Category: Research News

STARD – Treatment used in the Study

NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study — All Medication Levels

The NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to determine the effectiveness of different treatments for people with major depression who have not responded to initial treatment with an antidepressant. This is the largest and longest study ever conducted to evaluate depression treatment. This page provides information about the study.

What were the treatments used in the study?

In level 1, participants were given the antidepressant citalopram (Celexa) for 12 to 14 weeks. Those who became symptom-free during this time could move on to a 12-month follow-up period during which the citalopram was continued, and patients were monitored. Those who experienced intolerable side effects or did not become symptom-free during this level could go on to level 2.

Citalopram is representative of the class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs). It was chosen as the first treatment because it generally is not associated with troublesome withdrawal symptoms when it is stopped, is easy to administer (once a day), and has been shown to be safe for older adults and medically fragile patients. It does not appear to interact unfavorably with other medications that some participants may have been taking for other medical problems.

Level 2 was designed to help determine an appropriate next treatment step if the first step did not work. Thus, in level 2, participants had the option of switching to a different medication or adding on to their existing citalopram.

Those who joined the “switch” group were randomly assigned to either sertraline (Zoloft), bupropion-SR (Wellbutrin), or venlafaxine-XR (Effexor). These medications were chosen for comparison because they represent three different types of medications. Sertraline is an SSRI, the same class as the citalopram used in level 1. Bupropion belongs to another class of antidepressant medications that work on different neurotransmitters than SSRIs. Venlafaxine is a “dual-action” medication that works on two neurotransmitters at the same time.

Those who joined the “add-on” group were prescribed either the non-SSRI antidepressant bupropion-SR (Wellbutrin), or buspirone (BuSpar), which is not an antidepressant but enhances the action of an antidepressant medication. Participants could also switch to, or add on, cognitive psychotherapy.

As in level 1, those who became symptom-free with their level 2 treatment could continue with that treatment and entered the follow-up period. Those who did not become symptom-free, or who experienced intolerable side effects, could continue on to level 3.

In level 3, which like level 2 was designed to compare medications that are thought to work differently in the brain and produce different results, participants again had the option of either switching to a different medication or adding on to their existing medication. Those who chose to switch their medication were randomly assigned to either mirtazapine (Remeron) — a different type of antidepressant — or to nortriptyline (Aventyl or Pamelor) — a tricyclic antidepressant — for up to 14 weeks. Both work differently in the brain than the SSRIs and other medications used in levels 1 and 2.

In the level 3 add-on group, participants were randomly prescribed either lithium — a mood stabilizer commonly used to treat bipolar disorder — or triiodothyronine (T3) — a medication commonly used to treat thyroid conditions — to add to the medication they were already taking. These medications were chosen because they have been shown to boost the effectiveness of antidepressant medications.

In level 4, participants who had not become symptom-free in any of the previous levels (and therefore considered to have highly treatment-resistant depression) were taken off all other medications and randomly switched to one of two treatments — the monoamine oxidase inhibitor (MAOI) tranylcypromine (Parnate) or the combination of venlafaxine extended release (Effexor XR) with mirtazapine (Remeron). These treatments were chosen for comparison because previous research had suggested that they may be particularly effective in people who had not received sufficient benefit from other medications.

How were participant’s doses decided and how was their progress measured?

To ensure that every participant had the best chance of recovery with each treatment strategy, a systematic approach called measurement-based care was used. This method requires routine, consistent measurement of symptoms and side effects at each treatment visit with easy-to-use measurement tools. It also involves the use of a treatment manual that describes when and how to modify medication doses and dose adjustments to best tailor them for individual participants so as to minimize side effects, maximize safety, and provide the best chance of therapeutic benefit. This enabled STAR*D practitioners to provide consistent, high-quality care.

STAR*D employed easy-to-use rating tools of symptoms and side effects in a systematic and consistent way. These tools can readily be incorporated into real-world medical and psychiatric settings. Use of this measurement-based care may have caused greater than expected remission rates.

Patients were asked to self-rate their symptoms. The study demonstrated that most depressed patients can quickly and easily self-rate their symptoms and estimate their side effect burden in a very short time. Their doctors can rely on these self-rated tools for accurate and useful information to make informed judgments about treatment. The patients can also use these tools to help manage their illness at home in much the same way that hypertensive patients can measure their own blood pressure.

STARD – Results of the Study on Depression Other Treatments

NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study — All Medication Levels

The NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to determine the effectiveness of different treatments for people with major depression who have not responded to initial treatment with an antidepressant. This is the largest and longest study ever conducted to evaluate depression treatment.

What were the results?

In most clinical trials of treatment for depression, the measure of success (outcome) is called “response” to treatment, which means that the person’s symptoms have decreased to at least half of what they were at the start of the trial. In STAR*D, the outcome measure was a “remission” of depressive symptoms—becoming symptom-free. This outcome was selected because people who reach this goal generally function better socially and at work, and have a better chance of staying well than do people who only achieve a response but not a remission.

In level 1, about one-third of the participants reached remission and about 10-15 percent more responded, but did not reach remission. Still, these are considered good results because study participants had high rates of chronic or recurrent depression and other psychiatric medical problems.

It took an average of six weeks of treatment for participants to improve enough to reach a response and nearly seven weeks of treatment for them to achieve a remission of depressive symptoms. In addition, participants visited their care providers an average of five to six times. Participants who achieved remission stayed on the treatment for an average of 12 weeks before going on to a 12-month follow-up period.

In the level 2 switch group, about 25 percent of participants became symptom-free. All three of the switch medications performed about the same and were equally safe and well-tolerated. In the add-on group, about one-third of participants became symptom-free. Those who added bupropion experienced less troublesome side effects and slightly more reduction of symptoms than those who added buspirone.

In levels 2 and 3 where participants were allowed to either add-on or switch medications, most participants found only one or the other treatment strategies acceptable. Because most participants did not agree to be randomly assigned to one or the other treatment strategy, the findings of the add-on and switch approaches cannot be compared. It is likely, however, that people being treated in the real world also tend to limit their treatment preferences to switching or adding on medications. In addition, the people in the switch and add-on groups were a little different. The group who chose and were assigned to a switch medication had more problematic side effects while taking the preceding medication (citalopram) than the group who chose and were assigned to an add-on medication.

Level 2 also included cognitive psychotherapy as a switch or add-on treatment. Results for the psychotherapy treatment are not yet available.

In the level 3 switch group, 12 to 20 percent of participants became symptom-free, and the two medications used fared about equally well, suggesting no clear advantage for either medication in terms of remission rates or side effects. In the add-on group, about 20 percent of participants became symptom-free, with little difference between the two treatments. However, the T3 treatment was associated with fewer troublesome side effects than lithium.

In level 4, seven to 10 percent of participants became symptom-free, with no statistically significant differences between the medications in terms of remission, response rates or side effect burden. However, those taking the venlafaxine-XR/mirtazapine combination experienced more of a reduction in depressive symptoms than those taking the tranylcypromine. Also, those who were treated with tranylcypromine were more likely to discontinue the treatment citing side effects as the reason. It is also possible that the dietary restrictions associated with taking an MAOI could have limited its acceptability as a treatment.

In conclusion, about half of participants in the STAR*D study became symptom-free after two treatment levels. Over the course of all four treatment levels, almost 70 percent of those who did not withdraw from the study became symptom-free. However, the rate at which participants withdrew from the trial was meaningful and rose with each level—21 percent withdrew after level 1, 30 percent withdrew after level 2 and 42 percent withdrew after level 3.

What lessons are learned from the results?

For the first time, doctors and people with depression now have extensive data on antidepressant treatments from a federally funded, large-scale, long-term study directly comparing treatment strategies.

Results from level 2 indicate that if a first treatment with one SSRI fails, about one in four people who choose to switch to another medication will get better, regardless of whether the second medication is another SSRI or a medication of a different class. And if patients choose to add a new medication to the existing SSRI, about one in three people will get better. It appears to make some—but not much—difference if the second medication is an antidepressant from a different class(e.g. bupropion) or if it is a medication that is meant to enhance the SSRI (e.g. buspirone). Because the switch group and the add-on group cannot be directly compared to each other, it is not known whether patients are more likely to get better by switching medications or by adding another medication.

Results from level 3 apply to those who do not get better after two medication treatment steps. By switching to a different antidepressant medication, about one in seven people will get better. By adding a new medication to the existing one, about one in five people will get better. Level 3 results also tell us that adding T3 may have some advantages over adding lithium for patients who have tried two other treatments without success.

Finally, for patients with the most treatment-resistant depression, level 4 results suggest that tranylcypromine is limited in its tolerability and that up to 10 percent may benefit from the combination of venlafaxine-XR/mirtazapine.

An overall analysis of the STAR*D results indicates that patients with difficult-to-treat depression can get well after trying several treatment strategies, but the odds of beating the depression diminish with every additional treatment strategy needed. In addition, those who become symptom-free have a better chance of remaining well than those who experience only symptom improvement. And those who need to undergo several treatment steps before they become symptom-free are more likely to relapse during the follow-up period. Those who required more treatment levels tended to have more severe depressive symptoms and more co-existing psychiatric and general medical problems at the beginning of the study than those who became well after just one treatment level.

These results underscore both the need for a better understanding of how different people respond to different depression treatments, and the challenges in finding broadly effective, short- and long-term depression treatments. Future research may help identify which treatments work for which patients.

What do the STAR*D results mean to people with MDD and their doctors?

The results reiterate the need for high-quality care and attention to the individual needs of patients. Doctors should provide medication at optimal doses, be aware of and offer treatment choices, and maintain diligent monitoring of patients both during treatment and after they become symptom-free so as to avoid relapse.

Like other medical illnesses, depression affects different people in different ways, but a wide range of effective treatments exist. People with depression should not give up if their initial treatment attempts do not result in full benefits. They should continue to work with their doctors to find the best treatment strategy.

In addition, patience is required. While some people may experience benefits in the first six weeks of a treatment strategy, full benefits may not be realized until 10 or 12 weeks have passed. During this time, doctors should work with their patients to adjust dosages so as to find an optimal level, and avoid stopping a treatment prematurely.

STARD Study – What were the goals of trial?

NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study — All Medication Levels

The NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study was conducted to determine the effectiveness of different treatments for people with major depression who have not responded to initial treatment with an antidepressant. This is the largest and longest study ever conducted to evaluate depression treatment. This page provides information about the study.

What were the goals of the STAR*D trial?

The overall goal of the STAR*D trial was to assess the effectiveness of depression treatments in patients diagnosed with major depressive disorder, in both primary and specialty care settings. It is the largest and longest study ever conducted to evaluate depression treatment.

Each of the four levels of the study tested a different medication or medication combination. The primary goal of each level was to determine if the treatment used during that level could adequately treat participants’ major depressive disorder (MDD). Those who did not become symptom-free could proceed to the next level of treatment.

The design of the STAR*D study reflects what is done in clinical practice because it allowed study participants to choose certain treatment strategies most acceptable to them and limited the randomization of each participant only to his/her range of acceptable treatment strategies. No prior studies have evaluated the different treatment strategies in broadly defined participant groups treated in diverse care settings.

Who participated in the study?

Over a seven-year period, the study enrolled 4,041 outpatients, ages 18-75 years, from 41 clinical sites around the country, which included both specialty care settings and primary medical care settings. Participants represented a broad range of ethnic and socioeconomic groups. All participants were diagnosed with MDD and were already seeking care at one of these sites. No media advertisements were used to recruit participants. Instead, they were referred to the trial by their doctors.

So that results could be generalized to a broad group of real-world patients, most adults with MDD were eligible. People were not eligible for the study if they had not tolerated or did not get well with one or more of the treatments that were part of the first two STAR*D treatment steps, or if a STAR*D treatment could not be safely used because of another medical condition or because they were taking certain other medications. In addition, people with substance abuse disorders that required detoxification, anorexia or bulimia, or obsessive compulsive disorder were not eligible for the study because they required treatments that were not part of STAR*D.

Of the initial 4,041 participants, 1,165 were excluded because they either did not meet the study requirements of having “at least moderate” depression (based on a rating scale used in the study) or they chose not to participate. Thus, 2,876 “evaluable” people were included in level 1 results. Level 2 results include 1,439 people who did not become symptom-free in level 1 and chose to continue. Level 3 results include 377 people, and Level 4 results include 142 people.

Top Ways in Which Social Media is Changing our life

Rewind about 20 years from now, who would have ever thought about the smartphones, social media, twitter, facebook linkedin, etc. The Social Media Revolution has been in the corner since last one and half decade or so when it was present in some isolated places and with websites like Friendster and MySpace. Although they had decent adoption, still the population in general was not at all aware of such imminent revolution.

Fast forward to 2017 and the revolution has been converted to a buzzing trend in the current times. It has spread all across the world with Billions of people logging in to social media every day. It has not only attained the status of one of the most important part of modern lifestyle, but also a unique and surprisingly fruitful marketing channel for businesses types. My son once was stunned to know that cell phones (smartphones) was unheard of about 20 years back and we never carried phones earlier.

Things have been changing with a great pace and looking at the social changes it looks like things are changing permanantly. It has officially and diligently entered in our culture at all levels ranging from top to grass root level.

Effects of Social Media on People

According to Health experts we are more and more sitting than moving or walking. It is like sitting is the new smoking. Sitting is one of the worst thing we can do to our health and it can raise many disease vulnerabilities. There is similar risk carried by the things we are doing while we are sitting. If we are scrolling the social media accounts and news feeds mindlessly for either minutes, hours or days, it is ruining and affecting our mental health. This phenomenon is affecting our collective psychology.

The American Academy of Pediatrics has issued few warnings to parents about the negative effects of using social media on young kids and teens. They have shown increased risk of cyberbullying and facebook depression in children, same as like in adults.

Although there are few benefits of using Social media like getting connected with people far off and find all your old pals and relatives whom you have never talked since years. If you are looking at using social media as a time killing tool or using it for some emotional lift is a bad choice. Studies have shown that if you leave facebook or other social media activities, it is going to raise your psychological well-being.

Try to use this powerful tool in moderation and don’t let it become a emotional and psychological turbulence.

How Social Media has changed our daily lives

These brilliant communication tools have profoundly changed the world of communication and interactions all over.

1. Where We Get Our News – Now we rely on Facebook, Twitter, Linkedin for the news from friends and family, rather than relying on the newspapers and online news.In this way, you can choose the people or groups you wish to read or know about and rest you can keep in the back burner.

2. Start and Do Business – Setting up and launching business has become easier and simpler with the proliferation of social channels of marketing. Earlier, the setup and operations of business was quite a task but now, interest-focused Facebook groups, Twitter searches, and niche social networks helps in doing business activities easily and become more trget focused.

3. Providing newer means and horizons for Interactions – We will not stop using large media organizations and neither will we stop communicating by phone or in person meet. We will now have another tool to help in communication in the form of social media.

4. It has opened up the channel between customers and businesses. Now the orders can be placed on twitter rather than waiting to talk over phones, faxes, meetings, etc.

Four Different Biotypes of Depression

Is there a role of Biological balance and Biotypes in the onset and prognosis of depression in people? Born with unbalanced biochemistry, many people struggle with depression for most of their life. After taking anti-depressants such as Prozac and Zoloft, or acid therapies like 5-HTP, etc. or other herbal remedies, people realize that over time, their symptoms have worsened rather than soothing. Some of these medications helped little, but due to presence of nasty side-effects they actually make you feel worse.

Lot of psychiatrists believe that depression is caused by low levels of the neurotransmitter serotonin, which makes SSRI (Selective Serotonin Reuptake Inhibitors) to be the standard medication. This approach does not consider the unique biochemical imbalances and different symptoms of each individual.

There was a research conducted by William J. Walsh, Ph.D., at the Walsh Research Institute, and clinical applications by Drs. Albert Mensah. They condicted detailed study of about 300,000 blood and urine test results and 200,000 medical history from approximately 2,800 patients diagnosed with depression, They found that there are majorly 4 depression biotypes.

Typical symptoms of Patients with different Subtypes

Patient with Subtypes 1 and 2 – these people often report more fatigue. Subtype 1 were more likelier to benefit from transcranial magnetic stimulation (TMS). Many people take the antidepresant based treatment although their subtypes wants them to be treated with TMS.

Patients of Subtypes 3 and 4 often have difficulty in feeling pleasure. Brain on one hand have reduced connectivity in its network causing depressive anxiety, fear, etc., on the other hand people with subtype 3 and 4 has hyperconnectivity between stimuli center and brain control.

This subtyping helped in greater diagnostic precision, as well as finding accurate prognosis for patients bringing lot more relief with proper indivisualized treatment.

Different Biotypes in Depressive population

1. Type 1 – Undermethylators

2. Type 2 – Overmethylators

3. Type 3 – Pyrroluria or Pyrrole Depression

4. Type 4 – Copper Overload

Traits of Longer Life – Tips to Live longer and Healthier

Old is Gold, well yes or no both. We spend most of our lives lost in our reactive mind—worrying about the future, regretting the past. This way of living brings about the opposite of the personality traits associated with a long life. If we are alert and rooted in the present moment, we’ll be more conscientious, open, emotionally stable, friendly, and emotionally expressive, which are the five traits of leading a long and healthy life. Mindfulness is one of the trait which can bring out the other fundamentals found in people who tend to live long, healthy lives.

There is a delimma though, throughout history, elderly people were seen as respected leaders, pillars of wisdom for the community. And yet today, seniors are largely relegated to the corners of our society, marginalized and disrespected, which is partly because growing old is equated with becoming sick, decrepit, and senile.

Five key traits for longevity

1. Conscientiousness – Thorough and efficient people who are less likely to take risks lived longer.

2. Openness – You should be quick to listen to others. Always give a open ear to listen to other person’s feelings and ideas. This will ensure longer life span.

3. Emotional stability – Be emotionally stable which can be the strongest links to living a long life.

4. Friendliness – For women, friendliness is the second highest character quality associated with a long life.

5. Emotional expression – People who lived longer were openly expressed their emotions.

A New Way to Understand the Narcissistic Male

though many people can be selfish and conceited from time to time, some individuals take it to a whole other level. When these traits define the person – and they negatively impact everyone who is part of their life for as long as they are a part of it – they usually signal a mental health condition known as Narcissistic Personality Disorder. Like all personality disorders, naricissism can have far-reaching consequences for both the one suffering from it and the people who care about them.

Some typical characteristics of Narcissistic Males

Individuals with narcissistic personality disorder have a very distorted sense of self. They are generally “grandiose”, which means they have an inflated or exaggerated opinion of their positive traits and / or abilities. Even though some are very attractive, highly intelligent, or exceptionally talented, narcissists typically regard themselves as elite or exceptional compared to everyone else.

The Statistics of Narcissism

There are no firm statistics available in regard to the frequency of Narcissistic Personality Disorder (NPD). Psychologists state that 1% of the population is diagnosed with NPD, and that 75% of the cases in therapy are men. Remind yourself that this 1% statistic is gathered only from individuals diagnosed in therapy.

By definition, narcissists severely lack humility and will avoid admitting there’s something wrong with them at all costs. Most narcissists in therapy are forced there by the courts, or have arrived for ‘other’ reasons such as alcoholism or a divorce. They usually don’t show up to deal with ‘narcissistic’ behaviour.

According to experts estimates there are up to 16% of society who are severely narcissistic. This is almost 1 in every 6 people. I believe this is a much more accurate assessment. What is frightening is: narcissists are extremely emotionally insecure.

Narcissists thrive on the praise and admiration of others. Their air of superiority is exaggerated often quite obvious, although some narcissists are very skilled at pretending to be humble when necessary.

Symptoms of Narcissistic Persons

  1. Exaggerated sense regarding their accomplishments and talents
  2. Use of others to get what they want in life
  3. Belittlement of others to boost their fragile self-esteem
  4. Obsessive self-involvement
  5. Inability to feel empathy; lack of a sincere interest in others
  6. Slightest criticism is met with rage and/or shame
  7. Inability to maintain healthy relationships
  8. Unreasonable expectations of favoritism
  9. Striving for constant admiration and attention
  10. Fantasies revolving around personal success and attractiveness

Treatment or Handling options

While medication can help treat symptoms of depression or anxiety that may also be present, there is no medication that is effective for the treatment of narcissistic personality disorder.

Brain’s Alertness Circuitry Conserved Through Evolution

NIH-funded scientists revealed the types of neurons supporting alertness, using a molecular method called MultiMAP in transparent larval zebrafish. Multiple types of neurons communicate by secreting the same major chemical messengers: serotonin (red), dopamine and norepinephrine (yellow) and acetylcholine (cyan).

Using a molecular method likely to become widely adopted by the field, researchers supported by the National Institutes of Health have discovered brain circuitry essential for alertness, or vigilance – and for brain states more generally. Strikingly, the same cell types and circuits are engaged during alertness in zebra fish and mice, species whose evolutionary forebears parted ways hundreds of millions of years ago. This suggests that the human brain is likely similarly wired for this state critical to survival.

“Vigilance gone awry marks states such as mania and those seen in post-traumatic stress disorder and depression,” explained Joshua Gordon, M.D., Ph.D., director of the NIH’s National Institute of Mental Health (NIMH), which along with the National Institute on Drug Abuse, co-funded the study. “Gaining familiarity with the molecular players in a behavior – as this new tool promises – may someday lead to clinical interventions targeting dysfunctional brain states.”

Karl Deisseroth, M.D., Ph.D., Matthew Lovett-Barron, Ph.D., and Stanford University, Palo Alto, California, colleagues, report on findings using a neural activity screening technology they call Multi-MAP (Multiplexed-alignment of Molecular and Activity Phenotypes) online Nov. 2, 2017 in the journal Cell.

For the first time, Multi-MAP makes it possible to see which neurons are activated in a behaving animal during a particular brain state – and subsequently molecularly analyze just those neurons to identify the subtypes and circuits involved.

In this case, the researchers used the technique to screen activity of neurons visible through the transparent heads of genetically-engineered larval zebra fish. They gauged vigilance by measuring how long it took the animals to swish their tails in response to a threatening stimulus.

A molecular analysis revealing subtypes led to identification of six suspect circuits composed of distinct populations of neurons that modulate neuronal activity, only one of which had previously been linked to vigilance. Virtually the same players were operative in follow-up experiments examining such reaction time-related circuitry in mouse brain. Using optogenetics – another breakthrough exploratory tool developed by Deisseroth and colleagues — the researchers narrowed the field to three circuits that definitively boost alertness in mice, including the one previously known. The other three are thought to play a reportorial rather than regulatory role.

Depression’s Transcriptional Signatures Differ in Men vs. Women

Divergent illness processes may point to sex-specific treatments

Brain gene expression associated with depression differed markedly between men and women in a study by NIMH-funded researchers. Such divergent “transcriptional signatures” may signal divergent underlying illness processes that may require sex-specific treatments, they suggest. Experiments in chronically-stressed male and female mice that developed depression-like behaviors largely confirmed the human findings.

NIMH grantee Eric Nestler, M.D., Ph.D., of the Icahn School of Medicine at Mount Sinai, and colleagues, reported their findings online August 21, 2017 in the journal Nature Medicine.

Discovering the likely differing causes of “depression” may lead to more precise diagnosis and treatment. Sex differences could hold clues. Women are 2-3 times more likely than men to develop depression. Evidence has been mounting of sex differences in symptoms, treatment responsiveness and brain changes associated with the disorder. But, until now, little was known about molecular mechanisms in specific brain regions that might underlie such differences.

To explore these, Nestler’s team sequenced the transcriptomes of six suspect brain regions in postmortem brains of 13 males and 13 females who had depression and 22 unaffected people.

In both sexes, all six regions showed illness-linked changes in transcription, when compared to brains of controls. But there was little overlap (5-10 percent) between male and female brains in depression-linked gene expression patterns across the regions. Upon further analysis, males showed only 31 percent of illness-linked modules of co-expressed genes seen in females, and females shared only 26 percent of such modules with males. Moreover, functions of the depression-associated modules largely differed between the sexes. The transcriptional changes affected several brain cell types in males, but mostly neurons in females. Yet, despite the lack of overlap at the level of gene transcripts, several of the same overall molecular pathways were ultimately implicated in depression in both men and women.

Similarly, genetically identical male and female mice showed little (20-25 percent) overlap in transcriptional signatures associated with depression-like behaviors experimentally induced by chronic stress. In the brain’s executive hub and reward center, expression of dozens of the same implicated genes increased and decreased in the same sex-specific directions in both humans and mice. This indicated that both species may share sex-specific stress-induced pathology, converging on several of the same biological pathways.

“The mouse work allows investigation into the cellular mechanisms by which the observed changes in gene expression lead to changes in neural circuit function and behavior,” explained Laurie Nadler, Ph.D., chief of the NIMH Neuropharmacology Program, which co-funded the study.

Using genetic engineering, the researchers uncovered molecular mechanisms underlying the sex-specific effects of changes in activity of two genes never previously linked to depression or stress responses.

The study results suggest that depression-related stress susceptibility is mediated by mostly different genes and partly different pathways across the sexes, although these converge in some common outputs. Since genome-wide studies have not turned up sex differences in genetic variation (DNA) associated with depression, the researchers suggest that the differences instead take place at the level of gene transcription. Such changes in similar gene modules organized and expressed differently across brain regions in males and females may disrupt coordinated neural activity needed to cope with stress, they propose.

These findings illustrate the importance of examining sex differences in neuropsychiatric phenomena,” said Dr. Nestler. “They also provide insight into possible approaches for the treatment of depression that selectively target women or men.

Researchers found little overlap between illness-related gene expression changes in postmortem prefrontal cortex (an executive decision-making hub) of depressed men (blue) compared to those found in depressed women (pink). They found more, but still limited, overlap between gene expression changes in the comparable brain region of chronically stressed male and female mice. They say the latter finding is particularly striking, given that the mice were genetically identical, exposed to identical stresses, and subsequently showed equivalent depression-related behavioral abnormalities. The study suggests that depression appears to involve fundamentally different molecular abnormalities in men versus women.

The Art of Nostalgia

“The Art Of Nostalgia” is a elaborate collection of nine personal essays of Lauren. These essays aim to capture nostalgia’s essence on how does it effects the person and the thought process. The essays bring the reader on a journey as Lauren crafts a timeline of memories that reflect a deep-rooted nostalgia for places, people, and transient phases of life. She, inadvertently, strings together pieces of herself, pieces that shape who she is at her core, daring us to ponder our own stories, our own past that vitally remains within us.

Here is some insight on how to tame the phenomenon that is nostalgia.

The cycle of Nostalgia

Keep in mind that you’ve missed things a thousand times before, and it always becomes easier. It may take weeks, or months, but it always does. Whether it’s a place, a person, or your favorite food that you can no longer eat because you just found out you’re gluten free, it always gets easier.

Be Realistic: The most dangerous part of nostalgia is the tendency to romanticize. When you look back, look back on the past as it actually was. Doing so will prevent you from ranking the past as better than the present.

Look Forward: Avoid excessive planning, but when that new movie tells you how enlightening your twenty-something years are, or how incredible your forties are, listen. Your grandmother is right when she says you have a lot to look forward to. Be excited for, and do not fear, what lies ahead.

Always Live In The Moment – Try to embrace how exciting life can be when you truly live in the moment. Respect the epitomic Cards and try new things everyday.

Balance – Try to find a balance between the past and the present. Keep in touch with old friends, and remember the events that made you the person you are today. Most importantly, always participate in Instagram’s “throwback Thursday.”

The first and probably the most important consideration is the attitude with which we approach our material. Since nostalgia serves no immediate purpose besides providing pleasure it is a fundamentally aesthetic memory experience, which means we should approach our material with the mindset of an artist.