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.”

 

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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 & Community Leaders Talk: Paul Kurdyak

By Dr. Paul Kurdyak, Director, Health Outcomes for the Medical Psychiatry Alliance (MPA); Medical Director, Performance Improvement at the Centre for Addiction and Mental Health (CAMH).

What does health research mean to you?

Health research is a very broad topic, but to me, it means research aimed at finding ways to improve the health and well-being of individuals suffering from medical conditions, including mental illnesses and addictions. The burden of mental illness is high. Patients who are dealing with a physical health issue on top of their mental illness experience greater impact on their ability to function and on their quality of life. In Ontario, we spend billions of dollars on individuals living with combined mental and physical illness, but are not seeing great quality of care or outcomes. This is the worst case scenario – spending a lot of money to achieve poor health outcomes.

We know what needs to be done based on existing evidence, but we fall short on delivering evidence-based care. For example, we know that getting adequate and timely care for young Ontarians being diagnosed for the first time with schizophrenia is critical to achieve good outcomes. Our research shows that many of these young Ontarians are not receiving adequate physician follow-up. Patients with schizophrenia have double the amount of health care costs compared to those who don’t have this condition – and the costs are related to their physical health care in addition to their mental health. Despite these high health care costs, these patients have a shorter life expectancy – by up to 20 years — compared to individuals who don’t have a severe mental illness. This is unacceptable.

The Medical Psychiatry Alliance (MPA) was established in January 2014 with a six-year mandate, to kick start a transformation in Ontario that will help increase access to quality, integrated mental and physical health care. The MPA is the first of its kind in Canada with this urgent mandate. It is a unique collaboration between The Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners and the University of Toronto. Currently, the MPA is systematically generating evidence for the best models of integrated care in which to treat Ontarians, which we hope will reduce the burden of cost for patients and for the health system overall.

 

How does health research contribute to a healthier, wealthier, smarter Ontario?

The best health care policy is based on sound evidence. The MPA is leading the analysis of the impact of integrated care on patient outcomes, with an emphasis on rigorous research methods to determine system-level impact using data from the Institute for Clinical Evaluative Sciences. I am the Director of Health Outcomes for this arm of research under the MPA’s mandate.

Recently, our research discovered that treating psychotic illnesses cost the province of Ontario just under $2.1 billion in 2012, which was about four per cent of the total provincial health budget. We already knew costs for treating psychotic illnesses were high, but what our research now shows is how early patients start incurring long-term care and medical care costs. Patients with psychotic illnesses as young as 46 are in long-term care facilities and are generating high medical care costs, which is about 20 years earlier than the general population. The needs of patients with chronic psychotic illnesses change over time, and those needs become more complex as people age.

The MPA’s new models of clinical care, currently rolling out as pilot initiatives at CAMH, SickKids and Trillium Health Partners, hope to better serve the needs of these patients. These new models of care are backed by innovative new education programs spearheaded by U of T, to train learners and healthcare providers and equip them with the training and tools they need to better care for patients with complex needs.

If we are successful in increasing access to integrated health services for those with severe mental illness, we will be helping Ontarians live longer and healthier lives, with improved quality of life. Moreover, we have demonstrated that we are not getting very good outcomes despite very high costs. We hope to show that providing integrated, high quality health care for individuals with mental illnesses and addictions will improve health outcomes, quality of life, and reduce costs.

 

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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.

Patients + Research: Larry Meikle

Meet Larry 

Larry Meikle is a retired Ontario civil servant. He received his Master of Fine Arts in Creating Nonfiction Writing in 2015 from the University of King’s College in Halifax, and is currently writing his first book.

Larry participated in CAMH’s IMPACT study involving genetic testing and depression

 

My experience with personalized medicine

Over the past three years, I’ve felt better than I have for decades. I could not have completed my master’s if I were feeling as I did in the past, before I participated in CAMH’s IMPACT study on mental health problems and DNA.

I was diagnosed with clinical depression in 1997, and I’ve been taking antidepressants ever since. I tried going off my meds a few times, but painfully realized I couldn’t battle depression without them.

A few years ago, the antidepressant I had been taking for so many years suddenly stopped working. My family doctor started me on a new medication, which went reasonably well. But anxiety was still a problem and I felt I could be doing much better.

My doctor suggested yet another medication, but I dreaded facing the slow and painful process of winding down one med, then building up the dosage of a new one. And what if it didn’t work? There was no guarantee the new antidepressant would work any better than my current one; in fact, I could have gotten worse. Changing meds was a “crap shoot” – a roll of the dice.

In fall 2012, I learned about CAMH’s research project involving genetic testing and depression, and told my doctor that I was interested in participating. In January 2013, I was accepted into the study. Not only that – my doctor’s practice would be the first site in the official “rollout” of the study to the Ontario public, and I would be the first person genetically tested in this rollout.

Taking part in this study was a breeze. I provided a saliva sample for genetic testing at my next doctor’s appointment, and two days later I had the results.

The test results listed a number of common antidepressants in “green” –these medications my body would metabolize well, with little chance of experiencing negative side effects. Other antidepressants were listed in “yellow,” advising my doctor that they may not be as effective for me. Fortunately my current medication was in the “green” area, a perfect fit.

Because I felt I could be doing better, my doctor suggested two options – choose another antidepressant from the “green” category, or increase the dose of my current medication. He said he would not have been confident in increasing my dose without these test results.

It was an easy choice. I asked to have my dosage increased, which he did slowly, tracking my progress until we reached the point I’m at today: taking double the dose as before and feeling much, much better for it.

Some feelings of depression linger, as I expect they always will, but the anxiety has been dramatically reduced.

CAMH’s DNA test played a significant role in enabling me to get my life back on track, and now other Canadians with depression have the same opportunity. I believe this genetic test is an exciting new tool in the treatment of depression.

I hope my story will inspire more public discussion of depression, thereby reducing the stigma associated with this illness.

 

Larry participated in CAMH’s IMPACT study, which is still underway, Find out more about the IMPACT study at www.im-pact.ca.

 

If you would like to participate in the Patients + Research blog series, please email or call Elise Bradt at ebradt@caho-hospitals.com, 416-205-1469, or tweet to us at @CAHOhospitals.

Stay tuned on our blog for more Patients + Research posts and share your own insights on Twitter with the hashtag #onHWS. To learn more about why health research matters for Ontario and how you can support it, download the Healthier, Wealthier, Smarter Policy Platform and check out our other blog posts and videos.

 

Patients + Research: Gail Bellissimo

Patients + Research is a platform for patients to discuss their relationship and experience with the research that leads to new cures, cares and treatments. Ontario’s 24 research hospitals are committed to driving best practices for patient co-design of health research. When patients are at the table, the Ontario’s health research enterprise does a better job at making Ontario healthier, wealthier and smarter.

Continue reading “Patients + Research: Gail Bellissimo”

Health and Community Leaders Talk: Dr. Catherine Zahn

The HWS campaign is a platform for collaboration. We’re kicking off a new blog series that’s co-authored by community and health leaders from across the province to get their insights on why health research matters for Ontarians and our economy. Our first author is CAHO’s own Chair and the CEO of CAMH, Dr. Catherine Zahn.

Continue reading “Health and Community Leaders Talk: Dr. Catherine Zahn”

Event Advisory: A Health Research Conference for Patients, People and Prosperity

Gail Bellissimo, a mother of four sons, was diagnosed with major, treatment-resistant depression more than 10 years ago. She tried dozens of medications with little to no success, making psychotherapy less effective. Gail felt she existed in a dark, hopeless life, with little hope for a brighter future. Then last year, Gail joined a research study at the Centre for Addiction and Mental Health (CAMH) where she received repetitive transcranial magnetic stimulations. After only two weeks of treatment, Gail said that she felt like could breathe again. At three weeks, she felt like she deserved to be alive.

That study is just one example of how Ontario is making strides in innovative health research. But more is needed to help maintain Ontario’s position as the health innovation engine in Canada; finding and applying tomorrow’s cures today, while driving economic growth and attracting talent.

Currently, the Council of Academic Hospitals of Ontario’s (CAHO) 24 member hospitals invest $1.4 billion annually in health research in Ontario, which generates $3.4 billion in economic output and supports 41,000 total jobs across Ontario.

On June 1, CAHO will bring together more than 200 leading local and international health sector leaders to discuss how they can collaborate to drive and sustain a Healthier, Wealthier and Smarter province. The event will feature keynote remarks by the Honourable Dr. Reza Moridi, Ontario’s Minister of Research and Innovation, as well as presentations by key thought leaders, in addition to Gail:

Karen Michell, CAHO Executive Director, who will speak to how the work of Ontario’s research hospitals is delivering results and how Ontario can, and must, maintain this momentum.
Simon Denegri, UK National Director for Patients and Public at NIHR and Chair of INVOLVE, who will speak to the pioneering research-based patient engagement work being done in the UK and what lessons there are for Ontario from this work.
Honourable Michael Wilson, Chancellor of the University of Toronto and former Canadian Finance Minister, who will speak to the economic contribution made by health research and his experience with professional and community organizations, specifically as it relates to mental health.
Tina Ceroni, Toronto business owner, who will share her poignant journey of being diagnosed with a rare and incurable neuro-muscular disorder and how she got her life back thanks to a first-of-its-kind stem cell transplant procedure developed in Ontario.

Media are invited to attend the conference on June 1, and speakers are available for interviews. To RSVP to the conference or request an interview with one of the speakers, please see the contact information below.

Conference details:

Who: Council of Academic Hospitals of Ontario (CAHO) and its 24 member hospitals

What: Healthier, Wealthier, Smarter: A Health Research Conference for Patients, People and Prosperity. CAHO and its 24 member hospitals’ discussion to promote the goal of greater investment in a long-term health research funding strategy.

When: Monday, June 1, 2015, 10:30 AM – 6:00 PM

Where: MaRS Discovery District Atrium, 101 College St, Toronto, ON M5G 1L7

About CAHO
The Council of Academic Hospitals of Ontario is the non-profit association of Ontario’s 24 research hospitals. CAHO provides a focal point for strategic initiatives on behalf of our member hospitals. As research intensive hospitals, CAHO members are fully affiliated with a university medical or health sciences faculty. Our hospitals provide the most complex and urgent care, teach the next generation of health care providers and foster health care innovation derived from discovery research. For more information, visit www.caho-hospitals.com

For further information, to RSVP or to arrange interviews, please contact: Erin Collett, erin.collett@edelman.com, 416-849-8911.