Gov’t task force recommends wide U.S. screening for anxiety disorders

In a first, a government panel recommends all adults under 65 be screen regularly for anxiety disorders.

Adults under the age of 65 should be screened for anxiety disorders and all adults should be checked for depression, a government-backed panel said, as many Americans report symptoms of these mental-health conditions following the height of the Covid-19 pandemic.

The draft guidance released Tuesday marks the first time that the United States Preventive Services Task Force has made a recommendation on screening adults for anxiety disorders. The move comes months after the task force issued similar draft guidance for children and adolescents.

“This is a really important step forward,” said Arthur C. Evans, chief executive at the American Psychological Association. “Screening for mental-health conditions is critical to our ability to help people at the earliest possible moment.”

The task force said that there wasn’t enough evidence on whether or not screening all adults without signs or symptoms ultimately helps prevent suicide. The group didn’t recommend for or against screening for suicide risk, but called for more research in the area.

The task force, a panel of 16 independent volunteer experts, issues guidance on preventive-care measures. Health insurers are often required to cover services recommended by the task force under a provision in the Affordable Care Act.

More than 30% of adults reported having symptoms of an anxiety disorder or depressive disorder this summer, according to estimates from the federal Household Pulse Survey. The percentage of U.S. adults who received mental-health treatment within the past 12 months increased to 22% in 2021, up from 19% in 2019, according to the Centers for Disease Control and Prevention.

Mental-health screening often occurs in doctor’s offices, where patients fill out questionnaires during routine checkups or other appointments. The goal is to spot at-risk people who might not be showing obvious signs, so that the person can get the correct diagnosis and potentially get connected to care before they reach a crisis point.

As for people over 65, the article notes that “some anxiety-disorder screening questionnaires emphasize issues with sleep, pain and fatigue, which also often increase with age.” So screening older adults for those risk factors might turn up a lot of older people who are, you know, just regular old, tired and creaky.

It does strike me that they ought to come up with different a different screening regimen for older people, rather than just deciding to not issue screening recommendations as all.

Magic mushrooms slowly entering the mainstream as mental health treatment

Scientific American takes a look at the growing use of the psychoactive ingredient in magic mushrooms to treat all manner of mental health issues:

Magic mushrooms are undergoing a transformation from illicit recreational drug to promising mental health treatment. Numerous studies have reported positive findings using psilocybin—the mushrooms’ main psychoactive compound—for treating depression as well as smoking and alcohol addiction, and for reducing anxiety in the terminally ill. Ongoing and planned studies are testing the drug for conditions that include opioid dependence, PTSD and anorexia nervosa.

This scientific interest, plus growing social acceptance, is contributing to legal changes in cities across the U.S. In 2020 Oregon passed statewide legislation decriminalizing magic mushrooms, and the state is building a framework for regulating legal therapeutic use—becoming the first jurisdiction in the world to do so. For now psilocybin remains illegal and strictly controlled at the national level in most countries, slowing research. But an international push to get the drug reclassified aims to lower barriers everywhere.

After a flurry of research in the 1950s and 1960s, psilocybin and all other psychedelics were abruptly banned, partly in response to their embrace by the counterculture. Following the 1971 United Nations Convention on Psychotropic Substances, psilocybin was classed in the U.S. as a Schedule I substance—defined as having “no currently accepted medical use and a high potential for abuse.” Psilocybin production was limited, and a host of administrative and financial burdens effectively ended study for decades. “It’s the worst censorship of research in history,” says David Nutt, a neuropsychopharmacologist at Imperial College London.

You can read the rest at this non-paywalled link.

Scientists are starting to re-think the serotonin connection as the major driver behind depressive disorders

It has been simple for so long: attempt to treat many depressive disorders by increasing serotonin levels with a variety of pharmaceuticals.

However, as helpful as many people might find their anti-depression drugs to be, they are learning that serotonin is not as all-encompassing as they once thought it was:

For the last half-century, the dominant explanation for depression has centered on serotonin. The basic idea: low levels of brain serotonin or serotonin activity leads to symptoms of depression. This theory, which is known as the “serotonin hypothesis,” is based on several data points, including animal research and the effects of antidepressants that are supposed to work by increasing brain serotonin levels. But, in the last several decades, a number of researchers have challenged the idea that serotonin plays a principal or even major role in depression.

In recent days, the serotonin hypothesis of depression has been explicitly challenged by a number of scientific publications. Most notable (at the time of this writing), a paper published in Nature Molecular Psychiatry reviewed several lines of evidence on the subject of the serotonin-depression connection and concluded that “the main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.”

Datapoints like this recent study point to a major question: if serotonin isn’t driving depression, what does explain the brain state of the hundreds of millions of people living with it? While there are many potential explanations, here are four major systems that may prove more important to the brains of people with depression, and some ways we may be able to target them.

Those areas to study more include:

  1. Brain Rewiring (Neuroplasticity)

Supporting factors for the neuroplasticity-depression connection include imaging findings, cell study research, and measurements connected to the rewiring process. The basic idea is that in depression, there may be issues with the quality, number, and type of connections our neurons make, and this may help explain depression symptoms. Importantly, research is showing that we may be able to positively affect neuroplasticity through lifestyle factors like exercise, learning new things, and, potentially, certain dietary modifications. There is also data showing that conventional antidepressants, as well as psychedelics, may positively influence neuroplasticity.

  1. Inflammation

When excess or chronic inflammation is present in the brain, it appears to influence a number of pathways involved in depression. First, it may impair the healthy function of neurons by physically damaging them. Inflammation also may block healthy neuroplasticity, while leading to the generation of toxic breakdown molecules like quinolinic acid that could further damage neuron health and contribute to depressive pathology. Within the brain, research shows that unique immune cells called microglia may be key to sustaining inflammation. So how is our inflammatory status regulated? It appears to be sensitive to the quality of our diet, sleep, exercise, stress-lowering interventions, and potentially even nature exposure.

  1. The Gut-Brain Connection

One of the most impressive aspects of our gut is the quantity and diversity of microbes that call it home. These bacteria make up the gut microbiome. Alterations in the bacteria that live in the gut microbiome have been linked to depression. It’s thought that these bacteria may influence brain function through their effects on the vagus nerve (which runs from the gut to the brain), their impact on the immune system (e.g., by affecting levels of inflammation), and through tiny molecules they create (e.g., short-chain fatty acids) which may reach the brain by way of the bloodstream.

  1. Endocrine (Hormonal) Changes

When it comes to the regulation of brain function, a wide range of hormone pathways are thought to play important roles. This research extends to depression. And while certain hormonal changes can be hard to reverse, there’s also much we can do to help improve aspects of our endocrine signaling pathways.

Author Austin Perlmutter, MD, goes on to add insulin and estrogen levels as important possible links to depression for some people.

You can read the rest of his article in Psychology Today at this link.

Writing from personal experience, the simple act of getting some cardiovascular exercise 3-4 times a week allowed me to stop my blood pressure medications and my anti-depressants. I also stopped any substance use whatsoever. (As long as I’m on the subject of drugs, some researchers are seeing pretty amazing results in people with depression and/or PTSD through the use of psychedelics. Good article here.)

Having noted my experience, always remember that one person’s experience is an anecdote and nothing more. You should consult a board-certified mental health professional to find out what’s right for you.

A huge mental health win for Biden and the Democrats

It’s de rigueur to blast the Democrats in Washington as a bunch of timid do-nothings, Some of that is well-deserved. But the recent passage of a gun control law was not celebrated as much as I thought it would be once people actually realized what it does do, rather than what it doesn’t.

Admittedly that law doesn’t do enough. But it did close some important loopholes partially responsible for the flood of illegal guns from gun-permissive states like Iowa, Indiana, Wisconsin and Michigan into gun-restrictive states like Illinois. (Poor Illinois — and Chicago — have the bad luck to be surrounded by states with few real controls on guns. Chicago’s gun problem is largely a surrounding state problem, even as Republicans sneer at Chicago for its astronomical rate of gun violence despite having gun control laws with teeth.)

But, the gun-related provisions in the Bipartisan Safer Communities Act of 2022 aren’t the only story. The bill included “the biggest single expansion of mental health care in American history.”

That’s a huge deal. You’ll never hear this on Fox News, however:

The Bipartisan Safer Communities Act has been framed as a gun reform, but perhaps a more fitting frame for the law is as the biggest single expansion of mental health care in American history—and the biggest expansion of Medicaid—with a few gun provisions.

To be sure, packaging the two together makes both gun reform and mental health advocates uncomfortable. The overwhelming majority of people with mental illness will never commit a violent act, though statistics show that they’re more likely to be victims. Tying mental illness with gun violence only stigmatizes it, reducing the likelihood that people who need care will get it. But gun rights activists see mental illness as a convenient distraction from the fundamental issue driving gun violence—the guns themselves.

Getting Republican participation on any gun law reform, though, required that the two be linked. And any investment in our anemic mental health care system—whatever the pretext—should be welcomed. So the new law leverages Medicaid to vastly expand America’s mental health infrastructure through a system of Certified Community Behavioral Health Clinics, or CCBHCs, and school mental health investments.

This piece in The New Republic goes on to say:

The law’s massive investment in mental health care didn’t just happen over the course of a few weeks. It was the product of nearly a decade of slow, methodical planning. Stabenow and GOP Missouri Senator Roy Blunt had been co-sponsors of the bill reauthorizing community health center funding—consistent federal dollars to support community clinics—when Stabenow proposed a similar approach to funding mental health care. Until that point, mental health clinics were forced to operate on grants that they simply couldn’t rely on. “On the behavioral health side of things, it [was] all stop and start. It [was] all grants that go away,” Stabenow told me.

She approached the Substance Abuse and Mental Health Services Administration, or SAMHSA, to design quality standards for the proposed mental health centers that would eventually become CCBHCs. These included 24-hour psychiatric crisis services and integration with physical health services. Stabenow and Blunt eventually co-sponsored a 2013 bill that was signed into law the next year by President Obama. The Excellence in Mental Health and Addiction Treatment Act initially allocated $1 billion to fund a demonstration project across 10 states. The program offers enhanced Medicaid reimbursements to cover 80 to 90 percent of the start-up and operating costs for CCBHCs meeting SAMHSA standards.

The results were impressive. According to Stabenow, there was a 60 percent reduction in jail bookings stemming from mental health crises, a 63 percent reduction in mental health emergency room visits, and a 41 percent decline in homelessness.

In a country that has chronically underfunded mental health care, this is a landmark development.

Rates of mental health issues in incarcerated individuals.