Research: Mental Health in MS; Nutrition for Mental Health

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jimmylegs
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Research: Mental Health in MS; Nutrition for Mental Health

Post by jimmylegs » Mon Oct 30, 2017 3:43 pm

Nutritional medicine as mainstream in psychiatry
http://www.sciencedirect.com/science/ar ... 6614000510
Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest benefits in addressing the burden of poor mental health worldwide. Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology. Evidence is steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental health, and for the select use of nutrient-based supplements to address deficiencies, or as monotherapies or augmentation therapies. We present a viewpoint from an international collaboration of academics (members of the International Society for Nutritional Psychiatry Research), in which we provide a context and overview of the current evidence in this emerging field of research, and discuss the future direction. We advocate recognition of diet and nutrition as central determinants of both physical and mental health.

agree :)
take control of your own health
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don't let suboptimal self care muddy any underlying diagnostic picture!

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Dietitians' Review: Mental Health via Nutrition

Post by jimmylegs » Wed Nov 08, 2017 3:03 am

Promoting Mental Health through Healthy Eating and Nutritional Care
https://www.dietitians.ca/Downloads/Pub ... -2012.aspx

Key Findings
Mental health conditions are associated with long lasting disability and significant mortality through suicide, medical illness, and accidental death. It is estimated that mental health conditions cost the Canadian economy $51 billion dollars annually. By 2030, mental health issues are expected to be the leading cause of disability in Canada. Current treatments for mental health conditions (e.g., pharmaceuticals) only provide partial benefit. Other approaches, such as targeted nutrition interventions that can maintain the structure and function of neurons and brain centres and therapeutic approaches to modify disordered eating patterns, can effectively augment medical approaches to mental health care.
Nutritional interventions, as part of collaborative and integrative programs aimed at mental health promotion, contribute to positive health outcomes and are cost-effective. Comprehensive mental health promotion interventions that include nutrition education and food skills training components, with a focus on pregnant moms, infants, children, and adolescents, can lead to reductions in neural tube defects, low birth weight, and premature delivery, and an positively affect cognitive development, behaviour, and academic performance. Positive parenting programs that include healthy lifestyle interventions have led to a return on investment in excess of 6% based on reduced use of special education, social, mental health, and criminal justice services. Simulations of healthy worksite programs aimed at mental health promotion have shown returns on investment of 9 to 1. Many nutrition initiatives that Registered Dietitians help facilitate support mental health by enhancing social inclusion, self-reliance, self-determination, food security, healthy body image, and reducing health and social inequities.
Interventions provided by Registered Dietitians to individuals with mental health conditions and their care providers can lead to reduced nutrition-related side effects of psychiatric medications, improved cognition, better self-management of concurrent and comorbid conditions, and improved overall occupational, social, and psychological functioning. Targeted nutritional interventions exist for mental health symptoms such as depression, mania, psychosis, delirium, dementia, disordered eating, sleep problems, and substance use. In addition, therapeutic approaches such as cognitive behaviour therapy, mindful based eating awareness, dialectical behaviour therapy, motivational interviewing, cognitive adaptive training, and applied behavioural analysis used by Registered Dietitians in mental health practice show evidence that food intakes and eating behaviours can be positively modified and lead to enhanced well-being.
Other issues affecting mental health and dietetics practice include food insecurity, use of natural health products, and debate about food addictions. Mental health consumers may have diverse needs related to gender, life stage, culture, history of trauma, and co-occuring conditions. Registered Dietitians can draw on knowledge and skills such as cultural competence, trauma-informed care, and harm reduction, to foster mental well-being, reduce disparities, and strengthen response to diverse communities.

Recommendations
Optimal nutrition supports the mental health of Canadians, and could reduce health and social costs.
To better integrate nutritional and mental health services, the following recommendations are made:
1. Advocate for Nutrition and Mental Health in Practice and Policy
Advocacy is needed for nutrition interventions targeted for mental health consumers. Strategies include food security initiatives, healthy-eating education, food skills training (e.g., preparing, cooking, growing food), promoting nutrition literacy (e.g., develop easy-to-understand nutrition labelling of foods), and development of nutrition and mental health educational materials (e.g., diet to prevent mental health problems, how to manage nutritional side effects of psychiatric medications, nutrition guidelines for specific conditions).
Dietitian services are important to all levels of mental health practice: promotion, prevention, treatment, and rehabilitation. Diet therapy should be recognized as a cornerstone of mental health interventions in clinical practice guidelines and standards of care. Adequate funding is needed for nutrition services in mental health care, with monitoring and evaluation for effectiveness and efficiency.
Continued advocacy for nutrition services is needed at broader levels of public health and policy.
Government and non-government agencies are recognizing the links between diet and mental health.Public health messaging and social marketing initiatives need to highlight the importance of healthy eating and mental health. Initiatives targeted at building healthy food environments (e.g., sodium reduction, banning trans fats, food guidelines for schools) are important mechanisms to support mental
health in the general population. Food policy can be evaluated for impact, effectiveness, and appropriateness of key food regulatory initiatives. Standardized measurement of the cost of healthy eating should continue to be conducted regionally to monitor trends
and advocate for food security and poverty reduction...
take control of your own health
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ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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2017 study: Meeting MS Patients' Mental Health Needs

Post by jimmylegs » Thu Nov 16, 2017 3:15 pm

Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals
http://www.tandfonline.com/doi/abs/10.1 ... 16.1180547

Abstract
Purpose:
To explore perspectives and experiences of people with multiple sclerosis (MS) and health care professionals of mental health support for MS in the UK.

Method: 24 people with MS, 13 practice nurses, 12 general practitioners (GPs) and 9 MS specialist nurses were recruited through community groups and primary care practices across North West England. Semi-structured interviews were conducted, and data analyzed thematically using constant comparative analysis within and across the data sets. The theoretical framework of candidacy was used to interrogate data.

Results: Four themes were identified: candidates for care, management choices, defining roles, and permeability and responsiveness.

Discussion: Candidacy for care, and symptom management, depended on the framing of symptoms through a social or medical model of depression. Normalizing symptoms could prevent help-seeking by patients. Reported referral behavior varied by professional group, based on perceived remit, competency and training needs. GPs were perceived by patients and other professionals as central for management of mental health needs in MS, but may not perceive this role themselves, suggesting a need for increased knowledge, training, and improved access to specialist care.

(comment: classic, same issue with nutrition/lack of referral thereto)

Implications for Rehabilitation
Anxiety and depression are common in people with MS.

Management of mental health needs in people with MS relies on complex decisions made by both people with MS and health care professionals.

General practitioners may play a key role in the ongoing management of mental health needs of people with MS.
take control of your own health
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ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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Re: 2017 study: Meeting MS Patients' Mental Health Needs

Post by ElliotB » Fri Nov 17, 2017 4:28 am

"Anxiety and depression are common in people with MS"

Anxiety and depression are common in the general population!

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Re: 2017 study: Meeting MS Patients' Mental Health Needs

Post by jimmylegs » Fri Nov 17, 2017 8:11 am

certainly, but do you have one or more good references with stats for that? i'm interested in the actual comparison, if you've managed successful related google scholar time.
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Re: 2017 study: Meeting MS Patients' Mental Health Needs

Post by jimmylegs » Fri Nov 17, 2017 2:34 pm

findings from norway

Anxiety and depression in multiple sclerosis. A comparative population-based study in Nord-Trøndelag County, Norway
http://journals.sagepub.com/doi/abs/10. ... 8509351542
"Anxiety and depression occur more frequently in multiple sclerosis patients than in the general population."
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2014 post: Excessive Attention Seeking and Drama Addiction

Post by jimmylegs » Thu Aug 30, 2018 7:10 am

some less than optimal linguistics in here, but some good points also

Excessive Attention Seeking and Drama Addiction
Portrait of neglect

https://www.psychologytoday.com/us/blog ... -addiction

Some behavioral problems seem to plague compulsive overeaters and substance abusers more than other groups. Excess attention seeking appears to be one of them. All humans require attention. Without getting and giving attention, you could not have a social species. Getting attention is necessary for life’s vital enterprises and can be the difference between life and death in a crisis. Therefore, not getting adequate attention can threaten the quality and sustainability of life. [1] Thus, getting functional social attention is understandable. However, extreme attention seekers go to unhealthy lengths that are driven by emotional desperation.[2]

Excessive attention seeking is not a character flaw. It is a brain wiring response to early developmental trauma caused by neglect.[3] The developing brain observes its environment and wires itself accordingly to survive in that world that it presumes will be like those experiences.[4] Newborns are extremely dependent on getting their mother’s attention for survival. The more their needs are neglected during early development the more the child equates getting attention with survival and safety.[5] In turn, the more he or she develops the belief system that it is necessary to go to whatever lengths to get attention.

How excessive attention seeking evolves in adults

Brains wired to equate lack of attention as dangerous, naturally respond to it as threat in the amygdala, a subcortical structure, where thinking does not occur. [6-11] Now the anterior cingulate cortex (ACC), which is like a micromanaging mother, “don’t do this, do that, stop that, go here, don’t go there” can intervene in this, if given the opportunity.[12-16] But as my friend Greg says, “If a dog had wings, he wouldn’t be a dog.” The ACC is in the cortical thinking part of the brain, which disengages when the amygdala swings into action.[12, 17-21] In addition, the ACC needs serotonin to do its micromanaging. There are a number of conceivable problems with that: people who have these types of core issues are often over stressed. Sustained excess stress limits serotonin availability.[22-25] In addition, hypothalamic remodeling is one of the consequences of neglect.[23, 26-31] This often means that your hypothalamus is smaller, and has fewer receptors for serotonin and other neurochemicals. Thus, even if your ACC has troopers to dispatch, they may not have anywhere to land and do their work.

How This Partners With Drama Addiction

The obvious answer is drama gets attention. However, it is more than that. Drama causes the pituitary gland and hypothalamus to secrete endorphins, which are the pain-suppressing and pleasure-inducing compounds, which heroin and other opiates mimic.[32-40] Hence, drama eases the anxiety of wanting more attention than you are getting. Naturally, since drama uses the same mechanisms in the brain as opiates, people can easily become addicted to drama.[41-45] Like any addiction, you build up a tolerance that continuously requires more to get the same neurochemical affect.[46-49] In the case of drama, then means you need more and more crises to get the same thrill.

There is also another factor. Using drama as a drug feels good so it is rewarding. Reward uses dopamine, the brain’s happy dance drug.[50-52] Dopamine works by releasing more dopamine on anticipating getting the reward (the way evolution gets you to want to do what you need to do).[52-54] Like all addiction, this begins as a goal-directed behavior in the ventral striatum [55-58](I’m turning on the light because I walked into a dark room and want light), which becomes a stimulus response behavior in the dorsal striatum (I am flipping the light switch because every time I walk into a dark room I automatically flip the light switch). Once this train leaves the station, you have your classic attention seeking drama queen.

Is it fixable?

No, it is not fixable in the sense that you cannot change your brain’s basic hardwiring.[4, 27, 29, 59] Nor can you completely erase the residual effects of early life trauma.[4, 23, 27] However, it is manageable. One begins by accepting who they are, and loving what they have more than what they do not have. This means even if what they have is a challenge and difficult to manage. In additon, find a person who is honest, and cares enough about you to tell you the truth, even when you do not want to hear it. You can ask this person if your emotional interpretation of a situation is over the top. Use creative outlets to lessen your baseline stress level. Meditate. Do yoga. Act as if you are not a drama queen and a compulsive attention seeker. The more you do that the more efficiently those neurons will fire. Hence, the easier that behavior will become.

I suspect the reason compulsive overeaters, alcoholics and substance abusers are more prone to excess attention seeking and drama addiction is because those populations are more likely to have endured developmental trauma. The important thing to realize here is that not all neglect is evidence of a lack of love. Sometimes, people only have so much they can give; sometimes that is not enough. There is healing in accepting that your parents did not give you as much attention as you required. Forgiving them for being who they were is getting to higher ground. Sometimes, you have to give yourself the attention you needed from parents. However, most importantly, at all times, remain fabulous and phenomenal.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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2018 commentary: Nutrition <=> Mental Health

Post by jimmylegs » Sun Sep 02, 2018 4:54 pm

Nutrition and mental health: bidirectional associations and multidimensional measures
https://journals-scholarsportal-info.pr ... hbaamm.xml

"If modification of diet could help prevent mental health conditions, or reduce their symptoms, the benefits could be large: mental health disorders are common around the world(1) and their health burden is high and increasing(2). Brain structure, brain function and neuronal plasticity are all influenced by nutrients, and the immune system and antioxidant defence system too; thus there are various plausible mechanisms through which dietary factors could influence mental health(3).
However, there is more to the link between nutrition and mental health than the role of nutrients in biological mechanisms that may influence mental health. Associations between nutritional factors and mental health are likely to be bidirectional. While nutritional factors may influence mental health, mental health may also influence diet and nutrition. For example, inability or lack of motivation to purchase healthy foods and prepare these, preferential selection of foods that may enhance mood such as sweet foods(4), changed physical activity levels and possible interactions with psychiatric drugs(5,6) are all factors that may cause a person’s diet to change with the development of poor mental health.
...
As with the study of many disease outcomes, there is a growing body of evidence suggesting that dietary patterns may influence a person’s chance of developing poor mental health, particularly depression.
...
With both nutrition and mental health being multidimensional entities, and associations likely being bidirectional, much research work needs to be done to find better ways to utilise nutritional factors in the prevention of poor mental health and to establish how we can best help people affected by poor mental health to eat a healthy diet. This is certainly a cause worth putting our minds to."
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2018 study: factors x mental health care needs in MS

Post by jimmylegs » Sun Sep 30, 2018 11:24 am

Factors associated with perceived need for mental health care in multiple sclerosis (2018)
https://www.sciencedirect.com/science/a ... 4818302633

Highlights
•One-third of people with MS identified a need for mental health treatment.
•Symptoms of anxiety and depression were the predominant factors associated with a reported need for treatment.
•Older age was associated with a reduced need for mental health treatment.

Abstract
Background
Within the multiple sclerosis (MS) population, depression and anxiety are highly prevalent comorbidities that are associated with adverse outcomes such as diminished quality of life and disability progression. In the general population, many people who do not meet formal diagnostic criteria for depression or anxiety disorders still identify a need for mental health care. Limited data are available regarding the perceived need for mental health care among persons with MS.

Objective
We aimed to determine factors associated with a perceived need for mental health care in the MS population.

Methods
Participants with MS completed the Hospital Anxiety and Depression Scale (HADS) to assess severity of depression and anxiety symptoms, and reported whether they perceived a need for mental health care, in the context of a larger study examining the burden of psychiatric disorders in immune-mediated inflammatory disease. Participants were also evaluated using the Structured Clinical Interview for DSM-IV-TR (SCID) to diagnose depression or anxiety disorders. Participants reported their sociodemographic characteristics, and underwent physical assessments to determine their disability status. Descriptive analyses and binary logistic regression models were used to determine sociodemographic and clinical factors associated with perceived need for mental health care.

Results
Of 255 participants enrolled, 251 were included in this analysis. Most participants were women, Caucasian, with post-secondary education, with a mean (SD) age at enrollment of 50.9 (12.9) years. They predominantly had a relapsing-remitting MS course. Nearly one-quarter of participants had a current SCID diagnosis of depression or anxiety (n = 57, 22.7%). Overall, 31.8% (n = 80) of participants reported a need for mental health care. These individuals were slightly younger at enrollment (p = 0.037), but otherwise did not differ with respect to sociodemographic characteristics, compared to participants not reporting this need. Those identifying need for mental health care also had an earlier age of MS symptom onset (p = 0.011). After adjusting for sociodemographic and clinical factors, elevated symptoms of depression (odds ratio [OR] 2.36; 95%CI: 1.06, 5.25) and anxiety (OR 6.08; 95%CI: 2.78, 13.3) were associated with an increased likelihood of reporting a need for mental health care. Any current SCID diagnosis of depression or anxiety was not associated with perceived need for mental health care after accounting for symptoms of depression and anxiety.

Conclusions
One-third of people with MS identified a need for mental health care. Symptoms of anxiety and depression, but not current diagnosed mental health disorders, were the predominant factors associated with a perceived need for care.
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don't let suboptimal self care muddy any underlying diagnostic picture!

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2018 study: Mental health among children of mothers with MS

Post by jimmylegs » Fri Oct 05, 2018 6:55 am

Mental health among children of mothers with multiple sclerosis: A Danish cohort and register‐based study
https://onlinelibrary.wiley.com/doi/abs ... /brb3.1098

"Abstract
Background
Multiple sclerosis is associated with an increased risk of developing physical, cognitive, and mental health problems. Current studies have demonstrated variating outcomes of parental multiple sclerosis mental health problems and their children's mental health development.

Objective
The purpose of this study was to investigate whether maternal multiple sclerosis is associated with the mental health status of their child.

Methods
Data from the Danish National Birth Cohort (DNBC) were merged with information from the Danish Multiple Sclerosis Registry. Two proxies, total difficulties score and prediction of any psychiatric diagnosis based on the strengths and difficulties questionnaire, were used to measure the mental health status of the children. The two groups were compared using Mann–Whitney and logistic regression analyses.

Results
For the total difficulties score the control and exposed group consisted of respectively n = 42,016 and n = 40, and for the prediction of any psychiatric diagnosis respectively n = 16,829 and n = 17. We found no statistically significant association between maternal multiple sclerosis and mental health status on neither of the proxies.

Conclusion
Maternal multiple sclerosis did not show any association with the mental health status of their children at age eleven. On the contrary, other studies conclude that there is an association between maternal multiple sclerosis and the child's mental health status, one especially mediated by the maternal mental health status."
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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2018 study: health-related QoL, fatigue, depression in MS

Post by jimmylegs » Fri Oct 05, 2018 7:06 am

Is the association between health-related quality of life and fatigue mediated by depression in patients with multiple sclerosis? A Spanish cross-sectional study
https://bmjopen.bmj.com/content/8/1/e016297

Abstract
Objectives To determine the mediating effects of depression on health-related quality of life and fatigue in individuals with multiple sclerosis (MS).

Design A cross-sectional study.

Setting Tertiary urban hospital.

Participants One hundred and eight patients (54% women) with MS participated in this study.

Outcome measures Demographic and clinical data (weight, height, medication and neurological impairment), fatigue (Fatigue Impact Scale), depression (Beck Depression Inventory-II) and health-related quality of life (Short-Form Health Survey 36) were collected.

Results Fatigue was significantly associated with bodily pain, physical function, mental health and depression. Depression was associated with bodily pain and mental health. The path analysis found direct effects from physical function, bodily pain and depression to fatigue (all, P<0.01). The path model analysis revealed that depression exerted a mediator effect from bodily pain to fatigue (B=−0.04, P<0.01), and from mental health to fatigue (B=−0.16, P<0.01). The amount of fatigue explained by all predictors in the path model was 37%.

Conclusions This study found that depression mediates the relationship between some health-related quality of life domains and fatigue in people with MS. Future longitudinal studies focusing on proper management of depressive symptoms in individuals with MS will help determine the clinical implications of these findings.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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2018 study: Diet quality, depressive and anxiety disorders

Post by jimmylegs » Mon Oct 08, 2018 10:26 am

Diet quality in subjects with and without depressive and anxiety disorders
https://www.sciencedirect.com/science/a ... 5618308203

Abstract
Objective

This study examines the association of depressive and anxiety disorders and their clinical characteristics (disorder type, severity, chronicity and clinical subtypes) with diet quality.

Method
Data from 1634 adults (controls = 336, current disorder = 414, remitted = 886) were sourced from the 9-year follow-up of the Netherlands Study of Depression and Anxiety. Depressive and anxiety disorders were established with Composite International Diagnostic Interviews. Severity was measured with the Inventory of Depressive Symptomatology (IDS), Fear Questionnaire and the Beck Anxiety Inventory. Chronicity was measured with life-chart interviews expressed as percentage time with a disorder(s). Diet quality was evaluated using the Mediterranean Diet Score (MDS) and the Alternative Healthy Eating Index (AHEI).

Results
Diet quality was significantly worse among subjects with a current disorder than among healthy controls. Subdividing subjects showed that those with concurrent depressive and anxiety disorders had the lowest diet quality score (MDS: β = −0.41 per SD, 95% Confidence interval (95%CI) = -0.60, −0.21; AHEI β = −0.22 per SD 95% CI = −0.42,-0.03). More chronic depression or anxiety disorders and increased severity in all participants showed a dose-response association with poorer diet quality. There was no distinct pattern between IDS items related to depression subtypes and diet quality.

Conclusion
Diet quality is poorer in persons with depressive and anxiety disorders; in particular in those with comorbidity. The more severe and chronic the symptoms, the poorer the diet quality. Prospective studies are needed to confirm the direction of the relationship of depressive and anxiety disorders with diet quality and to examine whether improving diet quality could improve mental health.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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2015 clinical trial: zinc for depression in MS

Post by jimmylegs » Fri Nov 23, 2018 5:44 am

Zinc sulphate: A reasonable choice for depression management in patients with multiple sclerosis: A randomized, double-blind, placebo-controlled clinical trial (2015)

"Abstract
Introduction
Major Depressive Disorder (MDD) is known as one of the most common psychiatric disorders in patients with multiple sclerosis (MS). In recent years, zinc has been found to have beneficial effects on psychopathology and the therapy of depression. The aim of the present study was to examine the effect of zinc supplement on depression and neurological signs in patients with MS.

Methods
The present randomized, double-blind, placebo-controlled clinical trial was performed on 43 patients with MS and who also demonstrated MDD based on the Beck questionnaire. These patients were randomly selected and were divided into two groups: the placebo group (n = 22) and the intervention group (n = 21). The patients received either zinc sulphate (220 mg containing 50 mg zinc element) or a placebo for 12 weeks. Clinical examinations were obtained in terms of abnormal ocular movement, muscle power, and gait disorder.

Results
The results indicated that in the patients who received the zinc supplement, the mean score of depression was reduced compared to those in the placebo group, whereas the neurological examinations revealed that there were no differences between the treatment and control groups.

Conclusion
Therefore, the zinc supplementation is an appropriate choice for the depression management in patients with MS."


it would be interesting to have seen the serum zinc levels in the case and control groups before and after this treatment.

the results reported in this small trial seem consistent with some elements of my own experience with zinc deficiency and repletion. zinc repletion eradicated years-long cognitive deficits that were most logically the consequence of a very long term vegan diet. i used to have no short term memory whatsoever. perfectly fine now. it's weird but good to be able to recognize cognitive red flags, realize nutrient status likely needs some attention, and act to restore nutrient status and associated function.

cognitive measures aside, the other thing which resolved after zinc repletion was my stubborn 'ms average' uric acid level. i think it was all interconnected - low zinc, broken krebs cycle, ammonia toxicity, brain damage.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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Re: 2015 clinical trial: zinc for depression in MS

Post by jimmylegs » Fri Nov 23, 2018 11:07 am

also essential nutrient deficiency models used to trial antidepressant meds REALLY PISS ME OFF

Antidepressant activity of fluoxetine in the zinc deficiency model in rats involves the NMDA receptor complex (2015)
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2016 pilot RCT: cognitive behavioural therapy for newly dx'd pwMS

Post by jimmylegs » Mon Jan 07, 2019 10:39 am

A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis (2016)
https://bmcpsychiatry.biomedcentral.com ... 016-1152-7

...These data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted.
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pursue optimal self care at least as actively as a diagnosis
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don't let suboptimal self care muddy any underlying diagnostic picture!

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