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NHS Choices: Behind the headlines   + / -  
last updated: Thu, 19 Oct 2017 02:46:50 GMT

 Mon, 16 Oct 2017 17:50:00 GMT 'Magic mushrooms' may help 'reset' depressive brains, study claims

"Magic mushrooms can 'reboot' brain to treat depression," reports the Daily Telegraph.

The news is based on a small UK study that looked at the effects of psilocybin, a chemical found in magic mushrooms, on patients with severe depression.

All 19 patients said their depression improved immediately after taking psilocybin and almost half said they still felt the benefits 5 weeks later.
However, the study didn't include a comparison group, so it's hard to know whether this benefit can be attributed to the chemical.

The patients were also given special psychological care during and after taking psilocybin, as an integral part of their treatment.

The effects of psilocybin were measured using a functional MRI scan, an advanced MRI machine that measures blood flow in the brain.

The researchers believe psilocybin helps to change how networks of nerves communicate in the brain, which might disrupt negative thought patterns.

The suggestion of "re-setting" or "rebooting" the brain is attractive in an age when we are all used to fixing computers by turning them off and on again.

However, we need to see further, larger studies to know whether this treatment offers a comparable solution to the brain as the off switch does for computers.

The authors of the study warn that people with depression should not try psilocybin or other psychedelic drugs to treat themselves.

Psilocybin and the mushrooms that contain it are illegal to possess, give away or sell in the UK, outside of clinical trials. They could be dangerous if used without medical support.

Where did the story come from?

The researchers were mostly based at Imperial College in London, with some at Hammersmith Hospital, Cardiff University and University College London. The study was published in the peer-reviewed journal Nature Scientific Reports and is free to read online.

Although for the most part the UK media reported the study accurately, none of the reports pointed out the lack of comparison group in the study, which makes it hard to attribute the study results to the drug. The Guardian otherwise gave a good explanation of the study methods and results.

The Mail Online carried comments from the researchers suggesting that people in the study had reduced depression six months later, but this information was not included in the study so can't be checked.

The Independent wrongly stated that the study showed: "Eating magic mushrooms can help treat depression," and wrongly claimed that the researchers gave mushrooms to patients, rather than administering the extract psilocybin.

What kind of research was this?

This was a small experimental study with no control group. The researchers wanted to see how psilocybin affected brain activity and if that was linked to depression.

This type of study can yield interesting information in the early stages of exploring potential medical treatments, but needs to be backed up by more reliable randomised controlled trials (RCTs) before we can say whether the treatment works.

What did the research involve?

Researchers recruited 20 patients with depression that no longer responded to standard antidepressants. They scanned their brains and measured their depression using a symptom questionnaire. They then administered two doses of psilocybin, one week apart.

They scanned the participants' brains and measured depression symptoms the day after the second treatment, then measured depression symptoms again 5 weeks later.

Finally, the researchers looked to see whether the brain scans showed differences in activity before and after taking psilocybin, and whether these changes were linked to people's depression scores.

The brain scans used functional MRI. They measured two things:

  • cerebral blood flow – how much blood flowed around the brain. This is used as a general measure of brain activity
  • resting state functional connectivity. This is used to monitor how much activity takes place through nerve networks in different areas of the brain. The researchers focused on four areas that had previously been identified as potentially important

Depression was measured using the Quick Inventory Depression Score (QIDS-SR16). Psilocybin doses were 10mg followed by 25mg. Patients were given psychological support during and after taking their medication.

The researchers analysed whether changes seen on brain scans correlated with depression symptom scores the day after the second treatment, and with patients' chances of showing a treatment response 5 weeks later. A positive treatment response was defined as a halving of their initial QIDS-SR16 score.

What were the basic results?

One person dropped out of the study, and some of the brain images were not good enough quality to use. Of the 19 patients who took part in the whole study, all had improved QIDS-SR16 scores on the day after the second treatment, and in 47% the effects were still there after 5 weeks.

Based on brain scans from 16 people, the researchers said that cerebral blood flow to the brain was decreased the day after the second treatment, compared to before treatment. They said they found no instances where blood flow increased.

They said that comparisons between blood flow to the amygdala (an area of the brain that controls many emotions, such as fear and stress) and symptom scores the day after scanning showed a "significant relationship" between the two.

Based on brain scans from 15 people, the researchers said that resting-state functional connectivity increased in two of the regions studied, and decreased in one region. They found no difference in connectivity in a fourth region.

For the three regions that did show changes, two of them were linked to a positive treatment response at 5 weeks. None of the brain regions showed changes that correlated with improved symptom scores the day after treatment.

How did the researchers interpret the results?

The researchers said their findings suggested that psilocybin might have a similar action to electroconvulsive therapy (ECT).

They say their findings showed that "default mode network" – the resting patterns of connectivity between brain regions – may have "decreased acutely, then increased (or normalised) post-acutely, accompanied by improvements in mood. This process might be likened to a 'reset' mechanism."

They call for further testing to assess the "relative contributions" of psilocybin and the accompanying psychological support.

Conclusion

For people with depression who are not helped by conventional treatment such as antidepressants and talking therapies, studies such as this one may offer a glimmer of hope. This and previous studies on psilocybin suggest it may one day become a treatment option for people with a range of psychiatric conditions.

It's important to note that this is experimental, early-stage research. The study lacked a control group, so it's hard to know whether the improvement in mood, or the changes seen on MRI scans, can be attributed to the drug.

The study is very small and we should bear in mind that half of those taking part did not see a 50% reduction in depression symptoms after 5 weeks, suggesting they gained little real benefit.

Changes in brain function may help explain the effect of psilocybin and similar drugs. Previous studies with healthy (non-depressed) volunteers have shown changes in brain function after people took psychedelic drugs.

The suggestion of a "re-set" or "reboot" sounds plausible, especially in an age when we are all used to fixing computers by turning them off and on again. The idea of temporarily "powering down" the brain to fix problems is intuitively easy to grasp. However, we need to see further studies to know whether this treatment offers a comparable solution to the brain as the off switch does for computers.

Your GP is the first port of call if you have, or think you may have, depression. We strongly advise against self-medicating with any drug for depression. Psilocybin and magic mushrooms are class A drugs in the UK.

Links To The Headlines

Magic mushrooms can 'reset' depressed brain. BBC News, October 14 2017

Magic mushrooms can 'reboot' brain to treat depression - study. The Daily Telegraph, October 14 2017

Eating magic mushrooms can treat depression, study finds. The Independent, October 14 2017

Magic mushrooms may 'reset' the brains of depressed patients, study shows. Mail Online, October 13 2017

Magic mushrooms 'reboot' brain in depressed people – study. The Guardian, October 13 2017

Links To Science

Carhart-Harris RL, Roseman L, Bolstridge M et al. Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific Reports. Published online on October 13 2017

 Fri, 13 Oct 2017 17:00:00 GMT Pregnant women 'should avoid sleeping on back in last trimester'

"New warning to pregnant women: Do not sleep on your back in the last trimester as it could cause stillbirth, claim experts," the Mail Online reports.

This rather overdramatic headline stems from a new study that investigated the effects of mothers' sleep positions on baby behaviour in 29 women in the final weeks of pregnancy.

Compared with when mothers slept on their left side, which was most common, babies were slightly more likely to be active and awake when women slept on their right side, and slightly more likely to be quietly asleep when women slept on their back.

But the differences in the babies' activity patterns were very small.

Changes in maternal position and a baby's activity pattern naturally altered the baby's heart rate pattern, but all the babies were born completely healthy.

On its own, this research doesn't provide any evidence that the position a mother sleeps in may harm her baby.

But previous research has suggested that sleeping on your back when you're pregnant may increase the risk of stillbirth, as it compresses the mother's major blood vessels and alters the baby's heart rate.

For this reason, the study's authors suggest women avoid sleeping on their backs in the last trimester of pregnancy.

 

Where did the story come from?

The study was carried out by researchers from the University of Auckland in New Zealand.

Joint funding was received from the children's charity Cure Kids and the University of Auckland.

The study has been peer-reviewed and accepted for publication in The Journal of Physiology, but hasn't been formally published yet.

It's available to read free online as an accepted article, but there may be some changes in the production of the final draft.

Both the Mail Online and the Daily Mirror talk about an increase in the risk of stillbirths from a pregnant woman sleeping on her back.

The researchers didn't investigate this, and all the babies involved in this study were born healthy.

The main body of the media articles did, however, provide a more accurate representation of the findings.

 

What kind of research was this?

This observational study aimed to investigate the effects of pregnant women's sleep positions on foetal behaviour late in the third trimester.

The third trimester starts from 29 weeks and continues to the end of pregnancy.

The researchers wanted to assess the effects in as natural a setting as possible. Women wore foetal monitors while they slept at home and weren't advised what position to sleep in.

Observational studies are useful for testing the link between a possible exposure and outcome – in this case, the mother's sleep position and foetal behaviour – but can't confirm cause and effect.

Although a randomised controlled trial (RCT) would be the most ideal way to test an association, it wouldn't be ethical to make pregnant women sleep in positions that may risk harming their babies.

 

What did the research involve?

The study recruited 29 healthy pregnant women carrying a single foetus who were late into their third trimester (36 to 38 weeks).

All women were told to sleep as they would normally, and the researchers set up recording equipment to study the participants in their own homes.

Video footage was collected to determine maternal sleeping position.

The onset of sleep was defined as the first three minutes during which there were no movements.

Position changes were counted as positions that were assumed for longer than three minutes.

Sleep positions through the night were categorised as:

  • left lateral (left side)
  • right lateral (right side)
  • supine (back)

A continuous foetal echocardiogram (ECG) was used to record maternal and foetal heart rate.

Mean foetal heart rate was assessed for every minute from when the mother fell asleep until she woke up. Consistent states were defined upon duration of three minutes.

Foetal behavioural states were determined using the following:

  • 1F – quiet sleep
  • 2F – active sleep
  • 3F – quiet awake (rarely seen in foetuses)
  • 4F – active awake

Researchers analysed the relationship between maternal position and foetal state.

 

What were the basic results?

The average maternal sleep duration was approximately eight hours. Sleeping on the left side was the dominant position in the majority of women.

  • In all maternal sleeping positions, the foetuses were in a state of active sleep (2F) more than 80% of the time. They were in quiet sleep (1F) 13% of the time and spent little time actively awake.
  • Foetal heart rates were lower in the state of quiet sleep (1F) than when actively asleep (2F), and higher when actively awake (4F).
  • State 4F was found to be more likely earlier in the night compared with state 1F, which was more likely later into the night.

Compared with the mother sleeping on her left side:

  • Quiet foetal sleep (1F) was more common when the mother slept on her back (odds ratio [OR] 1.30, 95% confidence interval [CI]: 1.11 to 1.52) and less common when she slept on her right side (OR 0.81, 95% CI: 0.70 to 0.93). Although statistically significant, the actual difference in the amount of time the babies spent in this state was small (13.4% when mothers were on the left side versus 14% on the back and 11.3% on the right).
  • The foetus was less likely to be actively awake (4F) when the mother slept on her back (OR 0.33, 95% CI 0.21 to 0.52) and more likely when she slept on her right (OR 1.72, 95% CI 1.37 to 2.18). But the actual difference between sides was very small: 0.8% of foetal time when on the back compared with 4.4% of time on the left and 5.2% on the right.

All babies were healthy at their six-week postnatal check-up.

 

How did the researchers interpret the results?

The researchers said: "Our results have shown that time of night significantly influenced the likelihood of the foetus being in a particular state, with 4F being more likely in the early part of the night and 1F less likely then and more likely later after sleep onset.

"This may be due in part to the maternal position effects where position change, most often from non-supine to supine sleep, occurred after the period of most stable sleep.

"It was also found that the effects of foetal state on measures of foetal heart rate variability were modified by maternal position, likely mediated through autonomic nervous system activity.

"This further supports the concept that maternal position is an important modulator of circadian effects on foetal heart rate."

 

Conclusion

This observational study suggests a mother's sleep position may influence their baby's activity in late pregnancy.

Most mothers sleep on their left side, but babies were found to be slightly more likely to be actively awake if women slept on their right side.

If they slept on their backs, babies were slightly more likely to be quietly asleep.

These are interesting findings, but there are a few points to note:

  • In all maternal sleeping positions, the foetuses were in a state of active sleep more than 80% of the time. Although there was a statistically significant difference in the amount of time babies spent quietly asleep or actively awake during different maternal sleeping positions, the actual percentage difference was only very small (less than 5% difference in all cases).
  • This was a very small study – a much larger sample size of mothers would be needed to validate these findings.
  • There may be other factors in play, such as mothers' diet and physical activity during the day.
  • The baby's sleep or activity patterns automatically influence their heart rate.
  • All the babies were born healthy. There's no evidence that sleep position puts the baby at risk of harm.

Some organisations, such as the American Pregnancy Association, recommend pregnant women sleep on their left side as this will "increase the amount of blood and nutrients that reach the placenta".

Links To The Headlines

Expectant mothers should sleep on their side towards the end of pregnancy, experts warn. Daily Mirror, October 12 2017

New warning to pregnant women: Do not sleep on your back in the last trimester as it could cause stillbirth, claim experts. Mail Online, October 12 2017

Links To Science

Stone PR, Burgess W, McIntrye J, et al. An investigation of fetal behavioural states during maternal sleep in healthy late gestation pregnancy: an observational study. The Journal of Physiology. Published online October 11 2017

 Thu, 12 Oct 2017 18:00:00 GMT Hormonal fertility tests 'waste of time and money'

"'Fertility MOTs' are a waste of money," reports The Daily Telegraph after researchers in the US found hormones tested in "ovarian reserve" fertility test kits bear no relation to how likely women were to get pregnant – at least, in the early months of trying to conceive.

These tests usually measure the levels of three hormones:

  • anti-mullerian hormone (AMH)
  • follicle-stimulating hormone (FSH)
  • inhibin B

All of these hormones have been linked to measures of a woman's "ovarian reserve" – how many viable eggs she has left in her ovaries.

Researchers analysed hormone levels from 750 women aged 30 to 44 who'd been trying to get pregnant for three menstrual cycles or less.

They followed the women for 12 cycles to see how many got pregnant.

After taking account of factors including the women's age, they found hormone levels didn't affect the women's chances of becoming pregnant in any given cycle.

Levels of AMH decline over time and become undetectable at menopause, when a woman's egg supply is exhausted.

But the results of this study suggest it doesn't matter how many eggs a woman has in reserve to get pregnant – as long as she's still releasing eggs regularly.

There seems to be little reason for women to be offered these tests, which can cost more than £100 a time, unless they're undergoing fertility treatment, when the tests are used to help plan and predict IVF results.

 

Where did the story come from?

The study was carried out by researchers from the University of North Carolina, the University of Southern California, Duke University, the National Institute of Occupational Safety and Health, and the National Institute of Environmental Health Science, all in the US.

It was funded by the US National Institutes of Health.

The study was published in the peer-reviewed Journal of the American Medical Association (JAMA).

The UK media's reporting was reasonably accurate and balanced. Most headline writers focused on the cost of the tests, describing them as a "waste of money".

But the tests could also cause unnecessary emotional distress if they wrongly suggest a woman's fertility is lower or higher than it actually is.

 

What kind of research was this?

This prospective cohort study set out to learn whether women with high or low levels of specific hormones were more or less likely to get pregnant over a given period of time.

This type of study is useful for showing us whether there's a link between one factor (hormone levels) and another (pregnancy).

 

What did the research involve?

Researchers recruited 981 volunteers to take part in the study. After excluding those who didn't meet the criteria or withdrew or got pregnant before the study started, 750 women were left.

The women filled out questionnaires, and had blood and urine samples taken to test their hormone levels.

They also filled out diaries documenting menstrual bleeding, when they had sex, and the results of pregnancy tests.

The women were followed up for 12 months. Researchers adjusted their figures to take account of confounding factors, and then looked at whether hormone levels were linked to the women's chances of getting pregnant after 6, 12, or any given cycles.

Women were only included in the study if they were aged 20 to 44, had been trying to get pregnant for three cycles or less, had no history of fertility problems, and were living with a male partner.

Researchers defined normal AMH as above 0.7ng/ml, based on previous research. Normal FSH – which is higher in older women – was defined as below 10mIU/ml.

It's not currently clear if there's such a thing as a normal inhibin B level and what that would be, so the researchers considered this a continuous variable.

The outcomes measured were the cumulative probability of conception (measured by a positive pregnancy test) after 6 or 12 menstrual cycles.

The researchers took account of these potential confounding factors:

  • age
  • body mass index
  • race
  • smoking status
  • use of hormonal contraceptives in the past year

 

What were the basic results?

Of the 750 women in the study, 65% got pregnant, 17% didn't get pregnant, and the remainder dropped out before 12 months (for example, because they started fertility treatment).

After adjusting for confounding factors, the predicted probability of getting pregnant after 6 or 12 cycles wasn't lower for women who had low AMH or high FSH, and wasn't linked to inhibin B levels.

Looking at AMH:

  • 65% of women with low AMH were predicted to get pregnant within 6 cycles, compared with 62% with normal AMH
  • 84% of women with low AMH were predicted to get pregnant within 12 cycles, compared with 75% with normal AMH
  • the chances of getting pregnant in any given cycle was no different for women with low and normal levels of AMH (hazard ratio 1.19, 95% confidence interval 0.88 to 1.61), so the result wasn't statistically significant

Researchers also looked at different age groups to see if hormone levels made more of a difference to younger or older women. They found low AMH wasn't linked to lower chances of pregnancy in any age group.

 

How did the researchers interpret the results?

The researchers said their results were "surprising". They'd anticipated there would be a difference in fertility levels by hormone level, but say the results suggest there "may be little association between a woman's ovarian reserve and factors affecting fertility, such as egg quality".

They said their findings "do not support the use of urinary or blood FSH tests or AMH levels to assess natural fertility" for women aged 30 to 44 without fertility problems who have been trying to get pregnant for three cycles or less.

 

Conclusion

Anxiety about getting pregnant, especially at older ages, is common, and women may feel pressured into taking so-called fertility "MOT" tests to see whether they've left it too late.

But the results of this study strongly suggest that these tests don't predict how easily or quickly a woman will be able to get pregnant.

Some women may use the tests to find out whether they can delay pregnancy, and take a result showing a high ovarian reserve to mean that they have plenty of time to get pregnant.

But the tests only give a snapshot of ovarian reserve at one point in time – they don't tell you how quickly the levels may change in future.

The researchers may be right that other factors, such as egg quality or the quality of a partner's sperm (which also declines with age), are more important – as long as the woman is regularly releasing eggs.

The study was well-designed and carried out, but has some limitations.

For one, the researchers measured pregnancy rates, not birth rates. It's possible that hormone levels could affect the chances of a woman carrying a baby to term, although there's no research to suggest this is the case.

It's also important to remember that these women were all in the first few cycles of trying to get pregnant. The results may not be the same for women with known fertility problems.

There's no doubt that women do find it harder to get pregnant as they get older.

Women who want to get pregnant and have been unable to do so within six months of trying should see their doctor to find out whether there's a problem.

Women being investigated for fertility problems may well need to have these tests, which help plan and predict the success of IVF treatment.

Women who have just started trying for a baby and have no known fertility problems should probably save themselves the money and stress.

Links To The Headlines

'Fertility MOTs' are a waste of money, study finds. The Daily Telegraph, October 10 2017

Fertility MoT tests 'a waste of money'. BBC News, October 10 2017

'Fertility MOTs' for women trying to conceive may be waste of money, study suggests. The Independent, October 10 2017

Links To Science

Steiner AZ, Pritchard D, Stanczyk FZ. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. Published online October 10 2017


 

 
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