Vagus nerve stimulation may reduce the symptoms of rheumatoid arthritis

Electrostimulation of the vagus nerve may be key to reducing the symptoms of rheumatoid arthritis, according to findings that scientists presented at the Annual European Congress of Rheumatology in Madrid, Spain.
close up of a healthcare professional checking a senior woman's hand for signs of arthritis

Electrostimulation of the vagus nerve may help reduce the symptoms of rheumatoid arthritis.

This research gives hope that there may be a new way to help treat this autoimmune condition.

The vagus nerve, which is a very long nerve that runs between the brain and the neck, chest, and abdomen, is a complex structure.

Previous research has found an inflammatory reflex in the vagus nerve that reduces the production of cytokines, including certain molecules that are a component of autoimmune conditions. These molecules are called tumornecrosis factor (TNF).

The immune systems of healthy people block TNF, but in those with certain autoimmune conditions, excess TNF makes its way into the bloodstream and causes inflammation and a higher rate of symptoms associated with the conditions.

TNF is a target in many rheumatoid arthritis (RA) drugs, such as infliximab (Remicade) or etanercept(Enbrel). Many people call these drugs TNF-blockers.

The researchers thought that if they could boost this naturally occurring reflex in the vagus nerve, it might have a similar result — or one that was even better, as drugs that aim for TNF also suppress the immune system and have other unwelcome side effects.

“This is a really exciting development,” says Prof. Thomas Dörner, Chairperson of the Scientific Programme Committee at the Annual European Congress of Rheumatology, which this year takes place in Madrid, Spain.

“For many [people living with] RA, current treatments don’t work, or aren’t tolerated. These results open the door to a novel approach to treating not only RA but other chronic inflammatory diseases. This is certainly an area for further study,” adds Prof. Dörner.

Small neurostimulator led to big findings

The researchers implanted a small neurostimulator, called a MicrioRegulator, into 14 people with RA. To qualify for the study, each person had tried at least two medications that worked in different ways but that hadn’t helped reduce their symptoms.

The scientists then divided the participants into three groups: a placebo group, a group that had vagus stimulation once per day, and a group that had vagus stimulation four times per day.

The study, which took place over 12 weeks, revealed that those in the once-per-day group had a much better result, symptom-wise, than those in the other two groups — including those that had stimulation four times each day.

Both stimulation groups also had a distinct reduction of more than 30% in their cytokine levels during the course of the study.

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15 Heartburn Trigger Foods: Control Acid Reflux

Heartburn is a painful condition that affects around 20% of the population every week. The symptoms of heartburn are a tight, painful feeling through your chest. Heartburn is caused by acid reflux, which happens when stomach acid is released into the esophagus. The stomach acid eats away at the lining of the esophagus and can cause lasting damage.

If you experience frequent heartburn, you may have a condition called acid reflux disease, or gastroesophageal reflux disease (GERD). Lifestyle and overall health are important factors in heartburn symptoms. Losing excess weight, quitting smoking, and sleeping in an elevated position can decrease the likelihood of acid reflux.

The type of food you eat and the quantity can exacerbate acid reflux, causing heartburn. If you suffer from heartburn, try eating smaller portions in 4-6 meals a day. Overloading your stomach can cause acid to leak into your esophagus. Keep a food diary to identify which foods may trigger your heartburn. You don’t need to cut these foods totally out of your diet, but moderation can help keep your heartburn at bay.

Here are 15 of the biggest heartburn trigger foods that you can avoid for relief from acid reflux.

1. Alcohol

Alcohol can be a massive trigger for heartburn attacks. Red wine and beer are particularly likely to cause acid reflux. Alcohol relaxes your esophageal sphincter, allowing for stomach acid to creep up. Drinking alcohol with a large meal is a recipe for disaster as it increases the risk for acid reflux. If you enjoy a drink with your meal, eat smaller portions to minimize your risk of heartburn.

2. Fried Food

Fatty foods can be brutal for a person suffering from acid reflux. While fried foods may look crispy, they retain a lot of the oil in the coating. Foods high in fat take longer to digest, putting pressure on your stomach and esophagus. This increases the risk of acid reflux due to the time your stomach stays full. Instead of fried foods, try grilling or poaching your meals. This not only saves calories but can protect you from heartburn.

3. Spicy Food

The effect of spicy food on heartburn is interesting. Many people complain of massive heartburn after consuming a spicy dish, but others may find spicy food helps calm their chronic heartburn. Spicy food can affect the acid levels in your stomach, creating a more hostile environment that can promote acid reflux. If you find spicy food can trigger heartburn, then try reducing the heat in your meals.

4. Tomatoes

Tomatoes, fresh or canned, can be a major trigger for heartburn. While they are incredibly healthy vegetables, tomatoes are naturally high in acid. This can upset your stomach, causing acid reflux as you digest your meal. Be wary of tomatoes used in cooking. A delicious pasta sauce could come back to haunt you later that night. Also consider condiments high in tomatoes and acid, such as ketchup and salsa.

5. Oranges

Your breakfast orange juice could be giving you heartburn later in the day. Oranges and other citrus fruit are high in acid content, which can lead to acid reflux. Instead of citrus fruit, go for high alkaline foods. These include berries, apples, pears, bananas, and  melon. If you insist on drinking or eating citrus foods, try to get them in as early in the day as possible. This will minimize the risk of heartburn, as many people experience it in bed or while lounging.

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Treatable brain inflammation may be behind tinnitus

Scientists may have seen a way to cure a maddening symptom of hearing loss.

  • A treatment for tinnitus – a constant ringing in the ears – has been frustratingly elusive.
  • Out-of-control inflammation, the brain’s response to damage, may be the cause of long-term ringing in the ears.
  • A study that examined mice with noise-induced hearing loss seems to have found the neural trigger for tinnitus.

Common, or subjective, tinnitus is no fun. If you have it, you know what we mean. And a lot of people do — some 500 million worldwide. It’s a byproduct of hearing loss that produces a constant veil of high-frequency pitches that never abates. For sufferers, there is no silence, ever. Unfortunately, identifying its cause, much less a treatment, has proven elusive. Now, however, a new study published in PLOS Biology may have uncovered the physiological mechanism behind it: neuroinflammation in the auditory cortex. And it could be treatable.

Note the “may” in the paragraph above. It’s there because this study draws its conclusions based on the physiology of rodent test subjects, not humans, and things don’t always translate between species. Hence, its claims deserve a grain or two of salt. Ethics issues aside, this is often the case with exciting-sounding medical-breakthrough news. It’s so common, in fact, that there’s a Twitter hashtag for it: @justsaysinmice.

How to acquire tinnitus

Image source: Vagengeim/Yes – Royalty Free/Shutterstock/Big Think

Not that you’d want to. However, the recipe is simple: Expose your ears to overloud noise. Tinnitus is actually not an underlying condition — it’s a symptom of hearing loss. Noise-induced hearing loss (NIHL) can result from, for example, working in a loud environment without protecting your ears, or attending too many loud concerts, standing too close to speakers at a show, or from listening to loud music on headphones.

The way that we hear sound is not as direct as many think. Sound is really a matter of compression waves generated by a source that compresses and releases air on its way to your ears. Tiny hairs, the stereocilia, in your ears receive these air-pressure changes and fire off signals to your brain that we interpret as sound. Each hair has the job of producing a certain range of audio frequencies, and with tinnitus, some of these hairs get stuck in what amounts to their “on” position, continually firing off these signals to your brain even without the presence of an actual external sound source. Exactly what triggers this misbehavior is what the new study attempts to explain.


Image source: Alila Medical Media/Shutterstock

The study states, “Neuroinflammation is the central nervous system’s response to external and internal insults, such as infection, injury, diseases, and abnormal neural activity,” and so its authors looked at mice with NIHL to assess its possible role in tinnitus. They conclude “Our results indicate that neuroinflammation plays an essential role in a noise-induced excitatory-to-inhibitory synaptic imbalance and tinnitus in a rodent model.”

To protect the brain, an inflammatory response typically involves the activation of microglia, the central nervous system’s primary immune cells. When they remain active in response to chronic damage — as with hearing damage — though, they tend to release proinflammatory cytokines, which can make the problem worse. In the mice studies, the authors found one such proinflammatory cytokine, TNF-α. (“TNF” stands for “tumor necrosis factor.”) It seems to be the neural trigger for tinnitus.

When the researchers shut off the gene that results in the production of TNF-α in one set of mice, and likewise when they repressed it with medication in another, tinnitus disappeared. Testing the connection from the other direction, they also found that when they introduced TNF-α into the auditory cortex of normal mice and also mice who had no natural TNF-α, tinnitus appeared.

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20 Gluten-Free Holiday Cookies + Treats

Are you looking for some delicious gluten-free holiday cookies and treats to bake up this year for Christmas or Hanukkah? If so, look no further than my comprehensive list of delicious holiday cookies and treats!

Try any of these recipes and show your friends that gluten-free desserts can look and taste just as good – and sometimes even better – than their gluten-full rivals. Plus, us gluten-free folks have a secret ingredient – Vitamin L (love). I know, cheesy, but true!

Gluten-Free Flours Used

You’ll notice that I use a variety of gluten-free flours in my recipes. You can find all these flours at your local grocery store or online.

Gluten-free flours used include:

  • Bob’s Red Mill 1-to-1 Gluten-Free Flour Blend
  • Otto’s Cassava Flour
  • Honeyville Almond Flour

Be sure to stock up – I just keep these flours in my pantry at all times so I have them on hand when my baking needs arise.

20 Gluten-Free Holiday Cookies + Treats

(1) Gluten-Free Sugar Cookies: 

These gluten-free sugar cookies are perfect for cutting out your favorite shapes and decorating them with frosting and icing. Follow the instructions carefully to ensure these cookies hold their shape and don’t spread.

Gluten-Free Sugar Cookie - header

(2) Gluten-Free Peanut Butter Blossoms:

These stunning cookies are made using the original Hershey’s Kisses recipe and a simple gluten-free flour swap. Aren’t they beautiful? I use sparkling sugar instead of granulated sugar as the coating.

Gluten-free peanut butter blossoms recipe header

(3) Gluten-Free Lemon Crinkle Cookies:

These moist and sweet cookies are made with almond flour and are infused with lots of lemon. I love how they look too. They’re so cute and cozy coated in powdered sugar. These cookies offer up a totally sweet holiday treat for all!

Gluten-free Lemon Crinkle Cookies

(4) Gluten-Free Cassava Flour Chocolate Chip Cookies:

Cassava flour works like a charm in this simple chocolate chip cookie recipe. Don’t be fooled by the picture because these cookies are soft and doughy even though they’re slightly browned along the rim. Best part – they are totally grain-free too – score!

Cassava Flour Chocolate Chip Cookies II - 1

(5) Almond Flour Linzer Torte Cookies

Almond flour lovers delight in these soft-baked linzer torte cookies stuffed with raspberry jam. I’m craving these just by looking at ’em.

Linzer Cookie header

(6) Gluten-Free Rum Balls:

This adult cookie is perfect for Christmas and even better when you make them for your New Year’s celebrations. This is a no-bake recipe too – easy peasy!

Gluten-Free Rum Balls header

(7) Gluten-Free Chocolate Chip Cookie Dough Fudge:

Elevate your chocolate fudge recipe with this chocolate chip cookie dough fudge instead. It’s yummy and made with white chocolate.

Gluten-Free Chocolate Chip Cookie Dough Fudge 3

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23 ‘Surprising’ Symptoms of Thyroid Disease No One Talks About

Although thyroid disease is common, affecting nearly 12 percent of people in the U.S., many people don’t understand the reality of what it’s like to live with a thyroid condition.

Hurtful misconceptions about thyroid disease still perpetuate, as some believe it’s “not that bad,” only affects the thyroid or can always be easily “fixed” with medication. Others may simply be unaware of the different types of thyroid disease and all the symptoms and side effects thyroid conditions can cause. In fact, it’s estimated that up to 60 percent of people with thyroid disease don’t realize they have it. That’s why it’s so important to raise awareness and promote better understanding of the many ways thyroid disease can manifest.

The thyroid is a small, butterfly-shaped gland in the lower neck. As part of the endocrine system, it produces hormones that help regulate metabolism and autonomic bodily functions, affecting every tissue, organ and system in the human body. Any dysfunction of the thyroid gland falls under the umbrella of thyroid disease.

Hypothyroidism (underactive thyroid disease) occurs when the thyroid doesn’t produce enough thyroid hormone. This slows the body’s processes and metabolism, resulting in symptoms such as weight gain, depression and fatigue. Causes of hypothyroidism may include Hashimoto’s thyroiditis (an autoimmune condition), medications, radiation therapy or thyroid surgery.

Hyperthyroidism (overactive thyroid disease) occurs when the thyroid produces too much thyroid hormone. This accelerates the body’s metabolism, causing symptoms such as increased heart rate, weight loss and tremors. Hyperthyroidism has several possible causes, including Graves’ disease (an autoimmune condition), hyperfunctioning thyroid nodules and thyroiditis.

Thyroid nodules are small lumps that form in your thyroid. The majority are not serious and do not cause any symptoms. Some can become large enough to cause symptoms such as difficulty breathing or swallowing, while others may secrete extra hormones, causing symptoms of hyperthyroidism.

Goiter is the abnormal enlargement of your thyroid gland. It can occur for a number of reasons, including hypothyroidism, hyperthyroidism, nodule growth, thyroid cancer, pregnancy or inflammation.

There are several types of thyroid cancer, though it is considered relatively rare. Thyroid cancer can cause changes to your voice, difficulty swallowing, pain in your neck and throat, and a lump that can be felt on your neck. Most cases can be cured with treatment.

Whatever type of thyroid condition you have, know your symptoms are valid, and there is a community here that understands any struggles you may be facing.

To help raise awareness of some lesser-known thyroid symptoms and remind anyone struggling that they’re not alone, The Mighty teamed up with The National Academy of Hypothyroidism (NAH). We asked our Mighty community and the NAH community to share a surprising symptom of thyroid disease and what it’s like to experience it.

Here’s what our communities shared with us:

1. Throat Tightness

Thyroid disease can cause feelings of tightness or discomfort in the throat for several reasons. Different types of thyroiditis (inflammation of the thyroid gland) may cause pain or swelling in the gland, depending on the presentation of the specific condition.

Goiter, or abnormal enlargement of the thyroid gland, is known to cause throat tightness as well as cough, difficulty breathing or swallowing, hoarseness and swelling in the front of the throat or neck. Goiters can be caused by a few different factors, including Hashimoto’s thyroiditis (hypothyroidism) and Graves’ disease (hyperthyroidism).

Tightness and pain around my thyroid when I’m exercising, upset or stressed. It makes it hard to breathe and difficult to swallow. It also makes my voice sound strained when I’m talking to people. Although I now know this is a symptom of thyroid disease caused by inflammation, it didn’t come up at all when I first started doing research on thyroid disease. – Jessica M.

Tightness in throat quite frequently (not sore just tight, like I’m being strangled. It’s an awful feeling)! – Victoria B.

2. Hair Loss

People with prolonged and severe hypothyroidism or hyperthyroidism may experience hair loss that typically occurs evenly across the entire scalp. Much of the hair may grow back with proper treatment of the disease. It’s also possible to experience hair loss as the result of taking medications to treat your thyroid disease, though this is rare.

Little or no eyebrows when hypothyroid. – Theresa H.

Excessive hair loss. – Stephanie L.

3. Anxiety/Panic Attacks

Anxiety can be a symptom of thyroid disease, particularly hyperthyroidism. The thyroid gland is responsible for producing T3 and T4 hormones, which help regulate many of the body’s automatic functions, such as heart rate and digestion. When the thyroid is overactive, it can cause symptoms such as increased heart rate, high blood pressure, heart palpitations, insomnia and reduced appetite – which are also common symptoms of anxiety. If you’re experiencing these symptoms, it’s important to talk to your doctor to determine their root cause.

Anxiety. I have been told it will go away when my levels are right. They haven’t been right in three years. I’ve panicked driving over a bridge so bad, I didn’t know if I was going to be able to drive all the way across. It was terrifying and embarrassing. – Kelly S.

Panic attacks! Before I was diagnosed they would just come from nowhere. I honestly thought I was going to die or that something was really wrong with me. I still suffer with anxiety now, especially around the time of menstruation. I can feel my hormones changing. – Diane B.

4. Fatigue

Fatigue is one of the most common symptoms associated with hypothyroidism – and it involves a lot more than feeling “a bit tired.” Fatigue is sleep that doesn’t make you feel refreshed when you wake up. You won’t feel better even with 10 or more hours of sleep because you’re not getting deep sleep. This can make it difficult to do everyday activities because you don’t have the energy.

The bone crushing fatigue. I know fatigue is one of the first listed symptoms, but I never knew how severe it could get until I experienced it myself. That it was possible to fall asleep while walking to college. That I could regularly fall asleep mid sentence while talking. How it became impossible to stay awake through lectures. The tiredness scared me, it was so demanding. Still it took another two years after this to get diagnosed, kept being told I was depressed, and that was making me tired. – Heike K.

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Was Luke Perry too young for a stroke? No, they can happen at any age

(CNN)The death of Luke Perry, after the actor suffered what his publicist said was a massive stroke, is evidence that the disease can affect people of any age, the American Heart Association said.

Perry, who starred in “Beverly Hills 90210” and “Riverdale,” died Monday. He was 52.
“Although stroke often affects older individuals, it is not only a disease of the elderly,” said Mitchell S. V. Elkind, chair of the American Stroke Association Advisory Committee. “There is evidence that stroke rates among young people are increasing in the United States and this requires additional research.”
Luke Perry, star of 'Beverly Hills 90210' and 'Riverdale,' dead at 52

Luke Perry, star of ‘Beverly Hills 90210’ and ‘Riverdale,’ dead at 52
A 2017 report by the American Academy of Neurology found that 15% of all ischemic strokes happen to young adults and adolescents. But a lack of research, awareness and frequency makes diagnosing the symptoms early on a challenge.
Ischemic strokes account for 87% of all stroke cases. They occur when a blood vessel becomes blocked by fatty deposits and blood has trouble passing through to the brain.
Other types of strokes include thrombotic ischemic stroke — triggered by a blocked vessel — and a hemorrhagic stroke, caused by weakened blood vessels that rupture and bleed into the brain.
The cause and type of Perry’s stroke has not been revealed. But Elkind said it’s important to know risk factors and symptoms.

The risk factors

Stroke is the second leading cause of death worldwide — and high blood pressure is the leading cause of stroke, according to the American Stroke Association.
What happens during a stroke

What happens during a stroke
Smoking, diabetes, high blood pressure, high blood cholesterol, obesity and other cardiovascular diseases put people at greater risk for stroke, the heart association said. Avoiding diets with high calories, lots of saturated fat, trans fat and sodium can reduce the risk, as can getting 150 minutes of activity each week, the association said.

The symptoms

The American Heart Association recommends using the acronym F.A.S.T. to remember how to catch the warning signs of a stroke:
Face is drooping.
Arms are weak.A
Speech difficulty.
Time to call 911.

Source: CNN

15 Things No One Tells You About Alzheimer’s Disease

Every 65 seconds, someone develops Alzheimer’s, and their family and friends must become caregivers. Experts share the 15 things no one tells you about the challenges—and rewards.

Your loved one may do wildly inappropriate things

Senior woman with walking stick being helped by a female nurse at home. Full length shot of female doctor with elderly patient at nursing home.JACOB LUND/SHUTTERSTOCK

“Sometimes people say and do things that are out of character,” says Ruth Drew, director of Information and Support at Alzheimer’s Association. She recalls the time a woman—who had always been very proper—began taking off her clothes from the waist down. One of the residential care facilitators suspected that there was something going on and had her tested for a urinary tract infection—which turned out to be the problem. “You need to play detective and discover what is triggering the behavior,” says Drew.  “The circle of life reverses itself and sometimes the child becomes the parent,” notes Gail Pearson, Memory Care Unit Manager, Jeffrey and Susan Brudnick Center for Living.

Loss of inhibitions

Pleasant memories. Portrait of old charming couple remembering sweet moments. Woman is looking at husband while laughing. Man is regarding at picture while tenderly cuddling wifeOLENA YAKOBCHUK/SHUTTERSTOCK

“It is not uncommon that my husband opens his zipper. He doesn’t do it to be sexual. He thinks it’s funny,” reports a family caregiver. “He also tries to kiss strangers because he truly believes everyone likes him.”

Expect delusions and hallucinations

15 Things No One Tells You About Alzheimer's DiseaseLOGOBOOM/SHUTTERSTOCK

“Delusions can turn on a dime,” notes Pearson. Patients may say sexually inappropriate comments because they have no filter, she says.

Speech may disappear

Thoughtful retiree looking what going onOLENA YAKOBCHUK/SHUTTERSTOCK

Even though she had been a social worker for over two decades, Tanjulla Tyson-Wearren was surprised when her mother suddenly couldn’t speak. “It was an emotional roller coaster. I was not prepared to never hear her sing a song or say hi,” says Tyson-Wearren. “Even when they cannot speak, there are still ways to connect, “says Drew.

They may forget how to shower


“Confusion becomes the central way of thinking,” notes Crystal Polizzotti, Healthy Aging Program Manager at Elder Services of the Merrimack Valley. Polizzotti notes that there are about 15 steps to taking a shower that we don’t even think about—but that a person with Alzheimer’s may find impossible to complete. One of the caregivers told Polizzotti that the only way she could get her husband to shower was to go in first. “You have to get creative,” notes Polizzotti.

Alzheimer’s is deadly


It’s the sixth leading cause of death, Drew points out: “A lot of people still do not understand that Alzheimer’s cannot be prevented, slowed down, or cured.” The Alzheimer’s Association’s Annual Report notes that one in three seniors will die with Alzheimer’s or another form of dementia. Alzheimer’s kills more people than breast cancer and prostate cancer combined.

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Bipolar Disorder Increases Parkinson’s Risk Sevenfold

Bipolar patients are seven times more likely to develop Parkinson’s disease, according to a new study. Though the news may be disheartening to those suffering from the already-trying condition, the link might also lead to clues about the causes behind the two conditions.

Parkinson’s is a complex disease associated with a gradual decline in dopamine levels produced by neurons, or brain cells. It eventually leads to impaired movements and other bodily functions. The causes are unknown, and there is no cure.

Bipolar disorder, also known as manic-depressive illness, is characterized by episodic fluctuations in mood, concentration or energy levels. Its causes are also unknown, though some bipolar-associated genes have been identified. Researchers are still figuring out how brain structure and function changes under the disease.

Previous research has linked Parkinson’s with depression. So when the authors of the new study, most of whom are practicing physicians, noticed some of their bipolar patients developing Parkinson’s, they wondered if there was a connection.

Seven Times The Risk

The study, out today in Neurology, was led by Huang Mao-Hsuan, who practices in the department of psychiatry at Taipei Veterans General Hospital. The researchers compared data from two groups of adults in the Taiwan National Health Insurance Research Database. Members of one group — over 56,000 individuals — were diagnosed with bipolar disorder between 2001 and 2009. The other — 225,000 individuals — had never been diagnosed with the disorder. No one in either cohort had received a Parkinson’s diagnosis and all the patients were over 20. And researchers ensured the two groups had similar ages, socioeconomic status, and other traits that might influence health.

You Might Like: Child Bipolar Disorder Still Rare

The researchers followed up with all 278,000 people in 2011 to see how many had been subsequently diagnosed with Parkinson’s. They found that 0.7 percent of the patients with bipolar disorder ended up developing the disease — about 1 in 140. But for those without the disorder, the prevalence of Parkinson’s was about 1 in 1,000, or 0.1 percent.

Link Uncertain

Researchers found the trend held even when controlling for the potential effects of antipsychotic medications, which are frequently prescribed for bipolar disorder and are known to cause Parkinson’s-like symptoms (known as drug-induced parkinsonism, or DIP.)

The only clue to a mechanism that would explain the link was that patients with the highest frequency of psychiatric admission for bipolar episodes also had the highest prevalence of Parkinson’s. It’s not clear why this would be, though both bipolar disorder and Parkinson’s are known to be linked to impaired dopamine transmission in the brain. More research is needed to figure out what the connection between these two diseases might be.

You Might Like: Bipolar Disorder – A BRIDGE to nowhere?

Child Bipolar Disorder Still Rare

Bipolar disorder usually strikes between the ages of 15 and 25, and is extremely rare in preteens, according to a major study: Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients

The findings are old hat. It’s long been known that manic-depression most often begins around the age of 20, give or take a few years. Onset in later life is less common while earlier onset is very unusual.

The main graph could have been lifted from any psychiatry textbooks of the last century:

The red bars are the data. Ignore the black line, that just shows an imaginary ‘even’ distribution over the lifespan.

Why am I blogging about these remarkably unremarkable results? Because they undermines the theory, popular in certain quarters but highly controversial, that ‘child bipolar’ or ‘pediatric bipolar’ is a major health problem.

The study confirmed that early-onset bipolar I does exist, but just 5% of the bipolar I patients had an onset before the age of 15. Assuming a lifetime prevalence of 1% for bipolar I disorder, which is about right, that makes about 0.05%, 1 in 2000 kids, about the same prevalence as Down’s Syndrome. Even that’s an overestimate, though, because this sample was enriched for early-onset cases: some of the participating clinics were child and adolescent only.

There’s a few caveats. This was a retrospective study, that took adults diagnosed bipolar, and asked when their symptoms first appeared. It’s possible that early onset cases were under-sampled, if they were less likely to survive to adulthood, or get treated. The generally milder bipolar II might also be different from the bipolar I studied here. But in general, these numbers support the traditional view that childhood bipolar is just not very prevalent.

Bipolar Disorder – A BRIDGE to nowhere?

Last August I blogged about a research paper that claimed that almost half of all people suffering from depression actually have features of bipolar disorder – including me: So Apparantly I’m Bipolar

It was called the BRIDGE study. I took issue with it for various reasons, including the fact that it counted as ‘bipolar features’ any periods of irritable or elevated mood, even if they were associated with drug treatment:

Under the new regime if you’ve ever been irritable, high, agitated or hyperactive, on antidepressants or not, you meet “Bipolar Specifier” criteria, so long as it was marked enough that someone else noticed it…

A cynic would say that this is a breathtaking piece of psychiatric marketing. You give people antidepressants, then you diagnose them with bipolar on the basis of their reaction to those drugs, thus justifying selling them yet more drugs.

The cynic would not be surprised to learn that this study was sponsored by pharmaceutical company Sanofi.

Now a crack team of psychiatrists have written a Letter to the Editor criticizing BRIDGE and they say… pretty much what I said: BRIDGE Study Warrants Critique. They do make a couple of new points also.

The 8 authors of the Letter include David Allen, David Healy, Peter Parry and Jon Jureidini, all major critical voices in psychiatry. However… while this A-Team make an excellent case that BRIDGE is a step in the direction of overdiagnosis and overtreatment of bipolar, they drop the ball slightly when they say:

The article concluded with an appeal to use “mood stabilizers,” presumably atypical antipsychotics, which are less efficacious than lithium. The sponsor has a medication in this class.

Sanofi does make the atypical antipsychotic amisulpiride, but it’s not generally referred to as a “mood stabilizer”, and I’m not sure why you’d assume that Sanofi had amisulpiride specifically in mind. The BRIDGE team exploit this in their rebuttal letter:

Allen et al cast unseemly aspersions that the BRIDGE study was a vehicle to promote sales of an antipsychotic drug sold by sanofi-aventis. sanofi-aventis has no antipsychotic with an indication for bipolar disorder. We know of no evidence that this was the case at any stage of development and execution of the BRIDGE study.

Maybe so, but as I said in my post, Sanofi also make some popular brands of valproate/valproic acid, a prototypical “mood stabilizer” which is widely used in bipolar disorder. I’d have said that was the more likely candidate…

Fundamentally, we know that Sanofi “was involved in the study design, conduct, monitoring, data analysis, and preparation of the report.” We also know that Sanofi is exists to make profit by selling drugs. So either Sanofi thought that this study would make them a profit eventually, by selling more drugs… or they threw money and time at this for no commercial reason. Hmm.

The reply concludes with the frankly bizarre statement that:

Allen et al view their position as part of a “debate” about the “ever-widening bipolar spectrum.” We consider data, not debates, as central to the progress in the scientific understanding of mood disorders…

But science is a debate about data. Data by themselves are just numbers; to be useful, they must be interpreted, and scientific debates aim at arriving at such interpretations. No-one is questioning the BRIDGE data as such, we’re questioning what it means.

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