Recurent use of antiobiotics increases risk of depression and anxiety

Recurent use of antiobiotics increases risk of depression and anxiety, most likely though changes in your gut bacteria. The effect is noteworthy. More than 5 lifetime exposures to penicillin, and your risk is up almost 50%!

This is why it is really important to check for good gut health when you are depressed or anxious and have had antibiotic treamtent.



J Clin Psychiatry. 2015 Nov;76(11):1522-8. doi: 10.4088/JCP.15m09961.

Antibiotic exposure and the risk for depression, anxiety, or psychosis: a nested case-control study.



Changes in the microbiota (dysbiosis) were suggested to increase the risk of several psychiatric conditions through neurologic, metabolic, and immunologic pathways. Our aim was to assess whether exposure to specific antibiotic groups increases the risk for depression, anxiety, or psychosis.


We conducted 3 nested case-control studies during the years 1995-2013 using a large population-based medical record database from the United Kingdom. The study included 202,974 patients with depression, 14,570 with anxiety, and 2,690 with psychosis and 803,961, 57,862, and 10,644 matched controls, respectively. Cases were defined as individuals aged 15-65 years with any medical Read code for depression, anxiety, or psychosis. Subjects with diagnosis-specific psychotropic prescriptions > 90 days before index date were excluded. For every case, 4 controls were selected using incidence density sampling, matching on age, sex, practice site, calendar time, and duration of follow-up before index date. The primary exposure of interest was therapy with 1 of 7 antibiotic classes > 1 year before index date. Odds ratios (ORs) and 95% CIs were calculated for the association between each psychiatric disorder and exposure to individual classes of antibiotics using conditional logistic regression analysis. The risk was adjusted for obesity, smoking history, alcohol consumption, socioeconomic status, and number of infectious events before diagnosis.


Treatment with a single antibiotic course was associated with higher risk for depression with all antibiotic groups, with an adjusted OR (AOR) of 1.23 for penicillins (95% CI, 1.18-1.29) and 1.25 (95% CI, 1.15-1.35) for quinolones. The risk increased with recurrent antibiotic exposures to 1.40 (95% CI, 1.35-1.46) and 1.56 (95% CI, 1.46-1.65) for 2-5 and > 5 courses of penicillin, respectively. Similar association was observed for anxiety and was most prominent with exposures to penicillins and sulfonamides, with an AOR of 1.17 (95% CI, 1.01-1.36) for a single course of penicillin and 1.44 (95% CI, 1.18-1.75) for > 5 courses. There was no change in risk for psychosis with any antibiotic group. There was a mild increase in the risk of depression and anxiety with a single course of antifungals; however, there was no increase in risk with repeated exposures.


Recurrent antibiotic exposure is associated with increased risk for depression and anxiety but not for psychosis

New drug for Parkinson-Psychosis

Pimavanserin (Nuplazid (r) ) has been approved for the treatment of Parkinson-related psychosis.

This is new. Hitherto, more or less all effective treatments options blocked
dopamine, which leads to a worsening of Parkinson.

This drug has a new mechanism of action.
I will keep you aupdated, once it becomes available in Europe.

Seasonal greatings to all my patients!

Best wishes for the festival season and may all your wishes come true
next year!
Kind regards,

Now handicapped-accessible

I am happy to announce that we have made adaptations to make the practice
fully handicapped-accessible.

Blood brain barrier: Break through



This new technology to deliver drugs exactly at a specific brain region, although in this caser used for treating brain tumors, might be pivotal and provide a completely new approach to drugs targeted at various psychiatric disorders which are known to be caused by very local (as pposed to global) changes of brain metabolism.



Increased risk of violent crime in adolescents prescribed SSRIs?




Although selective serotonin reuptake inhibitors (SSRIs) are widely prescribed, associations with violence are uncertain.

Methods and Findings

From Swedish national registers we extracted information on 856,493 individuals who were prescribed SSRIs, and subsequent violent crimes during 2006 through 2009. Continue reading

Oxytocin against alcoholism?


Oxytocin is a natural human hormone primarily  known for its significance during pregnancy/birth.

However, many new aspects of its possible additional properties are known today.
New research (from animal studies) suggests that it may help to

- reduce alcohol craving and consumption
- reduce alcohol toxicity
- reduce alcohol withdrawal symptoms.

These new findings might helpt to develop a new koind of "sobriety pill" eventually.

The battle of the 4-hour clock against the 24-rhythm in psychiatric disorders


In mammals, there are different internal clocks. One of them has been know for a longer time and runs a 24-hour cycle. In depression, mania and schiziophrenie, this cycle is often disturbed,

New findingas indicate an ultradian clock with a circle of only 4 hours which operates independently and regulates motolocor acitivity. In healthy subjects. it is synchronized to the 24-hour circadian clock and is governed by rhythmis release of dopamin in the striatum.

Even for lays and at a first glance, a 4 hour rhythm is not completely unknown:

getting up at 8(7) and breakfast
work for 4 hours then break and have lunch
work for four more hours (maaybe snack), then relax and go home
4 hours private time/ family - it is now 8 pm.
slowly begin "evening routine.
4 hrs later at last: fall asleep (at the latest)
4 am: awake early, go back to slepp if possible
8(7) start from the beginning...







This rhythm is synchronized with dopamine release in the striatum and, under healthy conditions, is synchronized to the 24-hour clock.

However, too little or to much of dopamine may change the harmony.

Too much dopamine (as in mania an schizoprenia ) may lead to an increase of the "ultradian" circle to a 48-hour circle. this phenomenon is well known in some schizophrenic and manic patients.

On the other hand, blocking dopamine (which is what many anipsychotic and antimanic drugs do) shortens the circle.

In addition, psychoeducation focussing on a stabilization of circadian rhythms, may prove to be beneficial this way.

In the future, new medication and other treatments which focus on re-synchronization of ultrdian and circadian rhythms may open a new avenue to treating various psychiatric disorders.

Wake- and bright light therapy: robust effects and better than sports iin depression!

A chronotherapeutic intervention combining sleep deprivation (wake therapy), bright-light therapy, and sleep scheduling may have lasting benefits for some patients with major depression, follow-up data from a randomized, controlled trial suggest.

“This is the first study to show adjunct short-term wake therapy and long-term bright light therapy as an effective and feasible method to attain and maintain remission. Patients continued to improve in the follow-up phase and obtained very high remission rates,” report Klaus Martiny MD, PhD, from Psychiatric Centre Copenhagen, in Denmark.

The study was published online February 17 in Acta Psychiatrica Scandinavica.

Immediate, Large, Stable Effect

The study involved 75 patients with major depression and lasted for 29 weeks. During a 1-week run-in phase, all patients received duloxetine (Cymbalta, Eli Lilly and Company) (60 mg daily). This was followed by a 1-week intervention phase in which all patients were admitted to an open psychiatric ward and were randomly assigned to either the chronotherapeutic intervention (wake group) or to daily exercise.

During the intervention phase, the wake group participated in three total wake therapies interspersed by recovery sleep nights and started daily morning bright-light therapy along with a protocol to stabilize their sleep-wake cycle. Patients in the exercise group exercised for at least 30 minutes each day. All patients were discharged after 1 week.

In the 7-week outpatient continuation phase, wake-therapy patients continued with daily bright-light therapy and sleep time stabilization, and patients in the exercise group continued to exercise. During the next 20 weeks (follow-up phase), patients continued with their assigned regimen but were allowed to increase the dosage of duloxetine or to switch to other antidepressants.

The researchers previously reported that both groups responded to adjunctive treatment, but wake and light therapy produced an “immediate, large, stable and statistically significant better antidepressant effect.”

After 1 week of adjunctive treatment, response was obtained in 41.4% of patients in the wake group vs 12.8% of patients in the exercise group, and remission was achieved in 23.9% vs 5.4%, respectively. At week 9, response was obtained in 71.4% of chronotherapy patients vs 47.3% of exercise patients; remission was achieved in 45.6% and 23.1%, respectively.

The researchers now report that at week 29, the chronotherapeutic intervention maintained “superiority” over exercise, with a statistically significant higher remission rate in the wake- therapy group than in the exercise group (61.9% vs 37.9%; P = .01).

In addition, endpoint scores on the 17-item Hamilton Depression Scale Hamilton Depression Scale (HAM-D17) were statistically lower in the wake group than the exercise group (7.5 vs 10.1; P = .02).

“Fastest Antidepressant Known to Man”

“Response and remission rates were very high at endpoint but could have been inflated by drop-out of patients with persistent depression,” the authors note. During the first 9 weeks of therapy, seven patients dropped out of the wake-therapy group, and four patients dropped out of the exercise group, leaving 64 patients in the study at the 20-week follow-up phase (30 in the wake group and 34 in the exercise group).

During the follow-up phase, six patients dropped out of the wake group because of becoming pregnant, not wanting to use contraception, abuse of alcohol, being lost to follow-up, noncompliance with medication, or worsening of depression. Four patients in the exercise group dropped out because of mania, noncompliance with study procedures, traveling abroad, or worsening of depression.

The researchers note that the dropout rate is within “normal ranges” for studies of serotonin-norepinephrine reuptake inhibitors. However, the dropout rate for the whole 29-week period was somewhat higher in the wake group, “which could signify that the chronotherapeutic regime was difficult for some patients even though they did do better than the patients in the exercise group. This might influence the generalizability of the study,” the researchers say.

“It’s been known for decades that sleep deprivation is the fastest antidepressant known to man for about 40% to 60% of patients with depression,” Philip Gehrman, PhD, CBSM, of the Department of Psychiatry, University of Pennsylvania, Philadelphia, and member of the Penn Sleep Center, noted in an interview with Medscape Medical News.

“The problem is as soon as you go back to sleep, the depression comes back. So people have looked for ways to maintain the antidepressant effect, and the most effective strategies seem to be either starting morning bright-light therapy after sleep deprivation and/or phase advance, moving your schedule earlier,” explained Dr Gehrman, who was not involved in the study.

“There are a fair number of studies now showing that that combination actually works really well for some people and helps sustain the antidepressant effect of sleep deprivation. In the US, I don’t think anyone really does this routinely in clinical practice because no insurance company is going to pay to have people in the lab to do this. There are a couple of groups in Europe who do this more routinely,” Dr Gehrman said.

“It’s a shame it’s not part of more routine clinical care because it does work so well,” he added.

The authors report no relevant financial relationships.

Acta Psychiatr Scand. Published online February 17, 2015. <a href="http://onlinelibrary.wiley order levitra online">Abstract