Behavioral Problems, Such As Depression And Aggression, Linked To Cortisol Levels

By Christopher Fisher, PhD

Cortisol, the so-called stress hormone, seems to behave in contradictory ways in children. Some youngsters with behavioral problems have abnormally high levels of cortisol, while others with identical problems have abnormally low levels. Researchers at Concordia University and the Centre for Research in Human Development may have resolved this cortisol paradox.

In a groundbreaking study published in the journal Hormones and Behavior, they link cortisol levels not simply to behavior problems, but to the length of time individuals have experienced behavior problems.

“We studied the relationship between cortisol levels in young people with problematic behavior, such as aggression or depression, and the length of time since the onset of these behaviors,” explains Paula Ruttle, lead author and PhD candidate at Concordia’s Department of Psychology. “Cortisol levels were abnormally high around the time problem behaviors began, but abnormally low when they had been present for a long time.”

To obtain subjects’ cortisol levels, researchers analyzed saliva samples taken from 96 young people during early adolescence. They then matched cortisol levels to behavioral assessments taken in childhood and again during adolescence. Problem behaviors were classified as either “internalizing” (depression and anxiety) or “externalizing” (aggression, attentional problems).

Riding the cortisol roller coaster
Youngsters who developed depression-like symptoms or anxiety problems in adolescence had high levels of cortisol. However, those who developed symptoms earlier had abnormally low cortisol levels. The conclusion? Cortisol levels go up when individuals are first stressed by depression or anxiety, but then decline again if they experience stress for an extended period.

“It seems the body adapts to long-term stress, such as depression, by blunting its normal response,” says coauthor Lisa Serbin, a psychology professor who is Ruttle’s PhD supervisor and Concordia University Research Chair in Human Development.

“To take an extreme example, if someone sees a bear in the yard, that person experiences a ‘flight or fight’ reaction,” continues Serbin, a member of the Centre for Research in Human Development. “Stress levels and therefore cortisol levels go up. However, if the same person sees bears in the yard every day for a year, the stress response is blunted. Eventually, cortisol levels become abnormally low.”

Aggressive behavior in early childhood
At first glance, study results from children with aggressive behavior and attentional problems seem to contradict this theory. In this group they found that low levels of cortisol were related to aggressive behavior both during childhood and adolescence. However, the authors contend that since aggressive behavior often begins in the second year of life or earlier, subjects may have been stressed for years before entering the study, resulting in abnormally low cortisol levels.

“This blunted response makes sense from a physiological point of view,” says Ruttle. “In the short term, high levels of cortisol help the body respond to stress. However, in the long term, excessive levels of cortisol are linked to a range of physical and mental health problems. So, to protect itself, the body shuts down the cortisol system – but research shows that’s not good either.”

What, me worry?
Individuals with a blunted response to stress may not respond to things that would – and should – make other people nervous. For example, children with long-term behavior problems perform poorly in school. Because of their blunted stress response, these youngsters may not be worried about exams, so they do not bother to prepare as much as their peers.

The study has many significant implications, according to Serbin. “This research suggests interventions should begin as soon as a behavioral problem appears,” she says. “For children with severe externalizing problems, this may be very early, perhaps even when they are preschoolers or toddlers.

“We now have evidence that behavioural problems in children are linked to mental and physical health. Taking a ‘wait-and-see’ attitude may not be the right approach.”

Source The Behavioral Medicine Report

Interest In E-Cigarettes Is High, But Overall Safety And Effectiveness Remains Unknown

By Christopher Fisher, PhD

Electronic cigarettes are drawing heavy media and marketing attention, and while a new study finds that consumer interest also runs high, a companion study underscores that e-cigarettes’ ability to help smokers cut down or quit is unknown. E-cigarettes run on batteries and look like real cigarettes, cigars, or even ballpoint pens. Users inhale doses of nicotine or other toxins found in tobacco in vapor form. Because e-cigarettes do not contain tobacco or create smoke, manufacturers are marketing them both as a safer alternative to smoking and as a cessation aid.

Of the two studies appearing online and in the April issue American Journal of Preventive Medicine, one shows that consumer interest in e-cigarettes currently is much higher than interest in more traditional products.

“Although we don’t know much about the health effects of e-cigarettes, they are by far the most popular smoking alternatives and cessation products on the market,” said lead author John Ayers, a doctoral candidate at Johns Hopkins Bloomberg School of Public Health.

His group monitored English-language Google searches in the USA, Canada, the UK, and Australia from January 2008 until September 2010. They compared searches for e-cigarettes with searches for a nicotine lozenge and for cessation products like nicotine patches, nicotine gum, and the drug Chantix (varenicline).

Between July 2008 and February 2010, searches about e-cigarettes increased sharply in all nations, especially in the United States. “We found that e-cigarettes were more popular in U.S. states with stronger tobacco control,” Ayers said. This, he said, suggests that consumers are using e-cigarettes to either bypass smoking restrictions or to quit when faced with restrictions.

To see if searches on e-cigarettes led to sales, his group monitored online shopping searches. They found that shopping search trends mirrored informational search trends.

In the second study, Michael Siegel, M.D., looked at e-cigarettes’ effectiveness as smoking cessation aids using an online survey. Siegel, a professor at the Boston University School of Public Health, obtained 5,000 email addresses of people who had made a first-time purchase in 2009 from an e-cigarette distributor.

Of the 222 consumers replied to the survey, 216 were qualified to participate. Nearly 67 percent of these respondents said they reduced the number of cigarettes they smoked since using e-cigarettes and 49 percent reported that they had quit smoking for an unspecified time after trying e-cigarettes.

Siegel acknowledged and other smoking cessation experts have said that it is possible that smokers who had greater success cutting down or quitting were more likely to respond. This would bias the results, which already relied on a small fraction of those contacted.

“We don’t know anything about the 95 percent of the people who deleted the email,” said Jennifer Unger, Ph.D. “Maybe they’re still smoking the same number of cigarettes. Maybe they are using even more nicotine than before because they’re smoking ordinary cigarettes and e-cigarettes.” Unger, with the Institute for Health Promotion and Disease Prevention Research at the University of Southern California, has no affiliation with either study.

“Neither of these two studies provides scientific evidence that e-cigarettes are effective in helping people to quit,” said John Pierce, Ph.D., a professor of cancer prevention at the Moores Cancer Center at the University of California at San Diego. “It’s not clear to me that e-cigarettes aren’t harmful in some way. It’s not clear to the FDA, either.”

In Sept. 2010, the Food and Drug Administration cited five e-cigarette distributors for “unsubstantiated claims and poor manufacturing practices,” according to an agency release. In January 2011, the FDA moved unsuccessfully to block e-cigarette importation.

Source The Behavioral Medicine Report

New Technique Stimulates Brain Cells And Reveals How Those Neurons Influence The Brain

By Christopher Fisher, PhD

There are about 100 billion neurons in the human brain, and each one belongs to elaborate networks that control our behavior, thoughts and emotions. A message from a single neuron can have far-reaching consequences in other brain areas, but those connections are difficult to decipher with current technology.

To help map those networks, a team of researchers from MIT, Harvard, Boston University, and Tufts University has now developed a way to selectively activate neurons in the awake mouse brain with light and then track the resulting activity in other brain regions, using a brain-scanning technique called functional magnetic resonance imaging (fMRI).

By comparing this data to human fMRI brain scans, researchers could learn a great deal about the underlying brain circuits involved in disorders such as epilepsy, schizophrenia, autism, and post-traumatic stress disorder.

“In all of these cases, being able to link the human neuroimaging data to the actual circuit elements that generate those patterns could be very powerful,” says Edward Boyden, an associate professor in MIT’s Media Lab and co-senior author of a paper describing the new approach in the Dec. 15 online edition of the Journal of Neurophysiology.

Light control
The new technique, called opto-fMRI, builds on optogenetics – the genetic engineering of cells to respond to light, which allows scientists to selectively stimulate or silence individual nerve cells. Optogenetics was pioneered by the Boyden lab and colleagues over the past several years, and in 2010, the journal Nature Methods named it “Method of the Year.”

To create cells that can be controlled by light, the target cells are genetically engineered to produce proteins called channelrhodopsins, which sit in the cell membrane. Those channels control the flow of ions (charged molecules) into the cell. Pumping positive ions into a neuron changes its voltage, which then activates it.

Boyden, who is also an associate professor of brain and cognitive sciences and of biological engineering, realized that combining optogenetics with fMRI could allow him to not only control neurons, but also to determine how those neurons influence other targets in the brain. To make that connection, Boyden teamed up with Chris Moore, associate professor of brain and cognitive sciences at MIT and an expert in using fMRI to study sensory perception.

fMRI is a brain-imaging technique that allows scientists to see blood flow in the brain, which indicates activity in those regions. Neuroscientists use it to identify parts of the brain that are active during certain behaviors, or impaired in people with neurological disorders. fMRI enables the measurement of activity throughout the awake brain, providing the unique opportunity to assess a whole working brain at once.

Deciphering networks
The new paper marks the first time anyone has used optogenetics and fMRI to study awake mice (a previous study looked at anesthetized animals). Working with awake animals is more difficult because if the animal’s head is moving, the resulting MRI image will be blurry. To overcome that, the researchers created a new experimental setup in which they can secure the animal’s head in place during scanning.

“That’s a very big step, because otherwise you’re going to get very different answers, if you look at anesthetized animals only,” says Bruce Hope, senior scientist at the National Institute on Drug Abuse.

Boyden, Moore and colleagues also developed software that can analyze the fMRI data and calculate the underlying brain networks involved in the response. “That allows us to survey these neural networks in an unbiased way,” says Boyden. “We can drive a neuron and see what networks are downstream of it, which is really powerful.”

To test their system, the researchers inserted channelrhodopsins into neurons in the brain’s primary sensory cortex, which interprets sensations of touch and pain. Using fMRI, they found that after those neurons were activated with light, secondary sensory cortex, where additional sensory processing takes place, and primary motor cortex, which controls body movements, also became active. That result is consistent with a previously known neural circuit.

In future work, this technique could be used to study neurological conditions for which there is a lot of human fMRI data but little is known about the underlying neural circuits that control brain activity. Boyden believes this kind of work could eventually lead to new pharmaceuticals that target a specific circuit, rather than a specific molecule.

Many light sources
In the Journal of Neurophysiology study, Boyden used an implantable light source that directs light to only one target. However, in collaboration with MIT Vitesse Professor of Electrical Engineering and Computer Science Clif Fonstad, Boyden has also developed a probe that can deliver light to multiple sites. The new microfabricated device has 12 parallel light guides, each ending at a different spot, so they can be used to control different neurons.

Using this probe, described in a recent issue of the journal Optics Letters, each light source can be controlled separately. That could be important if this technology is ever developed into medical devices for humans. “From a prosthetics standpoint, the ability to enter information into multiple sites, while minimizing brain damage, is very valuable,” says Boyden.

In future studies, he would like to combine the new multiple-fiber probe with the fMRI techniques. This would allow scientists to create more comprehensive 3-D maps of the brain by measuring the roles of multiple regions in a circuit.

“We could perturb one site, observe which downstream sites are activated, and then perturb those downstream sites, iterating through the circuit in order to reveal how they all work together,” he says.

The lead authors on the studies are Mitul Desai and Itamar Kahn for the opto-fMRI paper, and Anthony Zorzos for the microfabricated waveguide paper. Other contributing authors to the studies include Ulf Knoblich, Jake Bernstein, Hisham Atallah, Aimei Yang, Nancy Kopell, Randy Buckner and Ann Graybiel.

Material adapted from MIT.

Source The Behavioral Medicine Report

Silly Uses of Sleeping Pills

by Matthew Edlund, M.D.

Snorting Sleeping Pills to Treat Your Feet

Not everyone snorts prescription sleeping pills to treat their feet. Aerosmith rocker Steve Tyler podiatric self-management included snorting lunesta (eszopiclone.) When he tried it while performing in South Dakota in 2009 he fell off the stage.

Please don’t do this when you’re judging American Idol, okay?

As fans of the Darwin awards know well, people can and do use drugs in surprising, ingenious ways. One of my better remembered patient encounters involved a Houston undergraduate who liked to get high injecting Vicks Vapo-Rub. He would grab his preferred substance, uncap the bottle, pour the liquid into a syringe, then subcutaneously inject. He never got infected and assured me he became “pleasantly whacked” for a while, though later he felt really tired.
Sleeping pills have different uses, but some are silly and others downright dangerous. Here are a few sleeping pill “uses” you may wish to avoid:

1. Getting high. Steve Tyler is not alone in his predilection for sleeping pills as a way to get “up”, though snorting them has hitherto been unfashionable. Many people use the class of benzodiazepine drugs, of which valium (diazepam), Librium (chlordiazepoxide), and ativan (lorazepam) are just some of the more popular members, to get high. Many of these “highs” occur in conjunction with other drugs including alcohol, opiates, and cocaine.
The problem – though very effective for anxiety disorders, benzodiazepines and drugs that mimic them, like lunesta and ambient (zolpidem,) can become physically addictive. Combined they can make you very dead. Many a celebrity, like the Beatles’ manager Brian Epstein and Australian actor Heath Ledger, died of overdosing on sleeping pills. Often sleeping pill lethality is increased through adding alcohol. Like many addicting drugs, sleeping pills also produce tolerance – you just need more and more of the stuff. Not recommended.

2. To nap. Sleeping pills, especially short acting ones like lunesta and ambient often let people fall quickly into sleep – so fast people use them to nap.
The problem – beyond the issues of dependence and tolerance, short acting sleeping pills have been implicated in hair-raising sleepwalking episodes where people drive their cars for hours or try to jump off buildings. They also leave their users, after a short two hours of exposure, in terrible shape to walk, move, or do anything requiring intelligence, as shown in a recently published study by Kenneth Wright done at the University of Colorado. Short acting sleeping pills hit some of the same benzodiazepine receptors in the brain that long acting ones, like valium, do. Benzodiazepines are famous for causing many accidents and falls, in part because people think they’re better navigators than they really are. Benzodiazepines produce a kind of global Lake Woebegone effect – taking them convinces people their reactions and driving skills are superior – when they’re really impaired.
Plus using sleeping pills for naps vastly complicates obtaining normal sleep at night. Sleeping pills for naps are Not Recommended, except perhaps in movies, weepie novels and some complicated jet lag strategies.

3. “Topping off” other sleeping pills. When you can’t sleep, you get frantic. Many respond by taking more pills. Occasionally they will sleep better that night, and perhaps a couple of nights or even weeks more.
The problem – you’re usually just adding another drug, like ambien, to what is functionally the same class of drug, for example valium or restoril (temazepam.) You’ve blasted the new drug onto the few remaining receptors that don’t already have pharmaceuticals attached, but the effect won’t last. Tolerance hits quickly, and much of the “effect” leading to sleep is the brain simply recognizing there’s a different sedating drug coming in. The overall results on balance, thought, cognition, and memory are generally highly unfavorable. Definitely not recommended.

4. Shifting different sleeping pills from day to day. Perhaps it’s the nature of my clinical practice, but I usually observe this particular strategy happily engaged in by Europeans and globe trotting Americans who notice they sleep “better” when they vary their dosing in ancient Chinese menu style – one pill tonight from column A, two tomorrow from column B, the next night one from column A and column C…
The problem – people will certainly feel a different buzz, but lots of what goes into sleeping pill use is behavioral. The old team at Henry Ford hospital, especially Tim Roehrs and Leon Rosenthal, years ago did a lovely study where they gave habitual sleeping pill users their choice of different colored pills. One color contained what they had been taking for years; the other was placebo.
They took equal amounts of each.
For long term users, placebo=sleeping pill of choice.
So shifting drugs night by night may give the illusion of an effect that is different and “powerful.” Yet beware. Combining different sleeping pills from day to day not only increases tolerance but leads to unpredictable cognitive and physical results as different drugs are detoxified in very different manners and speeds. There are times in the 24 hour day when you get far more or far less stuff working than users think – which can lead to terrible accidents as well as increasing dependence.

The Larger Problem

A major public health difficulty of sleeping pills is that they don’t produce normal sleep. Recent studies of short acting agents like ambien place them more in the category of inducing mini-coma than anything resembling sleep.
Rest is regeneration. You rebuild body and brain through sleep. The natural kind is still best.
The best uses of sleeping pills remain temporary ones. And they’re definitely not to be used for foot pain.

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How Cool Is Your Sleep?

by Rubin Naiman, Ph.D.

When I was a little boy and happened not to be feeling well, my mother would routinely ask me three questions. Having grown up in an old-world village, she clung to simpler, traditional views of health, including her folksy health assessment.

Her first question was always: “What did you eat?”

Today, more than ever, we are aware of the impact our diets have upon our health. Despite this, much of the modern world remains overfed, yet simultaneously undernourished. We simply consume too many empty, high-glycemic calories that provide quick energy, but limited nutrition. Such eating habits have been strongly linked to chronic inflammation — the most overlooked issue in our disturbed sleep epidemic.

Inflammation is hot. Chronic inflammation has emerged as a critical factor underlying most major illnesses from diabetes to cardiovascular disease and autoimmune disorders to depression. It refers to a subtle cellular smoldering caused by a confused and overactive immune system that is actually attacking its own host. This “friendly fire” results in a slight but clinically significant increase in body temperature that can impede sleep.

Chronic inflammation is not just about poor food choices; it’s about a widespread practice of consuming excessive energy. If we broaden our perspective, it becomes evident that in addition to food, we also “consume” light, oxygen, and information — all powerful sources of energy. And in today’s world, all are consumed in excess.

We are unquestionably overexposed to light at night. This not only energizes us, but also results in the suppression of melatonin, a neurohormone that both reduces inflammation and promotes sleep. Some specialists are now raising interesting concerns that we also over-breathe, consuming excessive oxygen that energizes us, but also contributes to inflammation. And who would argue with the fact that we are all inundated with excessive amounts of information? The over-consumption of information results in a unique kind of stress — a form of mental indigestion that can also contribute to inflammation.

The earth is hot. There is a striking parallel between our personal failure to cool at night and global warming. Satellite images of the Earth at night taken over recent decades reveal that the planet is growing measurably brighter with each passing year. Not long ago, Al Gore suggested that our planet has a fever. Global warming clearly results from the same general pattern of excessive energy consumption that contributes to our personal inflammation.

Consuming energy is, of course, a natural and necessary part of healthy life. Problems arise, however, not only when we consume more than we need, but also more than we are able to release or discharge.

My mother’s second question was: “Did you poop?”

If food might serve as a metaphor for all that we consume, then this question is about what we are, in turn, releasing. As a reflection of a broader, common tendency to hold on, it’s not surprising that constipation is also epidemic in our world. Natural, healthy sleep is about letting go. Letting go of the ways of the waking world — letting go of energy.

Sleep is cool. One of the most important yet overlooked features of sleep is that it is strongly linked to a decrease in body temperature. In fact, we are designed to do exactly what the outside world does when the sun goes down. At nightfall, the Earth releases its energy into the atmosphere, continuously drawing temperatures down until the sun returns at dawn. Likewise, our body temperature gradually decreases through the night, reaching its nadir just before we arise, when it returns to its waking levels. 

Dreaming is the coolest part of sleep. When body temperature hovers near its depths, dreaming reaches its heights. Dreaming involves a kind of psychological cleansing and renovation that supports our emotional and spiritual health. And we dissipate a lot of heat in the process. Unfortunately, the same forces that interfere with healthy sleep impede our dreams, leaving us at least as dream deprived as we are sleep deprived.

Not surprisingly, my mother’s third question was: “How did you sleep?”

Sleep is a kind of nightly energy fast that encourages the dissipation of heat. Could it be that sleep itself is a potent anti-inflammatory? I believe so. Research has confirmed that compromised sleep impairs our immune function and triggers inflammation. Healthy sleep and dreams keep us cool. Minimizing inflammation will improve our sleep, and improving our sleep will minimize inflammation. Here are eight basic suggestions for doing so:

(1) Eat an anti-inflammatory diet — the kind advocated by Dr. Andrew Weil. Consider reducing your caloric intake and increasing fruits, vegetables and sources of omega 3 fatty acids like salmon.

(2) Get adequate daily exercise, which has many important benefits including both improved sleep quality and reduced inflammatory markers. 

(3) Learn to slow your breathing by practicing breathing exercises. The Koran teaches that we are each given a specific number of breaths at birth, suggesting the benefit of slowing our breathing.

(4) Consider an information diet, including a news fast. Instead, enjoy time in nature, a walk or meditate instead.

(5) Cool your body and mind before bed. A warm bath can help drop body temperature. Consider an evening ritual including gentle yoga, as well as relaxation practices such as meditation and breathing exercises.

(6) Optimize your bedroom by keeping it cool, dark and quiet–try 68 degrees or lower (20 degrees Celsius).

(7) Befriend your dreams. Think, speak and write about them. Avoid excessive alcohol and sleeping tablets, which can interfere with dreaming. Remember that good dreaming accompanies good sleep.

(8) Practice letting go — a kind of spiritual cooling. If there is a secret to sleep, it is about learning to surrender our waking ways of being. Incorporate this surrender into personal spiritual, religious or meditation practices you have.

In summary, I am suggesting that we become more mindful of the flow of energy into and out of our lives. Consume less. Let go of more. Be cool.

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