All you need to know about agitated depression 01-2018

Depression is a persistent state of feeling hopeless, sad, or helpless. While there are some common symptoms associated with depression, people can experience depression differently.

One such example is agitated depression. Medical experts may also describe agitated depression as anxious depression or distraught depression.

Though agitated depression is not a distinct type of depression, psychiatric professionals recognize that some people have symptoms of depression as well as agitation.

Fast facts on agitated depression:

Psychiatrists do not define agitated depression as a distinct type of depression.

Agitation can be a common symptom of mood disorders.

Doctors call depression with agitation a "mixed episode" of depression.

Symptoms

Depression with agitation, is known as a "mixed episode" of depression.

Mental health professionals use a manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose mental health disorders, including depression.

By using the same criteria, doctors across America can diagnose depressive symptoms in the same way.

For a doctor to diagnose someone with depression, the person must have experienced depressed mood or a loss of interest or pleasure in life (anhedonia) for at least 2 weeks.

Also, a person will also have experienced at least five of the following symptoms:

Feelings of sadness, hopelessness, or irritability on a nearly daily basis.

Lack of interest or pleasure in activities almost every day.

Experiencing significant weight loss or appetite loss that results in weight loss.
Difficulty sleeping or sleeping excessively.

Experiencing psychomotor agitation, restlessness, or feelings of being "slowed down."

Feeling fatigued or having a lack of energy nearly every day.

Feeling worthless or having excessive and unexplained guilt almost every day.

Difficulty thinking clearly, concentrating, or making decisions on a daily basis.

Experiencing thoughts of death, thinking of harming one's self, or creating a specific plan for committing suicide.

Agitation is a symptom that can cause a person to experience feelings of uneasiness and anxiety.

Some of the symptoms associated with agitation include:

angry outbursts

clenching fists

disruptive behavior

excessive talking

feeling as if a person cannot sit still or focus
pacing or shuffling feet

tension

wringing of the hands

violent outbursts

A person who has agitated depression experiences feelings of helplessness that can make them feel out of control.

As a result, they can then feel hopeless, which may lead to depressive thoughts. Agitation can cause a person with depression to act impulsively. This could cause a person to hurt themselves or others and engage in harmful behavior.

Depression has many different methods of treatment including self-help. Learn more about the best depression blogs to manage low mood here.

A person with bipolar disorder may experience fluctuating symptoms of depression and mania (an elevated state of being).

Mania is different from agitation because mania causes a person to feel hyper, "high," or overly energetic. A person may only sleep a couple of hours each night and stay awake for extended periods.
Mania does not feel good or euphoric to every person, but it can to some people.

Causes

Depression may be caused by a significant life event, such as the loss of a family member.
Agitation is often a symptom of an underlying mood disorder and is not a condition of its own. The causes of depression itself can be varied and can occur if:

the brain does not regulate mood appropriately

a person has a family history of depression and is more vulnerable to the condition

a person has experienced significant life events that are especially stressful or sad, such as the loss of a family member or divorce

a person has several chronic medical problems

Several of these factors can contribute to depression. However, doctors do not know why a person may experience agitated depression.

A person's temperament that affects their behavior may increase the likelihood that they will experience agitation related to depression.

How is it diagnosed?

Doctors diagnose agitated depression by asking a person to describe the symptoms they are experiencing.

They may ask questions, such as when the symptoms first began, what makes the symptoms better, or what makes the symptoms worse. Sometimes a person's loved ones may also describe the changes they have observed in a person's personality.

A doctor will use the criteria from the DSM-5 to diagnose a person with major depressive disorder, but agitated depression is not diagnosed using DSM-5 criteria. A doctor will also try to rule out other similar conditions, including bipolar disorder.

How is agitated depression treated?

A psychiatrist or other mental health professional may help to treat agitated depression.

Doctors treat agitated depression with a variety of approaches.

In the first instance, a doctor may prescribe medications called sedatives or benzodiazepines.

Examples may include diazepam (Xanax) or lorazepam (Ativan). These medications work quickly to help a person feel calmer and can temporarily relieve agitation.

Additional steps include:

Medications to relieve depression: Doctors may prescribe a variety of drugs to relieve depression, including anti-depressants. If a person does not respond to these medicines, a doctor may add another drug or prescribe a different medication type entirely. Examples can include anti-anxiety medications or mood stabilizers.

Counseling: Seeing a psychiatrist or other mental health professional can help a person identify thoughts and feelings that can signal the start of agitation or depressive symptoms. Therapy can help a person focus on thoughts and behaviors that can help them feel better when they struggle with agitated depression.

Stress-relieving techniques: Relieving stress and depression through physical activity, meditation, deep breathing, and journaling can all help a person cope with feelings agitated depression.
There is no one single solution to treating agitated depression. A doctor must consider a person's unique symptoms.

They will likely take a variety of approaches, including prescribing medications and recommending therapy.

Sometimes it can take several months or even years for a person to find the right combination of medications, therapy, and stress-relieving techniques that help them live better with their agitated depression.

Takeaway

While there is no cure for agitated depression, there are many treatments that can help a person live a healthier, happier life. Although finding the right combination of treatments can take time, help is available.

If a person experiences suicidal thoughts or thoughts of self-harm, they should seek emergency medical attention. Medical professionals can help identify ways to stabilize the person medically, and reduce the risks of them injuring themselves. 

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Study identifies hundreds of genetic ‘switches’ that affect height 12-17

Researchers whittled their way to answers 

The network of factors behind height is becoming clearer, thanks to the work of Harvard scientists.Led by Associate Professor of Human Evolutionary Biology Terence D. Capellini, a team of researchers discovered hundreds of genetic “switches” that influence height, and then performed functional tests that demonstrated precisely how one switch altered the function of a key gene involved in height differences. The study is described in a Dec. 5 paper in eLife.

“Large genome-wide association studies on upwards of 250,000 people found about 700 genetic regions associated with height,” Capellini said. “But within each region there could be many single DNA variants linked together, so there are potentially tens of thousands of variants spanning those regions. The question is: How do you whittle that number down to those specific variants that influence height?”

The first step, Capellini said, was to narrow the list of more than 60,000 genetic variants to those involved in the cartilage growth plates of bones. To do this, the researchers identified in the femurs of developing mice regions of DNA that acted as regulatory “switches” — that is, sequences that caused nearby genes to turn on or off.

Capellini and colleagues focused on areas in which the genome was “open,” or available for transcription, using a technique called ATAC-seq. However, that process identified every switch in the growth plate cartilage cell, many of which were not involved in bone growth but rather basic cellular processes. To separate the “general” switches from those related to bone growth — and thus likely height — the team performed the same test again on a different cell type, and identified sequences that were open in both.

“If we find a common sequence that’s open in a brain cell and in a cartilage cell, we can say it likely turns on some gene that may be important for cells to live,” Capellini said. “So we filtered those out, but we didn’t ignore them completely, because they may actually be important.

“While we first concentrated on the bone-specific switches, we know there are a lot of inputs to height — it’s about the length of our bones, but we also know hormones trigger height, malnutrition can impact height, among other inputs, so there may be general genetic factors that influence height.”
Capellini said researchers also performed a number of quality control tests to ensure that the switches they identified were actually involved in bone and cartilage development as well as height. Then, co-author Michael Guo was able to determine that only 900 of the 60,000 variants associated with height actually reside in on/off switches for bone.

To make sure that this process identified unique height signals, Capellini and colleagues performed additional analyses.

“We took genome-wide analyses from other studies that had nothing to do with height and looked to see if we saw the same signal, and we didn’t, which makes sense,” he said. “We also looked at switches from other cell types to see if these genetic variants appeared, and they didn’t. That really suggests to us that the signals we’re seeing are very strong. It’s not just a property of the genome or a property of identifying these switches.”

The team chose one on/off switch, associated with a gene known as chondroitin sulfate synthase 1, which plays a key role in how cartilage cells create the extracellular matrix that hardens into bone. In turn, the gene influences femur length in mice and humans.

“We did some tests to find out how this switch effects CHSY1 activity, and found that both versions — for taller height and shorter height — act as repressors on the gene,” Capellini said. “But surprisingly, the height-increasing variant isn’t as strong.”

To verify that the switch indeed acts in a repressive manner, researchers used CRISPR tools to entirely remove the switch or the variant from human cartilage cells, and saw a very strong increase in the expression of the gene.

Going forward, Capellini and colleagues hope to use high-throughput functional methods to understand the role each variant plays in human height, and to develop other methods to test all 60,000-plus variants in order to study height in a more unbiased manner.

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A Chip That Mimics Human Organs Is the Design of the Year 07-06

A Chip That Mimics Human Organs Is the Design of the Year

 Paola Antonelli, the senior curator of design and architecture at the Museum of Modern Art, added an intriguing object to the museum’s permanent collection. It was a clear plastic chip, no bigger than a thumb drive, and it could soon change the way scientists develop and test life-saving medicines.

Called Organs-On-Chips, it’s exactly what it sounds like: A microchip embedded with hollow microfluidic tubes that are lined with human cells, through which air, nutrients, blood and infection-causing bacteria could be pumped. These chips get manufactured the same way companies like Intel make the brains of a computer. But instead of moving electrons through silicon, these chips push minute quantities of chemicals past cells from lungs, intestines, livers, kidneys and hearts. 

Networks of almost unimaginably tiny tubes give the technology its name—microfluidics—and let the chips mimic the structure and function of complete organs, making them an excellent testbed for pharmaceuticals. The ultimate goal is to lessen dependence on animal test subjects and decrease time and cost for developing drugs. Last year, researchers from Harvard’s Wyss Institute for Biologically Inspired Engineering started a company called Emulate, which is now working with companies like Johnson & Johnson on just this idea: pre-clinical trial testing. The company is currently working on incorporating Emulate’s chips into its research and development programs.

When the Harvard team first published its findings on the chips in 2010, the research was purely scientific. Now, five years later, it’s not only been inducted into the world’s foremost design collection, it’s also been named Design of the Year.very year, London’s Design Museum names one project as the year’s best. Past winners have included Zaha Hadid’s ethically-questionable (but stunning) Heydar Aliyev Cultural Centre in Azerbaijan, a lightbulb, and a government website. That a piece of medical equipment developed by biological engineers is this year’s winner isn’t just a nod to the design’s worthiness. It also says something about how views of what counts as “design” are changing.

To be sure, Organs-On-Chips is aesthetically brilliant. Antonelli, who recently called synthetic biology the most exciting frontier in design, described the chips as the epitome of design innovation. “In some lucky cases, the form is striking,” she says, referring to objects born out of scientific research. “In this particular case, added bonus, not only is the form striking, but so is the function—the idea behind the object.” Like a biological system, the chip’s form dictates its function, and its form is undeniably beautiful. But that’s not the end of the story. “Most people say form follows function, but it’s exactly the opposite in biology,” says Donald Ingber, a bioengineer and founding director of the Wyss Institute, which developed the chip and is working on commercializing it. 

“Actually, that’s not fair. It’s a dynamic relationship.” The structure of a biological system will inevitably affect the way it works, but Ingber says the design principle works both ways. “If you change the function, you can actually modulate the structure,” he says, noting how the diameter of blood vessels will adapt to decrease the tension in people who develop hypertension.

Working on the microscale requires precision. The chip effectively replaces the three-dimensional structures of an organ—the renal tubules of a kidney, the alveoli of the lungs, the veins in a liver—with tissue-lined microfluidic channels. Then it emulates the mechanics of those structures. For example, running air through a channel while using a vacuum to introduce a flexing motion will simulate the patterns of human breathing. The chip’s translucent polymer, in which the channels are encased, allows scientists to see what’s happening inside organs on the microscale. The prototypes can also be linked together to form a whole-body network of organs.

Organs-On-Chips embraces the most basic of design principles: efficiency. “Design in its greatest simplicity is minimizing any system down to its elements so as to have the greatest impact,” says Ingber. Like an increasing number of researchers, he understands that good science requires an understanding of good design. The principles that govern the two fields aren’t totally separate—in fact, design is a thread that runs through every field. It’s heartening when a big award reminds us of that.

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