There's been a bit of upheaval at the house...all will be well, but in the mean time, I'm trying to blog more and get some more clicks over at Psychology Today. Clicks support the writing and research I do and they are much appreciated! There's a new post up about ketamine, the noncompetitive inhibitor of the NMDA receptor that, in one single IV infusion, can alleviate a suicidal depression in about 30 minutes. However, the magic doesn't last, and depression comes back after a week or two. Still, the mechanism and understanding of this phenomenon is important to figuring out the physiology underlying depression.
For right now, ketamine is being used experimentally in hospitals and also in some "salvage" clinics where folks who've responded poorly to other treatments pay for to get a short break from depression. Other NMDA receptor antagonists might be useful drug targets for experimentation...but to be honest glutamate has been the holy grail neurotransmitter for several psychiatric disorders (schizophrenia, major depressive disorder, and bipolar disorder among them) for the past 20 years, and I've not seen anything come of it, or anything new in the drug pipeline that has panned out.
The supplement NAC utilizes the glutamate pathway via a somewhat convoluted mechanism. I've seen it work for obsessive thoughts, hair pulling (but never for picking behaviors in general) and, interestingly, bipolar depression when every other treatment has already been tried. There's only one study for bipolar depression, but the trichotillomania efficacy is solid and NAC should be part of the clinical arsenal for that symptom.
First off there is a brand new post over at Psychology Today. A new case study was recently published about the use of ketone esters, a supplement that raises blood ketones to levels in humans found only with prolonged fasting. A man with early onset dementia, formerly treated with a ketogenic diet, had lasting improvement on 20 months of ketone esters. Interesting stuff.
On the homefront I've been following the Ebola epidemic closely, partially because I have an amateur interest in emerging tropical diseases (I read all those virus hunter books from the 90s), and partially because I went to medical school in Dallas, so I know some of the folks on the front lines, both living in the neighborhoods of the infected and working in the hospitals there.
From what I know, the threat of Ebola (as the virus is now) seems minimal to the general public in the developed world, but it seems abundantly clear after this weekend that ordinary contact precautions (usually gloves, gown, booties, and masks/face shield) in hospitals will not protect the health care workers who are face to face with all those bodily fluids teeming with virus at the sickest stages of the disease. The higher level body suits and meticulous training in PPE (personal protective equipment) found at specialty units and hospitals will be required until everyone gets up to speed.
At the same time, Paul Whiteley tweeted a note from the Lancet with interesting observations about asymptomatic Ebola infections, perhaps quietly immunizing people without causing risk of infections in others.
There's also a terrific Frontline on the Ebola outbreak with all sorts of information about the virus and the experimental drug ZMapp which seems effective (though in very short supply, as in used up for now I think).
The first new post over at Psychology Today is about the big, recently released study shedding some real insight as to how schizophrenia is inherited and what might cause the diseases. It's a game-changer (the findings, not the blog post, though the post was picked as a Psych Today "Essential Read" and "Top Post" for the week).
The short answer is...it's possible, but it's probably not causing your irritable bowel symptoms. That's pretty much the FODMAPs if you respond well to a gluten-free diet.
I'm spending a lot of my free time working on a couple of science fiction manuscripts in a far future after most of the population has been wiped out by gluten (kidding! They are wiped out by something else, but I'll have to publish the book for you to find out, probably).
In the mean time, there's a lot of action about gearing up for next year's conferences. I kept a relatively low profile this year, but I've put in a proposal for the American Psychiatric Association Annual Meeting in Toronto, I'm considering PaleoFx in Austin 2015...and I've also been invited to AHS New Zealand, and can't wait to go.
Several weeks ago, I got an email from one of my best friends from medical school. She graduated top honors in the class and went on to Johns Hopkins, where she was a chief resident, then a fellowship, and basically has torn her way through the ranks in academic medicine like the firecracker. She told me once I ought to be in academic medicine (other than my tiny finger hold teaching a section of one class), but I’m not all that great dealing with something called a “boss,” so let’s just say I’m better off where I am. It’s very handy to have a crackerjack gastroenterologist as a friend when one is interested in the gut brain connection. Ergo…her email started off: “Saw this paper and I thought of you.”
Last weekend, I presented a workshop and symposium at the American Psychiatric Association Annual Meeting in New York City. This meeting is enormous…as many as 15,000 psychiatrists and researchers come from all over the world to these events. It’s a conservative psychiatric event, with the stress on biology and the evidence-base. In my residency years I remember fancy pharmaceutical company galas and exhibitions. That is all toned down now, with the companies situated at the back of the exhibition hall, and more prominent in the cabs and buses used to get to the convention center than at the event. The program is enormous, with 250 pdf pages, and the speakers as grand as Bill Clinton last year, and Vice President Biden this year. It’s the largest psychiatric stage in the world. So big, though, that you can get lost in the shuffle. Some great symposiums and workshops are sparsely attended.
Last year, thanks to the invitation of Drew Ramsey, MD, I was part of a Prescription Brain Food, From Bench to Table workshop that had attendance out the door. The chair of the scientific committee of the APA, Phil Muskin, introduced us, and each presenter had 15 minutes to make a point, with a long Q&A. Drew and I took advantage of the popularity of last year’s workshop to offer both a 1.5 hour workshop and the Evolutionary Psychiatry three hour symposium this year, both of which (much to my surprise, frankly) were accepted as part of the program. Both were heavily attended, the workshop, in a smaller room (250+ people) was filled to the brim, with many people turned away. People were standing at the back of Evolutionary Psychiatry as well, proving that psychiatrists are hungry for alternatives and preventative psychiatry.
The most important part of the weekend was being introduced to the folks from the international sociaety for nutritional psychiatry research. These are the people on the front lines, the masterminds of many of the studies I've discussed in this blog, who are devoting lives and careers to answering the questions about nutrition, the microbiome, and psychiatric disease that we all hold dear.
But with so many people (and many psychiatrists newly approached) interested in both nutritional psychiatry and evolutionary psychiatry, I thought I should write another “start here” post to get everyone going and not feeling too overwhelmed. So head over to the Psychology Today blog for the basics: