Mental Health Disorders Have Increased Significantly Among Teens and Young Adults

Mental health issues are one of the defining problems of this era.

The percentage of young Americans experiencing certain types of mental health disorders has risen significantly over the past decade, with no corresponding increase in older adults, according to research published by the American Psychological Association.

“More U.S. adolescents and young adults in the late 2010s, versus the mid-2000s, experienced serious psychological distress, major depression or suicidal thoughts, and more attempted suicide,” said lead author Jean Twenge, PhD, author of the book “iGen” and professor of psychology at San Diego State University. “These trends are weak or non-existent among adults 26 years and over, suggesting a generational shift in mood disorders instead of an overall increase across all ages.”

The research was published in the Journal of Abnormal Psychology.

Twenge and her co-authors analyzed data from the National Survey on Drug Use and Health, a nationally representative survey that has tracked drug and alcohol use, mental health and other health-related issues in individuals age 12 and over in the United States since 1971. They looked at survey responses from more than 200,000 adolescents age 12 to 17 from 2005 to 2017, and almost 400,000 adults age 18 and over from 2008 to 2017.

The rate of individuals reporting symptoms consistent with major depression in the last 12 months increased 52 percent in adolescents from 2005 to 2017 (from 8.7 percent to 13.2 percent) and 63 percent in young adults age 18 to 25 from 2009 to 2017 (from 8.1 percent to 13.2 percent). There was also a 71 percent increase in young adults experiencing serious psychological distress in the previous 30 days from 2008 to 2017 (from 7.7 percent to 13.1 percent). The rate of young adults with suicidal thoughts or other suicide-related outcomes increased 47 percent from 2008 to 2017 (from 7.0 percent to 10.3 percent).

There was no significant increase in the percentage of older adults experiencing depression or psychological distress during corresponding time periods. The researchers even saw a slight decline in psychological distress in individuals over 65.

“Cultural trends in the last 10 years may have had a larger effect on mood disorders and suicide-related outcomes among younger generations compared with older generations,” said Twenge, who believes this trend may be partially due to increased use of electronic communication and digital media, which may have changed modes of social interaction enough to affect mood disorders. She also noted research shows that young people are not sleeping as much as they did in previous generations.

The increase in digital media use may have had a bigger impact on teens and young adults because older adults’ social lives are more stable and might have changed less than teens’ social lives have in the last ten years, said Twenge. Older adults might also be less likely to use digital media in a way that interferes with sleep — for example, they might be better at not staying up late on their phones or using them in the middle of the night.

“These results suggest a need for more research to understand how digital communication versus face-to-face social interaction influences mood disorders and suicide-related outcomes and to develop specialized interventions for younger age groups,” she said.

Given that the increase in mental health issues was sharpest after 2011, Twenge believes it’s unlikely to be due to genetics or economic woes and more likely to be due to sudden cultural changes, such as shifts in how teens and young adults spend their time outside of work and school. If so, that may be good news, she said.

“Young people can’t change their genetics or the economic situation of the country, but they can choose how they spend their leisure time. First and most important is to get enough sleep. Make sure your device use doesn’t interfere with sleep — don’t keep phones or tablets in the bedroom at night, and put devices down within an hour of bedtime,” she said. “Overall, make sure digital media use doesn’t interfere with activities more beneficial to mental health such as face-to-face social interaction, exercise and sleep.”

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Healthier Diets Reduce Depressive Symptoms

There’s research that has again verified this connection.

An analysis of data from almost 46,000 people has found that weight loss, nutrient boosting and fat reduction diets can all reduce the symptoms of depression.

Dr Joseph Firth, an Honorary Research fellow at The University of Manchester and Research Fellow at NICM Health Research Institute at Western Sydney University, says existing research has been unable to definitively establish if dietary improvement could benefit mental health.

But in a new study published in Psychosomatic Medicine, Dr Firth and colleagues brought together all existing data from clinical trials of diets for mental health conditions.

And the study provides convincing evidence that dietary improvement significantly reduces symptoms of depression, even in people without diagnosed depressive disorders.

Dr Firth said: “The overall evidence for the effects of diet on mood and mental well-being had up to now yet to be assessed.

“But our recent meta-analysis has done just that; showing that adopting a healthier diet can boost peoples’ mood. However, it has no clear effects on anxiety.”

The study combined data from 16 randomised controlled trials that examined the effects of dietary interventions on symptoms of depression and anxiety.

Sixteen eligible trials with outcome data for 45,826 participants were included; the majority of which examined samples with non-clinical depression.

The study found that all types of dietary improvement appeared to have equal effects on mental health, with weight-loss, fat reduction or nutrient-improving diets all having similar benefits for depressive symptoms.

“This is actually good news” said Dr Firth; “The similar effects from any type of dietary improvement suggests that highly-specific or specialised diets are unnecessary for the average individual.

“Instead, just making simple changes is equally beneficial for mental health. In particular, eating more nutrient-dense meals which are high in fibre and vegetables, while cutting back on fast-foods and refined sugars appears to be sufficient for avoiding the potentially negative psychological effects of a ‘junk food’ diet.

Dr Brendon Stubbs, co-author of the study and Clinical Lecturer at the NIHR Maudsley Biomedical Research Centre and King’s College London, added: “Our data add to the growing evidence to support lifestyle interventions as an important approach to tackle low mood and depression.

“Specifically, our results within this study found that when dietary interventions were combined with exercise, a greater improvement in depressive symptoms was experienced by people. Taken together, our data really highlight the central role of eating a healthier diet and taking regular exercise to act as a viable treatment to help people with low mood.”

Studies examined with female samples showed even greater benefits from dietary interventions for symptoms of both depression and anxiety.

Study: Social Media Use Can Increase Depression and Loneliness

The study essentially found that people using social media less than they typically would results in major decreases in loneliness and depression, with that effect being more pronounced for people who were most depressed at the start of the study.

Social media does have its share of positives — it allows people otherwise separated by significant physical distance to keep in touch and interact, it provides platforms for sharing ideas and stories, and it provides ways for the disadvantaged in society to gain access to opportunities. There are clear downsides to social media services though:

The link between the two has been talked about for years, but a causal connection had never been proven. For the first time, University of Pennsylvania research based on experimental data connects Facebook, Snapchat, and Instagram use to decreased well-being. Psychologist Melissa G. Hunt published her findings in the December Journal of Social and Clinical Psychology.

Few prior studies have attempted to show that social-media use harms users’ well-being, and those that have either put participants in unrealistic situations or were limited in scope, asking them to completely forego Facebook and relying on self-report data, for example, or conducting the work in a lab in as little time as an hour.

“We set out to do a much more comprehensive, rigorous study that was also more ecologically valid,” says Hunt, associate director of clinical training in Penn’s Psychology Department.

To that end, the research team, which included recent alumni Rachel Marx and Courtney Lipson and Penn senior Jordyn Young, designed their experiment to include the three platforms most popular with a cohort of undergraduates, and then collected objective usage data automatically tracked by iPhones for active apps, not those running the background.

Each of 143 participants completed a survey to determine mood and well-being at the study’s start, plus shared shots of their iPhone battery screens to offer a week’s worth of baseline social-media data. Participants were then randomly assigned to a control group, which had users maintain their typical social-media behavior, or an experimental group that limited time on Facebook, Snapchat, and Instagram to 10 minutes per platform per day.

For the next three weeks, participants shared iPhone battery screenshots to give the researchers weekly tallies for each individual. With those data in hand, Hunt then looked at seven outcome measures including fear of missing out, anxiety, depression, and loneliness.

“Here’s the bottom line,” she says. “Using less social media than you normally would leads to significant decreases in both depression and loneliness. These effects are particularly pronounced for folks who were more depressed when they came into the study.”

Hunt stresses that the findings do not suggest that 18- to 22-year-olds should stop using social media altogether. In fact, she built the study as she did to stay away from what she considers an unrealistic goal. The work does, however, speak to the idea that limiting screen time on these apps couldn’t hurt.

“It is a little ironic that reducing your use of social media actually makes you feel less lonely,” she says. But when she digs a little deeper, the findings make sense. “Some of the existing literature on social media suggests there’s an enormous amount of social comparison that happens. When you look at other people’s lives, particularly on Instagram, it’s easy to conclude that everyone else’s life is cooler or better than yours.”

Because this particular work only looked at Facebook, Instagram, and Snapchat, it’s not clear whether it applies broadly to other social-media platforms. Hunt also hesitates to say that these findings would replicate for other age groups or in different settings. Those are questions she still hopes to answer, including in an upcoming study about the use of dating apps by college students.

Despite those caveats, and although the study didn’t determine the optimal time users should spend on these platforms or the best way to use them, Hunt says the findings do offer two related conclusions it couldn’t hurt any social-media user to follow.

For one, reduce opportunities for social comparison, she says. “When you’re not busy getting sucked into clickbait social media, you’re actually spending more time on things that are more likely to make you feel better about your life.” Secondly, she adds, because these tools are here to stay, it’s incumbent on society to figure out how to use them in a way that limits damaging effects. “In general, I would say, put your phone down and be with the people in your life.”

Study: Aerobic Exercise Has Antidepressant Effects for Those With Major Depression

It seems like doctors should prescribe this sort of moderate intensity aerobic exercise instead of pharmaceutical drugs much more.

An analysis of randomized controlled clinical trials indicates that supervised aerobic exercise has large antidepressant treatment effects for patients with major depression. The systematic review and meta-analysis is published in Depression and Anxiety.

Across 11 eligible trials involving 455 adult patients (18-65 years old) with major depression as a primary disorder, supervised aerobic exercise was performed on average for 45 minutes, at moderate intensity, 3 times per week, and for 9.2 weeks. It showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.

Also, aerobic exercise revealed moderate-to-large antidepressant effects among trials with lower risk of bias, as well as large antidepressant effects among trials with short-term interventions (up to 4 weeks) and trials involving preferences for exercise.

Subgroup analyses revealed comparable effects for aerobic exercise across various settings and delivery formats, and in both outpatients and inpatients regardless of symptom severity.

“Collectively, this study has found that supervised aerobic exercise can significantly support major depression treatment in mental health services,” said lead author Dr. Ioannis D. Morres, of the University of Thessaly, in Greece.

Three Types of Depression Identified in Research for the First Time

More knowledge about the societal problem of depression should lead to more effective treatments for it.

According to the World Health Organization, nearly 300 million people worldwide suffer from depression and these rates are on the rise. Yet, doctors and scientists have a poor understanding of what causes this debilitating condition and for some who experience it, medicines don’t help.

Scientists from the Neural Computational Unit at the Okinawa Institute of Science and Technology Graduate University (OIST), in collaboration with their colleagues at Nara Institute of Science and Technology and clinicians at Hiroshima University, have for the first time identified three sub-types of depression. They found that one out of these sub-types seems to be untreatable by Selective Serotonin Reuptake Inhibitors (SSRIs), the most commonly prescribed medicines for the condition. The study was published in the journal Scientific Reports.

Serotonin is a neurotransmitter that influences our moods, interactions with other people, sleep patterns and memory. SSRIs are thought to take effect by boosting the levels of serotonin in the brain. However, these drugs do not have the same effect on everyone, and in some people, depression does not improve even after taking them. “It has always been speculated that different types of depression exist, and they influence the effectiveness of the drug. But there has been no consensus,” says Prof. Kenji Doya.

For the study, the scientists collected clinical, biological, and life history data from 134 individuals — half of whom were newly diagnosed with depression and the other half who had no depression diagnosis- using questionnaires and blood tests. Participants were asked about their sleep patterns, whether or not they had stressful issues, or other mental health conditions.

Researchers also scanned participants’ brains using magnetic resonance imaging (MRI) to map brain activity patterns in different regions. The technique they used allowed them to examine 78 regions covering the entire brain, to identify how its activities in different regions are correlated. “This is the first study to identify depression sub-types from life history and MRI data,” says Prof. Doya.

With over 3000 measurable features, including whether or not participants had experienced trauma, the scientists were faced with the dilemma of finding a way to analyze such a large data set accurately. “The major challenge in this study was to develop a statistical tool that could extract relevant information for clustering similar subjects together,” says Dr. Tomoki Tokuda, a statistician and the lead author of the study. He therefore designed a novel statistical method that would help detect multiple ways of data clustering and the features responsible for it. Using this method, the researchers identified a group of closely-placed data clusters, which consisted of measurable features essential for accessing mental health of an individual. Three out of the five data clusters were found to represent different sub-types of depression.

The three distinct sub-types of depression were characterized by two main factors: functional connectivity patterns synchronized between different regions of the brain and childhood trauma experience. They found that the brain’s functional connectivity in regions that involved the angular gyrus — a brain region associated with processing language and numbers, spatial cognition, attention, and other aspects of cognition — played a large role in determining whether SSRIs were effective in treating depression.

Patients with increased functional connectivity between the brain’s different regions who had also experienced childhood trauma had a sub-type of depression that is unresponsive to treatment by SSRIs drugs, the researchers found. On the other hand, the other two subtypes — where the participants’ brains did not show increased connectivity among its different regions or where participants had not experienced childhood trauma — tended to respond positively to treatments using SSRIs drugs.

This study not only identifies sub-types of depression for the first time, but also identifies some underlying factors and points to the need to explore new treatment techniques. “It provides scientists studying neurobiological aspects of depression a promising direction in which to pursue their research,” says Prof. Doya. In time, he and his research team hope that these results will help psychiatrists and therapists improve diagnoses and treat their patients more effectively.

Mental Health Disorder Rates Rising Globally

This is a sign of regression or stagnation, not progress, and it suggests that there needs to be a shift in the general direction human societies are on. Outside of the economic impacts of lost productivity, there are many collateral effects (e.g., worsened interpersonal relationships) that are associated with widespread mental health problems continuing as well.

The “Lancet Commission” report by 28 global specialists in psychiatry, public health and neuroscience, as well as mental health patients and advocacy groups, said the growing crisis could cause lasting harm to people, communities and economies worldwide.

While some of the costs will be the direct costs of healthcare and medicines or other therapies, most are indirect – in the form of loss of productivity, and spending on social welfare, education and law and order, the report’s co-lead author Vikram Patel said.

The wide-ranging report did not give the breakdown of the potential $16 trillion economic impact it estimated by 2030.

“The situation is extremely bleak,” Patel, a professor at Harvard Medical School in the United States, told reporters.

He said the burden of mental illness had risen “dramatically” worldwide in the past 25 years, partly due to societies ageing and more children surviving into adolescence, yet “no country is investing enough” to tackle the problem.

“No other health condition in humankind has been neglected as much as mental health has,” Patel said.

The World Health Organization (WHO) estimates that around 300 million people worldwide have depression and 50 million have dementia. Schizophrenia is estimated to affect 23 million people, and bipolar disorder around 60 million.

The Lancet report found that in many countries, people with common mental disorders such as depression, anxiety and schizophrenia routinely suffer gross human rights violations – including shackling, torture and imprisonment.

Richard Horton, editor-in-chief of the medical journal the Lancet, which commissioned the report, said it highlighted the “shameful and shocking treatment of people with mental ill health around the world”.

It called for a human rights-based approach to ensure that people with mental health conditions are not denied fundamental human rights, including access to employment, education and other core life experiences.

Breakthrough in Making Much Less Addictive Opioids

Important research this is, for it shows that the powerful pain relief opioids provide doesn’t have to be such a dangerous double-edged sword.

In the US, more than one-third of the population experiences some form of acute or chronic pain; in older adults this number rises to 40 percent.

The most common condition linked to chronic pain is chronic depression, which is a major cause of suicide.

To relieve severe pain, people go to their physician for powerful prescription painkillers, opioid drugs such as morphine, oxycodone and hydrocodone.

Almost all the currently marketed opioid drugs exert their analgesic effects through a protein called the “mu opioid receptor” (MOR).

MORs are embedded in the surface membrane of brain cells, or neurons, and block pain signals when activated by a drug.

However, many of the current opioids stimulate portions of the brain that lead to additional sensations of “rewarding” pleasure, or disrupt certain physiological activities. The former may lead to addiction, or the latter, death.

Which part of the brain is activated plays a vital role in controlling pain. For example, MORs are also present in the brain stem, a region that controls breathing.

Activating these mu receptors not only dulls pain but also slows breathing. Large doses stop breathing, causing death.

Activating MORs in other parts of the brain, including the ventral tegmental area and the nucleus accumbens, block pain and trigger pleasure or reward, which makes them addictive. But so far there is no efficient way to turn these receptors “on” and “off” in specific areas.

But there is another approach because not all opioids are created equal. Some, such as morphine, bind to the receptor and activate two signaling pathways: one mediating pain cessation and the other producing side effects like respiratory depression.

Other drugs favor one pathway more than the other, like only blocking pain – this is the one we want.

“Biased opioids” to kill pain

But MOR isn’t the only opioid receptor. There are two other closely related proteins called kappa and delta, or KOR and DOR respectively, that also alter pain perception but in slightly different ways.

Yet, currently there are only a few opioid medications that target KOR, and none that target DOR. One reason is that the function of these receptors in the brain neurons remains unclear.

Recently KOR has been getting attention as extensive studies from different academic labs show that it blocks pain without triggering euphoria, which means it isn’t addictive.

Another benefit is that it doesn’t slow respiration, which means that it isn’t lethal. But although it isn’t as dangerous as MOR, activating KOR does promote dysphoria, or unease, and sleepiness.

This work suggests it is possible to design a drug that only targets the pain pathway, without side effects. These kind of drugs are called “biased” opioids.

[…]

The exciting news is that researchers in the Roth lab have discovered several promising compounds based on the KOR structure that selectively binds and activates KOR, without cavorting with the more than 330 other related protein receptors.

Now our challenge is to transform these molecules into safer drugs.