Tiny Molecule Could Help Diagnose and Treat Mental Disorders

Scientists “fingerprint” a culprit in depression, anxiety and other mood disorders

According to the World Health Organization, such mood disorders as depression affect some 10% of the world’s population and are associated with a heavy burden of disease. That is why numerous scientists around the world have invested a great deal of effort in understanding these diseases. Yet the molecular and cellular mechanisms that underlie these problems are still only partly understood.

The existing anti-depressants are not good enough: Some 60-70% of patients get no relief from them. For the other 30-40%, that relief is often incomplete, and they must take the drugs for a long period before feeling any effects. In addition, there are many side effects associated with the drugs. New and better drugs are clearly needed, an undertaking that requires, first and foremost, a better understanding of the processes and causes underlying the disorders.

The Weizmann Institute’s Prof. Alon Chen, together with his then PhD student Dr. Orna Issler, investigated the molecular mechanisms of the brain’s serotonin system, which, when misregulated, is involved in depression and anxiety disorders. Chen and his colleagues researched the role of microRNA molecules (small, non-coding RNA molecules that regulate various cellular activities) in the nerve cells that produce serotonin. They succeeded in identifying, for the first time, the unique “fingerprints” of a microRNA molecule that acts on the serotonin-producing nerve cells. Combining bioinformatics methods with experiments, the researchers found a connection between this particular microRNA, (miR135), and two proteins that play a key role in serotonin production and the regulation of its activities. The findings appeared today in Neuron.

The scientists noted that in the area of the brain containing the serotonin-producing nerve cells, miR135 levels increased when antidepressant compounds were introduced. Mice that were genetically engineered to produce higher-than-average amounts of the microRNA were more resistant to constant stress: They did not develop any of the behaviors associated with chronic stress, such as anxiety or depression, which would normally appear. In contrast, mice that expressed low levels of miR135 exhibited more of these behaviors; in addition, their response to antidepressants was weaker. In other words, the brain needs the proper miR135 levels – low enough to enable a healthy stress response and high enough to avoid depression or anxiety disorders and to respond to serotonin-boosting antidepressants. When this idea was tested on human blood samples, the researchers found that subjects who suffered from depression had unusually low miR135 levels in their blood. On closer inspection, the scientists discovered that the three genes involved in producing miR135 are located in areas of the genome that are known to be associated with risk factors for bipolar mood disorders.

These findings suggest that miR135 could be a useful therapeutic molecule – both as a blood test for depression and related disorders, and as a target whose levels might be raised in patients. Yeda Research and Development Co. Ltd., the technology transfer arm of the Weizmann Institute, has applied for a patent connected to these findings and recently licensed the rights to miCure Therapeutics to develop a drug and diagnostic method. After completing preclinical trials, the company hopes to begin clinical trials in humans.

A shock to the system: Electroconvulsive Therapy shows mood disorder-specific therapeutic benefits

The oldest well-established procedure for somatic treatment of unipolar and bipolar disorders, electroconvulsive therapy (ECT) has, at best, a variegated reputation – and not just in its reputation for being a “barbaric” treatment modality (which, as it turns out, it is not). The scientific, clinical, and ethical controversy extends to unanswered questions about its precise mechanism of action – that is, how major electrical discharge over half the brain shows efficacy in recovery from a range of sometimes quite distinct psychological and psychiatric disorders. Recently, however, scientists at Université de Lausanne, Lausanne, Switzerland and Charité University Medicine, Berlin, Germany found local but not general anatomical brain changes following electroconvulsive therapy that are differently distributed in each disease, and are actually the areas believed to be abnormal in each disorder. Since interaction between ECT and specific pathology appears to be therapeutically causal, the researchers state that their results have implications for deep brain stimulation, transcranial magnetic stimulation and other electrically-based brain treatments.

Prof. Bogdan Draganski discussed the paper that he, Dr. Juergen Dukart and their co-authors published in Proceedings of the National Academy of Sciences.

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What Color is Your Night Light? It May Affect Your Mood

Study Finds Red Light Least Harmful, While Blue Light is Worst

When it comes to some of the health hazards of light at night, a new study suggests that the color of the light can make a big difference.

In a study involving hamsters, researchers found that blue light had the worst effects on mood-related measures, followed closely by white light.

But hamsters exposed to red light at night had significantly less evidence of depressive-like symptoms and changes in the brain linked to depression, compared to those that experienced blue or white light.

The only hamsters that fared better than those exposed to red light were those that had total darkness at night.

The findings may have important implications for humans, particularly those whose work on night shifts makes them susceptible to mood disorders, said Randy Nelson, co-author of the study and professor of neuroscience and psychology at The Ohio State University.

“Our findings suggest that if we could use red light when appropriate for night-shift workers, it may not have some of the negative effects on their health that white light does,” Nelson said.

The study appears in the Aug. 7, 2013, issue of The Journal of Neuroscience.

The research examined the role of specialized photosensitive cells in the retina — called ipRGCs — that don’t have a major role in vision, but detect light and send messages to a part of the brain that helps regulate the body’s circadian clock. This is the body’s master clock that helps determine when people feel sleepy and awake.

Other research suggests these light-sensitive cells also send messages to parts of the brain that play a role in mood and emotion.

“Light at night may result in parts of the brain regulating mood receiving signals during times of the day when they shouldn’t,” said co-author Tracy Bedrosian, a former graduate student at Ohio State who is now a postdoctoral researcher at the Salk Institute. “This may be why light at night seems to be linked to depression in some people.”

What people experience as different colors of light are actually lights of different wavelengths. The ipRGCs don’t appear to react to light of different wavelengths in the same way.

“These cells are most sensitive to blue wavelengths and least sensitive to red wavelengths,” Nelson said. “We wanted to see how exposure to these different color wavelengths affected the hamsters.”

In one experiment, the researchers exposed adult female Siberian hamsters to four weeks each of nighttime conditions with no light, dim red light, dim white light (similar to that found in normal light bulbs) or dim blue light.

They then did several tests with the hamsters that are used to check for depressive-like symptoms. For example, if the hamsters drink less-than-normal amounts of sugar water — a treat they normally enjoy — that is seen as evidence of a mood problem.

Results showed that hamsters that were kept in the dark at night drank the most sugar water, followed closely by those exposed to red light. Those that lived with dim white or blue light at night drank significantly less of the sugar water than the others.

After the testing, the researchers then examined the hippocampus regions of the brains of the hamsters.

Hamsters that spent the night in dim blue or white light had a significantly reduced density of dendritic spines compared to those that lived in total darkness or that were exposed to only red light. Dendritic spines are hairlike growths on brain cells that are used to send chemical messages from one cell to another. 

A lowered density of these dendritic spines has been linked to depression, Nelson said.

“The behavior tests and changes in brain structure in hamsters both suggest that the color of lights may play a key role in mood,” he said.

“In nearly every measure we had, hamsters exposed to blue light were the worst off, followed by those exposed to white light,” he said. “While total darkness was best, red light was not nearly as bad as the other wavelengths we studied.”

Nelson and Bedrosian said they believe these results may be applicable to humans.

In addition to shift workers, others may benefit from limiting their light at night from computers, televisions and other electronic devices, they said. And, if light is needed, the color may matter.

“If you need a night light in the bathroom or bedroom, it may be better to have one that gives off red light rather than white light,” Bedrosian said.

Inside the Minds of Murderers

Impulsive murderers much more mentally impaired than those who kill strategically

The minds of murderers who kill impulsively, often out of rage, and those who carefully carry out premeditated crimes differ markedly both psychologically and intellectually, according to a new study by Northwestern Medicine® researcher Robert Hanlon.

“Impulsive murderers were much more mentally impaired, particularly cognitively impaired, in terms of both their intelligence and other cognitive functions,” said Hanlon, senior author of the study and associate professor of clinical psychiatry and clinical neurology at Northwestern University Feinberg School of Medicine.

“The predatory and premeditated murderers did not typically show any major intellectual or cognitive impairments, but many more of them have psychiatric disorders,” he said.

Published online in the journal Criminal Justice and Behavior, the study is the first to examine the neuropsychological and intelligence differences of murderers who kill impulsively versus those who kill as the result of a premeditated strategic plan.

• Compared to impulsive murderers, premeditated murderers are almost twice as likely to have a history of mood disorders or psychotic disorders — 61 percent versus 34 percent.
• Compared to predatory murderers, impulsive murderers are more likely to be developmentally disabled and have cognitive and intellectual impairments — 59 percent versus 36 percent.
• Nearly all of the impulsive murderers have a history of alcohol or drug abuse and/or were intoxicated at the time of the crime — 93 percent versus 76 percent of those who strategized about their crimes.

Based on established criteria, 77 murderers from typical prison populations in Illinois and Missouri were classified into the two groups (affective/impulsive and premeditated/predatory murderers). Hanlon compared their performances on standardized measures of intelligence and neuropsychological tests of memory, attention and executive functions. He spent hours with each individual, administering series of tests to complete an evaluation. Hanlon has spent thousands of hours studying the minds of murderers through his research.

“It’s important to try to learn as much as we can about the thought patterns and the psychopathology, neuropathology and mental disorders that tend to characterize the types of people committing these crimes,” he said. “Ultimately, we may be able to increase our rates of prevention and also assist the courts, particularly helping judges and juries be more informed about the minds and the mental abnormalities of the people who commit these violent crimes.”

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Suicidal behaviour is a disease, psychiatrists argue

As suicide rates climb steeply in the US a growing number of psychiatrists are arguing that suicidal behaviour should be considered as a disease in its own right, rather than as a behaviour resulting from a mood disorder.

They base their argument on mounting evidence showing that the brains of people who have committed suicide have striking similarities, quite distinct from what is seen in the brains of people who have similar mood disorders but who died of natural causes.

Suicide also tends to be more common in some families, suggesting there may be genetic and other biological factors in play. What’s more, most people with mood disorders never attempt to kill themselves, and about 10 per cent of suicides have no history of mental disease.

The idea of classifying suicidal tendencies as a disease is being taken seriously. The team behind the fifth edition of the Diagnostic Standards Manual (DSM-5) – the newest version of psychiatry’s “bible”, released at the American Psychiatric Association’s meeting in San Francisco this week – considered a proposal to have “suicide behaviour disorder” listed as a distinct diagnosis. It was ultimately put on probation: put into a list of topics deemed to require further research for possible inclusion in future DSM revisions.

Another argument for linking suicidal people together under a single diagnosis is that it could spur research into the neurological and genetic factors they have in common. This could allow psychiatrists to better predict someone’s suicide risk, and even lead to treatments that stop suicidal feelings.

Signs in the brain

Until the 1980s, the accepted view in psychiatry was that people who committed suicide were, by definition, depressed. But that view began to change when autopsies revealed distinctive features in the brains of people who had committed suicide, including structural changes in the prefrontal cortex – which controls high-level decision-making – and altered levels of the neurochemical serotonin. These characteristics appeared regardless of whether the people had suffered from depression, schizophrenia, bipolar disorder, or no disorder at all (Brain Research).

But there is no single neurological cause of suicide, says Gustavo Turecki of McGill University in Montreal. What is more likely, he says, is that environmental factors trigger a series of changes in the brains of people who are already genetically prone to suicide, contributing to a constellation of factors that ultimately increase risk. These factors include a history of abuse as a child, post-traumatic stress disorder, long periods of anxiety, or sleep deprivation.

The search for more of these factors is complicated by the rarity of brain samples from suicide victims and the lack of an animal model – humans are unique in their wilful ability to end their lives. But some studies are yielding insights. For example, when people with bipolar disorder who have previously attempted suicide begin taking lithium, they tend to stop attempting suicide even if the drug has no effect on their other symptoms. This suggests that the drug may be acting on neural pathways that specifically influence suicidal tendencies (Annual Review of Pharmacology and Toxicology).

In the genes?

There is also growing evidence that genetics plays a role. For example, according to one study, identical twins share suicidal tendencies 15 per cent of the time, compared with 1 per cent in non-identical twins (Journal of Affective Disorders). And a study of adopted people who had committed suicide found that their biological relatives were six times more likely to commit suicide than members of the family that adopted them (American Journal of Medical Genetics).

A number of individual genes have been linked to suicide, such as those involved in the brain’s response to mood-lifting serotonin, and a signalling molecule called brain-derived neurotrophic factor (BDNF), which regulates the brain’s response to stress. Both tend to be suppressed in the brains of people who committed suicide, regardless of what mental disorder they had. Other studies of post-mortem brains have found that people who commit suicide after a bout of depression have different brain chemistry from depressed people who die of natural causes.

A study by Turecki, published this month, compared the brains of 46 people who had committed suicide with those of 16 people who died of natural causes. In the first group, 366 genes, mostly related to learning and memory, had a different set of epigenetic markers – chemical switches that turn genes on and off (American Journal of Psychiatry). The results are complicated by the fact that many of the people who committed suicide suffered from mental disorders, but Turecki says that suicide, rather than having a mental disorder, was the only significant predictor for these specific epigenetic changes.

No one yet knows the mechanism through which environmental factors would alter these genes, although stress hormones such as cortisol may be playing a role.

Understanding risk

Ultimately, biological and genetic markers might allow psychiatrists to better predict which patients are most at risk of suicide. But David Brent of the University of Pittsburgh, Pennsylvania, cautions that even if we can one day use biomarkers to predict if someone will make a suicide attempt, they do not tell us when. “If clinicians are keeping an eye on a patient, they need to know if there’s imminent risk,” he says.

However, knowing someone’s long-term suicide risk may have important implications for how a doctor chooses to treat that person, says Jan Fawcett of the University of New Mexico in Albuquerque.

For instance, a doctor may decide not to prescribe certain antidepressants to a patient with these biomarkers, as many drugs are thought to increase suicide risk. Another question would be whether to commit a person to a mental hospital – a major decision, he says, as people are most likely to commit suicide right after being released from hospital (Archives of General Psychiatry).

David Shaffer of Columbia University in New York, who was a member of the DSM-V working group, says that suicide behaviour disorder is “very much in the spirit” of the new Research Domain Criteria system that the US National Institute of Mental Health proposed as an alternative diagnosis standard to DSM-V. Rather than diagnosing people with depression or bipolar disorder, for example, the NIMH wants mental disorders to be diagnosed and treated more objectively using patients’ behaviour, genetics and neurobiology.

Ultimately, says Nader Perroud of the University of Geneva in Switzerland, if suicidal behaviour is considered as a disease in its own right, it will become possible to conduct more focused, evidence-based research on it and medications that treat it effectively. “We might be able to find a proper treatment for suicidal behaviour.”

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Foetal exposure to excessive stress hormones in the womb linked to adult mood disorders

Exposure of the developing foetus to excessive levels of stress hormones in the womb can cause mood disorders in later life and now, for the first time, researchers have found a mechanism that may underpin this process, according to research presented today (Sunday) at the British Neuroscience Association Festival of Neuroscience (BNA2013) in London.

The concept of foetal programming of adult disease, whereby the environment experienced in the womb can have profound long-lasting consequences on health and risk of disease in later life, is well known; however, the process that drives this is unclear. Professor Megan Holmes, a neuroendocrinologist from the University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science in Scotland (UK), will say: “During our research we have identified the enzyme 11ß-HSD2 which we believe plays a key role in the process of foetal programming.”

Adverse environments experienced while in the womb, such as in cases of stress, bereavement or abuse, will increase levels of glucocorticoids in the mother, which may harm the growing baby. Glucocorticoids are naturally produced hormones and they are also known as stress hormones because of their role in the stress response.

“The stress hormone cortisol may be a key factor in programming the foetus, baby or child to be at risk of disease in later life. Cortisol causes reduced growth and modifies the timing of tissue development as well as having long lasting effects on gene expression,” she will say.

Prof Holmes will describe how her research has identified an enzyme called 11ß-HSD2 (11beta-hydroxysteroid dehydrogenase type 2) that breaks down the stress hormone cortisol to an inactive form, before it can cause any harm to the developing foetus. The enzyme 11ß-HSD2 is present in the placenta and the developing foetal brain where it is thought to act as a shield to protect against the harmful actions of cortisol.

Prof Holmes and her colleagues developed genetically modified mice that lacked 11ß-HSD2 in order to determine the role of the enzyme in the placenta and foetal brain. “In mice lacking the enzyme 11ß-HSD2, foetuses were exposed to high levels of stress hormones and, as a consequence, these mice exhibited reduced foetal growth and went on to show programmed mood disorders in later life. We also found that the placentas from these mice were smaller and did not transport nutrients efficiently across to the developing foetus. This too could contribute to the harmful consequences of increased stress hormone exposure on the foetus and suggests that the placental 11ß-HSD2 shield is the most important barrier.

“However, preliminary new data show that with the loss of the 11ß-HSD2 protective barrier solely in the brain, programming of the developing foetus still occurs, and, therefore, this raises questions about how dominant a role is played by the placental 11ß-HSD2 barrier. This research is currently ongoing and we cannot draw any firm conclusions yet.

“Determining the exact molecular and cellular mechanisms that drive foetal programming will help us identify potential therapeutic targets that can be used to reverse the deleterious consequences on mood disorders. In the future, we hope to explore the potential of these targets in studies in humans,” she will say.

Prof Holmes hopes that her research will make healthcare workers more aware of the fact that children exposed to an adverse environment, be it abuse, malnutrition, or bereavement, are at an increased risk of mood disorders in later life and the children should be carefully monitored and supported to prevent this from happening.

In addition, the potential effects of excessive levels of stress hormones on the developing foetus are also of relevance to individuals involved in antenatal care. Within the past 20 years, the majority of women at risk of premature delivery have been given synthetic glucocorticoids to accelerate foetal lung development to allow the premature babies to survive early birth.

“While this glucocorticoid treatment is essential, the dose, number of treatments and the drug used, have to be carefully monitored to ensure that the minimum effective therapy is used, as it may set the stage for effects later in the child’s life,” Prof Holmes will say.

Puberty is another sensitive time of development and stress experienced at this time can also be involved in programming adult mood disorders. Prof Holmes and her colleagues have found evidence from imaging studies in rats that stress in early teenage years could affect mood and emotional behaviour via changes in the brain’s neural networks associated with emotional processing.

The researchers used fMRI (Functional Magnetic Resonance Imaging) to see which pathways in the brain were affected when stressed, peripubertal rats responded to a specific learned task.

Prof Holmes will say: “We showed that in stressed ‘teenage’ rats, the part of the brain region involved in emotion and fear (known as amygdala) was activated in an exaggerated fashion when compared to controls. The results from this study clearly showed that altered emotional processing occurs in the amygdala in response to stress during this crucial period of development.”

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