Mental Health Medication Trends in the US, an Overview

Flooding the world with psychiatric drugs could boost the burden of mental disorders

Today in the United States, more than one in five adults — and more than one in 20 children and adolescents — take a psychiatric drug on a daily basis.

Overall, the number of Americans on medications used to treat psychological and behavioral disorders has substantially increased since 2001; more than one‐in‐five adults was on at least one of these medications in 2010, up 22 percent from ten years earlier. Women are far more likely to take a drug to treat a mental health condition than men, with more than a quarter of the adult female population on these drugs in 2010 as compared to 15 percent of men.

Women ages 45 and older showed the highest use of these drugs overall. Yet surprisingly, it was younger men (ages 20 to 44) who experienced the greatest increase in their numbers, rising 43 percent from 2001 to 2010.

The trends among children are opposite those of adults: boys are the higher utilizers of these medications overall but girls’ use has been increasing at a faster rate.

Read America’s State of Mind report and Flooding the world with psychiatric drugs could boost the burden of mental disorders on stat, OCTOBER 22, 2018.

Air pollution may increase dementia risk by 40 percent, London study finds

Are noise and air pollution related to the incidence of dementia ?
A cohort study in London, England, 2018

Air pollution may increase the chance of developing dementia, a study has suggested, in fresh evidence that the health of people of all ages is at risk from breathing dirty air, TheGuardian reports.

Abstract

Objective
To investigate whether the incidence of dementia is related to residential levels of air and noise pollution in London.

bmDesign
Retrospective cohort study using primary care data.

Setting
75 Greater London practices.

Participants
130 978 adults aged 50–79 years registered with their general practices on 1 January 2005, with no recorded history of dementia or care home residence.

Primary and secondary outcome measures
A first recorded diagnosis of dementia and, where specified, subgroups of Alzheimer’s disease and vascular dementia during 2005–2013. The average annual concentrations during 2004 of nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter ≤2.5 µm (PM2.5) and ozone (O3) were estimated at 20×20 m resolution from dispersion models. Traffic intensity, distance from major road and night-time noise levels (Lnight) were estimated at the postcode level. All exposure measures were linked anonymously to clinical data via residential postcode. HRs from Cox models were adjusted for age, sex, ethnicity, smoking and body mass index, with further adjustments explored for area deprivation and comorbidity.

Results
2181 subjects (1.7%) received an incident diagnosis of dementia (39% mentioning Alzheimer’s disease, 29% vascular dementia). There was a positive exposure response relationship between dementia and all measures of air pollution except O3, which was not readily explained by further adjustment. Adults living in areas with the highest fifth of NO2 concentration (>41.5 µg/m3) versus the lowest fifth (<31.9 µg/m3) were at a higher risk of dementia (HR=1.40, 95% CI 1.12 to 1.74). Increases in dementia risk were also observed with PM2.5, PM2.5 specifically from primary traffic sources only and Lnight, but only NO2 and PM2.5 remained statistically significant in multipollutant models. Associations were more consistent for Alzheimer’s disease than vascular dementia.

Conclusions
We have found evidence of a positive association between residential levels of air pollution across London and being diagnosed with dementia, which is unexplained by known confounding factors.

The Pill : Association of Hormonal Contraception With Depression

Are some side effects of birth control pills being kept secret ?

November 2016, JAMA Psychiatry published a Danish study that found a correlation between the use of hormonal birth control and being diagnosed with clinical depression. The study tracked hormonal birth control use and prescription of antidepressants over six years for over a million women. They found that women who were on hormonal birth control—be it the pill or a hormonal IUD or vaginal ring—were significantly more likely to be prescribed antidepressants.

These findings are only the latest in a long line of battles between women and their doctors over accurate information, broadly.vice reports in The Racist and Sexist History of Keeping Birth Control Side Effects Secret.

In 2018, the popularity of apps like Natural Cycles highlights the serious issues with contraceptives, the conversation reports.

Illustration by Eleanor Doughty, feature image credit broadly-images.vice.

Key Points

  • Question
    Is use of hormonal contraception associated with treatment of depression?
  • Findings
    In a nationwide prospective cohort study of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents.
  • Meaning
    Health care professionals should be aware of this relatively hitherto unnoticed adverse effect of hormonal contraception.

Abstract

Importance
Millions of women worldwide use hormonal contraception. Despite the clinical evidence of an influence of hormonal contraception on some women’s mood, associations between the use of hormonal contraception and mood disturbances remain inadequately addressed.

Objective
To investigate whether the use of hormonal contraception is positively associated with subsequent use of antidepressants and a diagnosis of depression at a psychiatric hospital.

Design, Setting, and Participants
This nationwide prospective cohort study combined data from the National Prescription Register and the Psychiatric Central Research Register in Denmark. All women and adolescents aged 15 to 34 years who were living in Denmark were followed up from January 1, 2000, to December 2013, if they had no prior depression diagnosis, redeemed prescription for antidepressants, other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment. Data were collected from January 1, 1995, to December 31, 2013, and analyzed from January 1, 2015, through April 1, 2016.

Exposures
Use of different types of hormonal contraception.

Main Outcomes and Measures
With time-varying covariates, adjusted incidence rate ratios (RRs) were calculated for first use of an antidepressant and first diagnosis of depression at a psychiatric hospital.

Results
A total of 1 061 997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31-1.42). For depression diagnoses, similar or slightly lower estimates were found. The relative risks generally decreased with increasing age. Adolescents (age range, 15-19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 (95% CI, 1.75-1.84) and those using progestin-only pills, 2.2 (95% CI, 1.99-2.52). Six months after starting use of hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46). When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71).

Conclusions and Relevance
Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.

Link between autoimmune disorders and psychosis, study says

Associations Between Non-neurological Autoimmune Disorders and Psychosis: A Meta-analysis

People with autoimmune disorders, a collection of diseases where the body’s immune system attacks its own cells, are more likely to have psychosis, according to a new study, the King’s College London reports.

Abstract

Background
A relationship between non-neurological autoimmune (NNAI) disorders and psychosis has been widely reported but not yet subjected to meta-analysis. We conducted the first meta-analysis examining the association between NNAI disorders and psychosis and investigated the effect of 1) temporality (as determined by study design), 2) psychiatric diagnosis, and 3) specific autoimmune disorders.

Methods
Major databases were searched for articles published until April 2018; 31 studies, comprising data for >25 million individuals, were eligible. Using random-effects models, we examined the overall association between all NNAI disorders and psychosis; rheumatoid arthritis was examined separately given the well-established negative association with psychosis. Stratified analyses investigated the effect of temporality, psychiatric diagnosis, and specific NNAI disorders.

Results
We observed a positive overall association between NNAI disorders and psychosis (odds ratio [OR] = 1.26; 95% confidence interval [CI], 1.12–1.41) that was consistent across study designs and psychiatric diagnoses; however, considerable heterogeneity was detected (I2 = 88.08). Patterns varied across individual NNAI disorders; associations were positive for pernicious anemia (OR = 1.91; 95% CI, 1.29–2.84), pemphigoid (OR = 1.90; 95% CI, 1.62–2.24), psoriasis (OR = 1.70; 95% CI, 1.51–1.91), celiac disease (OR = 1.53; 95% CI, 1.12–2.10), and Graves’ disease (OR = 1.33; 95% CI, 1.03–1.72) and negative for ankylosing spondylitis (OR = 0.72; 95% CI, 0.54–0.98) and rheumatoid arthritis (OR = 0.65; 95% CI, 0.50–0.84).

Conclusions
While we observed a positive overall association between NNAI disorders and psychosis, this was not consistent across all NNAI disorders. Specific factors, including distinct inflammatory pathways, genetic influences, autoantibodies targeting brain proteins, and exposure to corticosteroid treatment, may therefore underlie this association.

DES Adverse Health Outcomes

Le “condition branding” de l’industrie pharmaceutique

Addiction suprême après les jeux-vidéo

Publié par Luc Perino, médecin généraliste, humeur du 02/07/2018

Le critère essentiel et indispensable dans le diagnostic d’addiction a toujours été la présence d’un syndrome de sevrage. Autrement dit, l’addiction ne peut concerner que des toxiques (alcool, tabac, drogues) dont l’arrêt brutal provoque de graves troubles physiopathologiques.

Mais avec les dérives verbales et diagnostiques caractérisant nos sociétés surmédicalisées, le terme d’addiction est de plus en plus souvent utilisé pour des comportements. Après le sport, le pari et le sexe pathologiques, voici le jeu-vidéo pathologique des enfants, officialisé par l’OMS en juin 2018.

Comment expliquer un tel laxisme terminologique au sein d’une discipline qui ne cesse de revendiquer le statut de science exacte ?

Un minimum de sens de l’observation nous montre que tout cela relève du “condition branding” : terme intraduisible désignant ce que font les marketeurs de l’industrie pharmaceutique pour vendre des maladies au même titre que d’autres vendent une marque (brand) de chaussures ou de parfum.

La psychiatrie en est devenue le terrain favori après que les plus banales anxiétés et dépressions aient été déclinées avec tant de succès en diverses maladies. Il n’y a aucune limite prévisible à cette mentalisation pharmacologique, car rien n’est plus flou que les troubles mentaux.

  • Le trouble dysphorique prémenstruel a été promu pour recaser la fluoxétine (Prozac),
  • le trouble d’anxiété sociale pour créer une niche à la paroxétine (Deroxat),
  • le trouble panique pour élargir les indications de l’alprazolam (Xanax).

Ces campagnes où le nom du produit n’est jamais directement prononcé sont nommées “unbranded campaigns”. Même les médias publics, les ministères et l’OMS sont des acteurs ingénus ou subornés de ces campagnes invitant les citoyens à reconnaître au plus vite des “maladies” injustement méconnues comme l’ostéoporose, la DMLA, l’hyperactivité ou le déficit cognitif mineur.

N’en doutons pas, dans les mois ou années qui viennent, un médicament sera proposé pour soigner cette nouvelle addiction aux jeux-vidéo. Il s’agira, soit d’une nouvelle niche pour un produit existant, soit de la promotion d’un nouveau produit.

Cette nouvelle “maladie” vient gonfler la liste des centaines de troubles mentaux pour lesquels on vante une intervention pharmacologique. Bien que les régressions spontanées soient fréquentes et que les psychothérapies restent les meilleures options dans la très grande majorité des troubles de l’humeur et du comportement.

Le but de toutes ces savantes orchestrations est d’établir l’addiction suprême pour le plus grand nombre. Une addiction aux psychotropes (tranquillisants, neuroleptiques et antidépresseurs) qui est certainement la plus fréquente et la plus irrémédiable de toutes.

Peu importe alors que la cause initiale soit comportementale ou toxicologique, notre aveuglement face au “condition branding” aboutit généralement à une addiction aux psychotropes. Au sens le plus strict du terme.

En Savoir Plus

Stress and depression higher among people living near fracking sites

Associations of unconventional natural gas development with depression symptoms and disordered sleep in Pennsylvania

People who live near unconventional natural gas operations such as fracking are more likely to experience depression, Environmental Health News reports.
Featured image credit frackfreeryedale.org.

Abstract

Environmental and community factors may influence the development or course of depression and sleep problems.

In this study, we evaluated the association of unconventional natural gas development (UNGD) with depression symptoms and disordered sleep diagnoses using the Patient Health Questionnaire-8 and electronic health record data among Geisinger adult primary care patients in Pennsylvania.
Participants received a retrospective metric for UNGD at their residence (very low, low, medium, and high) that incorporated dates and durations of well development, distance from patient homes to wells, and well characteristics.

Analyses included 4,762 participants with no (62%), mild (23%), moderate (10%), and moderately severe or severe (5%) depression symptoms in 2014–2015 and 3,868 disordered sleep diagnoses between 2009–2015. We observed associations between living closer to more and bigger wells and depression symptoms, but not disordered sleep diagnoses in models weighted to account for sampling design and participation.

High UNGD (vs. very low) was associated with depression symptoms in an adjusted negative binomial model (exponentiated coefficient = 1.18, 95% confidence interval [CI]: 1.04–1.34). High and low UNGD (vs. very low) were associated with depression symptoms (vs. none) in an adjusted multinomial logistic model.

Our findings suggest that UNGD may be associated with adverse mental health in Pennsylvania.

Endocrine Disrupting Chemicals and Behavior

Special issue of Hormones and Behavior, Volume 101, Pages 1-148, May 2018

The peer-reviewed journal Hormones and Behavior, Volume 101, Pages 1-148 (May 2018), raises concern about how many of the 90,000+ chemicals in use today may disrupt our most basic endocrine systems with significant consequences for neurodevelopment, neurophysiology, healthy brain aging, and behavior.

Several articles address bisphenol A :

About PDBEs, triclosan, and other replacement chemicals :

Other studies included in this special issue address behavioral effects of voluntary taken pharmaceuticals, including birth control pills, and pain medications.

About DES and the BRAIN :

Prenatal exposure to several replacement chemicals linked to hyperactivity, problem behaviors in children

Exposure to perfluoroalkyl substances during pregnancy and child behaviour at 5 to 9 years of age

2018 Study Highlights

  • Serum levels of perfluoroalkyl substances were measured in 1023 pregnant women.
  • Child behaviour was assessed by use of the Strength and Difficulties Questionnaire
  • Prenatal perfluorohexane sulfonic acid (PFHxS) was associated with problem behaviour
  • Prenatal perfluorononanoic acid (PFNA) was associated with hyperactive behaviour
  • Prenatal perfluorodecanic acid (PFDA) was associated with hyperactive behaviour.

Abstract

We examined associations between prenatal exposure to perfluorohexane sulfonic acid (PFHxS), perfluoroheptanoic acid (PFHpA), perfluorononanoic acid (PFNA), and perfluorodecanic acid (PFDA) – and child behaviour (SDQ-total) and hyperactivity (sub-scale) at 5–9 years of age in birth cohorts from Greenland and Ukraine.

Pregnancy serum samples (N = 1023) were analysed for perfluoroalkyl substances (PFASs) and categorised into tertiles and also used as continuous exposure variables. Problem behaviour and hyperactivity were assessed, using the Strength and Difficulties Questionnaire (SDQ) and categorised as normal/borderline and abnormal. Associations were analysed using multiple logistic and linear regression.

High compared to low prenatal PFHxS exposure was associated with 1.16 (95% confidence interval (CI): 0.08; 2.25) point higher SDQ-total (more problem behaviour) in Greenland and 0.80 (CI: 0.06; 1.54) point higher SDQ-total in the combined analyses, whereas no association was present in Ukraine alone. One natural log-unit increase in prenatal PFNA exposure was associated with 0.90 (CI: 0.10; 1.71) points higher SDQ-total in Greenland and 0.72 (CI: 0.13; 1.31) points higher in the combined analysis and no association in Ukraine. Prenatal PFAS exposure was unrelated to problem behaviour (abnormal SDQ-total). In the combined analysis, odds ratio (OR) (CI) for hyperactivity was 1.8 (1.0; 3.2) for one natural log-unit increase in prenatal PFNA and 1.7 (1.0; 3.1) for one natural log-unit increase in prenatal PFDA exposure.

Findings are compatible with weak effects on child behaviour of prenatal exposure to some PFASs although spurious results are not entirely unlikely. The associations were strongest in Greenland.

Behavioral effects of prenatal and postnatal PBDE exposures

Exposure to polybrominated diphenyl ethers (PBDEs) and child behavior: Current findings and future directions

2018 Study Highlights

  • Prenatal PBDEs are associated with executive function impairments and inattention.
  • Prenatal and postnatal PBDE exposures increase externalizing problems in children.
  • PBDEs’ association with internalizing, adaptive, and social behaviors is not clear.
  • PBDE exposure adversely affects behavioral development in children.

Abstract

Polybrominated diphenyl ethers (PBDEs) are recognized neurotoxicants, but the extent to which PBDEs influence various domains of behavior in children is not fully understood.

As such, we reviewed epidemiologic studies published to date to provide an overview of the current state of knowledge on PBDEs’ potential role in behavioral development.

We identified 19 epidemiologic studies reporting on associations of prenatal and childhood concentrations of PBDEs with behaviors assessed in children from 1 to 12 years, including executive function, attention, externalizing and internalizing behaviors, adaptive skills, and social behaviors/Autism Spectrum Disorder (ASD).

While the mechanisms of PBDE neurotoxicity in humans are still not clearly elucidated, findings from this review indicate that PBDE exposure during fetal development is associated with impairments in executive function and poorer attentional control in children. Results from large prospective cohorts demonstrate that prenatal and postnatal PBDE exposure adversely impacts externalizing behavior (e.g., hyperactivity and conduct problems). Additional studies are needed to determine whether PBDEs are associated with internalizing problems, adaptive skills, and social behaviors/ASD in children.

Future studies will help better understand the potential neurotoxic effects of PBDE exposures during adolescence, possible sex-dependent effects, and the impact of exposure to BDE-209 and alternative flame retardants. Future studies should also examine chemical mixtures to capture real-world exposures when examining PBDEs and their impact on various behavioral domains in the context of multiple chemical exposures.

Changes in the vocalization patterns of the mice pups whose parents were exposed to BPA prenatally

Multigenerational effects of bisphenol A or ethinyl estradiol exposure on F2 California mice (Peromyscus californicus) pup vocalizations

California mice is used as a special model for parental behaviors with high relevance to humans, because they are monogamous, with both parents caring for neonates. In this study, Johnson and colleagues found changes in the vocalization patterns of the mice pups whose parents were exposed to BPA prenatally (i.e., through exposure of grandparents). These changes in communication abilities could have impacts on the amount of parental care they receive.

2018 Study Abstract

Rodent pups use vocalizations to communicate with one or both parents in biparental species, such as California mice (Peromyscus californicus). Previous studies have shown California mice developmentally exposed to endocrine disrupting chemicals, bisphenol A (BPA) or ethinyl estradiol (EE), demonstrate later compromised parental behaviors. Reductions in F1 parental behaviors might also be due to decreased emissions of F2 pup vocalizations. Thus, vocalizations of F2 male and female California mice pups born to F1 parents developmentally exposed to BPA, EE, or controls were examined. Postnatal days (PND) 2–4 were considered early postnatal period, PND 7 and 14 were defined as mid-postnatal period, and PND 21 and 28 were classified as late postnatal period. EE pups showed increased latency to emit the first syllable compared to controls. BPA female pups had decreased syllable duration compared to control and EE female pups during the early postnatal period but enhanced responses compared to controls at late postnatal period; whereas, male BPA and EE pups showed greater syllable duration compared to controls during early postnatal period. In mid-postnatal period, F2 BPA and EE pups emitted greater number of phrases than F2 control pups. Results indicate aspects of vocalizations were disrupted in F2 pups born to F1 parents developmentally exposed to BPA or EE, but their responses were not always identical, suggesting BPA might not activate estrogen receptors to the same extent as EE. Changes in vocalization patterns by F2 pups may be due to multigenerational exposure to BPA or EE and/or reduced parental care received.

About DES and the BRAIN ;