Depression

New online therapy for lingering depression symptoms could fill 'gap in care,' 91�Թ� researcher says

Christopher.Sorensen — Wed, 29 Jan 2020 13:50:22 +0000

New online therapy for lingering depression symptoms could fill 'gap in care,' 91�Թ� researcher says

Christopher.Sorensen Wed, 01/29/2020 - 08:50

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Zindel Segal, a clinical psychologist and professor at 91�Թ� Scarborough, says an online version of mindfulness-based cognitive therapy could help patients experiencing depression who don't warrant re-treatment, but remain at risk (photo by Ken Jones)

Don Campbell

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Depression

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91�Թ� Scarborough

An online version of a pioneering therapy aimed at reducing the lingering symptoms of depression can offer additional benefits for patients receiving care, a new 91�Թ� study has found.

When added to regular depression care, the online version of mindfulness-based cognitive therapy (MBCT) can help treat depression symptoms and help prevent its return, says 91�Թ� Scarborough Professor Zindel Segal, a clinical psychologist and lead author of the study.

“Treatments work well for many suffering from depression, but there remains a considerable group who continue to struggle with lingering symptoms such as sleep, energy or worry,” he says, adding that clinical data shows that, in the absence of treatment, these patients face a significantly higher risk of becoming fully depressed again.

“Patients with these residual symptoms face a gap in care since they are not depressed enough to warrant re-treatment, but receive few resources for managing the symptom burden they still carry.”

The digital version of MBCT, called Mindful Mood Balance (MMB), is an online adaptation of the effective treatment developed by Segal and his colleagues. It combines the practice of mindfulness meditation with the tools of cognitive therapy to teach patients adaptive ways of regulating their emotions.

The practice of mindfulness meditation helps patients observe rather than act automatically to any thought, feeling or sensation that comes to mind, setting them up for being able to choose how best to respond, according to Segal.

“Our goal has always been for people to develop skills that they could continue to rely on once treatment had ended,” he says.

While research indicates that MBCT is as effective as antidepressant medication in preventing relapse, access remains limited and nearly impossible for those living outside large cities.

“What drove us to develop MMB is to improve access to this treatment,” says Segal. “The online version uses the same content as the in-person sessions, except people can now avoid the barriers of cost, travel or wait times – and they can get the care they need efficiently and conveniently.”

Segal, along with colleagues Arne Beck, of Kaiser Permanente Institute for Health Research, and Sona Dimidjian, a professor of University of Colorado Boulder, received a $2 million grant in 2015 from the U.S. National Institute for Health (NIH) to develop MMB. The program was tested in a randomized clinical trial of 460 patients in clinics at Kaiser Permanente, a large American health maintenance organization in Colorado.

The results of the study, published in JAMA Psychiatry, found that adding MMB to depression care offered by Kaiser led to greater reductions in depressive and anxious symptoms, higher rates of remission and higher levels of quality of life compared to patients receiving conventional depression care alone.

“An online version of MBCT, when added with usual care, could be a real game-changer because it can be offered to a wider group of patients for little cost,” says Segal.

Segal says that even with the positive results, there is more work to be done. A common trade-off with online programs is that dropout rates tend to be higher than in-person treatment.

“The higher rates of dropout are somewhat offset by fact that you can reach many more people with online treatment,” says Segal. “But there’s still room for improvement and we will be looking at our user metrics and outcomes for ways to make MMB more engaging and durable.”

New Labatt Family Network at 91�Թ� provides hope for understanding the biology of depression

noreen.rasbach — Fri, 08 Feb 2019 18:38:30 +0000

New Labatt Family Network at 91�Թ� provides hope for understanding the biology of depression

noreen.rasbach Fri, 02/08/2019 - 13:38

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91�Թ� President Meric Gertler (centre) with Arthur Labatt and his daughter Jacquie Labatt (photo by Nick Iwanyshyn)

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Research & Innovation

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Collaborative research network will explore the underlying causes of this debilitating illness and train future leaders in the field

Thanks to a $20-million gift from the Labatt family, the 91�Թ�’s department of psychiatry is launching a groundbreaking network dedicated to understanding the biological causes of depression.

The Labatt Family Network for Research on the Biology of Depression will pioneer innovative approaches to depression research, advance our understanding of the biology of depression and foster the next generation of research talent.

This collaborative network will establish two Labatt family chairs at 91�Թ� with links to the Centre for Addiction and Mental Health (CAMH) and the Hospital for Sick Children (SickKids), and fund a professorship, numerous fellows, residents and early-stage scientists working across Toronto’s biomedical ecosystem. The Labatt Family Network’s principal aim will be to push beyond institutional and disciplinary boundaries to find new pathways of discovery.

“Depression can be a crippling challenge to those who suffer from it and to their families,” says 91�Թ� President Meric Gertler. “The Labatt family saw an opportunity at the 91�Թ� to make a real difference. With their generous gift, our talented researchers in the department of psychiatry, and those working at institutes across the Toronto region, can begin making headway in how we understand the biological causes of this devastating illness.”

The World Health Organization identifies depression as the leading cause of disability on the planet, and it is an illness with no single cause. Symptoms can vary from person to person as depressive disorders come in different forms, and the efficacy of treatments is different for each sufferer. Understanding the biological underpinnings of depression is widely seen as the next frontier for research in the field.

“The Labatt Family Network is truly a game-changer in the study of depression,” says Professor Trevor Young, dean of the Faculty of Medicine. “This support for the early, innovative work of clinician-scientists will allow them to pursue sustained interdisciplinary research that we hope will lead to a biomedical model of depression. This will help us understand how depression begins and develops across the lifespan.

“We are tremendously grateful to the Labatt family for this gift that will help us close a crucial gap in our understanding.”

"We hope that the fundamental work undertaken here will one day bring relief to the millions of families that depression affects worldwide,” says Arthur Labatt. Members of the Labatt family attended Friday's announcement (photo by Nick Iwanyshyn)

The Labatt family’s gift will build a network of talent, and fund multiple research trajectories, to ensure investigators can follow the most promising leads as they build a better biological model of depression. The Labatt Family Chair in Depression Biology and Children (91�Թ�/SickKids), the Labatt Family Chair in Depression Biology and Late Life Adults (91�Թ�/CAMH) and the Labatt Family Professorship in Depression Biology will support the best minds in depression research. The Labatt Family Research Fellowships in Depression Biology and the Labatt Family Research Program will develop the next generation of leaders by attracting students, residents and young scientists to the field.

The Labatt Family Network as a whole will benefit from guidance from the Labatt Family Network Advisory Council, an independent body led by the Cameron Wilson Chair that will include internationally acclaimed psychiatric researchers.

“We know that scientists are only beginning to grasp the complex interplay of genetic and environmental factors that can result in depression,” says Arthur Labatt. “With our gift, the Labatt Family Network will act as a catalyst for the next big wave of ideas for preventing and managing this illness, and develop the talent of tomorrow. We hope that the fundamental work undertaken here will one day bring relief to the millions of families that depression affects worldwide.”

Recognizing the Labatt family’s generosity, the chair of the department of psychiatry will now be named the Labatt Family Chair, with Professor Benoit Mulsant as the inaugural holder. This is the third named departmental chair in the Faculty of Medicine, taking an esteemed place alongside the Sir John and Lady Eaton Chair of the department of medicine, and the R.S. McLaughlin Chair of the department of surgery.

The director of the Labatt Family Network will be Professor Alastair Flint, an expert on geriatric psychiatry who is the vice-chair of research in the department of psychiatry and a senior scientist at the University Health Network.

“This gift from the Labatt family represents truly visionary support,” says David Palmer, vice-president advancement. “We don’t know where the next great discovery will come from, but by investing in ideas and approaches that show promise, and nurturing the talent of tomorrow, the Labatt family has taken an enlightened approach to how we will tackle depression in the future.

“And that is cause for hope for millions of people around the world.”

There’s no one solution for treating depression in seniors: 91�Թ� expert

noreen.rasbach — Tue, 19 Dec 2017 16:42:23 +0000

There’s no one solution for treating depression in seniors: 91�Թ� expert

noreen.rasbach Tue, 12/19/2017 - 11:42

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Almost one in 10 seniors suffers from clinical depression, a rate that doubles in long-term care homes (photo by BSIP/UIG via Getty Images)

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Depression is prevalent in older people and is often a greater challenge to treat, says Dr. Alastair Flint, a professor in the 91�Թ�’s Faculty of Medicine.

Almost one in 10 seniors suffers from clinical depression, a rate that doubles in long-term care homes, Flint writes in this week's edition of Doctors' Notes, the Toronto Star's weekly column created by 91�Թ� medical experts.

Read previous Doctors' Notes columns from 91�Թ� medical experts

“And a growing body of research suggests if you suffer from depression, you’re at a higher risk of developing memory loss or dementia,” writes Flint, who is also a geriatric psychiatrist at the University Health Network and a senior scientist in the Toronto General Hospital Research Institute.

But treating depression in older people can be tough: They often find it hard to tolerate medications, and side-effects can be severe, he writes. Seniors often take a lot of medications that can interact badly, and older people often are more forgetful, skipping some medications or taking them improperly.

Flint writes that he and his colleagues have launched a five-year study named OPTIMUM to study two strategies commonly used for treating older adults with difficult-to-treat depression – switching to a new medication, or continuing with the first medication and adding a second one.

Flint’s team is working with scientists in Canada and the U.S., with the hopes of recruiting 1,500 seniors with treatment-resistant depression.

“Right now, we don’t really have any evidence to show which is the best approach to help older adults, so my colleagues and I want to fix that,” Flint writes.

Read the full Doctors' Notes column in the Toronto Star

A gene for adapting to changing seasons? 91�Թ� researchers have identified it

ullahnor — Tue, 18 Apr 2017 16:58:35 +0000

A gene for adapting to changing seasons? 91�Թ� researchers have identified it

ullahnor Tue, 04/18/2017 - 12:58

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Researchers from 91�Թ� Mississauga have identified a gene that controls how we adapt to changing seasons. It is located in our circadian clock (photo by Christoffer Undisclosed via Flickr)

Nicolle Wahl

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Nicolle Wahl

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91�Թ� researchers have identified a gene that determines whether the body will adapt to changing seasons.

The gene, a micro-RNA called miR-132/212, is part of a mechanism in the brain’s central timekeeping system, known as the circadian clock, located in the suprachiasmatic nucleus. This gene has also been previously implicated in mood disorders including depression.

“Not only does the circadian clock control an organism’s behavioural and physiological processes during the 24-hour day-night cycle, it also controls mechanisms that allow the body to adapt to variable day lengths associated with different seasons,” says Lucia Mendoza-Viveros, a PhD student in the laboratory of Hai-Ying Mary Cheng, an associate professor of biology at 91�Թ� Mississauga. “Until now, this mechanism wasn’t well understood.”

The findings appear on the cover of the April 2017 edition of Cell Reports.

The miR-132/212 gene that Mendoza-Viveros and her colleagues identified is a micro-RNA. It doesn’t create a protein as most genes do. Instead, it controls the expression of other proteins that help run the body’s central timekeeping system.

The researchers drew their conclusions by studying mice bred without the miR-132/212 gene. They observed that these knockout mice – so-called because the gene was deleted – adapted most easily to a winter light cycle that offered eight hours of daylight and 16 hours of darkness.

Next, the researchers turned to proteomics – the understanding of an organism’s protein make-up – to determine how miR-132/212 affected levels of different proteins in the central clock of the brain. The proteomics screen, which was performed in collaboration with the lab of Professor Daniel Figeys at the University of Ottawa, revealed that mice lacking miR-132/212 had defects in the expression of proteins that control the structure of neurons within the central clock.

When the researchers looked further, they found that neuronal structure was indeed different between mice that had the miR-132/212 gene compared to the ones that did not. These structural differences affected the ability of the knockout mice to respond properly to variations in seasonal cycles.

To confirm their findings, the researchers compared the mice that lacked the miR-132/212 gene with hamsters, mammals that are very responsive to seasonal changes. They suspected that hamsters, which hibernate in winter and are reproductively inactive and experience metabolic changes during that period, would experience changes in neuronal structure and show levels of gene expression similar to those in the knockout mice.

“This comparison told us that we were on the right track – that this gene helps shape the structure of the part of the brain that houses the central timekeeping system,” Mendoza-Viveros said. “It helps the body tell the difference between seasons.”

“When people study circadian rhythms, they usually look at the time of day, but a system in the same part of the brain keeps track of the time of year. By manipulating conditions, you can try to align the body’s schedule to the outside environment.” Cheng said. “Now that we know that miR-132/212 affects the ability of the brain to adapt to seasons, it would be really interesting to figure out whether its misexpression may also be linked to seasonal affective disorders, given its previous connections to depression.”

Improving student mental health: Q & A with Professor Catherine Sabiston

ullahnor — Wed, 28 Sep 2016 20:01:43 +0000

Improving student mental health: Q & A with Professor Catherine Sabiston

ullahnor Wed, 09/28/2016 - 16:01

Katie Babcock

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Katie Babcock

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Professor Catherine Sabiston at 91�Թ�’s Faculty of Kinesiology and Physical Education believes the key to a province-wide mental health strategy lies in well-designed physical activity and wellness programs.

Sabiston conducts research at 91�Թ�’s Mental Health and Physical Activity Research Centre (MPARC), one of the first research facilities in Canada to integrate the study of physical activity and mental health. She has designed student-led physical activity programs – resulting in long-term, convenient, cost-effective and preventative measures for better health and well-being.

With the Ontario University and College Health Association's survey this week finding a rise in rates of anxiety, depression and suicide attempts among college and university students across Ontario, Sabiston talked about the issue and her research.

Why are rates of anxiety, depression and suicidal thoughts increasing among university students?

University students are facing increasing pressures to succeed, and they ultimately have a fear of failure. This is the first time that many of these young adults have dealt with independent responsibilities and goals. In addition, many students have lifestyle habits that are not conducive to restorative mental health, including poor sleep, less exercise and sub-par diets. These behaviours have known negative effects on mental health, yet they are not recognized in the bigger picture of academic success.

Also, students face changing social environments – different peers in a wide range of classes, group assignments that require dependence on others, changes in friendships and autonomy from family. These social challenges can contribute to poor mental health. In this age of social media the immediacy and overload of information, combined with the stress of academia, also weigh heavily on students.

What kind of support does MPARC offer?

MPARC offers two separate programs to help students increase their physical activity, learn self-regulation skills and monitor their lifestyles. MoveU.HappyU is a six-week supervised exercise program for students who are seeking relief from high levels of stress, negative moods and worry. Students can be referred by health and wellness clinicians and can start the program at any time.

We also offer a program called Secondary Prevention and Rehabilitation Kinesiology (SPARK). This is a 12-week program offered twice a year for students who are on medication for depression and/or anxiety, and who are followed by a clinician at 91�Թ�’s Health and Wellness Centre. This program also offers supervised exercise and behavioural counselling. Both programs are offered at convenient times and at a central location, and they set students up for long-term success – the programs ultimately help students feel confident in using the university's fitness facilities.

What has your research shown so far?

We have had 22 students complete the MoveU.HappyU program during our pilot year. Over 70 per cent of the students felt that the program met their needs, and the majority rated the program as “highly enjoyable, interesting and of high importance.” Importantly, many students felt they did not need psychological services beyond the program. Our findings also show that anxiety and depression symptoms decreased, and students felt they had more emotional control.

Positive mood and life satisfaction increased over the six-week MoveU.HappyU program. These findings are encouraging and demonstrate the immediacy of the effects of physical activity on mental health. The SPARK program has just started and the first group of students will be completing the program this fall.

How could the MPARC approach be extended to a province-wide strategy?

This program could easily work in other universities across Ontario and Canada. We have program materials, and we also have strategies for training physical activity program ambassadors and behavioural counselling specialists. Students could use the universities’ sport and recreation spaces, and universities could support this kind of programming by offering dedicated hours for mental health programs. This would be a cost-effective, feasible and sustainable way to reduce the burden on health, wellness and psychological services on campuses.

Depression a risk for post-ICU caregivers

lavende4 — Wed, 11 May 2016 21:00:59 +0000

Depression a risk for post-ICU caregivers lavende4 Wed, 05/11/2016 - 17:00

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Caregivers have different, unique needs, say professors Margaret Herridge (left) and Jill Cameron (right) (Photo by Carolyn Morris)

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University Health Network

91�Թ� researchers have found that caregivers are at a high risk of developing clinical depression up to a year after their critically ill patients leave the intensive care unit (ICU).

The study, published in the New England Journal of Medicine on May 12, highlights the need to consider the mental health of caregivers in post-ICU care.

The research was led by Professor Jill Cameron of the department of occupational science and occupational therapy. She notes that while caregiver assistance can be beneficial to patients, it may have negative consequences for those who provide it. That can include poor health-related quality of life, emotional distress, caregiver burden, and symptoms of post-traumatic stress disorder.

“In the world of critical illness, a lot of research has focused on making sure people survive – and now that people are surviving, we need to ask ourselves, what does quality of life and wellbeing look like afterwards for both patients and caregivers,” says Cameron, who is also an Affiliate Scientist at Toronto Rehabilitation Institute, which is part of the University Health Network (UHN). “We need to intervene and support caregivers of all patients, not just the ‘sickest’ patients. Caregivers are not a uniform body of individuals – they have different needs unique to their caregiving situation.”

See the Philadelphia Inquirer article

See the U.S. News & World Report article

From 2007-2014, caregivers of patients who received seven or more days of mechanical ventilation in an ICU across 10 Canadian university-affiliated hospitals were given self-administered questionnaires to assess caregiver and patient characteristics, caregiver depression symptoms, psychological wellbeing, health-related quality of life, sense of control over life, and impact of providing care on other activities. Assessments occurred seven days and three, six and 12-months after ICU discharge.

The study found that most caregivers reported high levels of depression symptoms, which commonly persisted up to one year and did not improve in some. Caregiver sense of control, impact on caregivers’ everyday lives, and social support had the largest relationships with the outcomes. Caregivers’ experienced better health outcomes when they were older, caring for a spouse, had higher income, better social support, sense of control, and caregiving had less of a negative impact on their everyday lives.

Poor caregiver outcomes may compromise patients’ rehabilitation potential and sustainability of home care. Identifying risk factors for caregiver distress is an important first step to prevent more suffering and allow ICU survivors and caregivers to regain active and fulfilling lives.

This study is part of Phase one of the RECOVER Program, a multi-phase project, involving 10 intensive care units across Canada, co-led by Cameron and Professor Margaret Herridge of the department of medicine and director of critical care research at UHN’s Toronto General Hospital. The project is a collaboration with the Canadian Critical Care Trials Group. It aims to identify risk factors for patients and families with the goal of designing rehabilitation models to improve outcomes.

A parallel companion study evaluating patients led by Herridge has been published in the American Journal of Respiratory and Critical Care Medicine. This project showed that patients who had been on a mechanical ventilator for one-week could be divided into disability risk groups using age and length-of-stay in an intensive care unit and that these groups determine one-year recovery and illuminate the details of functional disability in daily life.

“These findings will help patients and families make vital decisions about embarking on and also continuing treatment in an intensive care unit,” says Herridge.

“We need to educate patients, families and the public about what we can realistically offer in terms of functional outcome and quality of life for those patients with complex critical illness and who may come to the ICU in a debilitated state or may be older. We want people to understand and make informed choices about their care, given their circumstances.”

The next phase of this research will focus on developing models of rehabilitation to optimize patient recovery and a program for caregivers to better prepare them for their caregiving role, including education and information on community-based resources, access to home care, and how they can draw on social and psychological support.

Mindfulness therapy from 91�Թ� prof helps prevent recurrence of depression, major study finds

lanthierj — Wed, 27 Apr 2016 21:07:37 +0000

Mindfulness therapy from 91�Թ� prof helps prevent recurrence of depression, major study finds lanthierj Wed, 04/27/2016 - 17:07

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“There’s no question that depression can wreak havoc in people’s lives,” says Professor Zindel Segal. “It’s vital to provide patients with an approach that will help them prevent the return of symptoms once they are feeling better.”

Don Campbell

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Don Campbell

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Read about the study in The Independent

Read about the study in Huffington Post

“It’s encouraging that MBCT is proving to be an effective treatment in preventing the recurrence of depression,” says Professor Zindel Segal of 91�Թ� Scarborough, whose pioneering work helped in developing MBCT.

“It means there’s greater confidence in recommending it as a treatment option and getting more mental health workers trained on how to effectively deliver it.”

Among the key findings in the meta-analysis was that people who received MBCT were 31 per cent less likely to relapse to depression during a 60-week follow-up than those who did not receive the treatment. Factors such as age, sex, level of education and age at which participants first became depressed did not influence the effectiveness of the treatment.

Also, people who experienced more symptoms of depression when they entered treatment tended to show greater benefit from MBCT compared with other treatments.

Four of the of the nine trials also compared MBCT combined with antidepressants to just antidepressant treatment alone and found those who received the combined treatment were 23 per cent less likely to relapse to major depression.

“This suggests that people can continue taking an anti-depressant and gain the benefit of being protected against relapse, but if for some reason the anti-depressant stops working or if they have a high side effect burden, it’s really helpful to know there is this other approach,” says Segal.

MBCT combines skills from two different approaches to prevention that have been shown to be effective. For one, it uses the skills of cognitive therapy to teach patients how to recognize old habits of mind that may promote rumination and brooding. It also uses the practice of mindfulness, allowing patients to work more effectively with their negative thoughts and moods when they arise.

“Depression sufferers already have the daunting task of looking after themselves,” says Segal. “By arming them with ways to recognize depressive symptoms earlier, and giving them the tools to work with their thoughts and feelings, it may prevent these episodes from gathering steam and pulling them further downwards.”

Major depression is a significant public health concern. In Canada, approximately 8 per cent of adults will experience major depression at some time in their lives. It also affects young people; approximately 5 per cent of males and 12 per cent of females age 12 to 19 have experienced a major depressive episode. Depression has also been found to be a chronic and recurrent problem with a high likelihood of relapse.

“There’s no question that depression can wreak havoc in people’s lives, not to mention the high rate of suicide associated with it. It’s vital to provide patients with an approach that will help them prevent the return of symptoms once they are feeling better,” says Segal.

The meta-analysis, which will be published in the Journal of the American Medical Association, included nine trials conducted in the United Kingdom, Belgium, Canada, the Netherlands and Switzerland using data from 1,258 participants.

Lead author Willem Kuyken, professor of clinical psychology at the Oxford Mindfulness Centre, called the findings “very heartening.”

“While MBCT is not a panacea, it does clearly offer those with a substantial history of depression a new approach to learning skills to stay well in the long-term, and offers people a safe and empowering treatment choice alongside other mainstay approaches such as cognitive-behaviourial therapy and maintenance antidepressants,” he says.

“We need to do more research, however, to get recovery rates closer to 100 per cent and to help prevent the first onset of depression, earlier in life.”

Anxiety and pain: two sides of the same synapse?

sgupta — Fri, 16 Jan 2015 11:12:49 +0000

Anxiety and pain: two sides of the same synapse? sgupta Fri, 01/16/2015 - 06:12

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"Patients with chronic pain are often anxious, and that if this pain lasts a long time many will suffer depression and lose hope," Zhuo says (photo by Sarah Joy via Flickr)

Jim Oldfield

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Jim Oldfield

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"When you have chronic pain, you develop anxiety. Because you have anxiety, you suffer more chronic pain," says Professor Min Zhuo

Researchers have known for a decade what patients have suspected much longer: chronic pain produces anxiety, and anxiety makes the pain worse. But why? Scientists have found tantalizing clues, including intense activity in the same part of the brain during both sensations. But an answer has been elusive.

Now, neuroscientists at the 91�Թ� have mapped a mechanism in the brain’s anterior cingulate cortex, or ACC, that could explain the link between anxiety and chronic pain.

Min Zhuo is a professor in the department of physiology at 91�Թ� and the Canada Research Chair in Pain and Cognition. Zhuo and his lab recently published a paper in the journal Neuron that showed how neuroplasticity – the brain’s ability to physically re-organize itself in response to experience – can spur the interplay between chronic pain and anxiety. They also showed that a drug they developed for chronic pain can limit anxiety.

Zhuo spoke with Faculty of Medicine writer Jim Oldfield about his findings and what they could mean for patients.

What’s the link between pain and cognition in your work?
Most chronic pain researchers study pain as a sensory experience. They think that if we reduce the physical pain, the patient will be better. But I think we need to look at both the mental and physical in the study of pain. Recently we’ve seen more acknowledgment that patients with chronic pain are often anxious, and that if this pain lasts a long time many will suffer depression and lose hope. As well, more researchers are moving away from the idea that mental disorders are just genetic – i.e., you have a bad gene and that’s why you have disease. In my view, if chronic pain causes enough physical change in the brain, anyone can behave like a mentally ill patient. So to better understand and treat pain we need to look at its physical cause but also cognition and mental health, or emotional well-being.

What findings does the Neuron paper describe?
We found a possible explanation for why chronic anxiety and pain make each other worse. Neurons communicate through synapses, which are structures that convey nerve impulses from one neuron to another. These synapses are plastic, meaning they change physically in response to stimuli. Repeated experiences can reinforce these changes and over time the physical changes can become permanent. It’s like a learned memory. And when that happens, you can experience a sensation without an underlying cause. You’ve probably heard of amputees who have pain in a limb that doesn’t exist. Well, we found a similar “learned memory” process for anxiety, in a different part of the same synapse where we see activity linked to chronic pain.

So when these two functions become partners, they make each other worse. When you have chronic pain, you develop anxiety. Because you have anxiety, you suffer more chronic pain. This is the first evidence that anxiety is linked to long-lasting changes at synapses.

Is there a way to short-circuit this process?

We identified a channel or genetic process called HCN that maintains this anxious learning. So theoretically, if we find an inhibitor to erase the long-term potentiation for anxiety – the learned memory – we should be able to reduce anxiety through this channel. But a big challenge is that drugs in the central nervous system often produce side effects. The HCN channel is also expressed in heart and other types of cells, so any drug targeting this channel would have to be selective for neurons.

Fortunately, a drug we’ve been developing for pain called NB001 inhibits a protein called AC1 that is upstream from HCN, and it does so in a way that is selective for neural cells. It’s a very promising therapy for chronic pain and anxiety.

What are the challenges in bringing this drug to market?
Our research is still at the pre-clinical stage. But it’s very difficult to move drug discovery forward, in part due to the world economic situation. There are few angel funders because of the recession. Big Pharma is risk-averse. NGOs support experimental research, but their funds are very tight. On the bright side, we have teamed with investors and researchers internationally on clinical tests in cancer patients. Many cancer patients have pain that is badly managed; in the late stages they’re almost asleep with high-dose opiates. Others don’t get enough medicine and live with terrible pain and anxiety. My hope is that one day we can treat these patients with a drug that works.

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Depression

New online therapy for lingering depression symptoms could fill 'gap in care,' 91�Թ� researcher says

New Labatt Family Network at 91�Թ� provides hope for understanding the biology of depression

There’s no one solution for treating depression in seniors: 91�Թ� expert

Read previous Doctors' Notes columns from 91�Թ� medical experts

Read the full Doctors' Notes column in the Toronto Star

A gene for adapting to changing seasons? 91�Թ� researchers have identified it

Improving student mental health: Q & A with Professor Catherine Sabiston

Read more about MPARC

Depression a risk for post-ICU caregivers

See the Philadelphia Inquirer article

See the U.S. News & World Report article

Mindfulness therapy from 91�Թ� prof helps prevent recurrence of depression, major study finds

Read about the study in The Independent

Read about the study in Huffington Post

Anxiety and pain: two sides of the same synapse?