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The first effective web-based treatment for Bipolar Disorder based on the latest research evidence has been developed by psychologists.

People with Bipolar Disorder have problems getting access to psychological therapy and this online intervention, published in the Journal of Affective Disorders, may offer a round the clock solution at a reduced cost to the NHS.

It was developed as part of the ‘Living with Bipolar’ project led by Dr Nicholas Todd under the supervision of Professor Fiona Lobban and Professor Steven Jones at the Spectrum Centre for Mental Health Research, Lancaster University.

92% of the participants in the trial of the online intervention found the content positive – and one said it had changed her life.

“I have encountered insights in the modules that have significantly helped me to survive the blackest moments. I cannot measure the value of this, as it has contributed to their difference between life and death. My husband and I are sincerely grateful for the immeasurable impact this has had on our family.”

Therapeutic gains for the participants included improved stability, accessing additional help from friends and family, less reliance on services and more likely to turn to self-management.

One described the online help as “…a practical intervention…very positive, empowering, recovery orientated, fostering personal responsibility. It is not patronising at all…”

Focussed on recovery, supporting people to live a fulfilling and meaningful life alongside their symptoms, the programme includes elements of Cognitive Behavioural Therapy and Psycho-education delivered via ten audio-visual modules with a mood checking tool, interactive worksheets and worked examples. The intervention is supported by a peer support forum moderated by a member of the research team and motivational emails.

Dr Todd said the online intervention may be a way of overcoming the difficulties of enabling people with a severe mental illness to manage their condition.

“The intervention was most useful for improving non-symptomatic outcomes such as quality of life, recovery and wellbeing. These packages may therefore provide a useful alternative to the symptom focussed approaches.”

Further research trials are required before this intervention can be made available within the NHS.

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Depression can hit young fathers hard — with symptoms increasing dramatically during some of the most important years of their children’s lives, a new Northwestern MedicineR study has found.

Depressive symptoms increased on average by 68 percent over the first five years of fatherhood for these young men, who were around 25 years old when they became fathers and whom lived in the same home as their children. The results of the study were published in the journal Pediatrics.

This study is the first to identify when young fathers are at increased risk of developing depressive symptoms. Craig Garfield, M.D., lead author of the paper, said the results of this longitudinal study are significant and could lead to more effective interventions and treatment for young men early in the fatherhood years.

“It’s not just new moms who need to be screened for depression, dads are at risk, too,” Garfield said. “Parental depression has a detrimental effect on kids, especially during those first key years of parent-infant attachment. We need to do a better job of helping young dads transition through that time period.”

Garfield is an associate professor in pediatrics and medical social sciences at Northwestern University Feinberg School of Medicine and a pediatrician at Ann & Robert H. Lurie Children’s Hospital and Northwestern Memorial Hospital.

Previous research has shown depressed dads will use more corporal punishment, read less and interact less with their children, and are more likely to be stressed and neglect their children. Compared to the children of non-depressed dads, these children are at risk for having poor language and reading development and more behavior problems and conduct disorders.

“We knew paternal depression existed and the detrimental effects it has on children, but we did not know where to focus our energy and our attention until this study,” Garfield said. “This is a wakeup call for anyone who knows a young man who has recently become a new father. Be aware of how he is doing during his transition into fatherhood. If he is feeling extreme anxiety or blues, or not able to enjoy things in life as he previously did, encourage him to get help.”

This paper used data collected from 10,623 young men enrolled in the National Longitudinal Study of Adolescent Health (Add Health). It includes a nationally representative sample of adolescents in the U.S. and follows them in several waves over nearly 20 years into young adulthood. All participants’ symptoms of depression were scored at each wave through a survey using a subset of the Center for Epidemiologic Studies Depression Scale.

During the most recent wave of the Add Health study, the young men were age 24 to 32, and 33 percent had become fathers.

The majority of these fathers lived in the same home as their children. Young fathers who did not live with their children did not experience such a dramatic increase in depressive symptom scores in early fatherhood, the study found. Instead, these non-residential fathers’ depression symptom scores were elevated before fatherhood and start to decrease during early fatherhood, though this sample is smaller in number. Residential fathers’ depression symptom scores were lower before fatherhood and then dramatically increased after the birth of a child and into early fatherhood.

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According to the Centers for Disease Control and Prevention, around 1 in 10 American adults report having some form of depression. Now, researchers have revealed an unlikely strategy for treating the condition; activating neurons in the brain associated with stress-induced depression may actually trigger natural resilience to it.

The research team, led by Allyson K. Friedman, PhD, of the Icahn School of Medicine at Mount Sinai in New York, NY, says their research could lead to new targets for “naturally acting antidepressants.”

To reach their findings, recently published in the journal Science, the researchers conducted a study on mice that were susceptible to depression.

The team says mice that are resilient to social defeat stress – a form of stress triggered by losing a dispute or from a hostile interaction – currents in the cation channels, or ion channels, of the brain are significantly increased, compared with depressed or control mice. The cation channels are responsible for transporting positive ions in dopamine neurons.

For their latest study, the researchers wanted to see whether increasing currents in the cation channels of mice susceptible to depression would enhance their resilience and coping mechanisms.

Brain performs a ‘complex balancing act’ to become resilient to depression

The investigators exposed the mice to optogenetics. This involves using laser optics and gene virus transfer to control the signaling of dopamine neurons.

Mouse in cage
Increased activity of dopamine neurons in mice allowed them to cope with stress without developing symptoms of depression.

The team says that when the neurons of the mice were exposed to stress from light or lamotrigine – an anticonvulsant drug used to treat epilepsy and bipolar disorder – their signaling increased.

They found that increasing such activity allowed the mice to cope with stress without developing symptoms related to depression. Furthermore, they were amazed to find that the hyperactivity of the dopamine neurons normalized.

“To our surprise, we found that resilient mice, instead of avoiding deleterious changes in the brain, experience further deleterious changes in response to stress, and use them beneficially,” says senior study author Ming-Hu Han, PhD, also of the Icahn School of Medicine at Mount Sinai.

Friedeman explains that in order to achieve this resilience when under social stress, the brain must perform a “complex balancing act,” which involves negative stress-related changes in the brain activating positive changes.

The team says their findings may lead to the development of new antidepressant medication. They add that if a drug could boost the resilience and coping mechanisms of individuals susceptible to depression, it may have fewer side effects and could tackle depression in a more natural way.

Commenting on the team’s findings, Dr. Eric Nestler, of the Icahn School of Medicine – who was not involved in the study – says:

“In this elegant study, Drs. Friedman and Han and their colleagues reveal a highly novel mechanism that controls an individual’s susceptibility or resilience to chronic social stress.

The discoveries have important implications for the development of new treatments for depression and other stress-related disorders.”

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Depression may be better predicted and understood now that University of Illinois at Chicago researchers have discovered that young adults who previously experienced the mental illness have hyper-connected emotional and cognitive networks in the brain.

Rachel Jacobs and Scott Langenecker, University of Illinois at Chicago
Rachel Jacobs, UIC research assistant professor in psychiatry, and Scott Langenecker, UIC associate professor of psychiatry and psychology, use functional magnetic resonance imaging to examine the brain connectivity of young adults.
Credit: Photo: Joshua Clark/UIC Photo Services

UIC researchers used functional magnetic resonance imaging to examine the brain connectivity of young adults ages 18 to 23 while they were in a resting state. Thirty unmedicated young adults who had previously experienced depression and 23 healthy controls were used in the study, which has been published online in the journal PLOS ONE.

“We wanted to see if the individuals who have had depression during their adolescence were different from their healthy peers,” said Rachel Jacobs, research assistant professor in psychiatry at UIC’s Institute for Juvenile Research, the lead author of the study.

The researchers found many regions that are “hyper-connected – or talking to each other a little too much – among those who have a history of depression,” Jacobs said. These hyper-connected brain networks were related to rumination, with individuals thinking about a problem over and over without actively trying to come up with a solution.

“Rumination is not a very healthy way of processing emotion,” said Scott Langenecker, associate professor of psychiatry and psychology at UIC and corresponding author of the study. “Rumination is a risk factor for depression and for reoccurrence of depression if you’ve had it in the past.”

The researchers also looked at cognitive control (the ability to engage and disengage in thought processes or behaviors), which is a predictor of response to treatment and also relapse of illness.

“Cognitive control and rumination, as you might expect, are related to each other. As rumination goes up, cognitive control goes down,” said Langenecker.

The researchers will follow these young adults over time to see whether or not these hyper-connectivities predict who will or won’t have a recurrence of illness.

Psychosocial and medication treatments for depression can be helpful, said Jacobs, but within two years of recovery half of those teenagers will relapse.

The transition to adulthood, a time when brain networks are nearly mature, may be a critical window for interventions.

“If we can help youth learn how to shift out of maladaptive strategies such as rumination, this may protect them from developing chronic depression and help them stay well as adults,” Jacobs said.

“We think that depression is a developmental outcome, and it’s not a foregone conclusion that people need to become depressed. If we can provide prevention and treatment to those people that are most at risk, we might be able to prevent depression, reduce the number of depressive episodes, or reduce their severity,” said Langenecker.

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Reported poor sleep quality, independent of a depressed mood, appears to be associated with an increased risk for suicide in older adults.

Suicide is a preventable public health problem and accounts for almost 1 million deaths annually worldwide. Late life is characterized by an increased prevalence of sleep complaints and disproportionately elevated rates of suicide. The study sample included 420 individuals (400 control patients and 20 patients who died from suicide) who were selected from 14,456 participants.

The authors examined the risk for suicide associated with poor reported sleep in a group of older adults (with an average age of nearly 75 years) during a 10-year observation period.

Those individuals who reported poorer sleep quality at baseline had a 1.4 times increased risk for suicide. When authors controlled for the effects of a depressed mood, people with poorer sleep at baseline still demonstrated a 1.2 times greater risk for suicide during the 10-year observation period. Two sleep factors in particular – difficulty falling asleep and nonrestorative sleep – were associated with increased suicide risk.

“We suggest that poor subjective sleep quality may therefore represent a useful screening tool and a novel therapeutic target for suicide prevention in late life.”

The study is published in JAMA Psychiatry.

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