Wasn't polio wiped out? Why it is still a problem in some countries

Polio was eliminated from most parts of the world as part of a decadeslong effort by the World Health Organisation and partners to wipe out the disease. But polio is one of the world's most infectious diseases and is still spreading in a small number of countries. The WHO and its partners want to eradicate polio in the next few years.

Until it is gone from the planet, the virus will continue to trigger outbreaks anywhere children are not fully vaccinated. The recent polio infection in an unvaccinated baby in Gaza is the first time the disease has been reported in the territory in more than 25 years.

What is polio?

Polio is an infection caused by a virus that mostly affects children under 5. Most people infected with polio don't have any symptoms, but it can cause fever, headaches, vomiting and stiffness of the spine. In severe cases, polio can invade the nervous system and cause paralysis within hours, according to the WHO. The UN agency estimates that 1 in 200 polio cases results in permanent paralysis, usually of the legs. Among children who are paralysed, up to 10% die when their breathing muscles are paralysed.

The virus spreads from person to person, entering the body though the mouth. It is most often spread by contact with waste from an infected person or, less frequently, through contaminated water or food.

Just how bad was polio in the past?

Very bad. Polio has existed for centuries; ancient Egyptian hieroglyphics show children walking with canes, with the wasted limbs characteristic of polio victims.

Before the first vaccine was developed in the 1950s, polio was among the most feared diseases. An explosive 1916 outbreak in New York killed more than 2,000 people and the worst recorded US outbreak in 1952 killed more than 3,000. Many people who survived polio suffered lifelong consequences, including paralysis and deformed limbs. Some

people whose breathing muscles were paralysed required “iron lung” chambers to help them breathe.

When did the eradication campaign begin?

WHO passed a resolution to eradicate polio in 1988, spurred on by the success of eliminating smallpox eight years earlier. Their original target was to wipe out polio by 2000. The WHO — along with partners including the US Centres for Disease Control and Prevention, UNICEF and Rotary International — boosted the production of an oral vaccine and rolled out widespread immunisation campaigns. Polio cases dropped by more than 99%.

Afghanistan and Pakistan are the only countries where the spread of polio has never been stopped. There are also outbreaks in more than a dozen other countries, mostly in Africa. WHO and partners now aim to wipe out polio by 2026.

Why has it taken so long?

It's extraordinarily difficult. Stopping polio outbreaks means vaccinating at least 95% of the population everywhere, including in conflict-ridden countries and poor regions with broken health systems and other priorities.

The oral vaccine is cheap, easy to use and is better at preventing entire populations from becoming infected. But it contains weakened, live polio virus and in very rare cases can spread and cause polio in unvaccinated people. In even rarer instances, the live virus from the vaccine can mutate into a new form capable of starting new outbreaks.

Health authorities have become more successful in reducing the number of cases caused by the wild polio virus. Vaccine-related cases now cause the majority of infections worldwide.

“The problem with trying to eradicate polio is that the need for perfection is so great and there are so many weak links,” said Scott Barrett, a Columbia University professor who has studied polio eradication. “The technical feasibility is there, but we live in a vastly imperfect world.”

https://www.hindustantimes.com/lifestyle/health/wasnt-polio-wiped-out-why-it-is-still-a-problem-in-some-countries-101724928759787.html

75 pc corneal blindness cases untreated in India due to lack of eye donors

A whopping 75 per cent of corneal blindness cases in India are untreated due to lack of eye donors, said an expert on Thursday.

Corneal blindness is the second leading cause of visual impairment in India with a current burden of 1.1 million people.

However, only 25,000 out of these requirements are met each year.

"This makes it feasible for only one out of every four individuals with corneal blindness to avail of the required surgery, while 75 per cent of the cases are left untreated," said the ophthalmologist at Amrita Hospital, Faridabad.

A growing ageing population, higher incidence of corneal infections and injuries are some of the reasons why corneal blindness is rising in India.

"Vitamin-A deficiency in children, degenerative conditions like keratoconus and corneal dystrophies, congenital opacification of the cornea and post-surgical complications are some other causes of corneal blindness worldwide," said Dr. Meenakshi Dhar, HoD, Ophthalmology, Amrita Hospital.

"The symptoms can vary based on the underlying cause of the corneal damage. Most patients experience blurred vision in the affected eye. Eye infections usually cause significant eye pain, watering, redness and severe photophobia in the acute phase. Visible scars on the cornea are often detectable during an eye examination," she added.

Certain regions in India are more prone to corneal blindness due to various factors like healthcare access, environmental conditions, and socioeconomic status.

States like Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh have reported higher rates of visual impairment, including corneal blindness, the doctors said.

These regions face challenges such as inadequate eye care facilities, lower rates of eye donation, and higher exposure to risk factors like agricultural injuries and infectious diseases.

Corneal blindness is also common in agricultural regions where eye injuries may lead to fungal infections.

While corneal transplantation is the most definitive option for advanced cases, other treatments include laser therapy, scleral contact lenses, amniotic membrane transplants, and stem cell therapy.

Preventive measures such as proper eye hygiene, prompt treatment of infections, vaccination, and health education can significantly reduce the risk of corneal blindness.

Early diagnosis and treatment of corneal conditions are vital, the doctor said.

https://www.newkerala.com/news/2024/53094.htm

Endometriosis may surge women's risk of heart attack by 35pc

Women with endometriosis -- a chronic gynaecological disease -- are at a 35 per cent higher risk of severe heart attack, according to a study on Thursday.

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, such as in the ovaries and fallopian tubes. It is more common among women between the ages of 30 and 40 and can cause severe pelvic pain, and abnormal or heavy menstrual flow.

To date, there is no cure or way to prevent endometriosis. Its symptoms can be treated with medicines.

While men are long known to be at higher risk of heart disease, the study by Danish researchers showed women with endometriosis have a 35 per cent increased risk of acute myocardial infarction (heart attack). They also had 20 per cent more chances of ischaemic stroke compared to those without endometriosis.

The study showed that the 40-year cumulative incidence of these conditions was 17.5 per cent and 15.3 per cent, respectively.

"For decades, cardiovascular disease (CVD) has been thought of as a man's disease and risk factors have been considered from the male perspective, for example, including erectile dysfunction in guidelines on CVD risk assessment. Yet, one in three women die from CVD and one in 10 women suffer from endometriosis," said lead author Dr. Eva Havers-Borgersen from Rigshospitalet Copenhagen University Hospital, in Denmark.

"Our results suggest that it may be time to routinely consider the risk of CVD in women with endometriosis," she added.

The research made use of Danish registries that included women diagnosed with endometriosis between 1977 and 2021.

In the analysis, 242,032 matched controls and 60,508 endometriosis-affected women were included. The controls were followed for a maximum of 45 years, and the median follow-up period was 16 years.

The women with endometriosis were also likely to be more prone to a higher risk of arrhythmias and heart failure. The study suggests that women with endometriosis should undergo cardiovascular risk assessment and consider female-specific risk factors in cardiovascular risk prediction models.

This research will be presented at the ongoing European Cardiology Congress, London (August 30-September 2).

https://www.newkerala.com/news/2024/53066.htm

New Mpox strain poses a notable risk to children: Experts

The new and deadlier Mpox strain -- Clade 1b -- poses a notable risk to children, said experts on Thursday, amid an outbreak of the infectious disease in Africa.

The ongoing outbreak of Mpox which has been declared as a global health emergency by the World Health Organization (WHO) on August 15, is different from what the world experienced earlier in the 2022 outbreak.

The 2022 outbreak was driven by Clade II, which is less virulent, and the infections were primarily seen in men who had sex with other men.

Since then, the WHO has reported 99,176 cases and 208 deaths due to Mpox from 116 countries. India detected a total of 30 cases, with the last case in March 2024.

The number of cases and deaths has increased significantly this year, with over 15,600 cases and 537 deaths reported so far in 2024.

The latest outbreak is majorly caused by Clade Ib which jumped to humans from animals in September 2023.

Dr Rajeev Jayadevan, co-chairman of the Indian Medical Association’s National Covid-19 Task Force, told IANS that the pattern of spread and mortality are markedly different from what we experienced in 2022.

This time “greater numbers of people are being infected, including women and children,” he said.

Traditionally, Mpox was transmitted through close physical contact or sexual contact -- as was observed in the 2022 outbreak -- and the infection was largely confined to the MSM (men having sex with men) community.

Historical data shows that while paediatric cases were rare in past outbreaks, the current resurgence has highlighted a growing vulnerability in this age group.

“Mpox is posing a notable risk to children, though they represent a smaller proportion of cases compared to adults,” Dr Rohit Garg, Consultant, Infectious Disease, Amrita Hospital, Faridabad, told IANS.

“Recent data indicates an increase in paediatric cases during the current resurgence, with children showing symptoms similar to those in adults but potentially facing more severe outcomes,” he added.

As per WHO data (2022-2024), as of July 2024, there were 1,156 (1.3 per cent) cases reported aged 0-17, out of which 333 (0.4 per cent) were aged 0-4.

“Observed changes include higher transmission rates in households and schools, emphasising the need for vigilant monitoring and preventive measures,” Garg said.

This suggests that we need to keep an open mind about the possible modes of transmission, Jayadevan said, amid debate on whether transmission can occur through the air.

“The fact that children are readily getting infected suggests that either close contact or respiratory or both modes of transition could potentially be involved. This requires validation, however,” he said.

https://www.newkerala.com/news/2024/52972.htm

Researchers discover how body's natural killer cells protects from cancer

After discovering how the immune system of the body targets cancer-ravaged cells, scientists are on the approach of a significant breakthrough in the fight against the disease.

According to a recent study, human immune system's natural killer cells, which guard against infections and illness, have an innate ability to identify and target a protein that promotes the formation of cancer.

The experts say that by hijacking this protein, known as XPO1, they may be able to activate more killer cells to destroy the disease.

Scientists from the University of Southampton, working with experts worldwide, led the study and now believe it could offer new and less invasive forms of treatments.

The findings have been published in the Science Advances journal.

Lead author Professor of Hepatology Salim Khakoo, from Southampton, said it was previously believed that killer cells attack cancer cells in a random manner.

He added: "Our findings actually show how our body's immune system recognises and attacks these cancer cells.

"Killer cells are an emerging form of immunotherapy that shows huge promise.

"They don't attack healthy tissue in the way chemotherapy and other immunotherapies do, so are safer and have less side-effects than traditional forms of cancer treatment."

The XPO1 protein examined by the scientists is essential for normal cell function.

However, in many cancers, it becomes overactive and allows malignant cells to multiply unchecked.

The Southampton scientists found that a peptide - short chains of amino acids - derived from the XPO1 protein attracted the natural killer cells.

This, they say, triggers the body's immune response against the cancerous cells.

Prof Khakoo added: "Patients with cancer who had both active killer cells and high levels of XPO1 had significantly better survival rates.

"This holds true for a range of cancers including those with higher rates of death such as liver cancer, which has an average survival rate of only 18 months.

"As well as liver cancer, killer cell treatment in the future could be used to treat head and neck cancers, endometrial, bladder or breast cancer."

Previous studies have linked natural killer cells to the body's protection against cancer.

But the latest study is the first of its kind to highlight a viable technique of activating killer cells - to target the XPO1 protein - to fight the disease.

Co-author Professor Ralf Schittenhelm, from Monash University in Australia, said the discovery could change the course of immunotherapy.

"We hope it could lead to personalised cancer treatment, especially in cases where traditional therapies have failed.

"The potential to develop targeted therapies that utilise the body's own immune system is incredibly exciting."

The scientific team at Southampton are now working on the development of the world's first vaccine that uses natural killer cells to fight cancer.

https://www.newkerala.com/news/2024/53157.htm

Will men go extinct? Study finds Y chromosomes are shrinking in the world

A study from the University of Kent has been making the rounds on social media lately and sparked concern among netizens. The findings revealed that the Y chromosome is dwindling, which is primarily responsible for male sex determination. This has raised questions about the potential extinction of males altogether in the future.

Role of chromosomes

Humans have 23 pairs of chromosomes in each cell. A chromosome is a thread-like structure found in cells and is composed of the genetic material of an organism. The 23rd chromosome pair is unique and determines the sex of the baby. Females have a pair of X chromosomes, while males have one X and one Y chromosome. The Y chromosome is the foundation of male biology and carries SRY (sex-determining region Y gene) and is responsible for the formation of testes in the embryo.

Deteriorating Y chromosomes

Y chromosome is the base for male existence. It is passed from male parent to male offspring. But it is not necessary for basic life functions. X on the other hand has essential life genes, making it indispensable. X chromosome has 900 protein-coding genes, while Y has only 100 protein-coding genes. Over time, the Y chromosome has a limited gene repertoire, shrivelling and degenerating slowly.

However, this has not always been the case. 166 million years ago, the Y chromosome was as gene-rich as the X chromosome. There’s an inherent shortcoming, as the Y chromosome is the odd one out of the lot. All the chromosomes exist in pairs, and each cell has two copies of each. But, the Y chromosome is a single copy, unable to undergo genetic recombination. With two copies of the chromosome, it is possible to get rid of damaging genetic mutation by shuffling the genes after every generation. Y chromosome lacks the benefits of genetic recombination and starts to shrink generation after generation it keeps carrying the damaging genetic mutation, causing the chromosome to degenerate.

Evolutionary resilience

However, the Y chromosome shows resistance and adaptability. A Danish study, published in PLoS Genetics, revealed that the Y chromosome attempts to preserve itself and develops a particular DNA sequence, palindromes, that essentially repairs the damaged genes. Here, undamaged genes are utilised as a blueprint to fix the damaged ones. The study also illustrated the likelihood of the Y chromosome’s structural rearrangement for gene amplification, to maintain sperm health.

However, despite all attempts, the Y chromosome is continuing on its path of decline. The Y chromosome has disappeared in Japanese spiny rats and mole voles. In such a case, the SRY gene in the Y chromosome, responsible for the male characteristics, would latch onto another chromosome. Y chromosome would no longer determine sex, without the SRY gene. Although, it is doomed as well, and the new sex-determining chromosome SRY gene has moved onto, would experience the same degeneration as the Y chromosome.

Future of reproduction

The dwindling Y chromosome raises concern for human reproduction as the Y chromosome is essential for sperm production, and the continuation of the species. With the aid of assisted technologies, many of the genes can be bypassed. This implies that soon in the future, with the help of genetic engineering same-sex female couples or infertile men might be able to have children. But, even if it’s feasible, it’s unlikely to replace the natural reproduction completely. As per the study, the Y chromosome’s disappearance is set to happen 4.6 million years into the future. But it does indicate that the future holds a new system of sex determination, reproduction, or if anything, an entirely new species.

https://www.hindustantimes.com/lifestyle/health/will-men-go-extinct-study-finds-y-chromosomes-are-shrinking-in-the-world-101724841117274.html

What to know about the Oropouche virus, also known as sloth fever

First found in a three-toed sloth, Oropouche virus is spread by midges and mosquitoes.

More than 20 people returning to the U.S. from Cuba have been infected with a virus transmitted by bugs in recent months, federal health officials said Tuesday. They all had Oropouche virus disease, also known as sloth fever.

None have died, and there is no evidence that it's spreading in the United States. But officials are warning U.S. doctors to be on the lookout for the infection in travelers coming from Cuba and South America.

What is Oropouche virus?

Oropouche is a virus that is native to forested tropical areas. It was first identified in 1955 in a 24-year-old forest worker on the island of Trinidad, and was named for a nearby village and wetlands.

It has sometimes been called sloth fever because scientists first investigating the virus found it in a three-toed sloth, and believed sloths were important in its spread between insects and animals.

How does Oropouche virus spread?

The virus is spread to humans by small biting flies called midges, and by some types of mosquitoes. Humans have become infected while visiting forested areas and are believed to be responsible for helping the virus make its way to towns and cities, but person-to-person transmission hasn't been documented.

How many cases have there been?

Beginning late last year, the virus was identified as the cause of large outbreaks in Amazon regions where it was known to exist, as well as in new areas in South America and the Caribbean. About 8,000 locally acquired cases have been reported in Bolivia, Brazil, Colombia, Cuba, and Peru.

Some travelers have been diagnosed with it in the U.S. and Europe. The U.S. Centers for Disease Control and Prevention on Tuesday said 21 U.S. cases have been reported so far — 20 in Florida and one in New York — all of whom had been in Cuba. European health officials previously said they had found 19 cases, nearly all among travelers.

What are the symptoms and treatments?

Symptoms can seem similar to other tropical diseases like dengue, Zika or malaria. Fever, headaches and muscle aches are common, and some infected people also suffer diarrhea, nausea, vomiting or rash.

Some patients suffer recurring symptoms, and 1 in 20 can suffer more severe symptoms like bleeding, meningitis and encephalitis. It is rarely fatal, though there are recent reports of deaths in two healthy young people in Brazil.

There are no vaccines to prevent infections and no medicines available to treat the symptoms.

Are there other concerns?

In Brazil, officials are investigating reports that infections might be passed on from a pregnant woman to a fetus — a potentially frightening echo of what was seen during Zika outbreaks nearly a decade ago.

The CDC has recommended that pregnant women avoid non-essential travel to Cuba and suggested all travelers take steps to prevent bug bites, such as using insect repellents and wearing long-sleeved shirts and long pants.

https://www.hindustantimes.com/lifestyle/health/what-to-know-about-the-oropouche-virus-also-known-as-sloth-fever-101724831805626.html

Plastic in our brains: shocking new study raises health concerns

The study, which has yet to be independently verified by other scientists, has been described in the media as scary, shocking and alarming.

Plastic is in our clothes, cars, mobile phones, water bottles and food containers. But recent research adds to growing concerns about the impact of tiny plastic fragments on our health.

A study from the United States has, for the first time, found microplastics in human brains. The study, which has yet to be independently verified by other scientists, has been described in the media as scary, shocking and alarming.

But what exactly are microplastics? What do they mean for our health? Should we be concerned?

What are microplastics? Can you see them?

We often consider plastic items to be indestructible. But plastic breaks down into smaller particles. Definitions vary but generally microplastics are smaller than five millimetres.

This makes some too small to be seen with the naked eye. So, many of the images the media uses to illustrate articles about microplastics are misleading, as some show much larger, clearly visible pieces.

Microplastics have been reported in many sources of drinking water and everyday food items. This means we are constantly exposed to them in our diet.

Such widespread, chronic (long-term) exposure makes this a serious concern for human health. While research investigating the potential risk microplastics pose to our health is limited, it is growing.

How about this latest study?

The study looked at concentrations of microplastics in 51 samples from men and women set aside from routine autopsies in Albuquerque, New Mexico. Samples were from the liver, kidney and brain.

These tiny particles are difficult to study due to their size, even with a high-powered microscope. So rather than trying to see them, researchers are beginning to use complex instruments that identify the chemical composition of microplastics in a sample. This is the technique used in this study.

The researchers were surprised to find up to 30 times more microplastics in brain samples than in the liver and kidney.

They hypothesised this could be due to high blood flow to the brain (carrying plastic particles with it). Alternatively, the liver and kidneys might be better suited to dealing with external toxins and particles. We also know the brain does not undergo the same amount of cellular renewal as other organs in the body, which could make the plastics linger here.

The researchers also found the amount of plastics in brain samples increased by about 50 per cent between 2016 and 2024. This may reflect the rise in environmental plastic pollution and increased human exposure.

The microplastics found in this study were mostly composed of polyethylene. This is the most commonly produced plastic in the world and is used for many everyday products, such as bottle caps and plastic bags.

This is the first time microplastics have been found in human brains, which is important. However, this study is a “pre-print”, so other independent microplastics researchers haven't yet reviewed or validated the study.

How do microplastics end up in the brain?

Microplastics typically enter the body through contaminated food and water. This can disrupt the gut microbiome (the community of microbes in your gut) and cause inflammation. This leads to effects in the whole body via the immune system and the complex, two-way communication system between the gut and the brain. This so-called gut-brain axis is implicated in many aspects of health and disease.

We can also breathe in airborne microplastics. Once these particles are in the gut or lungs, they can move into the bloodstream and then travel around the body into various organs.

Studies have found microplastics in human faeces, joints, livers, reproductive organs, blood, vessels and hearts.

Microplastics also migrate to the brains of wild fish. In mouse studies, ingested microplastics are absorbed from the gut into the blood and can enter the brain, becoming lodged in other organs along the way.

To get into brain tissue, microplastics must cross the blood-brain-barrier, an intricate layer of cells that is supposed to keep things in the blood from entering the brain.

Although concerning, this is not surprising, as microplastics must cross similar cell barriers to enter the urine, testes and placenta, where they have already been found in humans.

Is this a health concern?

We don't yet know the effects of microplastics in the human brain. Some laboratory experiments suggest microplastics increase brain inflammation and cell damage, alter gene expression and change brain structure.

Aside from the effects of the microplastic particles themselves, microplastics might also pose risks if they carry environmental toxins or bacteria  into and around the body.

Various plastic chemicals could also leach out of the microplastics into the body. These include the famous hormone-disrupting chemicals known as BPAs.

But microplastics and their effects are difficult to study. In addition to their small size, there are so many different types of plastics in the environment. More than 13,000 different chemicals have been identified in plastic products, with more being developed every year.

Microplastics are also weathered by the environment and digestive processes, and this is hard to reproduce in the lab.

A goal of our research is to understand how these factors change the way microplastics behave in the body. We plan to investigate if improving the integrity of the gut barrier through diet or probiotics can prevent the uptake of microplastics from the gut into the bloodstream. This may effectively stop the particles from circulating around the body and lodging into organs.

How do I minimise my exposure?

Microplastics are widespread in the environment, and it's difficult to avoid exposure. We are just beginning to understand how microplastics can affect our health.

Until we have more scientific evidence, the best thing we can do is reduce our exposure to plastics where we can and produce less plastic waste, so less ends up in the environment.

An easy place to start is to avoid foods and drinks packaged in single-use plastic or reheated in plastic containers. We can also minimise exposure to synthetic fibres in our home and clothing.

https://www.tribuneindia.com/news/health/plastic-in-our-brains-shocking-new-study-raises-health-concerns/

New study links using semaglutide drugs like Ozempic to suicidal thoughts

Scientists have linked semaglutide use to suicidal ideation.

A new study finds a significant correlation between the use of semaglutide drugs such as Ozempic, antidepressant, or benzodiazepine use, and suicidal ideation.

• No such link was found between liraglutide GLP-1 drugs and suicidal ideation.
• National health authorities have so far found no connection between GLP-1 medications and suicidal thoughts, but research is continuing.

A new study adds to the conversation regarding the possible effect of GLP-1 diabetes/weight loss drugs on suicide ideation, although its message is a subtle one.

The study finds a disproportionality in the number of people who take semaglutide-based GLP-1 drugs and antidepressants or benzodiazepines and who report suicidal ideation.

Glucagon-like peptide 1 (GLP-1) receptor agonist medications were originally developed to help people with diabetes maintain blood sugar levels and a healthy weight. They have since become popular as weight loss drugs, with Wegovy officially being approved by the U.S. Food and Drug Administration (FDA) for this use, as well as Zepbound (tirzepatide) receiving approval from the FDA for weight management in November 2023.

Many of these drugs are based on semaglutide, which was first made available to patients in 2017. These include Wegovy, Ozempic, and Rybelsus, all manufactured by Novo Nordisk.

Among the early GLP-1 drugs still in use is liraglutide. Drugs based on liraglutide include Saxenda and Victoza.

The researchers found no indication of increased suicidal ideation in people who took liraglutide GLP-1 drugs alongside antidepressants.

Experts’ concerns regarding GLP-1 drugs and suicidal ideation stem from three patients reported in Iceland, and 201 similar reports received by the FDA. Since that time, the European Medicines Agency (EMA) and the FDA have investigated the issue. On January 11, 2024, the FDA released a statement saying it had found no connection between the drugs and suicidal thoughts. In April 2024, EMA did the same.

In fact, in January 2024, the U.S. National Institutes of Health reported on a study finding people on GLP-1 drugs had less suicidal ideation than other people.

What is unusual about the new study, and what it adds to the discussion, is that it found a disproportionality “signal” specifically among people who were taking both semaglutide medications and antidepressants and benzodiazepines.

In arriving at their findings, the authors of the new study analyzed the World Health Organization’s global database of adverse drug reactions that were suspected to be attributable to semaglutide or liraglutide.

The study is published in the JAMA Network Open.

A possible connection between GLP-1 drugs and suicidal ideation

To begin with, lead author Georgios Schoretsanitis, MD, PhD, pointed out to Medical News Today, “The disproportionality signal is a hint and cannot be interpreted as a proxy of severity.”

It is not clear how strong the association is, nor does the study in any way demonstrate a causal relationship.

Mir Ali, MD, board certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, said:

“As far as I know, no definite mechanism to link GLP-1 medications and suicidal ideation [has been described].” He also said, “There is disagreement because the incidence [of suicidal ideation] is so rare that it is difficult to accurately assess and try to delineate a possible reason for this.”

Separating existing psychological stressors from those possibly caused by GLP-1 is also difficult.

Ian Douglas, PhD, BSc, professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, who was also not involved in the study, pointed out:

“The time at which someone starts a treatment for obesity can itself be correlated with mental health difficulties, and the effects of the medication on weight, whether this is a dramatic reduction in weight, or a disappointing lack of weight reduction, can also trigger changes in mental health.”

“If we want to know whether GLP-1 agonists cause changes in mental health status, either through their direct pharmacological action or indirectly through their action on weight, we ideally need studies that compare people treated with GLP-1 agonists with similar people not receiving them to see if there are differences in their risk of mental health outcomes.”— Ian Douglas, PhD, BSc

Of the NIH study, Douglas said, “I wouldn’t go so far as to say GLP-1 agonists prevent mental health problems based on these findings, but the results are certainly not consistent with a harm.”

Douglas questioned the methodology used in the new study, saying, “Individual spontaneous reports of suspected adverse drug reactions… such as those used in the new study are not an appropriate resource in which to test this hypothesis about GLP-1 agonists.”

Ali expressed a similar concern. “A disproportionality analysis is a quick and inexpensive way to assess whether a certain group is overrepresented or underrepresented in a particular outcome.”

Keeping semaglutide users safe

Schoretsanitis said they suggest “that physicians prescribing semaglutide should inform their patients about the medications’ risks, assess their psychiatric history, and evaluate the mental state of patients before starting treatment with semaglutide.”

“If needed, such as in cases of persisting suicidal ideation or in cases of other relevant mental disorders, the treating physician should involve different specialists, including a psychiatrist and/or clinical psychologists for a psychological and psychiatric evaluation.”— Georgios Schoretsanitis, MD, PhD

Of particular concern with GLP-1 drugs is that some people obtain online prescriptions and receive them by home delivery. “We highly discourage off-label use of semaglutide and without any medical supervision,” said Schoretsanitis.

“One of the reasons most medications are only available by prescription is to make sure they are used appropriately, and this includes potential monitoring for emerging side effects,” added Douglas.

“There is a world of difference,” Douglas said, “in terms of follow-up between being prescribed a medication by a known family physician and a relatively anonymous online operator. There is a vital duty of care for all prescribers to ensure they are available and accessible for follow-up and monitoring.”

https://www.medicalnewstoday.com/articles/new-study-links-semaglutide-drugs-ozempic-suicidal-thoughts-weight-loss#Keeping-semaglutide-users-safe

Psilocybin may be as effective as common antidepressant in treating depression

Researchers are testing psychedelics as a novel treatment for depression. Psychedelics are substances that may be beneficial in treating mental illness.

• Research is ongoing about the effectiveness of using psychedelics such as psilocybin and how they compare to more traditional treatment options.
• Evidence from a recent review suggests that the psychedelic psilocybin at high doses was slightly more effective at treating depression than the common antidepressant escitalopram.

Depression is a widespread mental illness, impacting about 280 million people worldwide. Researchers are interested in expanding treatment options and finding the most effective medications. Using psychedelics to treat depression is one area of ongoing research.

A review and meta-analysis published in the BMJ compared the effectiveness of psychedelics to escitalopram.

The results of the review indicate that high doses of psilocybin were minimally more effective than escitalopram in relieving depressive symptoms and slightly more effective than the placebo results in escitalopram trials.

The results suggest that psilocybin may be comparable to current antidepressant treatment.

How do psychedelics stack up to other treatments for depression?

Psychedelics are psychoactive substances that have the potential to treat several mental illnesses like depression and post-traumatic stress disorder (PTSD). Common examples of psychedelics include psilocybin, LSD, and MDMA.

While psychedelics have shown promise in the treatment of depression, it can be challenging to do blinded studies because of the subjective effects of psychedelics. Thus, there can be differing placebo effects and possible bias.

The researchers of the current review wanted to compare monotherapy use of psychedelics with escitalopram, a common medication used to treat depression. To help get over some of the problems with the reduced placebo effects of psychedelics trials, the review authors made sure to distinguish between the placebo response in psychedelic studies and the placebo response in antidepressant studies.

This review and Bayesian network meta-analysis included randomized controlled trials with adult participants who had clinically diagnosed depression.

For all the data, they focused on changes in depressive symptoms as the primary outcome. Altogether, they were able to include data from 19 trials: 811 participants in psychedelic trials and 1968 participants in escitalopram trials.

Based on their synthesis of the data, researchers did find that the placebo effect in psychedelic trials was lower than the placebo effect in escitalopram trials.

Compared to the placebo results of escitalopram trials, high-dose psilocybin was slightly more effective. The researchers typically defined high doses of psilocybin as 20 mg or more. In addition, high dose psilocybin was also slightly more effective than escitalopram.

David Merrill, MD, PhD, board certified geriatric psychiatrist at Providence Saint John’s Health Center in Santa Monica, CA, and Singleton Endowed Chair in Integrative Brain Health, who was not involved in the study, noted the following about the review’s findings:

“This study used meta-analysis techniques to compare the effectiveness of psychedelics and escitalopram (Lexapro) for depressive symptoms. It’s notable that only high dose psilocybin showed greater effectiveness than escitalopram. High-dose psilocybin shows promise as a fast-acting, short-term treatment for depression. This is in comparison to antidepressants, which take weeks, if not months, to kick in and only continue to work with continued use,” he told Medical News Today.

“Though not addressed in this study, the clinical consensus is that benefits of high dose psilocybin can last for months and potentially years after the acute episode of treatments. At times even only one treatment session is needed for otherwise chronic intractable depression. This is part of why psychedelic-assisted psychotherapy under safe, controlled professional settings is gathering such momentum and enthusiasm in the field of psychology and psychiatry,” he added.

Review limitations

This review does have limitations. First, it’s essential to acknowledge that any study included in the review had limitations. For example, researchers acknowledge that the effects of psychedelics may be overestimated compared to internal trial placebos, which is why researchers chose to look at how psychedelics compare to antidepressant placebo effects and low dose psychedelics. They also acknowledge that participants receiving psilocybin were often also receiving psychotherapy or psychological support, which could have impacted the results.

The researchers also only focused on acute effects, so future research will need to evaluate long-term effects of all related medications.

Researchers chose to include a broad range of depression types and included studies with participants who had terminal illnesses or life threatening diagnoses and depressive symptoms alongside participants who had PTSD. Most participants in trials using MDMA had PTSD, while most participants in escitalopram trials had major depressive disorder (MDD). Since the two conditions are different, the results may not necessarily be translated. The review also included only a small number of trials.

The researchers were also limited by choosing to make comparisons to extremely low psychedelics, which is not a true placebo. The results may also have been affected by the struggles of direct and indirect evidence and direct evidence biases, which could have overestimated the effects of high dose psilocybin compared to other treatments.

The inclusion and exclusion parameters also limited the researchers, so future research could include different parameters and inclusion criteria.

Finally, the researchers acknowledge that their meta-analysis may not have enough statistical power to identify publication bias. Researchers also recognize that “Most of the certainty of evidence for treatment comparisons was moderate or low.”

Standardization in psychedelic treatment

The study authors suggest that improving blinding methods and having more standardized psychotherapies could help increase understanding of the effectivenesss of psychedelics.

Matthew W. Johnson, PhD, senior researcher at the Sheppard Pratt Center of Excellence for Psilocybin Research and Treatment, who was not involved in the study, was skeptical about the review’s findings and noted the following to Medical News Today:

“A major reason for my lack of confidence in this particular method is that the various studies differed too widely, including the population studied and the disorder treated (existential distress, MDD, PTSD), in order to directly compare them in a such a way.”

“When conducting aggregate analyses such as meta-analysis or the network analysis conducted here, it is important to make sure that the studies aggregated are similar enough to each other to make sense. Otherwise, such techniques can lead one to think they are getting a valid answer, but you are really basing it off of an apples-to-oranges comparison,” he explained.

More treatment options for people with depression

Despite the limitations of this review, the findings do potentially point to expanding treatment options for people with depression. This allows doctors and people with depression to choose from more therapies to find what works for the individual.

Based on this study, high dose psilocybin appeared to be similar to the effects of antidepressants in treating major depressive disorder. Thus, the researchers recommended that psilocybin should likely be used alongside psychotherapeutic support.

“These findings give hope to those with depression — especially those who find antidepressants to be ineffective or intolerable due to side effects. While there are always potential risks of using drugs to treat health conditions, this review shows that, with the proper mindset and treatment setting, high dose psychedelics can be used safely and effectively to treat depression, with results on par or better than seen with antidepressant medications.”— David Merrill, MD, PhD

“Many in the field are working diligently to build a renewed evidence base to allow for the legalization and regulated approval of psilocybin and other psychedelic therapies for depression, PTSD, addiction, and other health conditions,” Merrill noted.

https://www.medicalnewstoday.com/articles/psilocybin-may-be-as-effective-as-antidepressant-escitalopram-treating-depression#Review-limitations