Tag Archives: mental illnesses

Health

Mindfulness and medication work equally well to curb anxiety, a new study found

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CNN
 — 

A mindfulness meditation course may be as effective at reducing anxiety as a common medication, according to a new study.

The research, published on November 9 in JAMA Psychiatry, involved a group of 276 adults with untreated anxiety disorders. Half of the patients were randomly selected to take 10 to 20 mg of escitalopram, the generic form of Lexapro, a common medication used to treat anxiety and depression. The other half were assigned to an eight-week course in mindfulness-based stress reduction.

The results were stunning: Both groups experienced about a 20% reduction in their anxiety symptoms over the eight-week period.

Elizabeth Hoge, the lead author on the study and the director of the Anxiety Disorders Research Program at Georgetown University Medical Center, told CNN that she hopes the research can open up more treatment options for patients with anxiety.

“Lexapro is a great drug; I prescribe it a lot,” she said. “But it’s not for everyone.”

Meditation could be prescribed in lieu of medication for patients who experience severe side effects or have allergies to anti-anxiety medications, for instance, Hoge says. And starting meditation could also be a first step for people who have untreated anxiety and are wary of medication.

But the research shouldn’t be a trigger for patients to stop taking their medication without consulting a doctor. “If someone’s already taking a medication, they can try meditation at the same time,” Hoge said. “If they wanna come off the medication, they should talk to their doctor.”

There may be undetermined factors that make some patients respond better to meditation. Hoge says that after data collection had ended, participants were given the option to try the treatment option that they hadn’t been assigned. Some patients who had been assigned to the meditation group found that the medication was actually much more effective for them, and vice versa, according to Hoge.

Hoge says that further research could explore “what are the predictors of response in the different treatments,” studying which patients benefit more from meditation versus medication. Then clinicians could prescribe different treatment regimens based on their patient profiles.

And she hopes that the research leads to more insurance companies covering meditation courses as anxiety treatment.

“Usually, insurance companies are willing to pay for something when there’s research supporting its use,” she said. “If they know it’s just as effective as the drug which they do pay for, why don’t they pay for this too?”

The patients assigned to the meditation group were asked to attend a mindfulness meditation group class in-person once a week. Each class was around two-and-a-half hours long and held at a local clinic. They were also asked to meditate on their own for around 40 minutes per day.

Hoge compared the time commitment to “taking an exercise class or an art class.”

But according to Joseph Arpaia, an Oregon-based psychiatrist specializing in mindfulness and meditation, the daily time commitment is likely too much for many patients dealing with anxiety.

“Telling people who are that overworked they should spend 45 minutes a day meditating is the ‘Let them eat cake’ of psychotherapy,” he wrote in a response to Hoge’s publication, also published in JAMA Psychiatry.

Arpaia says that he has worked to find less time-intensive mindfulness methods to help patients manage their anxiety. One technique he teaches is called a “one-breath reset” that helps patients calm themselves over the course of a single breath.

But despite his reservations, “It’s always interesting to see meditation work, and it works as well as medication,” he said. “My hope would be that people realize that there are things other than medication that can work.”

“My other hope would be they realize that if sitting and following your breath makes you feel relaxed, great, but it doesn’t make everyone feel relaxed. Find something that does. Read a book, go for a walk, spend time gardening,” he said.

The patients assigned to the meditation group participated in a specific program called mindfulness-based stress reduction, first developed by Jon Kabat-Zinn in the 1970s. The program is secular but based on some Buddhist teachings.

“It’s like a skill you practice,” Hoge said. “People learn to have a different relationship with their thoughts. In the practice, we train people to just let go of the thoughts, be patient and gentle with the thoughts, just let them pass.”

The “practice of doing that over and over lets people put a little distance between themselves and their thoughts,” she said.

Patients shouldn’t expect meditation – or medication – to completely eliminate their anxiety, according to Hoge. “It’s normal to have anxiety,” she said. “But we can make it quiet down a little bit.”

“People think meditation is hard, that you have to keep your mind clear of thoughts,” she said. “That is not the case. You’re still meditating even if you’re having thoughts. Just having the intention to meditate counts.”

And Arpaia says that meditation can help disrupt the feedback loops that foster anxiety.

“Anxiety tends to be something that feeds on itself,” he said. “What happens is a person becomes anxious, which impairs their cognitive and social skills. As the person starts to feel more impaired, that builds anxiety.”

Anxiety isn’t the only challenge that meditation might help patients address.

A study published in the American Journal of Nursing in 2011 found that an eight-week mindfulness program was just as effective as antidepressants for preventing a relapse of depression.

Hoge said that different meditation programs might be appropriate for helping treat depression and ADHD, among other conditions.

“I think there’s great promise there,” she said.

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Entertainment

Aaron Carter, singer, dead at 34

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CNN
 — 

Aaron Carter, a former child pop singer and younger brother of Backstreet Boys’ Nick Carter, has died, a source close to the family told CNN. He was 34.

A spokesperson for the Los Angeles County Sheriff’s Department told CNN they responded to a call for help at Carter’s Lancaster, California home on Saturday morning around 11 a.m. local time, where a deceased person was found at the scene.

He was found dead in his bathtub, the source said.

Authorities gave no information about a possible cause of death.

Carter, who first found fame as a boy with pop songs like “I Want Candy” and “Crush on You,” is survived by his 11-month-old son, Prince.

The singer’s debut studio album, “Aaron Carter,” was released in 1997 and he performed as the opening act for the Backstreet Boys earlier that year. His fifth and final studio album, “Love,” was released in 2018.

Carter was also known for his roles on television shows such as “Lizzie McGuire” on Disney Channel and “7th Heaven,” which debuted on The WB Television Network. He also appeared on his family’s reality series on E! Entertaiment Television, “House of Carters.”

The singer received an outpouring of of love and support from fans and other celebrities in 2017 after he came out as bisexual.

“There’s something I’d like to say that I feel is important for myself and my identity that has been weighing on my chest for nearly half of my life,” Carter wrote on Twitter. “This doesn’t bring me shame, just a weight and burden I have held onto for a long time that I would like lifted off me.”

He then explained that at around the age of 13 he “started to find boys and girls attractive.”

“There were years that went by that I thought about it, but it wasn’t until I was 17-year-old, after a few relationships with girls, I had an experience with a male that I had an attraction to who I also worked with and grew up with.”

The singer opened up in 2019 in an episode of “The Doctors” about his battle with multiple mental health issues, including multiple personality disorder, schizophrenia, acute anxiety and manic depression.

“This is my reality,” Carter said as he held up a plastic bag of multiple prescription bottles in one clip featured on the show’s Facebook page.

In 2017, Carter was arrested in Georgia under suspicion of driving under the influence and marijuana possession as he and then-girlfriend Madison Parker were traveling through Habersham County.

The singer later said in an interview that he doesn’t drink and denied that he has a drug problem, CNN previously reported.

“I don’t need help,” he said. “What I need is for people to understand that I’m human and that I make mistakes just like every other human in this world, but I would never risk my life or my girlfriend’s life.”

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US

Parkland shooting: School shooter avoids the death penalty after jury recommends life in prison

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Fort Lauderdale, Florida
CNN
 — 

The Parkland school shooter has avoided the death penalty after a jury recommended he be sentenced to life in prison without the possibility of parole for the February 2018 massacre at Florida’s Marjory Stoneman Douglas High School – a move that left some of the victims’ loved ones disappointed and angry.

The jury’s recommendation Thursday, coming after a monthslong trial to decide Nikolas Cruz’s punishment, is not an official sentence; Broward Circuit Judge Elizabeth Scherer still is expected to issue the gunman’s formal sentence on November 1. Under Florida law, however, she cannot depart from the jury’s recommendation of life.

Families of the gunman’s victims bowed or shook their heads as the verdict forms for each of the 17 people he killed were read in court Thursday morning. The jury found the aggravating factors presented by state prosecutors did not outweigh the mitigating circumstances – aspects of Cruz’s life and upbringing his defense attorneys said warranted only a life sentence.

None of the jurors looked in the direction of the victims’ families as their verdicts were read, but instead looked down or straight ahead. Cruz – flanked by his attorneys, wearing a blue and gray sweater over a collared shirt and eyeglasses – sat expressionless, looking down at the table in front of him.

Live updates: Jury reaches decision in Nikolas Cruz sentencing trial

Tony Montalto, the father of 14-year-old victim Gina Montalto, called the jury’s recommendation a “gut punch” for the victims’ families, lamenting that “the monster that killed them gets to live to see another day.”

“This shooter did not deserve compassion,” he said outside the courtroom, after the jury’s findings were read. “Did he show the compassion to Gina when he put the weapon against her chest and chose to pull that trigger, or any of the other three times that he shot her? Was that compassionate?”

Cruz, now 24, pleaded guilty last October to 17 counts of murder and 17 counts of attempted murder for the shooting in Parkland, Florida, in which 14 students and three school staff members were killed, and 17 others were injured. Because Cruz pleaded guilty to all counts, the trial phase was skipped and the court went directly to the sentencing phase.

Prosecutors had asked the jury to sentence the gunman to death, arguing Cruz’s decision to carry out the shooting was not only especially heinous or cruel, but premeditated and calculated and not, as the defense contended, related to any neurological or intellectual deficits.

To illustrate their point, prosecutors detailed Cruz’s thorough planning for the shooting, as well as comments he made online expressing his desire to commit a mass killing.

In their case, the shooter’s defense attorneys said Cruz had neurodevelopmental disorders stemming from prenatal alcohol exposure, and presented evidence and witnesses claiming his birth mother had used drugs and drank alcohol while pregnant with him. Cruz’s adoptive mother was not open about this with health professionals or educators, preventing him from receiving the appropriate interventions, the defense claimed.

Of the 12 jurors, three voted against the death penalty, jury foreman Benjamin Thomas told CNN affiliate WFOR, saying, “I don’t like how it turned out but it’s that’s how the jury system works.”

“There was one with a hard ‘no,’ she couldn’t do it, and there was another two that ended up voting the same way,” said Thomas.

The woman who was a hard no “didn’t believe because he was mentally ill he should get the death penalty,” Thomas said.

The parents of Alyssa Alhadeff, another 14-year-old victim, said they were disgusted by the verdict.

“I’m disgusted with those jurors,” Alyssa’s father, Ilan Alhadeff, said. “I’m disgusted with the system, that you can allow 17 dead and 17 others shot and wounded, and not get the death penalty. What do we have the death penalty for?”

Linda Beigel Schulman, the mother of geography teacher Scott Beigel, echoed that question, telling reporters, “If this was not the most perfect death penalty case, then why do we have the death penalty at all?”

She, like many of the families who addressed reporters, commended prosecutors for their work, saying they perfectly executed the state’s arguments against the gunman.

“Justice was not served today,” her husband, Michael Schulman, said.

The jury’s recommendation robbed the victims’ families of justice, the father of 14-year-old Jaime Guttenberg told reporters, saying it could make another mass shooting “more likely.”

“We are all in this position now of doing the work that we do around this country to keep this from happening to another family,” Fred Guttenberg said after court. “This decision today only makes it more likely that the next mass shooting will be attempted.”

“This jury failed our families today,” Guttenberg said.

The widow of 49-year-old Christopher Hixon, who was the school’s athletic director, said the jury’s decision indicated the gunman’s “life meant more than the 17 that were murdered” and the rest of the community who remain “terrorized and traumatized.”

Debra Hixon also rejected the defense’s arguments about the gunman’s mental or intellectual struggles, pointing to another one of her sons, who has special needs.

“I have a son that checked … a lot of those boxes that the shooter did as well,” she said. “And you know what? My son’s not a murderer. My son’s the sweetest person that you could ever meet.

Florida Gov. Ron DeSantis also was disappointed by the jury’s decision, he said Thursday, as well as how long it took for the judicial process to play out.

“I was very disappointed to see that,” he said of the jury’s verdict. “I’m also disappointed that we’re four and a half years after these killings, and we’re just now getting this.”

Broward County Public Defender Gordon Weekes commended the attorneys in his office who represented the gunman, telling reporters, “With the greatest bit of sympathy, we attempted to prepare this case and present this case in the most professional and legal manner as we could.”

Weekes urged the community to respect the verdict, saying Thursday “is not a day of celebration, but a day of solemn acknowledgment, and a solemn opportunity to reflect on the healing that is necessary for this community.”

Weekes declined to comment when asked whether Cruz had a reaction to the jury’s recommendation.

To decide on a recommended sentence, jurors were asked to weigh the aggravating factors and mitigating circumstances presented by the prosecution and defense during trial.

Prosecutors pointed to seven aggravating factors, including that the killings were especially heinous, atrocious or cruel, as well as cold, calculated and premeditated. Other aggravating factors, prosecutors said, were that the defendant knowingly created a great risk of death to many people, and that he disrupted a lawful government function – in this case, the running of a school.

The defense, meantime, offered 41 possible mitigating circumstances, including that Cruz was exposed to alcohol, drugs and nicotine in utero; that he has a “neurodevelopmental disorder associated with prenatal alcohol exposure;” and that his adoptive mother did not follow the recommendations of medical, mental health and educational providers, among many others.

For each victim, jurors unanimously agreed the state had proven the aggravating factors beyond a reasonable doubt and that they were sufficient to warrant a possible death sentence.

However, to recommend death, all jurors still would have needed to find that the aggravating factors outweighed the mitigating circumstances. They did not unanimously agree on this, the jurors indicated Thursday on their verdict forms – meaning Cruz must be sentenced to life in prison and not death.

In closing arguments Tuesday, prosecutors argued Cruz’s decision to commit the shooting was deliberate and carefully planned, while Cruz’s defense attorneys offered evidence of a lifetime of struggles at home and in school.

“What he wanted to do, what his plan was and what he did, was to murder children at school and their caretakers,” lead prosecutor Michael Satz said Tuesday. “The appropriate sentence for Nikolas Cruz is the death penalty,” he concluded.

However, defense attorney Melisa McNeill said Cruz “is a brain damaged, broken, mentally ill person, through no fault of his own.” She pointed to the defense’s claim that Cruz’s mother used drugs and drank alcohol while his mother was pregnant with him, saying he was “poisoned” in her womb.

“And in a civilized humane society, do we kill brain damaged, mentally ill, broken people?” McNeill asked Tuesday. “Do we? I hope not.”

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US

Parkland shooter’s death penalty trial nears its end as the prosecution and defense make closing arguments

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CNN
 — 

Prosecutors have called on a Florida jury to recommend the Parkland school shooter be put to death, saying in a closing argument Tuesday he meticulously planned the February 2018 massacre, and that the facts of the case outweigh anything in his background that defense attorneys claim warrant a life sentence.

“What he wanted to do, what his plan was and what he did, was to murder children at school and their caretakers,” lead prosecutor Michael Satz said of Nikolas Cruz, who pleaded guilty to 17 counts of murder and 17 counts of attempted murder for the shooting at Marjory Stoneman Douglas High School, in which 14 students and three school staff members were killed. “That’s what he wanted to do.”

But Cruz “is a brain damaged, broken, mentally ill person, through no fault of his own,” defense attorney Melisa McNeill said in her own closing argument, pointing to the defense’s claim that Cruz’s mother used drugs and drank alcohol while his mother was pregnant with him, saying he was “poisoned” in her womb.

“And in a civilized humane society, do we kill brain damaged, mentally ill, broken people?” McNeill asked Tuesday. “Do we? I hope not.”

With closing arguments, the monthslong sentencing phase of Cruz’s trial is nearing its end, marking prosecutors’ last chance to convince the jury to recommend a death sentence and defense attorneys’ last opportunity to lobby for life in prison without parole.

Prosecutors have argued Cruz’s decision to commit the deadliest mass shooting at an American high school was premeditated and calculated, while Cruz’s defense attorneys have offered evidence of a lifetime of struggles at home and in school.

Each side was allotted two and a half hours to make their closing arguments.

Jury deliberations are expected to begin Wednesday, during which time jurors will be sequestered, per Broward Circuit Judge Elizabeth Scherer.

If they choose to recommend a death sentence, the jurors must be unanimous, or Cruz will receive life in prison without the possibility of parole. If the jury does recommend death, the final decision rests with Judge Scherer, who could choose to follow the recommendation or sentence Cruz to life.

In his remarks, Satz outlined prosecutors’ reasoning, including the preparations Cruz made. For a “long time” prior to the shooting, Satz said, Cruz thought about carrying it out.

Revisiting ground covered in the trial, the prosecutor said Cruz researched mass shootings and their perpetrators, including those at a music festival in Las Vegas; at a movie theater in Aurora, Colorado; at Virginia Tech; and at Colorado’s Columbine High School.

Cruz modified his AR-15 to help improve his marksmanship; he accumulated ammunition and and magazines; and he searched online for information about how long it would take police to respond to a school shooting, Satz said.

Then, the day of, Satz said, Cruz hid his tactical vest in a backpack and took an Uber to the school, wearing a Marjory Stoneman Douglas JROTC polo shirt to blend in. Based on his planning, he told the Uber driver to drop him off at a specific pedestrian gate, knowing it would be open soon before school let out.

“All these details he thought of, and he did,” Satz said.

Satz also detailed a narrative of the shooting, which he called a “systematic massacre,” recounting how the shooter killed or wounded each of his victims, whose families and loved ones filled the courtroom gallery.

Cruz, wearing a striped sweater and flanked by his public defenders, looked on expressionless, occasionally looking down at the table in front of him or talking to one of his attorneys.

“The appropriate sentence for Nikolas Cruz is the death penalty,” Satz concluded.

In her own statement, McNeill stressed to jurors that defense attorneys were not disputing that Cruz deserves to be punished for the shooting.

“We are asking you to punish him and to punish him severely,” she said. “We are asking you to sentence him to prison for the rest of his life, where he will wait to die, either by natural causes or whatever else could possibly happen to him while he’s in prison.”

The 14 slain students were: Alyssa Alhadeff, 14; Martin Duque Anguiano, 14; Nicholas Dworet, 17; Jaime Guttenberg, 14; Luke Hoyer, 15; Cara Loughran, 14; Gina Montalto, 14; Joaquin Oliver, 17; Alaina Petty, 14; Meadow Pollack, 18; Helena Ramsay, 17; Alex Schachter, 14; Carmen Schentrup, 16; and Peter Wang, 14.

Geography teacher Scott Beigel, 35; wrestling coach Chris Hixon, 49; and assistant football coach Aaron Feis, 37, also were killed – each while running toward danger or trying to help students to safety.

The lengthy trial – jury selection began six months ago, in early April – has seen prosecutors and defense attorneys present evidence of aggravating factors and mitigating circumstances, reasons Cruz should or should not be put to death.

The state has pointed to seven aggravating factors, including that the killings were especially heinous, atrocious or cruel, as well as cold, calculated and premeditated, Satz said Tuesday. Other aggravating factors include the fact the defendant knowingly created a great risk of death to many people and that he disrupted a lawful government function – in this case, the running of a school.

Together, these aggravating factors “outweigh any mitigation about anything about the defendant’s background or character,” Satz said.

Satz rejected the mitigating circumstances presented during trial by the defense, including that Cruz’s mother smoked or used drugs while pregnant with him. Those factors would not turn someone into a mass murderer, Satz argued, adding it was the jury’s job to weigh the credibility of the defense witnesses who testified to those claims.

Satz cast doubt on the defense’s other proposed mitigators. In response to a claim that Cruz has neurological or intellectual deficits, Satz pointed to the gunman’s ability to carefully research and prepare for the Parkland shooting.

In response to claims Cruz was bullied by his peers, Satz argued Cruz was an aggressor, pointing to testimony that he walked around in high school with a swastika drawn on his backpack, along with the N-word and other explicit language.

“Hate is not a mental disorder,” Satz said.

During trial, prosecutors presented evidence showing the gunman spent months searching online for information about mass shootings and left behind social media comments sharing his express desire to “kill people,” while Google searches illustrated how he sought information about mass shootings. On YouTube, Cruz left comments like “Im going to be a professional school shooter,” and promised to “go on a killing rampage.”

“What one writes,” Satz said, referencing Cruz’s online history Tuesday, “what one says, is a window to someone’s soul.”

In their own case, the public defenders assigned to represent Cruz have asked the jury to take into account his troubled history, from a dysfunctional family life to serious mental and developmental issues, with attorney McNeill describing him earlier in the trial as a “damaged and wounded” person.

“His brain is broken,” she said during her opening statement in August. “He’s a damaged human being.”

Among the first witnesses was Cruz’s older sister, Danielle Woodard, who testified their mother, Brenda Woodard, used drugs and drank alcohol while pregnant with him – something McNeill said made his brain “irretrievably broken” through no fault of his own.

“She introduced me to a life that no child should be introduced to,” she said. “She had no regards for my life or his life.”

The defense also called teachers and educators who spoke to developmental issues and delays Cruz exhibited as a young child, including challenges with vocabulary and motor skills. Various counselors and psychiatrists also testified, offering their observations from years of treating or interacting with Cruz.

Former Broward County school district counselor John Newnham testified Cruz’s academic achievements in elementary school were below expectations. Cruz would describe himself as “stupid” and a “freak,” Newnham said.

Despite these apparent issues, Cruz’s adoptive mother, the late Lynda Cruz, was reluctant to seek help, according to the testimony of a close friend who lived down the street from the family, Trish Devaney Westerlind.

Newnham’s testimony echoed that: While Lynda Cruz was a caring mother, after the death of her husband, she would ask for help but not use the support available.

“She was overwhelmed,” Newnham said. “She appeared to lack some of the basic foundations of positive parenting.”

Westerlind still accepts calls from Cruz and, says though he’s in his 20s, Cruz still talks like an 11-year-old child.

Cruz’s attorneys acknowledged as he grew older he developed a fascination with firearms, and school staff raised concerns about his behavior to authorities, McNeill said.

In June 2014, an adolescent psychiatrist and a school therapist at the school Cruz attended at the time wrote a letter to an outside psychiatrist treating Cruz, in which they expressed concern Cruz had become verbally aggressive and had a “preoccupation with guns” and “dreams of killing others.”

The psychiatrist, Dr. Brett Negin, who testified he treated Cruz between the ages of 13 and 18, said he never received the letter.

As part of the prosecution’s case, family members of the victims were given the opportunity this summer to take the stand and offer raw and emotional testimony about how Cruz’s actions had forever changed their lives. At one point, even members of Cruz’s defense team were brought to tears.

“I feel I can’t truly be happy if I smile,” Max Schachter, the father of 14-year-old victim Alex Schachter, testified in August. “I know that behind that smile is the sharp realization that part of me will always be sad and miserable because Alex isn’t here.”

Before the prosecution rested, jurors also visited the site of the massacre, Marjory Stoneman Douglas’ 1200 building, which had been sealed since the shooting to preserve the crime scene – littered with dried blood, Valentine’s Day cards and students’ belongings – for the trial.

The defense’s case came to an unexpected end last month when – having called just 26 of 80 planned witnesses – public defenders assigned to represent Cruz abruptly rested, leading the judge to admonish the team for what she said was unprofessionalism, resulting in a courtroom squabble between her and the defense (the jury was not present).

Defense attorneys would later file a motion to disqualify the judge for her comments, arguing in part they suggested the judge was not impartial and Cruz’s right to a fair trial had been undermined. Prosecutors disagreed, writing “judicial comments, even of a critical or hostile nature, are not grounds for disqualification.”

Scherer ultimately denied the motion.

Prosecutors then presented their rebuttal, concluding last week following a three-day delay attributed to Hurricane Ian. Their case included footage of Cruz telling clinical neuropsychologist Dr. Robert Denney he chose to carry out the shooting on Valentine’s Day because he “felt like no one loved me, and I didn’t like Valentine’s Day and I wanted to ruin it for everyone.”

Denney, who spent more than 400 hours with the gunman, testified for the prosecution that he concluded Cruz has borderline personality disorder and anti-social personality disorder. But Cruz did not meet the criteria for fetal alcohol spectrum disorder, as the defense has contended, Denney testified, accusing Cruz of “grossly exaggerating” his “psychiatric problems” in tests Denney administered.

When read the list of names of the 17 people killed and asked if fetal alcohol spectrum disorder explained their murders, Denney responded “no” each time.

Correction: An earlier version of this story misspelled the first name of defense attorney Melisa McNeill.

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Health

Antidepressant use during pregnancy doesn’t harm child development, study says

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CNN
 — 

Expectant mothers taking many common antidepressants need no longer worry the medication may harm their child’s future behavioral or cognitive neurodevelopment, a new study found.

Antidepressant use during pregnancy was not associated with autism, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, developmental speech, language, learning and coordination disorders or intellectual disabilities, according to a study of over 145,000 women and their children across the United States followed for up to 14 years. The study was published Monday in the journal JAMA Internal Medicine.

“This is truly an important paper. Women and health professionals are often concerned about antidepressants in pregnancy, and sometimes decide to suddenly stop these medications as soon as pregnancy becomes known,” said Carmine Pariante, professor of biological psychiatry at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, in a statement.

Instead, women with depression and other mental conditions for which antidepressants are prescribed should be told the risk in pregnancy “is not as high as previously thought,” said Pariante, who was not involved in the study.

“I am grateful for this study,” Dr. Tiffany Moore Simas, a member of the Committee on Clinical Practice Guidelines on Obstetrics for the American College of Obstetricians and Gynecologists, told CNN via email.

“One in 5 perinatal individuals will experience a mental health condition,” said Moore Simas, who was not involved in the study. “We must stop shaming them for doing what is needed to care for themselves. Healthy babies need healthy mothers.”

Numerous studies over the decades have found associations between antidepressant use during pregnancy and developmental concerns in children, predominately autism and ADHD. But newer research has called the quality of that prior research into question. Many older studies were observational in nature and often failed to control for contributing factors such as obesity and other health conditions, environmental toxins, inflammation and even maternal stress.

Older research also failed to consider the impact on a developing fetus carried by a mother with uncontrolled depression, anxiety or another psychiatric disorder. Not treating a mother’s mental disorder has also been linked to “stillbirth, preterm birth, growth restriction and birthweight weight issues, impaired bonding, adverse neurodevelopmental outcomes, and increased risk of offspring mental health,” Moore Simas said.

Depressed women can also miss prenatal visits, skip meals, overuse alcohol or cigarettes, and in general fail to care for their growing fetus as they fail to care for themselves, experts say.

A very small number of antidepressants have been linked to an increased risk of birth defects, according to the US Centers for Disease Control and Prevention, so pregnant women should discuss their medication with their doctors.

Despite the advance of knowledge showing little to any impact from most common antidepressants, many physicians and mothers-to-be are still wary of their use, Moore Simas said.

Consultations between pregnant people and their doctors regarding antidepressant use are often “framed in the context of the risk of the medications – despite the data overall being reassuring,” she said. “Conversations about medication use for mental health in pregnancy or otherwise needs to account for the risk of untreated disease.”

The American College of Obstetricians and Gynecologists meets regularly to update guidance on medications that are safe to use during pregnancy, a spokesperson told CNN, and will be reviewing recent research such as this new study.

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Health

Flint residents reported high rates of depression, PTSD years after water crisis

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CNN
 — 

In a new study, researchers say the experiences of residents of Flint, Michigan, show that environmental disasters like the water crisis can have long-term consequences for mental health.

Flint residents reported changes to the water’s color, smell and taste soon after the city turned to the Flint River as a water source in April 2014. Following outraged pushback by residents and reports of children with mysterious illnesses, tests by the US Environmental Protection Agency and scientists at Virginia Tech detected dangerous levels of lead in the water.

For the new study, published in JAMA Network Open on Tuesday, nearly 2,000 adults living in Flint throughout the crisis were asked about their experiences, their psychological symptoms five years after the crisis and whether they had access to or used mental health services between August 2019 and April 2020. Most of the responses were gathered before the Covid-19 pandemic.

Researchers found that 1 in 5 Flint residents met the criteria for presumptive major depression, 1 in 4 for presumptive post-traumatic stress disorder (PTSD) and more than 1 in 10 for both disorders.

“Our findings from the study conducted with Flint residents five years after the water crisis indicate that Flint residents report extremely high levels of PTSD and depression, which are higher than rates found in Veterans post-deployment and US and global prevalence rates,” Angela Moreland-Johnson, one of the study authors and an assistant professor at the National Crime Victims Research and Treatment Center at the Medical University of South Carolina, told CNN in an email.

More than half of the people surveyed were women, and more than half of all respondents identified their race as Black or African American.

“Individuals who believed that their or their family’s health was moderately or greatly harmed by the water crisis were 123% more likely than their peers to have depression, 66% more likely to have PTSD, and 106% more likely to have comorbid depression and PTSD,” the study said.

According to the results, men were 28% less likely than women to meet the criteria for depression, and Black residents were offered more mental health services than White residents.

“The Flint community may require expanded mental health services to meet continued psychiatric need,” the researchers wrote in the study. “National disaster preparedness and response programs should consider psychiatric outcomes.”

The new study did not examine the mental health of residents in other communities such as Jackson, Mississippi, which recently experienced its own water crisis. But Moreland-Johnson said that the study’s results suggest that people involved in crises like Flint “may experience heightened PTSD and depression.”

The finding is especially relevant for those who experienced a potentially traumatic event before an environmental disaster, as “these prior experiences may place them at heightened risk for mental health concerns including PTSD and depression.”

Researchers said that communication with residents is key.

“Importantly, we found that people who experienced the greatest harm from the Flint crisis and those with low confidence in the information provided by authorities about water safety were significantly more likely to experience adverse mental health outcomes half a decade after the crisis,” study author Salma Abdalla, a research fellow with the Boston University School of Public Health, told CNN in an email.

Eight years after the water crisis began in Flint – even with new pipes and a different water source – some city residents recently told CNN they still don’t trust the water.

“I’ll never drink the water again,” said Audra Bell, whose family buys about 10 cases of bottled water a week for cooking, brushing teeth and making coffee and for them and their dogs to drink.

Their neighbor LeeAnne Walters says she does the same.

“There’s not been any justice in Flint. There has been no rebuilding of trust with the government because they haven’t done anything to do so. So the voices go unheard, and people have serious PTSD when it comes to water. I don’t know if there will ever be justice as far as Flint and the damage that’s been done to the people,” she told CNN.

Bell said the crisis has been hard on families, and choosing to stay in Flint hasn’t been an easy decision.

Her advice to Jackson residents: “Just do the best that you can, and keep your family safe.”

The water is back on in Jackson after historic flooding took out the water treatment plant where pumps were already failing. But problems for residents may linger.

Abdalla said the research in Flint “highlights the importance of early action following environmental disasters such as the current Jackson MS water crisis.”

“It showcases the importance of coupling efforts to fix the water supply system with clear communication by officials to restore trust in the safety of the system. Efforts should also include mental health recourses to those who need it,” Abdalla said.

CNN has contacted the city of Jackson to find out what options residents have for mental health support but did not immediately hear back. In a statement, the Mississippi Department of Mental Health said community mental health centers can provide therapy, peer support and intensive outpatient programs for people in need of psychiatric care and substance abuse treatment.

In a statement to CNN, study author Aaron Reuben, a postdoctoral fellow with the Medical University of South Carolina, said the new research “indicates that public works environmental disasters have a long tail, with psychological harms that can continue for many years if not treated.”

“Simply put, clean water is a requirement for health, well-being, productivity, and dignity – and we are failing our citizens in providing for this basic necessity. We feel that the residents of Flint who lived through the water crisis have been remarkably resilient – and yet there is still a large, unmet need for mental health services to address the psychological impacts of the event, which are reflected in very high rates of diagnosable depression and PTSD across the Flint community,” Reuben said.

“The lesson for communities like Jackson, MS, is to not overlook psychological injury, and to not assume that, just because community members are resilient, they could not benefit from services to address the psychological scars of a long-term water crisis.”

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Health

Having a history of psychological distress may trigger long Covid, study says

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CNN
 — 

You may have up to a 50% higher risk of developing long Covid-19 if you suffer from common psychiatric issues such as anxiety or depression, a recent study found.

Signs of the malady can include breathing problems, brain fog, chronic coughing, changes in taste and smell, overwhelming fatigue, difficulties in performing daily life functions, and disruptions in sleep that can last months, even years, after the infection has cleared the body.

People who self-identified as having anxiety, depression or loneliness, or who felt extremely stressed or worried frequently about the coronavirus were more likely to experience long Covid-19, according to the study published this month in JAMA Psychiatry.

“We found participants with two or more types of psychological distress before infection had a 50% higher risk of getting long Covid,” said study coauthor Dr. Siwen Wang, a research fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston.

About 40 million adults over 18 in the United States live with an anxiety disorder, while over 21 million have suffered from major depression, according to national statistics. Many mental health conditions often overlap, with concurrent diagnoses, experts say. More than a fifth of adults in the US (22%) and the UK (23%) say they often or always feel lonely, a Kaiser Family Foundation study said.

“Having higher levels of psychological distress prior to a Covid infection also increased the risk of getting long Covid by 50%,” Wang said. “Those people also reported more symptoms seen in long Covid.”

It’s possible that some could use the study’s findings to support a hypothesis that post-Covid illness is psychosomatic, a prevalent belief in the early days of the pandemic, said Dr. Wesley Ely, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee. He was not involved in the study.

Instead, the study’s message should be that people with existing psychological distress are closer to the “disaster” of long Covid, said Ely, codirector of Vanderbilt’s Critical Illness, Brain Dysfunction and Survivorship Center.

“Imagine 10 people are running a race, and you give five people a head start,” Ely said. “Those are the people who already had a mental health issue – they are just closer to the unfortunate finish line of getting long Covid.”

The idea that mental distress can affect the body in negative ways isn’t new. It’s also a two-way lane: Having a chronic illness is strongly associated with the development of depression and other psychological disorders.

With common noninfectious disorders such as heart disease, “depression/anxiety/emotional distress do appear to play a role,” said Dr. Joseph Bienvenu, a professor in the department of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, in an email. He was not involved in the study.

People with major depression can develop blood pressure issues and may be more likely to have a heart attack. Chronic depression, stress and anxiety have been linked to insomnia, and a lack of quality sleep is a major culprit in the development of obesity, type 2 diabetes and other disorders.

And psychological distress has been shown to weaken the immune system, said study coauthor Dr. Angela Roberts, an associate professor of pulmonary and critical care medicine at Stanford University in California.

“Your brain and your immune system are very tightly interconnected,” Roberts said. “Studies have shown when you’re depressed or anxious, your immune system doesn’t work as well against targets like viruses and bacteria.”

To do the new study, researchers worked with nearly 55,000 people with no history of Covid-19 who were enrolled in three major longitudinal studies: the Nurses’ Health Study II, the Nurses’ Health Study 3 and the Growing Up Today Study. Participants in those studies tend to be predominantly female and White, which can limit how much the results can be generalized to a wider population, the study said.

Participants were asked about their mental health in April 2020, quite early in the pandemic. They continued to fill out mental health surveys each month for six months, then quarterly. At the end of a year, researchers narrowed the pool of subjects to nearly 3,200 people who had developed Covid-19 and met study requirements.

“This study is particularly nice in that participants’ baseline characteristics were assessed independently in time from their later Covid symptoms,” Johns Hopkins’ Bienvenu said.

Compared with people not having mental distress, those with depression and loneliness had a 1.32 times greater chance of developing long Covid symptoms. Participants who worried a good deal about the coronavirus – predominantly people of color, women and asthma sufferers – were 1.37 times more likely to develop long Covid, the study found.

Anxiety was associated with a greater risk – 1.42 times more likely – but people with higher levels of perceived stress were nearly 50% more likely to develop post-Covid symptoms, said Wang, the study coauthor.

All the associations between psychological distress and long Covid remained significant, even after researchers adjusted for demographics, body weight, smoking status and a history of asthma, cancer, diabetes, and high blood pressure or cholesterol.

In addition, all types of psychological distress except loneliness were linked to a higher risk of being unable to complete the actions of daily life due to ongoing long Covid symptoms.

While many cases of long Covid are mild and resolve within a few months, other patients continue to suffer for an extended time. Some still haven’t recovered their quality of life more than two years into the pandemic, according to Dr. Aaron Friedberg, a clinical assistant professor of internal medicine who works in the Post-Covid Recovery Program at Ohio State University’s Wexner Medical Center in Columbus.

“They can’t think, they can’t breathe. I have one person whose disease is so severe, they basically can’t get out of bed,” Friedberg told CNN in an earlier interview. “I saw a person recently who is still not working because of Covid symptoms two years later.”

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