Dr. Holland

Low serotonin levels thought to influence gut health and spark depression

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New study suggests that depression and GI trouble sometimes spring from the same source

For people with depression, gastrointestinal distress is a common additional burden, and a new study suggests that for some, the two conditions arise from the same glitch in neuron chemistry -- low serotonin.The study, conducted in mice, shows that a shortage of serotonin in the neurons of the gut can cause constipation, just as a serotonin shortage in the brain can lead to depression. The study also found that a treatment that raises serotonin in the gut and the brain may alleviate both conditions.

Up to a third of people with depression have chronic constipation, and a few studies report that people with depression rate their accompanying bowel difficulties as one of the biggest factors reducing their quality of life. Severe constipation can obstruct the GI tract and cause serious pain. The condition leads to 2.5 million physician visits and 100,000 hospitalizations each year. Though some antidepressants are known to cause constipation, medication side effects do not explain all cases.

"Ultimately, many patients with depression are faced with limited treatment options and have to suffer with prominent GI dysfunction," says study leader Kara Gross Margolis, MD, associate professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeon.

Similarities between the gut and the brain suggest the two conditions may also share a common cause. "The gut is often called the body's 'second brain,'" says Margolis. "It contains more neurons than the spinal cord and uses many of the same neurotransmitters as the brain. So it shouldn't be surprising that the two conditions could be caused by the same process."

Because low levels of serotonin in the brain have been linked to depression and serotonin is also used by neurons in the gut, the researchers studied mice to determine if a serotonin shortage also plays a role in constipation. The serotonin shortage in the gut, the researchers found, reduced the number of neurons in the gut, led to a deterioration of the gut's lining, and slowed the movement of contents through the GI tract.

"Basically, the mice were constipated," Margolis says, "and they showed the same kind of GI changes we see in people with constipation." (In previous studies, these same mice also showed depressive symptoms).

The treatment -- slow-release drug-delivery of 5-HTP, a precursor of serotonin -- works in part by increasing the number of GI neurons in study subjects. The discovery of this connection between a brain and a gastrointestinal disorder suggests that new 5-HTP slow-release therapies could treat related brain-gut conditions simultaneously. The study is also one of the first to show that neurogenesis in the gut is possible and can correct abnormalities in the gut. "Though it's been known for many years that neurogenesis occurs in certain parts of the brain, the idea that it occurs in the gut nervous system is relatively new," Margolis says.

Neurogenesis may help treat other types of constipation. "We see a reduction of neurons in the GI tract with age, and that loss is thought to be a cause of constipation in the elderly," Margolis says. "The idea that we may be able to use slow-release 5-HTP to treat conditions that require the development of new neurons in the gut may open a whole new avenue of treatment."

An immediate-release version of 5-HTP is available as a supplement, but it has not been proved scientifically to work and physiologically it should not, as it is too short-acting, Margolis says. 5-HTP is the immediate precursor to serotonin. Once ingested, 5-HTP is converted to serotonin, but the serotonin is rapidly inactivated before it can work effectively. The slow-release version of 5-HTP used in the current study produces constant administration of 5-HTP which has been demonstrated to remedy the limitations of currently available immediate-release 5-HTP. Clinical studies are already planned for testing a slow-release 5-HTP drug in people with treatment-resistant depression. Planning for testing a slow-release 5-HTP drug in constipation is in progress.

Story Source -- Read the full article on Science Daily: Materials provided by Columbia University Irving Medical Center. Note: Content may be edited for style and length. Columbia University Irving Medical Center. "A moody gut often accompanies depression: New study helps explain why." ScienceDaily. ScienceDaily, 7 May 2019. www.sciencedaily.com/releases/2019/05/190507080148.htm.

Dr. Jenny Holland provides cutting edge, integrative and evidence-based care, proven effective with depression and anxiety, life transitions; pregnancy, parenting, ageing, loss and caring for a parent or loved one during a health crisis or decline. To schedule an appointment call 707-479-2946.

Sticking to life goals can fend off depression, anxiety, panic disorders

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Looking on the bright side also acts as a safeguard, according to 18-year study

People who don't give up on their goals (or who get better over time at not giving up on their goals) and who have a positive outlook appear to have less anxiety and depression and fewer panic attacks, according to a study of thousands of Americans over the course of 18 years. Surprisingly, a sense of control did not have an effect on the mental health of participants across time.

The study was published by the American Psychological Association in the Journal of Abnormal Psychology.

"Perseverance cultivates a sense of purposefulness that can create resilience against or decrease current levels of major depressive disorder, generalized anxiety disorder and panic disorder," said Nur Hani Zainal, MS, from The Pennsylvania State University and lead author of the study. "Looking on the bright side of unfortunate events has the same effect because people feel that life is meaningful, understandable and manageable."

Depression, anxiety and panic disorders are common mental health disorders that can be chronic and debilitating and put a person's physical health and livelihood at risk, according to Zainal and her co-author, Michelle G. Newman, PhD, also of The Pennsylvania State University.

"Often, people with these disorders are stuck in a cycle of negative thought patterns and behaviors that can make them feel worse," said Newman. "We wanted to understand what specific coping strategies would be helpful in reducing rates of depression, anxiety and panic attacks."

Zainal and Newman used data from 3,294 adults who were studied over 18 years. The average age of participants was 45, nearly all were white and slightly fewer than half were college-educated. Data were collected three times, in 1995 to 1996, 2004 to 2005 and 2012 to 2013. At each interval, participants were asked to rate their goal persistence (e.g., "When I encounter problems, I don't give up until I solve them"), self-mastery (e.g., "I can do just anything I really set my mind to") and positive reappraisal (e.g., "I can find something positive, even in the worst situations"). Diagnoses for major depressive, anxiety and panic disorders were also collected at each interval.

People who showed more goal persistence and optimism during the first assessment in the mid-1990s had greater reductions in depression, anxiety and panic disorders across the 18 years, according to the authors.

And throughout those years, people who began with fewer mental health problems showed more increased perseverance toward life goals and were better at focusing on the positive side of unfortunate events, said Zainal.

"Our findings suggest that people can improve their mental health by raising or maintaining high levels of tenacity, resilience and optimism," she said. "Aspiring toward personal and career goals can make people feel like their lives have meaning. On the other hand, disengaging from striving toward those aims or having a cynical attitude can have high mental health costs."

Unlike in previous research, Zainal and Newman did not find that self-mastery, or feeling in control of one's fate, had an effect on the mental health of participants across the 18-year period.

"This could have been because the participants, on average, did not show any changes in their use of self-mastery over time," said Newman. "It is possible that self-mastery is a relatively stable part of a person's character that does not easily change."

The authors believe their findings will be beneficial for psychotherapists working with clients dealing with depression, anxiety and panic disorders.

"Clinicians can help their clients understand the vicious cycle caused by giving up on professional and personal aspirations. Giving up may offer temporary emotional relief but can increase the risk of setbacks as regret and disappointment set in," said Zainal. "Boosting a patient's optimism and resilience by committing to specific courses of actions to make dreams come to full fruition despite obstacles can generate more positive moods and a sense of purpose."

Story Source -- Read this article on Science Daily: American Psychological Association. "Perseverance toward life goals can fend off depression, anxiety, panic disorders: Looking on the bright side also acts as a safeguard, according to 18-year study." ScienceDaily. ScienceDaily, 2 May 2019. www.sciencedaily.com/releases/2019/05/190502100852.htm.

Dr. Jenny Holland provides cutting edge, integrative and evidence-based care, proven effective with depression and anxiety, life transitions; pregnancy, parenting, ageing, loss and caring for a parent or loved one during a health crisis or decline. To schedule an appointment call 707-479-2946.
How some people control sad thoughts after a major loss

How some people control sad thoughts after a major loss

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People who are grieving a major loss, such as the death of a spouse or a child, use different coping mechanisms to carry on with their lives. Psychologists have been able to track different approaches, which can reflect different clinical outcomes. One approach that is not usually successful is avoidant grief, a state in which people suffering from grief show marked, effortful, repeated, and often unsuccessful attempts to stop themselves from thinking about their loss. While researchers have shown that avoidant grievers consciously monitor their external environment in order to avoid reminders of their loss, no one has yet been able to show whether these grievers also monitor their mental state unconsciously, trying to block any thoughts of loss from rising to their conscious state.