Research Spotlight: CAMH

The brain, mental health and therapeutics
A new dietary kit, developed as a result of brain imaging research, reduced the baby blues in women after giving birth

Why is brain research so important in mental illness and addictions?

The story behind a new dietary therapeutic kit shows how a better understanding of the brain can lead to health benefits.

In a CAMH study by Dr. Jeffrey Meyer, published earlier this year, this dietary kit led to a dramatic drop in “baby blues” among women after giving birth. Postpartum blues are common among women, but when severe, substantially increase the risk of clinically diagnosed postpartum depression (PPD). Overall, PPD affects 13 per cent of new mothers and is the most common complication of child-bearing.

As with other forms of depression and mental illness in general, postpartum depression is caused by a combination of factors such as a person’s genetics, environment and experiences. Specific symptoms are due to biological changes in the brain’s complex networks and chemical neurotransmitters.

Brain imaging is one way to help unravel how these networks and chemicals are linked to mental health and illness. Dr. Meyer, a psychiatrist and neuroscientist, has led a number of major studies in this area. Dr. Meyer heads the Neuroimaging Program in Mood & Anxiety, part of the Research Imaging Centre in CAMH’s Campbell Family Mental Health Research Institute.

In an earlier study, Dr. Meyer’s group had shown a surge in the brain protein MAO-A in the early postpartum phase. MAO-A breaks down three brain chemicals that help maintain mood: serotonin, norepinephrine and dopamine. When these chemicals are depleted, it can lead to feelings of sadness. MAO-A levels peak five days after giving birth, the same time when postpartum blues are most pronounced. In another previous study, Dr. Meyer showed that this also resembles brain changes that last for longer periods in clinical depression.

Based on these findings, Dr. Meyer developed a nutritional kit with three supplements carefully selected to compensate for a surge in the brain protein MAO-A.

The kit includes tryptophan and tyrosine, which compensate for the loss of the three mood-regulating chemicals, as well as a blueberry extract with blueberry juice for anti-oxidant effects.  Dr. Meyer’s team had also tested and confirmed that the tryptophan and tyrosine supplements, given in higher amounts than people would normally get in their diet, did not affect the overall concentrations in breast milk.

The current study, administered by research fellow Dr. Yekta Dowlati, included 21 women who received the supplements and a comparison group of 20 mothers who did not. It was an open-label study, meaning the women knew they were receiving nutritional supplements. The supplements were taken over three days, starting on the third day after giving birth.

On day five after giving birth – when the baby blues peak – the women underwent tests to assess the kit’s effect on mood.  The testing included sad mood induction, which measured the ability to be resilient against sad events. The women read and reflected on statements with sentiments that expressed pessimism, dissatisfaction and lethargy, and then listened to a sad piece of classical music. Before and after this test, researchers measured depressive symptoms.

The results were dramatic. Women who were not taking the supplements had a significant increase in depression scores. In contrast, women taking the dietary supplements did not experience any depressed mood. The study was published in the Proceedings of the National Academy of Sciences (PNAS).

“We believe this is the first study to show such a strong, beneficial effect of an intervention in reducing the baby blues at a time when postpartum sadness peaks,” says Dr. Meyer, who holds a Canada Research Chair in the Neurochemistry of Major Depression. “Postpartum blues are common and usually resolves 10 days after giving birth, but when they are intense, the risk of postpartum depression increases four-fold.”

These effects need to be replicated in a larger sample in a randomized, controlled trial. Further study could assess the kit’s ability to reduce both the postpartum blues as well as clinically diagnosed postpartum depression.

While the potential will take time to be fully realized, the kit is an important example of how brain imaging studies have led to a new therapeutic method that has potential to help women after giving birth, and perhaps even prevent PPD.

“Developing successful nutrition-based treatments, based on neurobiology, is rare in psychiatry,” says Dr. Meyer. “We believe our approach also represents a promising new avenue for creating other new dietary supplements for medicinal use.”

 

Related Stories:

 

CAMH is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

 

 

Health and Community Leaders Talk: Karen Michell

By Karen Michell, outgoing Executive Director of the Council of Academic Hospitals of Ontario (CAHO)

Healthier, Wealthier, Smarter: My Reflections on the Value of CAHO Hospitals

For the past eight years as CAHO’s Executive Director, I’ve had the unique privilege of supporting the shared vision of Ontario’s research hospitals. And every day, I continue to be inspired by the significant value and leadership that they bring to our province by working together as a community.

During my first 30 days at CAHO, Dr. Bob Bell, now Ontario’s Deputy Minister of Health and Long-Term Care, told me that research is about hope. Over my years here, patients like Tina Ceroni, Gail Bellissimo, and Rick King have made that statement real for me by sharing their own stories of how research has given them hope, and frankly, changed their lives. It has been a true highlight of my time at CAHO to meet and learn from them and other patients, caregivers and families, whose stories have made an indelible mark on my understanding of the value of health research: that it is a necessity, not a luxury.

Read more Patients + Research stories

I’ve often said that my favourite part of this job is to meet the health researchers and scientists who transform the lives of our patients. From the first week on the job to the last, I’ve been fortunate to have been invited to spend time in our member hospitals, often taking tours of the world-class research institutes that they run. I never fail to come away with a sense of awe about the curiosity of the scientists, their perseverance, their keen observance of the micro and the macro, their willingness to allow the unexpected to surprise them, and take them on joyful journeys of discovery. I appreciate the policy-makers and funders who support a research environment that nurtures these scientists and provides a rich training ground for the next generation.

Finally, I have been grateful to the CAHO CEOs for being willing to take risks together. We often talk about the understandably risk-averse nature of health care. And yet I’ve found that the CAHO community is motivated to try new things in order to improve the health care system in Ontario and to make the most and best out of the investments that Ontarians have made in us and our hospitals. I saw this with the creation of the Adopting Research to Improve Care (ARTIC) Program to find ways to get the best research evidence to improve care for patients faster, and through CAHO’s willingness to work together as an Innovation Broker to clear the path into market for health care innovators.  I’m looking forward to watching how CAHO’s Innovation Broker role helps to foster a more innovative culture in health care, and encourage innovators to consider Ontario as a destination of choice.

Sharing these reflections helps me to realize anew that research hospitals truly do make Ontario healthier, wealthier and smarter. They do this, not just as part of a smart business plan, but because it is part of their mission and mandate – it is who they are. I’m honoured to have served as the Executive Director of CAHO, and to have had a front-row seat to the excellence and opportunity created for Ontarians by Ontario’s research hospitals.

As I move on from my role at CAHO, I am thrilled to continue supporting this community – and its vision of a Healthier, Wealthier, Smarter Ontario – in my new role as Vice President, Strategy at the Sinai Health System.

 

 

Related Stories:

 

Read more Health and Community Leaders Talk blog posts on our Healthier, Wealthier, Smarter site and share your insights on Twitter with the hashtag, #onHWS. To learn more about how health research makes Ontario healthier, wealthier, and smarter, check out our website and our other blog posts and videos.

Research Spotlight: SickKids

A new review at SickKids suggests paediatricians should think twice before routinely testing for respiratory viruses

In 2014, more than 2,000 kids who visited SickKids Emergency Department with respiratory symptoms were given an invasive and uncomfortable nasopharyngeal swab test. This is when a doctor or nurse inserts a long swab into the nostril to the back part of the nose to collect a sample of cells. The swabs are sent to the lab to test for six common respiratory viruses, but the results come back the next day, often after patients have already been discharged from the Emergency Department. With no set process for communicating positive or negative results for this test, the results generally did not impact the child’s care.

With an increased emphasis on ‘choosing wisely’ and reducing unnecessary medical tests and therapies across the medical field, paediatricians at The Hospital for Sick Children (SickKids) say it is not good enough to ‘do’ these tests just because we ‘can’. The team examined the benefits and limitations for this specific type of test and reviewed the scientific evidence as to when it is actually helpful in improving patient care. The review, including their recommendations, is published in the July 3 advance online edition of JAMA Pediatrics.

“Just because a test is available doesn’t mean we should automatically order one.”

Most viral respiratory illnesses can be diagnosed clinically based on the child’s symptoms (for example, runny nose, cough, nasal and chest congestion), but with more sophisticated and sensitive tests available, frontline clinicians frequently order tests to identify the specific offending virus.

“While the number of testing options has grown rapidly, the same attention has not been given to deciding how and when these tests can add value to the care of our patients. Just because the test is available, doesn’t mean we should automatically order one, especially since we know that for the majority of healthy children the result will have no impact on their care,” says Dr. Jeremy Friedman, senior investigator of the review and Associate Paediatrician-in-Chief at SickKids.

The review describes some of the common rationales used to justify respiratory viral testing but found poor evidence to support these rationales. Unsupported rationale includes:

  • to reduce the number of lab blood tests and chest x-rays performed, as well as unnecessary antibiotic use
  • to reduce the length of hospital stay
  • to offer prognostic information on length of the illness, and a confirmed diagnostic label for the physician and the family
  • to reduce health care costs

The team emphasized that there are clinical scenarios where respiratory viral testing can inform treatment decisions and improve overall patient care and therefore should be seriously considered. These examples include children with compromised immune systems, those at risk for influenza-related complications, children admitted to intensive care units, and infants with fever younger than three months old.

Healthier, Wealthier, Smarter results

“We hope this review helps health care providers make better decisions and think twice before ‘checking the box’ for a nasopharyngeal swab on the list of possible investigations,” Dr. Peter Gill, lead author of the review and senior paediatric resident at SickKids.

As part of SickKids Choosing Wisely initiatives, SickKids has reduced nasopharyngeal testing for typical respiratory viruses in the Emergency Department by greater than 80 per cent since 2014.

 

Related Stories:

 

SickKids is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.