupt respiratory control, playing a critical role in predisposing infants to SIDS.

From Science Daily:

This is the first time doctors might be able to identify newborns at risk for SIDS by a simple, affordable and routine hearing test administered shortly after birth. In the study, medical records and hearing tests of 31 babies who died from SIDS in Rhode Island were examined and compared to healthy babies. Rhode Island has a particularly robust database of newborn hearing test data.
The SIDS infants in Rubens' study showed a consistent four point lower score in their standard newborn hearing tests, across three different sound frequencies in the right ear, when compared to babies that didn't die from SIDS. Additionally, healthy infants typically test stronger in the right ear than the left. However, in each of the SIDS cases studied, the right ear tested lower than the left, reversing the test results of healthy babies.

If he's right, this will hopefully bring us many steps closer to preventing such a devastating, deadly disease.

Predict and prevent seizures with a brain implant?

A wonderful technology that could significantly improve the quality of life for some of the 2 million people with seizures in the United States. Apparently, 30-40% of those with seizure disorders don't have any control or benefit from medications.

From Science Daily:

Researchers at the Jefferson Comprehensive Epilepsy Center are enrolling patients in a study of the Responsive Neurostimulator System (RNS) made by Neuropace to determine if it is effective in stemming seizures. The system contains a computer chip that detects seizures and then delivers electric current to the brain to stop them.

This part is fascinating:

Patients will also receive a device that is able to scan the chip for information about seizures just by holding a wand over the scalp, he said. The information can then be downloaded by the patient onto a computer and sent via telephone to epilepsy researchers to review.

They are even looking for more participants:

Participants in the RNS study must be from 18 to 70 years of age and meet the following requirements:
have disabling (significant enough to impair functional abilities or day-to-day life activities) motor simple partial seizures, complex partial seizures and/or secondarily generalized seizures; failed treatment with a minimum of two antiepileptic medications; and experienced an average of three or more disabling seizures every 28 days for three consecutive periods prior to enrollment and have no more than two regions that induce seizures in the brain.

For more information or to participate in the study, please call 1-800-Jeff-now, 215-955-4672 or 1-866-904-6630.

Ketamine may be the key to faster acting antidepressants?

Current antidepressants take an average of 4 to 8 weeks to relieve symptoms of depression.

Researchers have been experimenting with ketamine with interesting results.

Ketamine [from wikipedia] is a dissociative anesthetic for use in human and veterinary medicine. Ketamine has a wide range of effects in humans, including analgesia, anesthesia, hallucinations, arterial hypertension, and bronchodilation.[3] It is primarily used for the induction and maintenance of general anesthesia, usually in combination with some sedative drug. Other uses include sedation in intensive care, analgesia (particularly in emergency medicine), and treatment of bronchospasm. It is also a popular anesthetic in veterinary medicine.

Because of these side effects, it has also become a somewhat popular recreational drug.

Here's the latest from physorg:

A new study has revealed more about how the medication ketamine, when used experimentally for depression, relieves symptoms of the disorder in hours instead of the weeks or months it takes for current antidepressants to work...
Ketamine blocks a receptor called NMDA on brain cells, an earlier NIMH study in humans had shown, but the new study in mice shows that this is an intermediate step. It turns out that blocking NMDA increases the activity of another receptor, AMPA, and that this boost in AMPA is crucial for ketamine’s rapid antidepressant actions. The study was reported online in Biological Psychiatry on July 23, by NIMH researchers Husseini K. Manji, MD, Guang Chen, MD, PhD, Carlos Zarate, MD, and colleagues.

Sounds like it may still be several years down the line, but being able to have antidepressants that take hours instead of months to work would make my job much easier. Seems that we may also have a new mechanism of antidepressant action that focuses on AMPA and the glutamate system(an inhibitory neurotransmitter) instead of serotonin.

Telemedicine: Bluetooth Heart Monitor SMSs your heart attack to the ER

From physorg:

A Bluetooth heart monitor could text your local hospital if you are about to have a heart attack, according to research published today in Inderscience's International Journal of Electronic Healthcare. The device measures electrical signals from the heart, analyses them to produce an electrocardiogram (ECG) and sends an alert together with the ECG by cell phone text message.

They are also exploring the addition of a GPS into this system to be able to locate the patient even faster.

Very cool. Hopefully someday they will have similar devices for sending a diabetic's blood glucose data to their care providers, notify family members when a woman is going into labor, or even find missing children.

Antidepressants: most prescribed drug in the United States

Joe Raedle / Getty Images file

According to CNN, , the CDC "looked at 2.4 billion drugs prescribed in visits to doctors and hospitals in 2005. Of those, 118 million were for antidepressants. High blood pressure drugs were the next most-common with 113 million prescriptions. "

Critics worry: "Doctors are now medicating unhappiness," said Dworkin. "Too many people take drugs when they really need to be making changes in their lives."

This unfortunately is very true. In our 'quick fix' society, people often would rather take a pill to lose weight rather than exercise and diet. People would often rather take a pill to manage their anxiety, OCD, and sadness rather than take classes, go to therapy, or work on themselves and improve their life situations.

People with major depression will greatly benefit from antidepressants, and according to CNN, "...She added that 25 percent of adults will have a major depressive episode sometime in their life, as will 8 percent of adolescents. "Those are remarkably high numbers," Posner said. "

The trick is figuring out who is suffering from a chemical imbalance that will improve from psychotropic medication, and who is simply in a bad situation and needs to make changes to their lives. The gray area is that often people who have been under stress from tough situations will often develop brain changes and end up with major depression as well, and though antidepressants will not fix their life stressors, it may help them to get a good night's sleep, help them concentrate long think through their problems, and help them stay calm long enough to initiate positive change.