Friday, October 19, 2007

TLC for Depression: Story on Youtube Broadcast of Watercooler Diaries

The Watercooler Diaries has just released this story on Therapeutic Lifestyle Change (TLC) for depression. See what you think.


Here are some additional links to TLC-related content you may find of interest:

1) Los Angeles Times story

2) In-depth piece in KU Alumni Magazine

3) Neuroscene podcast interview with Dr. Ilardi

4) Kansas City Star story on TLC, picked up by national newswires

5) Radio interview with Dr. Ilardi

Monday, October 15, 2007

Taking on the Depression Epidemic: A Promising New Treatment Approach

According to a sweeping epidemiological survey, roughly one in four Americans will now succomb to debilitating depressive illness by the age of 75. Sadly, the risk of depression is even higher among young adults (see chart below); it now looks like over half of all 18-29 year-olds will become clinically depressed at some point!

And we're talking about a disorder that robs people of their energy, their sleep, their memory, their concentration, their ability to love and work and play. It robs over 500,000 people each year of their very lives (via depression-linked suicide).

Bizarrely, the depression epidemic keeps getting worse, despite the fact that antidepressant use has gone up over 400% in the past two decades (150 million antidepressant prescriptions are written each year in the U.S. alone). The rate of depression in the U.S. is now 10 times higher than it was in the 1940s, before the advent of antidepressants. (And, no, this is not merely an artifact of greater public awareness or people's willingness to admit their symptoms; it's a genuine scientific finding.)

What's going on? I believe the answer lies in the fact that we were never designed for the modern sedentary, socially isolated, sleep-deprived, fast food-laden, indoor, frenetic pace of modern life. In fact, because the vast majority of human history was lived out in a hunter-gatherer context, it appears that humans are best adapted to that ancient way of life. There are many features of the hunter-gatherer lifestyle that - according to the best available research - confer powerful protective benefit against the experience of depression: abundant exercise, ample dietary omega-3 fatty acids, extensive social support and connectedness, sunlight exposure, 8+ hours of sleep each night, and engaging activity that prevents against the psychologically toxic process of rumination (i.e., dwelling on negative thoughts).

These antidepressant lifestyle elements not only fight depression, but they are capable of changing the brain as effectively as any medication.

Over the past few years, clinical research group of Dr. Steve Ilardi (aka, Psych Pundit) at the University of Kansas has worked hard to help depressed patients find a lasting cure by reclaiming these protective lifestyle elements from the past. We call the approach Therapeutic Lifestyle Change (TLC) for Depression. The preliminary results thus far (to be presented at next month's ABCT Conference in Philadelphia) have been enormously encouraging: 76% of TLC patients have experienced a favorable treatment response, in comparison with only 27% of patients on a waitlist who received 'treatment as usual' (mostly meds or therapy) in the community.

This work has recently received considerable attention in the national press, including an in-depth story in the November/December issue of AARP Magazine (readership: 30 million). As a clinical researcher, of course, I am eager to see the results of this work published in a peer-reviewed journal, and my research team currently has 4 articles at various stages in the publication pipeline.

In upcoming posts, I'll plan to give more details about the treatment program, as well as updates about scholarly publication as they become available.

Saturday, July 14, 2007

Feline Parasite Alters Human Personality

Over the years, I've treated a few patients who were convinced that a sinister, unseen entity was trying to seize control of their minds. Such a delusional belief - usually regarded as clear evidence of psychosis - strikes us as obviously out of touch with reality. And yet straight from the front lines of scientific research comes evidence of a parasite that can exert its own version of mind-control . . .

The villain in this story is Toxoplasma gondii, a microscopic parasite that likes to take up temporary residence inside the brain and muscle tissue of warm-blooded animals. Once safely lodged inside the brain, Toxoplasma orchestrates a series of subtle neurological changes in the host. This process has numerous effects on the infected animal's behavior - effects that are especially pronounced in rodents. Afflicted mice and rats become fearless and disinhibited, and they exhibit particular boldness around housecats. Instead of avoiding cats at all costs (as any sane rodent would do), infected mice and rats will charge straight at a feline nemesis. It's a sure-fire strategy for winding up as cat chow, especially given the parasite's annoying tendency to induce slowed reaction times in its host.

If we didn't know any better, we might guess that Toxoplasma is trying to commandeer the rodent's body, to use it as a delivery vehicle to get itself inside a cat . . . and, in a very real sense, this is exactly what's going on. For it turns out that Toxoplasma can only reproduce effectively inside the feline small intestine. Its offspring can then hitch a ride back out into the world encased in cat feces, from which they make their way into the ground and then on into the body of any animal that happens to ingest them. Often the unsuspecting critter is something a cat can then prey on, after which the entire reproductive cycle repeats itself . . . Over the millenia, Toxoplasma has evolved a remarkable ability to make its way back inside cats to reproduce - primarily through altering the brain function of its temporary non-feline hosts.

Now, by this point in the story, some of you are no doubt wondering, "Hey, wait a minute; haven't I heard of this parasite somewhere before? Isn't it the one that causes toxoplasmosis, that disease pregnant women can catch from cats and pass on to their babies?"

Indeed it is. Fortunately, though, the best research suggests that Toxoplasma infection is no more likely among cat owners than it is among the general population, so the risk of contact with cats appears to be minimal. Medical experts do, however, urge some caution when cleaning out a litter box, as Toxoplasma is readily transmitted to humans through the accidental ingestion of cat feces. (As if such an unsavory fate weren't bad enough!)

Here's an unsettling fact to consider: according to the latest large-scale study, 16% of Americans are now infected with Toxoplasma. And most are completely oblivious to their infected status, since contracting the parasite usually brings about no obvious signs or symptoms. (Roughly 10%-20% of infected individuals will experience vague flu-like symptoms that can last for several days). In some countries, the rate of infection is even higher: it's nearly 50% in France and Germany.

But if people aren't typically contracting Toxoplasma from contact with cats, how are they getting it? The biggest culprit is the eating of undercooked meat. As we've seen, Toxoplasma can lodge itself in the muscle tissue (i.e., meat) of any warm-blooded animal, including pigs, cattle, sheep, and chickens. A non-trivial portion of our meat supply is infected. Luckily, heating tainted meat to at least 155 degrees Fahrenheit (67 degrees C) for a few minutes appears to be sufficient to prevent infection. Obviously, to be completely safe, you might want to consider going even hotter and longer . . .

Another common route to infection involves accidentally ingesting little bits of soil - e.g., by eating poorly washed vegetables or wiping one's mouth while gardening. (Kind of makes you think twice about all those mud pies we used to make back in kindergarten . . . )

Soon after entering the human body, the parasite begins taking up residence in muscle and brain tissue, forming very small cysts that - until recently - were thought to be completely harmless. But lately researchers have been wondering . . . hey, if Toxoplasma can hijack the brain of a rat and force the animal to do its bidding, what - if anything - can it do to a human host? Unfortunately, the answer is turning out to be: "quite a lot."

Even though research in this area is still in its infancy, the findings thus far have been unsettling, to say the least:

1) Just as Toxoplasma reduces reaction times in rodents - presumably, to make them easier for cats to catch - it also makes people react more slowly. In fact, infected individuals are at much higher risk of experiencing an automobile accident. (And remember, most people who have contracted Toxoplasma are completely oblivious to the fact.)

2) Women infected with Toxoplasma experience a suite of changes that might be considered generally positive. They tend to be very kindly, and to exhibit, on average, slightly higher IQ, conscientiousness, warmth, generosity, and guilt-proneness. Why in the world would the parasite engender these particular effects? Well, anything Toxoplasma can do to aid and abet its genetic kin will be subject to evolutionary selection pressure, since this will still effectively help pass along its genes. Thus, Toxoplasma appears to be trying to turn its female hosts into people who will be particularly nice to cats - aka, "cat ladies!"

3) Men, on the other hand, have a completely different set of reactions to Toxoplasma infection. They experience reduced IQ and initiative, and tend to become more stoic, laid-back, and slow-tempered. In other words, they become just the sort of guys who would be unlikely to interfere with their "cat lady" wives, to hinder them from tending to their brood of adoring felines!

Now, having outlined this array of creepy Toxoplasma effects, I need to give the following disclaimer: these effects on personality are often fairly subtle, and many infected individuals exhibit no measurable effects at all.

Nevertheless, the obvious question for each of us is: what if I'm infected, and if so, what can be done about it? I am duty-bound to urge you to consult with your physician on this one. Certainly, there are fairly straightforward blood tests that can determine whether or not you have Toxoplasma antibodies in your system (which would in turn indicate whether or not you've ever had an active infection, in which case it's likely that you would still have Toxoplasma cysts in muscle and nervous tissue).

There are a number of different antibiotics that seem to have at least some effect in combating the Toxoplasma cysts in the brain, although at this point it's premature to say that any single drug (or combination) is a guaranteed cure. Given the enormous potential public health implications of this issue - which is just now coming to widespread attention - I think it's safe to say that finding a reliable way to eradicate Toxoplasma will become a high clinical research priority in the years ahead.

Tuesday, June 26, 2007

Top Recipients of Big Pharma Cash: Psychiatrists

Drug companies spend roughly 2.5 times as much on marketing as they do on research and development, and a large share of this promotional money is funneled directly to doctors in the form of "marketing payments," speaking fees, junkets, and so forth. In other contexts, the word bribery might come to mind, but because this is the medical profession we're talking about, the term is rarely invoked. Nonetheless, there is emerging evidence that the drug makers' massive investment in physician payments is paying off in the form of altered clinical practice, at least when it comes to the field of psychiatry.

In fact, according to a story in today's New York Times, psychiatrists are now the top recipients of drug company money (among all medical specialists). Psychiatrists in Vermont - the most recent state to make such data available - received an average of over $45,000 apiece in payments from Big Pharma last year* - more than double the figure for the preceding year. Moreover, individual psychiatrists who received the largest payments just happen to be the most likely to engage in questionable activities like prescribing expensive (highly profitable) anti-psychotic medications to children - an enormously controversial practice in light of the high potential of these medications to cause massive weight gain, debilitating sedation, insulin resistance, and cognitive slowing.

Most psychiatrists, of course, care deeply about their patients, and would never deliberately allow their practice to be influenced by drug company payouts. But psychiatrist are still human, and it's human nature to reciprocate as best we can when someone has given us something of value. Thus, psychiatry, now heavily indebted to the pharmaceutical industry - not just through payouts to individual psychiatrists, but also, for example, through millions of dollars spent each year on drug company advertisements in psychiatric journals - is a discipline that can no longer afford to ignore the looming scandal of drug company "promotional spending." Word is getting out, and the profession's credibility is now on the line.

*Many thanks to Dr. X for bringing my attention an apparent error in the NY Times' coverage of the story: the reported $45,000 average applies only to the subset of 11 psychiatrists who were among the state's top 100 recipients of pharmaceutical largesse. According to Dr. X's trenchant analysis, the average psychiatrist statewide received "only" about $4,000 in drug company handouts last year.

Tuesday, July 11, 2006

Dietary Sugar and Mental Illness: A Surprising Link

Noted British psychiatric researcher Malcolm Peet has conducted a provocative cross-cultural analysis of the relationship between diet and mental illness. His primary finding may surprise you: There is a strong link between high sugar consumption and the risk of both depression and schizophrenia.

In fact, there are two known mechanisms through which sugar intake could exert a toxic effect on mental health.

First, eating sugar actually suppresses the activity of a key growth hormone in the brain called BDNF. This hormone promotes the health and maintenance of neurons in the brain, and it plays a vital role in memory function by triggering the growth of new connections between neurons. BDNF levels are critically low in both depression and schizophrenia, which explains why both syndromes often lead to shrinkage of key brain regions over time (yes, chronic depression actually leads to brain damage). There's also evidence from animal models that low BDNF can trigger depression.

Second, sugar consumption triggers a cascade of chemical reactions in the body that promote chronic inflammation. Now, under certain circumstances (like when your body needs to heal a bug bite), a little inflammation can be a good thing, since it can increase immune activity and blood flow to a wound. But in the long term, inflammation is a big problem. It disrupts the normal functioning of the immune system, and wreaks havoc on the brain.

Inflammation is associated with an increased risk of heart disease, diabetes, and cancer . . . and also linked to a much greater risk of depression and schizophrenia. And again, eating sugar triggers inflammation. So does eating ubiquitous processed sugars like 'high fructose corn syrup'.

If you think about it, it makes sense that our bodies don't handle sugar very well. After all, for the vast majority (99.9%) of our existence as a species, there simply was no sugar. We were endowed with a sweet tooth so that we'd crave the highly nutritious fruits that were in rare supply in the ancestral environment. But with the advent of processed sugar cane a few centuries ago, the blessing of our formerly adaptive sweet tooth suddenly turned into a curse - causing us to crave foods that we were simply never designed to process.

As I've become increasingly convinced by these research data, I've begun gently encouraging my depressed patients to simply try cutting out sugars for a week to see if they notice any effect. (I also ask them to cut out simple starches - like crackers and white bread - which the body converts directly to sugars). Many patients have given it a go . . . often with rather remarkable improvements in mood, energy level, and mental clarity.

And, even though I've been very fortunate to escape the debilitating scourge of depression, I tried cutting out sugar myself a few months ago. Although one can never rule out placebo effects in such self-directed trials (!) . . . I've definitely noticed a nice improvement in energy and mental sharpness (I used to get a little foggy for an hour or two after lunch, and that just doesn't happen any more).

If you decide to give it a try, please be sure to pass along the results under the blog's Comments section. Good luck!

Tuesday, July 04, 2006

Social Isolation: A Modern Plague

The latest research confirms it: Americans are now perilously isolated. In a comprehensive new study by scientists at Duke University (Psych Pundit's alma mater), researchers have observed a sharp decline in our social connectedness over the past 20 years.

Remarkably, 25% of all Americans are now completely alone - without a single person they can confide in. And over half of all Americans report having no close confidants or friends outside their immediate family. The situation today is much worse today than it was when similar data were gathered in 1985 (when, for example, only 10% of Americans were completely alone).

How could this happen? It's hundreds of little things. You can probably think of several off the top of your head: longer work hours, surfing the Internet, tuning out the world as you march along to the isolating beat of your iPod . . . and don't forget all that time stuck in traffic.

According to Robert Putnam, sociologist and author of the influential book, Bowling Alone, for every 10 minutes added to your commute time, there's a 10% decrease in the likelihood of maintaining social ties.

But we're truly not designed to live like this. For the vast majority of human history, everyone lived in intimate, hunter-gatherer communities of 100-150 people. Anthropologists who spend time with modern-day hunter-gatherer bands report that social isolation and loneliness are competely unknown . . . as people spend virtually all day every day in the company of friends and loved ones.

Even Americans of a couple generations ago used to benefit from a richness of community life that has slowly disappeared. We've witnessed a long slow retreat into the hermetically sealed existence of our own fortress-like homes . . . friendships replaced by computer screens, Netflix videos, and exhausted couch potato stupor.

The toll? Increased vulnerability to mental illness. Social isolation is a huge risk factor for the onset of depression. There's also growing evidence that isolation increases vulnerability to various forms of addiction. I'll discuss this more in a future post . . .

Sunday, June 25, 2006

Blogging Is Hard Work

My apologies, Dear Reader, for this lengthy hiatus from the blogosphere. Academic duties have been all-consuming these past few months, but I've thought wistfully on many occasions about the need to return with more Punditry. Now that summer is upon us, there should be ample time to make it happen.

Stay tuned . . .