Experts urge caution in using deep brain stimulation

It is sometimes described as a pacemaker for the brain. Yet deep brain stimulation (DBS) is not yet ready for widespread use. Unlike cardiac pacemakers, DBS does not have an established track record of success or clear guidelines for its use. The research on DBS is at a much earlier stage — known in the research literature as “proof of principle.” Although small preliminary studies suggest that DBS appears safe and may be effective for some patients, questions remain about its applicability and long-term effects. In DBS, a surgeon implants electrodes in the brain and connects them to a small electrical generator in the chest. DBS uses electricity to modulate the transmission of brain signals in particular areas of the brain, although exactly how it does so remains unknown. Most psychiatric research on DBS has focused on its use in patients with treatment-resistant major depression or obsessive-compulsive disorder (OCD). And although the early results are promising, they are based on findings from only a small number of patients. Published results are available for 46 patients with depression. About 100 patients with OCD have undergone DBS, but only some of the results have been published. But the early state of the science hasn’t stopped patients from wondering whether DBS is a reasonable treatment option, especially when other approaches haven’t provided sufficient symptom relief. Recognizing this, the National Institutes of Health and the Dana Foundation convened an international group of experts, who published a detailed set of recommendations for when DBS should be considered and what challenges remain. In addition, some of the leading researchers in the field have published their own advice in separate papers. More »

Mental health problems in the workplace

Mental health problems affect many employees — a fact that is usually overlooked because these disorders tend to be hidden at work. Researchers analyzing results from the U.S. National Comorbidity Survey, a nationally representative study of Americans ages 15 to 54, reported that 18% of those who were employed said they experienced symptoms of a mental health disorder in the previous month. But the stigma attached to having a psychiatric disorder is such that employees may be reluctant to seek treatment — especially in the current economic climate — out of fear that they might jeopardize their jobs. At the same time, managers may want to help but aren’t sure how to do so. And clinicians may find themselves in unfamiliar territory, simultaneously trying to treat a patient while providing advice about dealing with the illness at work. As a result, mental health disorders often go unrecognized and untreated — not only damaging an individual’s health and career, but also reducing productivity at work. Adequate treatment, on the other hand, can alleviate symptoms for the employee and improve job performance. But accomplishing these aims requires a shift in attitudes about the nature of mental disorders and the recognition that such a worthwhile achievement takes effort and time. More »

References for "Experts urge caution in using deep brain stimulation"

Bewernick BH, et al. "Nucleus Accumbens Deep Brain Stimulation Decreases Ratings of Depression and Anxiety in Treatment-Resistant Depression," Biological Psychiatry (In press). Greenberg BD, et al. "Deep Brain Stimulation of the Ventral Internal Capsule/Ventral Striatum for Obsessive-Compulsive Disorder: Worldwide Experience," Molecular Psychiatry (May 20, 2008): Electronic publication ahead of print. Greenberg BD, et al. "Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD," Neuropsychopharmacology (Sept. 16, 2009): Electronic publication ahead of print. (Locked) More »

References for "Mental health problems in the workplace"

Barkley RA. Attention Deficit Hyperactivity Disorder in Adults: The Latest Assessment and Treatment Strategies (Jones and Bartlett Publishers, 2010). De Graaf R, et al. "The Prevalence and Effects of Adult Attention-Deficit/Hyperactivity Disorder (ADHD) on the Performance of Workers: Results from the WHO World Mental Health Survey Initiative," Occupational and Environmental Medicine (Dec. 2008): Vol. 65, No. 12, pp. 835–42. Greenberg PE, et al. "The Economic Burden of Anxiety Disorders in the 1990s," Journal of Clinical Psychiatry (July 1999): Vol. 60, No. 7, pp. 427–35. (Locked) More »

References for "Vitamins unlikely to revitalize the mind"

Aisen PS, et al. "High-Dose B Vitamin Supplementation and Cognitive Decline in Alzheimer's Disease: A Randomized Controlled Trial," Journal of the American Medical Association (Oct. 15, 2008): Vol. 300, No. 15, pp. 1774–83. Annweiler C, et al. "Association of Vitamin D Deficiency with Cognitive Impairment in Older Women. Cross Sectional Study," Neurology (Sept. 30, 2009): Electronic publication ahead of print. Buell JS, et al. "Vitamin D and Neurocognitive Dysfunction: Preventing D–ecline?" Molecular Aspects of Medicine (Dec. 2008): Vol. 29, No. 6, pp. 415–22. (Locked) More »

Resources for employees and companies

For more information: Anxiety Disorders Association of Children and Adults with Attention Deficit/Hyperactivity Disorder800-233-4050 (toll-free) (Locked) More »

Vitamins unlikely to revitalize the mind

As people age, they tend to suffer from vitamin deficiencies. The elderly are commonly deficient in vitamin B12, for example, because they produce less stomach acid than younger people, and therefore are not as able to metabolize this vitamin from food sources. Age-related changes also make older adults less efficient at producing vitamin D following sun exposure. Certain vitamin deficiencies can impair brain functioning. Probably the best known example is vitamin B12 deficiency, which can mimic symptoms of Alzheimer’s disease and other types of dementia by causing disorientation and confusion. People can prevent or treat a vitamin B12 deficiency by taking supplements or eating fortified foods — which do not require stomach acid for absorption. Evidence is growing that other sorts of vitamin deficiencies are also associated with cognitive decline or dementia. This has prompted researchers to investigate whether, as in the case of a vitamin B12 deficiency, providing supplements might either prevent deterioration or treat symptoms once they appear. Here’s a quick review of three vitamin therapies most often investigated. (Locked) More »