Temperament could predict diagnosis and presenting symptoms

Your temperament could affect your diagnosis, presenting symptoms, and psychopathologic conditions. The results of a recent study indicate that distinguishing between the various temperaments of irritable, depressive, hyperthymic, and cyclothymic might be helpful.

The study researchers report that in their study of 129 patients, hyperthymic temperament showed a preferential association with bipolar I disorder (BD-I) and bipolar disorder not otherwise specified diagnoses (BD-NOS), whereas depressive temperament was more frequent in patients with bipolar II disorder (BD-II) and major depressive disorder (MDD).

Anxious and depressive temperaments were more frequent in current depressive and mixed episodes compared with manic ones, while irritable temperaments were most frequent in mixed episodes and in patients suffering from alcohol dependence compared with nondependent patients.

Additionally the study showed that hyperthymic temperaments protected against depressive and anxiety symptoms while it increased the susceptibility towards manic symptoms. In contrast depressive, irritable, and cyclothymic temperaments increased the susceptiblity towards psychopathologic sysmptoms such as somatization, and interpersonal sensitivity.
The authors conclude by suggesting that temperament be taken into consideration when diagnosing and treating. Given the small size of the study and cross sectional design, the study needs to be replicated by others.

Reassessing mood disorders

New research is causing researchers to reassess the DSM’s view of mood disorders. Recently a Canadian researcher by the name of McIntyre performed a study that challenges the DSM model. McIntyre gave a neuroleptic, lurasidone, to two groups of bipolar patients. One group consisted of depressed individuals while the other consisted of those in a mixed state. Somewhat surprisingly the drug helped both equally which implies the two states aren’t all that different.

Additional research by John Geddes, chairman of Oxford University’s Department of Psychiatry at Oxford also supports the idea that the various states in bipolar disorder are more similar than different and that instability is the key feature. The idea of pure depression or pure mania in the DSM is idealistic and limits our understanding. In reality mood episodes usually consist of depressive and manic symptoms imposed on top of an unstable temperament instead of a completely euthymic mood.

This constant mood lability throws into doubt the entire DSM-based distinction between “bipolar” and “major depressive” disorders. It is instead consistent with Kraepelin‘s original view of manic-depressive insanity as a broad illness of recurrent mood episodes, irrespective of polarity (in other words, recurrent depression is manic-depressive illness even without classic manic episodes), in contrast to the current faith in bipolar disorder (mania is required) vs major depressive disorder (mania is absent).

Nassir Ghaemi concluded his article by suggesting that metanalysis on antidepressants efficacy are obscured by the fact that major depression is categorized too broadly and consequently there is too much heterogeneity. I believe he is suggesting that if depression is subcategorized to a greater degree the efficacy issue will be come much clearer. Perhaps antidepressants are more efficacious in one subtype than another? Additionally he suggests the opposite of most critics which is that bipolar disorder is too narrowly defined. I have had similar thoughts regarding the heterogeneity of depression and consequently I am in agreement.

Probiotics can reduce symptoms of anxiety

I have always been interested in the relationship between diet and depression. Of all the food items yogurt is one that has consistently yielded the most improvement in my symptoms. Yogurt was unique in that it reduced my stress while at the same time increasing my motivation/energy. Additionally, I have also been interested the relationship between the vagus nerve and mood disorders. Recently there has been research that confirms my experience with diet and my intuition that the vagus nerve is somehow involved. This most recent study was performed on humans whereas previous studies were only on animals.

The vagus nerve connects the brain with the gut. A considerable percentage of the nervous system is devoted to the gut and to me that implies that something very important is going on there.

Scientists had already found that the brain sends signals to the gut, which is why stress and other emotions can contribute to gastrointestinal symptoms. The new study of 36 women show that the signals also travel the opposite way.

One method of research included brain imaging which is somewhat controversial. The fact that there was reduced activity in the part of the brain that deals with cognition agrees with previous studies on antidepressants which have shown decreased activity in the prefrontal cortex in responders. Perhaps the reduced activity in the areas associated with cognition were due to less anxious thoughts?

The women all had a functional magnetic resonance imaging (fMRI) brain scans before and after the one-month study period, which included asking the participants to match a series of faces showing angry or fearful expressions on a computer screen to other faces that appeared, the Daily Mail reported.

The women who ate the probiotic yoghurt had reduced activity in the part of the brain that handles aspects of cognition and emotion, while the women who ate non-probiotic yoghurt or no dairy showed either no change or an increase in activity, the results showed.

The study was relatively small and further studies are needed to confirm the connection.

Presence of ‘activation syndrome’ suggests bipolarity

When younger(in my twenties) I noticed that SSRIs initially gave me panic attacks and akathisia. I always had a suspicion that my depression had a degree of bipolarity about it and this study confirms it a little. Activation syndrome is more common among bipolar patients and it consists of the following symptoms:

The components of activation syndrome, as stated by the US Food and Drug Administration, are anxiety, agitation, panic attack, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, and mania/hypomania. The syndrome is believed to flag suicidality risk in patients taking antidepressants.

If an individual has these symptoms it increases the chance of being bipolar by 3.27 fold.

On multivariate analysis, a bipolar diagnosis was one of only two variables independently associated with activation syndrome, increasing the likelihood 3.27-fold.

The other variable was experiencing a mixed depressed state which like a bipolar diagnosis, increases suicidality. In the past another mood researcher Benazzi, a proponent of ‘mixed depression’, believed that individuals with a few hypomanic traits such as irritability, insomnia and agitation while depressed were more likely to have bipolar disorder.

The other significant variable was being in a depressive mixed state, which raised the likelihood for activation syndrome 4.13-fold. The researchers note that a depressive mixed state is reportedly almost as common in patients with MDD who attempt suicide while on antidepressive treatment as it is in patients with bipolar disorder.

Given the small size of the study and the naturalistic/retrospective nature, further studies are needed to confirm the connection between activation syndrome and bipolarity.

Not all fish supplements created equal

I have been taking a variety of fish oil supplements( Twinlab, Now) since 2003 and I believe, for the most part, that they were helpful, however I couldn’t say for certain. Recently I came across some information that is new to me. A website PsychEducation mentioned that if you purchase fish oil the amount of EPA should be 60 percent of the total amount of Omega-3 fatty acids per/pill.  A fish oil pill with less than that percentage acts more or less like a placebo. I found it difficult to discern this from some of the brands since some don’t give you much detail.

a big review of all these studies and more suggests that the ratio of EPA to DHA (the two omega-3 fatty acids) really matters. Their analysis shows that of these two omega-3’s in each pill, at least 60%  must be EPA. Less than that and it does not work better than a placebo; in fact in several studies, less than 60% EPA was worse than a placebo.

The Mayo Clinic gives fish oil a grade of C due to the fact that results of various studies have been mixed. I’m not sure if the information from this latest review has been taken into account?