Volume 7, Issue 1
Newsletter
JULY 2016
Blood test to personalize depression treatment Inside this issue: Scientists at King’s College London have developed a blood test that accurately and reliably predicts whether depressed patients will respond to common antidepressants, which could herald a new era of personalized treatment for people with depression. Guided by this test, patients with blood inflammation above a certain threshold could be directed towards earlier access to more assertive antidepressant strategies, such as a combination of antidepressants, before their condition worsens. Approximately half of all depressed patients do not respond to first-line antidepressants and a third of patients are resistant to all available pharmacological treatments. Until now, it has been impossible to establish if individual patients will respond to common antidepressants or if they need a more assertive treatment plan. As a result, patients are treated with a trial-and-error approach whereby one antidepressant is tried after another, often for 12 or more weeks for every type of antidepressant. This can result in long periods of ineffective treatment for individuals who may not show an improvement in symptoms anyway. The study, published by The International Journal of Neuropsychopharmacology, focused on two biomarkers that measure blood inflammation, as previous studies have already shown that elevated levels of inflammation are associated with poor response to antidepressants. They measured the quantity of two biomarkers (Migratory Inhibitory Factor, MIF and interleukin (IL) 1-Beta) in two independent clinical samples of depressed patients, before or after they took a range of commonly prescribed antidepressants. The researchers found that blood test results above a specified threshold level could precisely and reliably predict the probability of individuals responding to the treatments. Patients with levels of MIF and IL above the thresholds showed a 100 percent chance of not responding to conventional, commonly prescribed antidepressants. Those with inflammation below the suggested threshold could be expected to respond to first-line antidepressants, according to the study authors. The two biomarkers are involved in several brain mechanisms relevant to depression, including the birth of new cells and connections between them, as well as the death of brain cells due to “oxidative stress.” Oxidative stress occurs them the body both overproduces and then struggles to remove ‘free-radical’ molecules, which break down brain connections and disrupt the brain’s chemical signaling, which in turn can lead to the development of depressive symptoms by reducing the brain’s protective mechanisms. Professor Carmine Pariante, King’s College, said: “The identification of biomarkers that predict treatment response is crucial in reducing the social and economic burden of depression, and improving quality of life of patients. This study provides a clinically-suitable approach for personalizing antidepressant therapy.” Dr. Annamaria Cattaneo, King’s College, added: “These results also confirm and extend the mounting evidence that high levels of inflammation induce a more severe form of depression, which is less likely to respond to common antidepressants. This study moves us a step closer to providing personalized treatment at the earliest signs of depression. It is really crucial now to carry out a clinical study comparing the current clinical practice in antidepressant prescription, based on trial-and-error, with our novel approach of ‘personalized psychiatry,” where the treatment plan is guided by the blood test.” The research was funded by the Medical Research Council and the NIHR Maudsley Biomedical Research Centre. Plans are underway for clinical trials to test whether adding an anti-inflammatory drug to an antidepressant improves depression. Source: London, King’s College. “Blood test to personalize depression treatment for the first time.” Medical News Today, www.medicalnewstoday.com/releases
Military members with PTSD/depression can be treated successfully in primary care settings
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No method reliable in assessing suicide risk in mental health patients
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Virtual counselling and peer support now accessible at MDAO
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Small study shows that memory loss from Alzheimer’s can be reversed
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MDAO online peer support forum and TIPS line
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New Anxiety Support Group in Kingston
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AMHS-KFLA in Napanee Schedule of Events
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Feel Good Page
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Address: 385 Princess Street Kingston, ON K7L 1B9
613-544-2886 Callers in crisis will be referred to the crisis line:
613-544-4229
[email protected]
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Military members with PTSD/depression can be treated successfully in primary care settings Military members who visited a primary care clinic while suffering from post-traumatic stress disorder and depression reported fewer symptoms and better mental health functioning a year after enrolling in a treatment program that included specially trained care managers and telephone therapy options, according to a new study. The study focused on primary care as a way of combating the stigma many service members feel about going directly to a mental health specialist. The intervention assigns patients to nurse care managers with special training to help patients remain in care and follow treatment recommendations, coordinate patients’ status with the health care team, and help patients to access telephone-based therapy. Researchers found that the approach resulted in significant improvements in recovery after one year, as compared to peers assigned to care managers without the added training and tele-therapy options. The findings are published online by the journal JAMA Internal Medicine. “Although the improvements were modest, the reach of the program can be large and has the potential to bring more people under a highquality treatment umbrella sooner,” said Dr. Charles Engel, the study’s lead author and a senior natural scientist at RAND, a non-profit research organization. “These findings suggest that the military health system might use this strategy to extend the reach of mental health care and reduce time to first treatment for PTSD and depression.” The prevalence of mental health issues is relatively high in the US military, with an estimated 13-18 percent of members suffering from PTSD, anxiety or depression after deployment. Fewer than half of the affected personnel receive military mental health services and when services are received they often are not timely or adequate. Collaborative care models that provide mental health treatment in primary care settings with the support of nurse managers and options to see mental health professionals have widely shown to provide high-quality care and improve clinical outcomes. However, few studies have examined whether the approach is useful for PTSD and no previous studies have examined whether the concept can work within the military health care system. The study examined the experiences of over 660 military members treated in 18 primary care clinics at large Army bases during 2012-13. Participants, who were mostly men in their 20s, were randomly assigned to one of two different programs that provided care for mental health problems in primary care settings. The existing Army model, used for test comparison, trained staff at primary clinics to screen for PTSD and depression. Nurses contacted patients monthly to check on symptoms, coordinate care with primary care providers and increase access to mental health professionals. The test model, centrally assisted collaborative telecare, preserved existing Army model and added some key features. The nurses were specially trained in behavioral activation, problem solving and motivational interviewing to help patients remain in follow-up and stick to treatment recommendations. In addition, the test model used psychologists to deliver telephone-based cognitive-behavioral therapy and offered face-to-face psychotherapy in a primary care or specialty setting. The nurse care managers also helped patients access and complete online cognitive-behavioral selfmanagement programs. A centrally located psychiatrist, psychologist and nurse care manager remotely assisted the clinic sites, using a central database of symptoms to review caseloads weekly and suggest changes in treatment as needed. Engel said that while the extra improvement seem among those treated in the centrally assisted telecare model was not large, it is important given that the original Army approach already is an improvement over usual approaches to PTSD in primary care. “Our findings are consistent with what has been observed in non-military health care settings,” Engel said. “This approach results in better outcomes and improved access to high-quality care. This is particularly important for a population that has a demonstrated need for mental health services.” After 12 months of care, 25 percent of military members with PTSD who were treated in the centrally assisted telecare model showed a 50 percent improvement in their symptoms, compared to 17 percent for those treated under the first model. Among patients with depression, 30 percent treated under the second model showed a 50 percent improvement in symptoms after a year, compared to 20 percent for the first model. People treated in the second model also had fewer suicidal thoughts and physical symptoms. In addition, patients treated under the model had more telephone contact with care managers and more months on appropriate medication for PTSD and depression. “The results support the idea that high-quality mental health care can be provided in primary care settings,” Engel said. “While many military members are reluctant to seek out mental health specialists, they are more willing to receive primary medical care. So this is a good way to encourage more people to receive mental health care, while also improving the quality of mental health services for military members.” Source: RAND Corporation “Military members with PTSD/depression can be treated successfully in primary care settings” Science Daily, www.sciencedaily.com/releases
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No method reliable in assessing suicide risk for mental health patients An Australian study has cast doubt on the effectiveness of the tools used by medical professionals to assess suicide risk in mental health patients, prompting calls for a review of the allocation of resources based on the assessments. The meta-analysis, led by clinical psychiatrist and Conjoint Professor Matthew Large from UNSW Australia’s School of Psychiatry, has been published in the PLOS One journal. It found that suicide risk assessment tools were not successful in predicting suicide outcomes, with no evidence of scientific progress over the past 50 years, pointing to a need for a more patient-focused approach to crisis mental health care. “It is widely assumed that the care of psychiatric patients can be guided by a mental health professional’s estimate of suicide risk and by using other patient characteristics to define high-risk patients,” Dr. Large said. “However, the reliability of categorizing suicide risk remains unknown.” The objective of the study was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in these two groups. The researchers reviewed every long-term prospective study of suicide risk assessment published worldwide over the past 50 years. They found there was no reliable method of assessing suicide risk, with the results of the assessments varying enormously across the 37 studies reviewed. They found half of all suicides occurred in lower-risk groups while 95 percent of high-risk patients did not suicide. Overall, the study demonstrated that suicide risk assessments provide results that are slightly better than chance, however complex methods of risk measurement that take into account multiple risk factors offer no statistical advantage than using a single factor. “Much of what happens when a mentally distressed person presents to a hospital depends on a suicide risk assessment, based on a whole range of risk factors,” Dr. Large said. “Lower-risk patients can be denied treatment, while some high-risk patients get hospitalized, sometimes against their wishes, based on an inaccurate risk assessment. In many hospitals, resources are still being allocated on the basis of suicide risk. It is time we moved away from paternalistic medical decision making and classifying people into suicide risk categories. It a patient presents with a suicide crisis they should be thoroughly assessed, without categorization. Mental health professionals must also involve patients in the decision making process about their ongoing care to improve their outcomes,” Dr. Large said. The study’s authors stress that the focus of the study was on mental health patients, rather than the potential strength of risk categorization for suicide among the general community. Source: University of South Wales, Science Daily, www.sciencedaily.com/releases
Virtual counselling and peer support now accessible at MDAO The Mood Disorders Association of Ontario (MDAO) in now able to provide remote one-to-one peer support to our participants across the province through Medeo. Medeo is an innovative technology connecting participants with MDAO Peer Support Workers for video visits, secure messaging, and care plans. Medeo allows individuals to connect face to face over the computer through a secure video link. Peer support workers can connect with participants online via computer, tablet, or smartphone (iOS or Android). Installation or downloading of special plug-ins or applications is NOT required. You must have access to a computer with a stable internet connection, webcam, microphone, and speakers, and use the Google Chrome browser. Appointments are available every Wednesday from 1:00—4:00 p.m.
To book an appointment for One to One Peer Support, please call 1-888-486-8236—please indicate that you are requesting a Medeo appointment.
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Small study shows memory loss from Alzheimer’s can be reversed A small trial of 10 patients has found that broad-based treatment with personalized therapy can reverse memory loss from Alzheimer’s disease. Results from quantitative MRI and neuropsychological testing show “unprecedented” improvements in patients with early Alzheimer’s disease (AD) or its precursors following the treatment, according to researchers from the Buck Institute for Research on Aging and the University of California, Los Angeles (UCLA) Easton Laboratories for Neurodegenerative Disease Research. The study, published in the journal Aging, shows that memory loss can be reversed, and improvement sustained, using a 36-point therapeutic personalized program that involves changes in diet, brain stimulation, exercise, sleep optimization, specific pharmaceuticals and vitamins, and multiple additional steps that affect brain chemistry, researchers said;. “All of these patients had either well-defined mild cognitive impairments (MCI), subjective cognitive impairment (SCI), or had been diagnosed with AD before beginning the program,” said Dale Bredesen, MD, a professor at the Buck Institute and Easton Labs at UCLA. “Follow-up testing showed some of the patients going from abnormal to normal.” Bredesen noted that some patients who had to discontinue work were able to return to work and those struggling at their jobs were able to improve their performance. According to the researchers, one of the more striking cases was a 66-year-old man whose neuropsychological testing was compatible with a diagnosis of MCI and whose PET scan showed reduced glucose utilization indicative of AD. An MRI showed hippocampal volume at only the 17th percentile for his age. After 10 months on the protocol, a follow-up MRI showed a dramatic increase of his hippocampal volume to the 75th percentile, with an associated absolute increase in volume of nearly 12 percent, the researchers reported. In another instance, a 69-year-old entrepreneur who was shutting down his business went on the protocol after 11 years of progressive memory loss. After six months, his wife, co-workers, and he noted an improvement in his memory. A lifelong ability to add columns of numbers rapidly in his head returned and he reported an ability to remember his schedule and recognize faces at work. After 22 months on the protocol he returned for follow-up quantitative neuropsychological testing. The results showed marked improvements in all categories with his long-term recall increasing from the third to 84th percentile, according to the researchers, who add he in now expanding his business. Another patient, a 49-year-old woman who noted progressive difficulty with word finding and facial recognition went on the protocol after undergoing quantitative neuropsychological testing at a major university. She had been told she was in the early stages of cognitive decline and was therefore ineligible for an Alzheimer’s prevention program. After several months on the protocol she noted a clear improvement in recall, reading, navigating, vocabulary, mental clarity, and facial recognition. Her foreign language ability had returned. Nine months after beginning the program she did a repeat of the neuropsychological testing at the same university site. She no longer showed evidence of cognitive decline, according to researchers. All but one of the 10 patients included in the study are at genetic risk for AD, carrying at least one copy of the APOE4 allele. Five of the patients carry two copies of APOE4, which gives them a 10-12 fold increased risk of developing AD. “We’re entering a new era,” said Bredesen. “The old advice was to avoid testing for APOE4 because there was nothing that could be done about it. Now we’re recommending that people find out their genetic status as early as possible so they can go on prevention.” He added that 65 percent of Alzheimer’s cases in the US involve APOE4, with seven million people carrying two copies of the allele. According to Bredesen, decades of biomedical research has revealed that an extensive network of molecular interactions is involved in AD, suggesting that a broader-based therapeutic approach may be more effective. “Imagine having a roof with 36 holes in it, and your drug patched one hole very well—the drug may have worked, a single ‘hole’ may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much,” he said. “We think addressing multiple targets within the molecular network may be additive, or even synergistic, and that such a combinatorial approach may enhance drug candidate performance, as well.” While encouraged by the results of the study, Bredesen admits more needs to be done. “The magnitude of improvement in these 10 patients is unprecedented, providing additional objective evidence that this programmatic approach to cognitive decline is highly effective,” he said. “Even though we see the far-reaching implications of this success, we also realize that this is a very small study that needs to be replicated in larger numbers at various sites.” Plans for larger studies are underway, he added. “The Bredesen Protocol,” Bredesen’s book describing the interventions described in the study, will be released by Penguin Random House in May 2017. Source: Buck Institute for Research on Aging, Psych Central, www.psychcentral.com/2016/06/18
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MDAO Online Peer Support Forum & TIPS Line The Mood Disorders Association of Ontario (MDAO) offers an online community, moderated by members of the MDAO Peer Support programs from across the province. Areas covered include depression, bipolar disorder, anxiety, and family matters. Or feel free to start your own discussion. Check it out!!
mooddisorders.ca/forum Telephone information Peer Support (TIPS) is a toll-free phone resource that allows callers from across the province to access information and support. Trained volunteers are available during office hours (Monday to Friday, 9:30 a.m. to 5:00 p.m.) to provide callers with local support group details, guidance on how to find a doctor, and navigate the system, as well as offering peer to peer support.
TIPS Line 1-866-363-MOOD (6663)
New Anxiety Support Group in Kingston The Kingston office of the Canadian Mental Health Association (CMHA) is starting a new support group for adults (18+) in the Kingston area who are dealing with anxiety. Everyone is welcome to attend, and it is a great opportunity to meet some new people and share your story with likeminded individuals. The group is scheduled to begin on Monday, August 8, 2016. The group will be held at the CMHA Kingston main office at 400 Elliot Avenue, Unit 3, and begins at 7 p.m. For more information, please contact the CMHA office at 613-549-7027 or email
[email protected]
AMHS-KFLA in Napanee Effective Monday, June 27, 2016, all services/groups provided by the Napanee AMHS-KFLA agency will be accessed from the 70 Dundas Street East location (the Daly Tea Company building). Offices previously located at 37 Dundas St. W. will be closed, and all staff relocated to the Daly Tea Co. building effective June 27.
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JULY 2016 Sun
Mon
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AA
FSG
10
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AA
Tue
FASG
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24
25
AA
FASG
FASG
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1 CLOSED
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Canada Day
GA
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Mood Disorders Group
GA
ABI
Walking Group
GA
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Mood Disorders Group
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Walking Group
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Mood Disorders Group
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Walking Group
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Mood Disorders Group
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Walking Group
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28 SBG
31 AA
Schedule of Events Family Support Group (FSG) Meets the first and third Monday of the month (except for holidays) at Ongwanada Resource Centre, 191 Portsmouth Ave., Kingston. 6:30—8 p.m. Drop-in format, no registration required. Family Addiction Support Group (FASG) This group is offered to provide support and education to family members who are struggling with their loved ones addictive behaviours. The group is confidential, free, and is only available through referral. Please contact Melissa Switzer-Ferguson for more information—call 613-329-6498 or email
[email protected] Mood Disorders Peer Support Group Meet every Tuesday evening at Ongwanada Resource Centre, 191 Portsmouth Ave., Kingston. Open group meets from 7—9 p.m.; Young Adult group is not currently meeting. Affiliated with Mood Disorders Association of Ontario (MDAO). No registration required. Gamblers Anonymous (GA) 552 Princess St., Kingston. Enter the back door from the parking lot (ring the bell). Please call for details 613-5441356 ext. 4200. Wednesdays at 6:30 p.m., Saturdays at 10 a.m. Alcoholics Anonymous (AA) 552 Princess St., Kingston. Enter the back door from the parking lot (ring the bell). Please call for details 613-5441356 ext. 4200. Sundays at 10:30 a.m. Suicide Bereavement Group (SBG) Held the 4th Wednesday of the month at CMHA Kingston, 400 Elliott Ave., Kingston, Unit 3. For further information contact CMHA Kingston at 613-549-7027 or
[email protected]. Best to confirm time/place of meeting prior to attending. Path of Recovery Walking Group Informal, peer-led walking group for people wishing to socialize and exercise. For further information, please contact Keith at 613-331-6777. ABI Caregiver Support Group (ABI) Open to any adult caregiver of people with acquired brain injury. Meetings are held at the Community Brain Injury Services Office, 303 Bagot St., Kingston, 4th Floor, Suite 401, La Salle Mews. Meets the first Thursday of the month from 3– 4:30 p.m. For info, call 613-547-6969. NAMI Family-to-Family Educational Classes Next session, Fall 2016. No cost to attend but MUST be pre-registered. Classes held at 552 Princess St., Kingston, in the evening. Classes fill up quickly, so if you are interested in attending, contact FRC to put your name of the waiting list. 613544-2886 or
[email protected]
Information about most of these groups is available at FRC—613-544-2886 or
[email protected]
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Feel Good Page