Ravens’ Hurst reveals suicide attempt, mental health challenges

Baltimore Ravens tight end Hayden Hurst established himself as an NFL player in 2019 when he made 30 receptions for a 14-2 team.

But the 26-year-old is sharing details about a less-successful time in his life when his battles with anxiety and depression led to a suicide attempt.

“I’m not this superhero that’s portrayed on TV. I’m a regular person,” Hurst told Jacksonville station WTLV. “I struggle with depression, anxiety and things like that.”

The Jacksonville native’s long-term struggles included a scary incident in January 2016 after he quit pursuit of a professional baseball career and was a walk-on with South Carolina’s football program.

A night of drinking while depressed led to him slashing his wrist and waking up in a hospital. He was handcuffed to the bed.

“I woke up in the hospital,” Hurst told WTLV. “I didn’t know what happened. I had to have a friend fill me in. Apparently, I had been drinking and went into my apartment and cut my wrist. My friend found me in a puddle of blood. He called 911.”

That episode led Hurst to seek help for his mental health challenges. Now, he is intent on raising the awareness.

“I don’t have the answers to fix all of this,” Hurst told the station. “It’s still a trial and error to this day, but I will say I have much more good days than I do bad days.”

Hurst also detailed times when he would withdraw from family and friends and heavily drink in an attempt to cure his problems.

“There were weeks at a time I would sit in a dark room and not want to be around people,” Hurst said. “Just that fear of embarrassment. I had never experienced anything like that.”

After one of those experiences, he learned his father also struggled with mental health issues.

“He told me the family history with his (obsessive-compulsive disorder),” Hurst said. “His anxiety and things as well. The depression he went through and it was easier than understanding, ‘Hey he’s been through this and he understands what’s going on.’ Then I laid out ‘Here’s what’s going on in my life.’”

Hurst is one of approximately 40 million adults dealing with an anxiety disorder, according to the Anxiety and Depression Association of America. The group said it is common for people with anxiety to also suffer from depression.

Hurst is doing his part to lessen the stigma involved with mental health issues.

“For some reason, people equate mental illness with having to be ashamed. It’s something you shouldn’t talk about,” Hurst said. “I don’t think it’s anything to be ashamed of. Everybody goes through something … If my story is going to change the narrative on this and people are going to talk about it more, then so be it.”

–Field Level Media

How to Recognize Your Child Might Have OCD

Does your child constantly need to re-write, re-read or re-do projects or work? Are they constantly seeking reassurance? Do they often stress about dirt and germs? If so, your child might be living with obsessive compulsive disorder, or OCD, a condition affecting one in every hundred American children.

Parents may consider symptoms of OCD as just a phase their child is experiencing, but they’re actually predictors of OCD-related struggles that can carry on into adulthood, and often times, pediatricians don’t screen for it.

A child with OCD often exhibits repetitive, farfetched and unrealistic thoughts and behaviors. These actions often fall into a four symptom clusters, which Michigan Medicine psychiatrist Kate Fitzgerald, M.D. says includes:

  • Harm and safety worries: Does your child worry about properly locking and re-locking doors? Are they often worried about safety and potential thieves in the neighborhood?

  • Contamination and cleaning worries: Does your child obsess about washing their hands properly? Are they overly focused on dirt and germs?

  • Symmetry and ordering: Does your child insist on drawing in the lines or not stepping on cracks while walking? Do they insist on clothes looking and feeling “even” or keeping things in perfect order?

  • Magical thinking or superstitions: Is your child preoccupied with unlucky numbers, colors, certain words, sayings or superstitions and link them to catastrophe or “bad things” that might happen?

“Most children have occasional obsessive thoughts or need for sameness, such as wanting to hear their favorite story read the exact same way, have clothes feel or look ‘just right’, or feeling safest when they get ready for bed in a particular order,” Fitzgerald said. “But if these sorts of worries affect you or your child for more than one hour a day, it might be time to see a specialist.”

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Diagnosing OCD

OCD isn’t considered a disorder until it causes one of three things:

  1. Affects your child more than an hour a day.

  2. Really upsets them or makes them sad or anxious.

  3. Interferes with family (e.g., temper tantrums), causes distractions at school or gets in the way of interactions with friends.

As with all anxiety disorders, it’s better to address OCD as early as possible. When OCD goes untreated, it can become more severe and evolve into depression.

SEE ALSO: Using Cognitive Behavioral Therapy to Treat Teen OCD

Perinatal Insomnia May Induce Concurrent and Postpartum Anxiety

NEWS BRIEF

What is the relationship between insomnia and anxiety during pregnancy? In the first prospective study of its kind, researchers found that mid-pregnancy insomnia may be a marker not only for concurrent anxiety but also may act as a predictor of postpartum anxiety.1

In the study, which was part of the Norwegian Depression and Anxiety in the Perinatal Period (DAPP) study, 530 women received questionnaires during pregnancy week 17 (considered mid-pregnancy) and 8 weeks postpartum; the Bergen Insomnia Scale, Hopkins Symptom Checklist, and Mini-International Neuropsychiatric Interview were used to measure insomnia, anxiety, and obsessive-compulsive disorder symptoms, respectively. Most (97%) of the women were married; average age was 30.5. This was the first pregnancy for 38% of the women. A small percentage reported smoking (1.5%) and dipping tobacco use (1.4%) during pregnancy. At mid-pregnancy, 59.8% of the respondents reported insomnia.

About 12% of the women with insomnia reported a previous anxiety or related disorder, compared with 7% of their counterparts who had normal sleep during pregnancy. Similarly, 43% of the women with insomnia had previous depression, while 26% of the women with normal sleep reported previous depression.

After adjusting for potential confounders, Rannveig S Osnes, MD, and colleagues found a significant positive association (b = 0.01, p = 0.001) between mid-pregnancy insomnia and both concurrent and postpartum anxiety. However, mid-pregnancy insomnia was not more strongly associated with concurrent anxiety than postpartum anxiety, indicating it may be a predictor of postpartum anxiety. Women who reported insomnia also had higher levels of postpartum OCD symptoms than those participants who did not report sleeping difficulties.

Insomnia is a fairly common problem during pregnancy, with incidence increasing as pregnancy progresses. While incidence rates are close to 13% at the beginning of pregnancy, about 16% and 4% of women report moderate and severe insomnia, respectively, at a median of 39 weeks.2 Similarly, research shows anxiety to be fairly common, with 1 in 5 women meeting criteria for at least one anxiety disorder and 1 in 20 meeting criteria for at least two anxiety disorders.3

Since overactive arousal systems are believed to be common in both insomnia and anxiety, the researchers noted negatively toned cognitive activity of insomnia might trigger arousal and distress, which in turn may lead to anxiety symptoms. They further hypothesized that cognitive behavioral therapy (CBT) for insomnia might improve or prevent perinatal anxiety. A recent study of digital CBT for pregnant women with insomnia confirms this hypothesis.4 In that study, researchers found digital CBT improved insomnia severity, sleep efficiency, global sleep quality, depressive symptoms, and anxiety symptoms.

Although further research is warranted, Osnes and colleagues1 believe these results have great clinical implications. “Antenatal insomnia could be an important intervention target, and screening for insomnia during mid-pregnancy could be an efficient strategy for detecting women who are struggling with or at risk of developing anxiety, not least of all because reporting insomnia symptoms may feel less stigmatizing,” they concluded.

Exposure Therapy Types And Health Benefits

Being crippled by intense fear does not help an individual grow. Staying in the comfort zone could become a hindrance to experiencing all that life has to offer. For instance, the fear of heights is very real. It can prevent people from enjoying a range of adventure sports such as bungee jumping or paragliding, which elevate adrenaline levels and help us conquer our fears. 

In a completely different scenario, a victim of post traumatic stress order (PTSD) may need help overcoming intrusive thoughts, not allowing the person to move on from the traumatic episode. A type of behavioral therapy called exposure therapy can be explored by people wanting to look fear in the eye and confront external stimuli such as cockroaches, flying or other phobias. 

Otherwise, distressing thoughts and physical sensations are the internal stimuli that can be possibly addressed through exposure therapy. By recreating the feared object or situation through virtual reality, imagination or exposure to the fear itself in real life, the therapy aims to stimulate a neutral and unemotional reaction with recurrent exposure.

The therapy is largely the treatment of anxiety disorders. For it to work, it can either take a few sessions to a year or more of therapy. It depends on the person and what works for each individual. Here are some of the various techniques employed by exposure therapy:

Prolonged Exposure Therapy

A combination of psychoeducation and cognitive behavioral therapy are needed to learn how to respond better to the triggers ( smells, sounds etc). People with PTSD are taught to reframe their destructive thought patterns concerning the traumatic experience with the help of prolonged exposure therapy. 

Self-Exposure Therapy

The therapy can be completed without the presence of a psychologist just by the person taking the initiative to confront fears independently. The individual can randomly get immersed in this situation and train his or her mind to be less responsive in a negative way. Making a list of the steps to be taken to fight the fear and doing them bit by bit makes it easier. 

trauma Exposure therapy is the learning of an unemotional response through recurrent exposure to the anxiety causing situation or object. TraumaAndDissociation, CC by 2.0

Exposure And Response Prevention

This is mainly for people with obsessive-compulsive disorder. The patient is exposed to the obsessions as a surprise without telling them in advance to test them. They are expected to react with normal compulsive behavior learned in therapy. If not, the unannounced exposure to the fear is repeated until the behavior is learnt. 

Graduated Exposure Therapy

The person is gradually made to face the perceived danger on a hierarchical level of their choice, from least to most threatening. 

Flooding Exposure Therapy

This type of exposure therapy is used to get over phobias by engaging the person in the anxiety causing situation without a prior warning. 

Health Benefits

Exposure therapy benefits people with generalized anxiety disorder, social anxiety and people who are battling ongoing anxiety or stress in a particular situation. This is achieved by habituating the person to the negative stimuli so they respond to the feared object or situation with less reactivity. 

OCD, PTSD and irrational phobias are the result of negative thought processes on loop. With the help of the exposure therapy, patients learn how to identify the disturbing thoughts and compulsions, then eventually change their approach to the situation with adequate coping mechanisms. 

Deep Brain Stimulation Successfully Treats Refractory OCD Although Targets Vary

Deep brain stimulation (DBS) can significantly decrease symptoms in approximately 60% of patients with refractory obsessive-compulsive disorder (OCD), which affects a fifth of all patients with OCD.1,2,3 The safety and efficacy of DBS, which involves permanent surgically implanted hardware, has been established in patients with severe refractory major depressive disorder. In these cases, DBS may provide long-term relief (8 years) for patients.4 

However, responses to treatment depend on the target chosen, with 5 targets yielding positive outcomes, including the ventral anterior limb of the internal capsule (vALIC), subthalamic nucleus (STN), nucleus accumbens (NAcc), ventral capsule/ventral striatum (VC/VS), or inferior thalamic peduncle (ITP), all involving fronto-striato-thalamocortical circuits.5 Irrespective of the area targeted for implanted electrodes, 60% of patients who respond to DBS show 35% decreases on the Yale-Brown obsessive-compulsive scale (Y-BOCS),6 while partial responders’ scores decrease from 25% to 34% and non-responders show decreases of 24%.7

Ventral Anterior Limb of the Internal Capsule

Early research focused on the vALIC based on studies demonstrating improvements in patients after anterior capsulotomy,8 with half of patients responding to treatment. A study of 70 patients — the largest cohort of patients to receive DBS for OCD — demonstrated positive outcomes.At 12-month follow up, 52% of patients were responders, and 17% experienced partial relief.7

Subthalamic Nucleus

The STN became a target after DBS in Parkinson disease (PD) demonstrated relief from OCD symptoms in 3 patients with comorbid PD and OCD.9 In 2 of 3 completed studies targeting the STN, all patients reported a mean reduction of as much as 31 points in Y-BOCS scores.10,11 In the largest study (n=16) of the STN, 75% of patients with OCD had decreased Y-BOCS scores. However, this higher response rate may stem from the study’s low threshold for response.12

Nucleus Accumbens

The NAcc is a promising target for DBS based on evidence of reward system dysfunction in OCD.13 In an early study of unilateral, right-sided NAcc implantation in 4 patients with OCD, 3 patients were responders, although the study failed to report Y-BOCS scores.14 A monetary incentive task-functional magnetic resonance imaging (fMRI) study of 18 patients measured outcomes based entirely on NAcc imaging, only using Y-BOCS scores for baseline OCD severity. Patients exhibited reduced NAcc activity, with more hypoactivation in patients with symptoms relating to the fear of contamination than risk avoidance.15 Following DBS, patients showed NAcc activation comparable to healthy controls. Other studies of the NAcc have shown decreases in Y-BOCS scores of as much as 52%16-19 although few patients partially responded to treatment.16,18 While most patients experienced relief from OCD symptoms, anxiety or mood issues remained.16-18

Ventral Capsule/Ventral Striatum

The VC/VS target places DBS leads in the same anterior-posterior plane as the NAcc, stimulating the NAcc and ALIC and aligning with limbic projections from the amygdala, hippocampus, and prefrontal and cingulate cortices.20 In the largest study of this target, 61% of patients experienced 35% reductions in Y-BOCS scores, with improvements seen across 36 months. Notably, 100% of responders reported major reductions in obsessions and checking, 55.6% in symmetry and ordering, and 45.5% in cleanliness and washing. As researchers refined VC/VS placement across the study period, more patients experienced greater symptom relief.21 While the STN may play a role in improved cognitive flexibility, the VC/VS might ameliorate anxiety and mood symptoms.22,23

Anterior Limb of the Internal Capsule and Nucleus Accumbens

Researchers have attempted to more broadly cover the striatal region by simultaneously targeting the ALIC and the NAcc. In a study of DBS for both the ALIC and NAcc (n=20), 40% of patients experienced a full response and 70% at least a partial response at 12-month follow-up.24 A study using a similar treatment (n=22) found that patients’ connectivity profiles between the ALIC and NAcc stimulation sites and their medial and lateral prefrontal cortices significantly predicted patient response rates.25

Inferior Thalamic Peduncle

The ITP, involved in depression and OCD pathophysiology, connects the circuitry of the nonspecific thalamic system and the orbitofrontal cortex. In an early study (n=8), 75% of patients were full responders at 3-month follow-up, although researchers reported an unusually high number of serious adverse events in the surgery and active stimulation periods.26 A later study (n=6) demonstrated promising results and few adverse events, with 66% of patients fully responding to treatment; 1 patient with OCD and depression experienced almost complete relief from all symptoms 5 years later.27 The attractiveness of the ITP in attenuating OCD symptoms led to a phase 1 pilot study, in which all 5 patients responded completely to treatment. However, at 2-year follow-up, 3 adverse events occurred, 1 resulting in the removal of the DBS.28

DBS: Still Rare in the Treatment of OCD

To date, DBS for OCD remains rare, treating fewer than 300 patients worldwide and with most studies enrolling 5 patients.29 Larger studies in the future will prove invaluable in assessing the efficacy of DBS for OCD and identifying the most efficacious placement of leads.Meta-analyses across targets yield different outcomes, depending on the criteria for clinical improvement and the unilateral or bilateral placement of electrodes.30 Some researchers have challenged the accuracy of the Y-BOCS in capturing the multidimensional nature of OCD symptoms,suggesting that a Maudsley’s challenge test during fMRI can reveal the best DBS placement and the extent of improvement after activation.30 This test enables clinicians to target dysfunctional circuits specific to each patient by breaking their presentation of OCD into 4 dimensions: contamination and washing; hoarding; symmetry and repeating or ordering; and forbidden thoughts and checking.29

The promise of DBS in attenuating the impact of severe refractory OCD resulted in the US Food and Drug Administration granting a Humanitarian Device Exemption.21 Notably, 75% of a random sample of American Psychiatric Association members stated that they would consider referring patients for neurosurgical treatment of severe refractory OCD.31 Nevertheless, few patients can experience the potential relief of DBS, as private insurers have chosen not to cover costs. Currently, DBS is mostly available to patients enrolled in studies.

“The US healthcare system fails patients with mental illness,” notes Kelly Foote, MD, a professor of neurosurgery at the University of Florida in Gainesville and co-investigator on multiple studies on the impact of DBS on refractory OCD, “These patients’ quality of life could be salvaged because DBS is a cost-saving intervention [that works] after all other treatments have proven ineffective.”

References

1. Skapinakis P, Caldwell DM, Hollingworth W, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2016;3:730–9. doi:10.1016/S2215-0366(16)30069-4

2. Alonso P, Cuadras D, Gabriëls L, et al. Deep brain stimulation for obsessive-compulsive disorder: a meta-analysis of treatment outcome and predictors of response. PloS One. 2015:10:e0133591. doi:10.1371/journal.pone.0133591

3. Kisely S, Hall K, Siskind D, et al. Deep brain stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis. Psychol Med. 2014;44:3533-3542. doi:10.1017/S0033291714000981

4. Crowell AL, Riva-Posse P, Holtzheimer PE, et al. Long-term outcomes of subcallosal cingulate deep brain stimulation for treatment-resistant depression. Am J Psychiatry. 2019;176(11): 949-956. doi:org/10.1176/appi.ajp.2019.18121427

5. Senova S, Clair A-H, Palfi S, et al. Deep Brain Stimulation for refractory obsessive-compulsive disorder: towards an individualised approach. Front Psychiatry. 2019;10:905. doi:org/10.3389/fpsyt.2019.00905

6. Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Arch Gen Psychiatry 1989;46:1006-1011. doi:org/10.1001/archpsyc.1989.01810110048007

7. Denys D, Graat I, Mocking R, et al. Efficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients [published online January 7, 2020]. Am J Psychiatry.  doi:org/10.1176/appi.ajp.2019.19060656

8. Mindus P, Rasmussen SA, Lindquist C. Neurosurgical treatment for refractory obsessive-compulsive disorder: implications for understanding frontal lobe function. J Neuropsychiatry Clin Neurosci. 1994;1:26-36.

9. Mallet L, Mesnage V, Houeto JL, et al. Compulsions, Parkinson’s disease and stimulation. Lancet. 2002;360:9342:1302-1304. doi:org/10.1016/S0140-6736(02)11339-0

10. Fontaine D, Mattei V, Borg M, et al. Effect of subthalamic nucleus stimulation on obsessive-compulsive disorder in a patient with Parkinson’s disease: Case report. J Neurosurg. 2004;100(6):1084-1086. doi:org/10.3171/jns.2004.100.6.1084

11. Le Jeune F, Verin M, N’Diaye K, et al. Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study. Biol Psychiatry. 2010;68:1016-1022. doi:org/10.1016/j.biopsych.2010.06.033

12. Mallet L, Polosan M, Jaafari N, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008;359(20):2121-2134. doi:org/10.1056/NEJMoa0708514

13. de Koning PP, Figee M, van den Munckhof P, et al. Current status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets. Curr Psychiatry Reports. 2011;13(4):274-282. doi:org/10.1007/s11920-011-0200-8

14. Sturm V, Lenartz D, Koulousakis A, et al. The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat. 2003;26:293-299. doi:org/10.1016/j.jchemneu.2003.09.003

15. Figee M, Vink M, de Geus F, et al. Dysfunctional reward circuitry in obsessive-compulsive disorder. Biol Psychiatry. 2011;69(9):867-874. doi:org/10.1016/j.biopsych.2010.12.003

16. Huff W, Lenarz D, Schormann M, et al. Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: outcomes after one year. Clin Neurol Neurosurg. 2010;112(2):137-143. doi:org/10.1016/j.clineuro.2009.11.006

17. Aouizerate B, Cuny E, Martin-Guehl C, et al. Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report. J Neurosurg. 2004;101:682-686. doi:org/10.3171/jns.2004.101.4.0682

18. Franzini A, Messina G, Gambini O, et al. Deep brain stimulation of the nucleus accumbens in obsessive compulsive disorder: clinical, surgical and electrophysiological considerations in two consecutive patients. Neurol Sci. 2010;31(3):353-359. doi:org/10.1007/s10072-009-0214-8

19. Denys D, Mantione M, Figee M, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010;67(10):1061-1068. doi:org/10.1001/archgenpsychiatry.2010.122

20. Burdick A, Goodman WK, Foote, KD. Deep brain stimulation for refractory obsessive-compulsive disorder. Front Biosci, Landmark Ed 2009;14:1880-1890. doi:org/10.2741/3348

21. Greenberg B, Gabriels L, Malone Jr D, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010;15:64. doi:.org/10.1038/mp.2008.55

22. Barcia JA, Reneses B and Nombela C. Precision surgery for obsessive compulsive disorder-which is the proper target? Ann Transl Med. 2019;7. doi:org/10.21037/atm.2019.07.65

23. Tyagi H, Apergis-Schoute AM, Akram H, et al., A randomized trial directly comparing ventral capsule and anteromedial subthalamic nucleus stimulation in obsessive-compulsive disorder: clinical and imaging evidence for dissociable effects. Biol Psychiatry 2019;85(9):726-734. doi:org/10.1016/j.biopsych.2019.01.017

24. Huys D, Kohl S, Baldermann JC, et al. Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained. J Neurol Neurosurg Psychiatry. 2019;90:805-812. doi:org/10.1136/jnnp-2018-318996

25. Baldermann, JC, Melzer, C, Zapf, A, et al. Connectivity profile predictive of effective deep brain stimulation in obsessive-compulsive disorder. Biol Psychiatry. 2019;85(9):735-743. doi:org/10.1016/j.biopsych.2018.12.019

26. Mallet L, Polosan M, Jaafari N, et al. Subthalamic nucleus stimulation in severe obsessive–compulsive disorder. New Engl J Med. 2008;359(20):2121-2134. doi:org/10.1056/NEJMoa0708514

27. Jiménez F, Nicolini H, Lozano AM, et al. Electrical stimulation of the inferior thalamic peduncle in the treatment of major depression and obsessive compulsive disorders. World Neurosurg. 2013;80 (3-4):S30-e17-S30-e25. doi:org/10.1016/j.wneu.2012.07.010

28. Lee DJ, Dallapiazza RF, De Vloo P, et al. Inferior thalamic peduncle deep brain stimulation for treatment-refractory obsessive-compulsive disorder: A phase 1 pilot trial. Brain Stimulation. 2019;12(2):344-352. doi:org/10.1016/j.brs.2018.11.012

29. Lipsman N, Neimat JS, Lozano AM. Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: the search for a valid target. Neurosurgery. 2007;61:1-11. doi:org/10.1227/01.neu.0000279719.75403.f7

30. Barcia JA, Reneses B and Nombela C. Precision surgery for obsessive compulsive disorder—which is the proper target? Ann Transl Med. 2019;7(6):S184. doi:org/10.21037/atm.2019.07.65

31. Mathew SJ, Yudofsky SC, McCullough LB et al. Attitudes toward neurosurgical procedures for Parkinson’s disease and obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci. 1999;11:259-267. doi:org/10.1176/jnp.11.2.259

Biohaven’s anxiety med fizzles in phase 3 but carries on in Alzheimer’s, OCD

Biohaven’s glutamate-targeting drug fell short in a phase 3 study in generalized anxiety disorder (GAD), failing to beat placebo at reducing patients’ anxiety scores. The data “do not support continued development” of the drug for GAD, but the company will keep pushing it forward in other areas, including Alzheimer’s disease, said CEO Vlad Conric, M.D. 

The study tested the drug, troriluzole, against placebo in 402 adult patients with GAD. After eight weeks of treatment, patients taking troriluzole saw their Hamilton Anxiety Rating Scale (HAM-A) scores drop 9.28 from baseline, while patients on placebo saw a slightly better improvement of 9.35 points from baseline. 

The data come after a small, 21-patient study showed troriluzole beat placebo at reducing anxiety in patients with social anxiety disorder and public speaking anxiety who carried out an anxiety-provoking speech task. 

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The company’s stock took a 10% dive on Monday morning. 

RELATED: Too scared to speak in public? Biohaven says it has a drug that can help 

Although Biohaven will give up developing troriluzole as a monotherapy for GAD, Conric pointed to its programs in other diseases and with different dosing regimens. The drug works by reducing levels of the neurotransmitter glutamate in the synapses. Problems with glutamate are linked to the development of many disorders, including certain cancers and chronic pain, as well as central nervous system disorders like Alzheimer’s, spinocerebellar ataxia, depression and obsessive-compulsive disorder (OCD). 

“Since it is often difficult to predict clinical outcomes from preclinical and early clinical proof of concept studies, our strategy has been to test troriluzole in four distinct disorders where glutamate has been implicated in the underlying pathophysiology of the illnesses,” he said in a statement.  “We eagerly await topline data from our adjunctive therapy trial in OCD and our symptomatic treatment trials in Alzheimer’s disease and Spinocerebellar Ataxia.” 

RELATED: Biohaven sets up Shanghai outpost to handle Asia-Pacific portfolio 

Biohaven expects to reveal topline data from the OCD study in the second quarter this year and wrap the phase 2/3 Alzheimer’s trial by the end of the year. Topline spinocerebellar ataxia data is slated to come in 2021. 

The company is also plugging away at its CGRP inhibitor rimegepant, which the FDA is reviewing for the acute treatment of migraine. In the first quarter, Biohaven is gearing up for a potential launch in that indication, as well as topline data for the drug as a preventive treatment.

OCD: Not A Trendy Term

Obsessive-Compulsive Disorder (OCD) is not “trendy.” It is not a “cute quirk” and it is not something that should be used to describe common organizational preferences. OCD is not just normal worrying or mild anxiety. The trendy use of the term OCD, and using the term loosely without meaning, is damaging to people’s understanding of the disorder and the stigmas surrounding OCD. Comments that imply that OCD is cute, quirky, or funny are harmful to those suffering from this serious mental illness. Obsessive-Compulsive Disorder is an extreme form of anxiety. It is a disorder that is debilitating and harmful to those who suffer from the illness. As a society, we need to alter the way we talk about OCD. 

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria for Obsessive-Compulsive Disorder includes a presence of obsessions and compulsions which are time-consuming and cause significant distress or impairment in functioning. Obsessions, or recurrent, intrusive, and unwanted thoughts/sensations, are not just preferences or every day worries. They are intrusive, harmful, and overpowering. Many people with OCD realize that their obsessions may be unreasonable, however, they cannot seem to settle these obsessions with logic or reasoning. These obsessions may cause or result from anxiety, and make the individual feel driven to complete an action repeatedly to reduce or eliminate that anxiety. The repetitive actions and behaviors those with OCD engage in are known as compulsions. Compulsions may help the individual reduce stress or fear about an obsession. Compulsions are not habits or quirks. They are debilitating and often involuntary, excessive, and are not realistically connected to what they are trying to prevent. Obsessions and compulsions take over one’s life and are extremely challenging and distressing to live with.

A common example of someone who is suffering from OCD is an obsession over the fear of contamination. This individual’s obsession is not just about being clean or tidy. Sure, someone without OCD may feel a little icky or gross if they find out the soap has just run out right before washing their hands after using the bathroom. But just because you feel a little anxious that your hands are not clean does not mean you have OCD. For someone suffering from OCD in this scenario, the individual may have an intense obsession over the fear of contamination. This obsession causes them to act in compulsions- they may wash their hands over and over a certain number of times until their anxiety is reduced and they feel better. And they are not just washing their hands two or three times. They are possibly washing them 15 or 16 times or until their hands become raw and are bleeding because their fear of contamination obsession has driven them to complete these compulsions. OCD is not just normal stress or worrying. It is much more than that. When the individual is not able to continue on with daily activities, is in distress, and is in emotional or physical pain, the anxiety doesn’t become normal anymore. It becomes an illness.

The term OCD is misused in many different ways, all of which are harmful to those suffering from the illness. Some phrases that I have personally heard are, “I need my binders to be labeled and color-coded- I’m so OCD about it,” and “I’m a bit OCD when people leave their Christmas decorations up for too long.” Even popular internet news companies misuse the term OCD routinely. Buzzfeed’s “33 Meticulous Cleaning Tricks for the OCD Person Inside You” article is a perfect example of how OCD is used as a trendy adjective that seems to only be a ‘quirky’ part of someone who likes being organized. Not only does the Buzzfeed’s article use OCD as a personality trait, but the article’s opening phrase, “And if you don’t follow these rules, your world will probably fall apart. Just kidding! But OCD or not, you can probably stand to get a little more thorough with your cleaning, while saving time in the long run,” completely belittles and humorizes the distress and debilitation that individuals who actually suffer from OCD feel on a daily basis. People on all different platforms are using the term OCD as a way to describe simple habits, preferences, and personality quirks. However, simple habits, preferences, and personality quirks are all those things are. They last a brief moment and rarely cause the amount of anxiety and debilitation that those living with OCD face. They should have no relation to OCD and OCD should not be used to describe any of these terms.

While the misuse of the term OCD creates many misconceptions about the disorder, it is also extremely harmful to those who suffer from the illness. The misconceptions that sprout from the misuse of the term often alter what people believe or understand those with OCD have to live with. If all that came with OCD was the simple want for everything to be organized, clean, repeated, and put in order the correct way, then it would not be an illness. But OCD is an illness. The misuse of the term indirectly or directly causes people to believe that the disorder is not as serious or debilitating than it actually is. When people form this belief, OCD is not taken as seriously, and people begin to think that it is simply normal, everyday anxiety and worry. We need to understand that this disorder is not just about preferences and desires. People who suffer from OCD do not engage in compulsions simply because they want to. They do so out of fear of what might happen if they don’t. Many people do not correctly understand what OCD actually is because of the wide misuse of the terminology associated with the disorder.

Because this is such a prominent problem, it is vital that society begins to work on ways to fix these misunderstandings and decrease the incorrect use of OCD related terms. We can begin to change this trend by correcting those who misuse OCD terms and by offering different terminology for people without OCD to use instead. Some alternatives to saying, “I’m so OCD about…” include, “I prefer for things to be organized,” and “I like having a routine when I complete this activity,” and “It makes me feel better when I double-check things.” 

When you experience someone misuse OCD related terms it is extremely important to explain why they should not use that term, but also to suggest other phrases or terms they can use instead. This way, they not only will be informed, but they also are now able to practice the correct terminology. Beginning to educate, correct, and call out those who frequently misuse OCD and other related terminology brings us one step closer to decreasing the incorrect conceptions and ideas about what Obsessive Compulsive Disorder entails, and how debilitating the mental illness actually is. OCD is not “trendy, cute, or quirky.” It is a mental illness and it should not be stripped of its reality.

Sources: American Psychiatric Association, OCDUK, Buzzfeed

Melton woman backs mental health campaign urging people to talk about issues

A 30-year-old Melton woman who suffers from anxiety and obsessive compulsive disorder (OCD) has urged others who have mental health issues to open up and talk to people.

Carly, who didn’t want to give her full name, was speaking today (Thursday) on Time to Talk Day – which was established seven years ago to encourage more open conversations about the topic of mental health, which one in four people in the UK have struggles with.

A survey carried out to coincide with the event found that over half of the adults interviewed would prefer not to tell anyone if they were struggling even if it would help to talk.

And two in people in the study felt that not talking about their mental health or emotions was important.

But Carly is grateful she opened up about her own issues which have had a bad effect on her relationships and working life.

“For many years I kept my feelings to myself which was very isolating,” she said.

“I found that people had very misguided views about OCD and self-harm particularly, often trivialising the conditions.

“I later opened up to my family and found a very supportive partner.

“Talking made me feel better.

“I avoided it for so long because I didn’t want people to worry or judge me.

“I now talk openly, even to colleagues when relevant, and it is surprising how many people can relate to the things that you say.”

Carly has has had problems of anxiety and depression since she was a teenager and admits it would often lead to self-harm episodes.

She had repetitive and vivid images of bad things that might happen if she didn’t do certain things and says the thoughts were constantly present and the compulsions took up all of her time.

Carly said there were services in the Melton area which have been very helpful, such as the Let’s Talk Wellbeing service.

She added: “The crisis team there have really helped me to manage more difficult times.

“The staff and doctors at Long Clawson medical practice have also been incredibly helpful.

“In the past I’ve found that GPs lack knowledge in mental health, but here they are compassionate and understanding.”

So what advice would Carly give to others to help them cope with mental health issues?

“During really bad times I premptively created a list of things that I knew could make me feel better and a step by step plan to help me avoid a crisis,” she said.

“I made a deal with myself that I would choose one thing off the list and do it, even if I felt I couldn’t.

“For example, go for a walk with the dog.

“Most of the time it helped.

“Don’t be scared to access services that are available to you and if you see a GP that doesn’t understand try not to take it personally.

“There are some great ones out there too and some services allow you to self refer.

“Talk to the people around you.

“Let them know that they don’t need to understand why you do/think certain things and they don’t need to fix it, just listen.

“There will be times that people say the wrong thing, but that isn’t your fault and doesn’t minimise the way you feel.”

Experts advise people not to shy away from talking to people who have mental struggles after the Time to Talk survey found that one in three people would avoid conversations about someone’s issues because it would be awkward, with many saying they feared saying the wrong thing.

Jo Loughran, director of Time to Change, said: “It’s not an overstatement to say that having a conversation about mental health could change someone’s life.

“It’s vital that we don’t avoid or delay these important conversations because of our own worries.

“You don’t need to have all the answers; if someone close to you is struggling, just being there will mean a lot.

“The more we all talk about mental health, the more we can remove the fear and awkwardness.

“This Time to Talk Day we’re urging everyone to take action on one day when thousands of others will be doing the same and continue that conversation throughout the year.”

The body dysmorphic disorder that’s affecting teen boys, and what to do about it

For individuals with MDD, popularly known as reverse anorexia or bigorexia, the body type desired is not thinner as we see in anorexia nervosa, but bigger and more muscular. Driven by the fear of not being muscular enough, individuals with MDD exercise compulsively, restrict their diets, take protein and other supplements, and even use performance-enhancing drugs such as steroids.

Some surprisingly good news about anxiety

The study reports that 72% of Canadians with a history of GAD have been free of the mental health condition for at least one year. Overall, 40% were in a state of excellent mental health, and almost 60% had no other mental illness or addiction issues, such as suicidal thoughts, substance dependence, a major depressive disorder or a bipolar disorder, in the past year,

The definition of excellent mental health sets a very high bar. To be defined in excellent mental health, respondents had to achieve three things: 1) almost daily happiness or life satisfaction in the past month, 2) high levels of social and psychological well-being in the past month, and 3) freedom from generalized anxiety disorder and depressive disorders, suicidal thoughts and substance dependence for at least the preceding full year.

“We were so encouraged to learn that even among those whose anxiety disorders had lasted a decade or longer, half had been in remission from GAD for the past year and one-quarter had achieved excellent mental health and well-being,” says Esme Fuller-Thomson, lead author of the study. Fuller-Thomson is Director of the University of Toronto’s Institute for Life Course and Aging and Professor at the Factor-Inwentash Faculty of Social Work and the Department of Family Community Medicine.

“This research provides a very hopeful message for individuals struggling with anxiety, their families and health professionals. Our findings suggest that full recovery is possible, even among those who have suffered for many years with the disorder,” she says.

Individuals who had at least one person in their lives who provided them with a sense of emotional security and wellbeing were three times more likely to be in excellent mental health than those without a confidant.

“For those with anxiety disorders, the social support that extends from a confidant can foster a sense of belonging and self-worth which may promote recovery” says co-author Kandace Ryckman, a recent graduate of University of Toronto’s Masters of Public Health.

In addition, those who turned to their religious or spiritual beliefs to cope with everyday difficulties had 36% higher odds of excellent mental health than those who did not use spiritual coping. “Other researchers have also found a strong link between recovery from mental illness and belief in a higher power,” reports Fuller-Thomson.

The researchers found that poor physical health, functional limitations, insomnia and a history of depression were impediments to excellent mental health in the sample.

“Health professionals who are treating individuals with anxiety disorders need to consider their patients’ physical health problems and social isolation in their treatment plans” says Ryckman.

The researchers examined a nationally representative sample of 2,128 Canadian community-dwelling adults who had a generalized anxiety disorder at some point in their lives. The data were drawn from Statistics Canada’s Canadian Community Health Survey-Mental Health. This research was published online ahead of press this week in the Journal of Affective Disorders.