Latest news with #psychiatry
WebMD
3 days ago
- Health
- WebMD
The Overlooked Symptom That Makes Depression So Hard to Treat
July 28, 2025 – It's one of the first symptoms when diagnosing depression: "Loss of interest or pleasure in activities once enjoyed." Psychologists call it anhedonia, from Greek roots meaning "without pleasure." (It's the opposite of "hedonism," the pursuit of pleasure.) You may not be familiar with the term (unless you're a big Annie Hall fan – it was the film's original title), but anhedonia is one of two core features, alongside persistent low mood, in depression's long list of symptoms. It's also one of the hardest to treat, and a significant risk factor for battling lifelong depression. But new research offers encouragement. Scientists are uncovering anhedonia's little-understood causes, opening doors to new treatments like exploring the meaning of life during therapy or identifying brain biomarkers that predict the most effective medications. Though the symptom is notoriously stubborn, really tuning into your anhedonia can set you on a path to overcoming it, experts say – and lessen the chances that depression will recur. "We see it all the time in our clinics, where patients are significantly struggling with the lack of motivation and the lack of experiencing pleasurable activities that they used to enjoy," said Majd Al-Soleiti, MD, a resident psychiatrist at the Mayo Clinic in Rochester, Minnesota, and author of a recent anhedonia study review. "So it's a clinical problem, but also we have gained a lot of knowledge in terms of how it may explain so many problems that we have that go beyond depression." Cracking the Mystery of Anhedonia Anhedonia shows up in a broad range of health conditions, including substance use disorders, eating disorders, and neurodegenerative diseases like Alzheimer's and Parkinson's. An estimated 35% of people with epilepsy have anhedonia, plus nearly 20% of people who've had strokes, and 25% of those with chronic pain. Among depression patients, up to 70% have anhedonia. We've all learned to tolerate a lack of pleasure in certain situations, like traffic jams and toddler tantrums. Anhedonia is different – it persists, and it's the result of the brain's reward processing circuitry malfunctioning. "People need to take anhedonia very seriously because it can have very negative consequences," including a heightened risk of suicide, said Diego Pizzagalli, PhD, an anhedonia expert and founding director of the Noel Drury, MD, Institute for Translational Depression Discoveries at the University of California, Irvine. Neuroimaging has refined the understanding of anhedonia – in particular, that there are two main subtypes: consummatory and anticipatory. Knowing the type of anhedonia can help identify the most effective treatment. Before and After: Anticipation and Consumption Most of us get excited knowing that something good is about to happen – you're going to eat your favorite meal or go on a trip. This is the anticipatory reward processing effect. When anticipatory anhedonia sets in, the pleasure and excitement aren't there. Consummatory anhedonia, by contrast, refers to a lack of pleasure during activities or interests that were once enjoyable. In both cases, imaging shows that the brain no longer responds as though it is expecting or experiencing a reward. "When someone is depressed, they will often stop meeting up with friends as often, or they'll stop doing the hobbies that they usually enjoy because those kinds of things just don't feel as enjoyable or they don't feel as interesting as they used to," said Jennifer N. Bress, PhD, a psychologist at Weill Cornell Medicine in New York City who researchers brain activity linked to depression and treatment response. Bress's research shows that people with anhedonia have differences "on a neural level" – meaning the symptom is linked to changes in the way neurons (brain cells) communicate using electrical and chemical signals. "The brain's reactivity to rewards also decreases," said Bress. A classic experiment demonstrates this. It's a guessing game where people being researched can win 50 cents for each correct answer, or lose 25 cents if they're wrong. "People have less electrical activity in their brain in response to winning money when they're depressed versus when they're not," Bress said. And yes, they really give people 50 cents – or take a quarter away. "There's something about knowing that this is real and that they will actually win something that's important to getting a robust response." What that means outside the lab: When you're working to overcome anhedonia, it's important that the rewards you anticipate or experience be real – because your brain responds more strongly when stakes are tangible. Treatments That Help One of the most effective treatments for anhedonia – whether anticipatory or consummatory – is a therapy called "behavioral activation," said Pizzagalli. Behavioral activation takes a step-by-step approach to help patients get back to activities they once enjoyed. This includes scheduling each step leading up to the activity, such as deciding who will join you, and organizing the smallest logistics in advance. Therapists help clients overcome barriers along the way. New potential therapy approaches are emerging. One is "positive affect" treatment, where people work to focus more on positive emotions with the added goal of feeling fewer negative emotions. The idea is that increasing positive emotions can heighten reward sensitivity – helping the brain break out of its anhedonic cycles. Other research suggests that therapies focused on identity, purpose, and social connection may help by boosting a person's "meaning in life," which may in turn reduce anhedonia. Here's the theory behind why these therapies work: With anhedonia, brain connections in reward processing weaken when people disengage from their usual activities and interests. "You end up in this sort of feedback loop where you become even more depressed and feel even less like doing things," Bress said, "so you get even fewer opportunities for rewards, which in turn leads to becoming even more depressed." Ultimately, the brain becomes less responsive to rewards. Behavioral activation gives patients "more opportunities to be exposed to these rewarding outcomes," she said, which "may help to strengthen some of these connections in the brain that help people respond in a healthy way to rewarding experiences." Antidepressants tend not to work as well for anhedonia, particularly for the most severe cases, research shows. Still, there is hope for the future, as researchers develop a more detailed understanding of what is happening in the brain. Pizzagalli's team is studying brain biomarkers that may help predict which medications will work well for a particular person, laying the groundwork for a personalized approach. But for now, drugmakers have yet to develop a medication to specifically treat anhedonia, he said. One promising contender is ketamine, which has been shown to rapidly reduce anhedonia and likely impacts the brain's functional connections. Al-Soleiti's recent paper also mentioned transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) as being notably effective in treating anticipatory anhedonia. Also helpful is simply improving diet and lifestyle, since these changes can reduce inflammation and stress, which both are linked to anhedonia, Pizzagalli said. Weighing Your Options While many unanswered questions remain in the science of anhedonia, researchers do know that the two types affect separate areas of the brain. While both anticipatory and consummatory anhedonia have been linked to depression, the association with anticipatory anhedonia has been demonstrated more consistently. "You could have no problem actually enjoying things that you might like – say you watch a funny video and really enjoy it," Bress said. "But you may have a lot of trouble with the anticipatory piece or the motivational piece. You might notice it's really hard to actually get yourself to turn on the video, or it might be that you really enjoy seeing your friends once you go out, but it might be hard to push yourself to actually make that plan and go meet up with them at the coffee shop." For therapy approaches, treatment usually involves weekly sessions for anywhere from two to six months. Some of Bress's clients have shown improvement within just a couple of weeks. Even if past treatments haven't worked, Pizzagalli urged people not to give up. Most therapists are trained in more than one type of therapy, so if you are considering therapy, ask if they use behavioral activation therapy or another approach specific to anhedonia.
ABC News
5 days ago
- Health
- ABC News
Woman says faecal transplant saved her and could help many more like her
As the blender blitzed and Jane Dudley prepared for a radical procedure, the concept of being at the forefront of a potentially revolutionary change in the treatment of bipolar disorder was far from her mind. Mostly, Jane was thinking about how revolted she was by what was about to happen. But months after her husband Alex, a park ranger with a lifelong interest in ecology, first proposed the "gross" idea to Jane as a way of managing her crippling bipolar, she decided it was worth a try. "I was at a point of desperation where I felt I can't continue living with this level of suffering," Jane tells Australian Story. "It was a desperate act." Eight years ago, Jane began a series of home-administered faecal microbiota transplants (FMT), or "poo transplants", with the hope it would "take the edge off" her mental illness, which had led to her being hospitalised multiple times. The couple took Alex's faeces, blended it with saline, passed it through a sieve, put the slurry into an enema bottle and "then head down, bum up, squeeze it in". To Jane's astonishment, as the months went on, she began "to feel joy for no reason". "I started to have self-esteem for no reason," she says. "I started to have motivation." Now, all those years on from that first tentative blending, and without a manic episode since September 2017, Jane feels confident in saying she has been cured of an illness psychiatry labels incurable. It was a world-first use of FMT to cure bipolar and experts were stunned. Jane's psychiatrist, Russell Hinton, monitored Jane's progress during the treatment. He describes the change in Jane as "bordering on miraculous". Gordon Parker of the University of NSW's psychiatry faculty said Jane's recovery through FMT was one of the most exciting developments in his 50 years of psychiatry. But Jane and specialists warn that the DIY method she had turned to carries significant risks — including death — if the faecal donor is not properly screened. There is a risk that serious disease, obesity or antibiotic resistance can be transferred from an unscreened donor to a recipient. It's why there is now a push to raise $10 million to enable the Food and Mood Centre at Deakin University to run a randomised control trial of faecal transplants for depression. "The fact that people are finding my story and doing DIY FMT … scares me because I'm worried that people are going to get even sicker, that it's not going to work, or they're going to end up with an autoimmune disease or have a severe reaction, which just speaks to the urgency of why we need clinical trials now," Jane says. "We need them funded now." It's a campaign that Jane believes could bring relief to millions of people living with depression and bipolar worldwide — and it all began with a frog. It was November 2013 when Jane popped her arm through her raincoat and, as her hand emerged, there sat "a very beautiful frog". Transfixed, she found the name of a frog expert and sent off a message and a photograph to him. His name was Alex Dudley. Alex quickly advised Jane that the emerald-dotted frog was not rare or endangered, as she imagined, but a Peron's tree frog. A very common frog. But to the couple, it was a magical frog because from the moment they started talking, their lives were destined to be forever intertwined. "It was bafflingly fast. Before I even laid eyes on her physical self, I was confident that Jane was the one. We just connected," Alex says. Within the first 20 minutes of a 10-hour chat, Jane told Alex she had bipolar 1 disorder. He had a loose understanding of the mental illness but no concept of the extreme highs and lows that Jane experienced. Over the ensuing months, Alex learned how Jane had been a bright, sporty kid with expectations of going to university and becoming a professional soccer player. But, by her teenage years, anxiety crept in. Then, at age 15, she was sexually abused by an uncle she didn't grow up with. "It broke me on a fundamental level and was definitely the trigger for me developing serious mental illness," Jane says. An extended bout of tonsillitis and glandular fever followed and the illness and her mental health conspired to keep her from school. Jane said she dropped out at year 11 and "lost myself for the next 18 years". For vast chunks of time, Jane's depression was so severe she could not get out of bed or tend to her basic needs, requiring family or friends to look after her. At times, she was suicidal. Jane would flip into mania, where she would travel to other planets and speak with aliens. "I would be talking to spirits … I would feel like I had godlike powers and that I was the chosen one," she says. Alex says it was only when Jane went into psychosis that he realised the severity of her mental illness. He still becomes emotional when he recalls the lows that Jane would reach. "She wasn't living … she wasn't living in a way that was sustainable," he says, choking back tears. Alex became desperate to help the woman he loved. "I never dreamed about running away from her or being frightened off by this. I was like, 'How can I help?'" he says. Alex knew that the gut biome — a range of bacteria, viruses, fungi and other microbes in the gut — influenced the production of serotonin and dopamine, neurotransmitters that were crucial for mood and motivation. He recalled Jane's stories of being given large amounts of antibiotics over almost two years to combat her tonsillitis. He figured that her gut biome could have been starved and diminished by the antibiotics. Alex delved into the scientific literature and came across a study in which the faeces of a depressed human were put into a rat. The rat developed depression. He wondered if that could be reversed. "Suddenly, everything just fell into place," Alex said. "This could work." Professor Parker said the fact that FMT — a procedure already approved to manage a severe gut infection — did cure Jane's bipolar could represent a paradigm shift in the way some mental illnesses were treated. "Jane's story knocked my socks off," he said. "It was a story that caused me to say 'wow' and keep on saying 'wow' for quite a long time." Professor Parker interrogated the details of Jane's recovery — speaking to her psychiatrist Dr Hinton, analysing her medication intake, consulting gut specialists — and it stood up to scrutiny. He has since written a book, A Gut Mood Solution, presenting five FMT case studies other than Jane's, including one of his own patients. Two of those people have experienced remission. "The concept of our gut microbiome and how that might be actually influencing our mood for the worst or for the better is the new paradigm and that has huge implications in terms of managing mood disorders," Professor Parker says. "We've now got strongly suggestive evidence that we have an intervention that will help people with intractable mood disorders, be it depression or bipolar. We now need the science to be put in place." It confounds Jane that the Food and Mood Centre has been unable to attract funding for a clinical trial despite being ready to launch after conducting a successful pilot study based on her case. "If we can show with clinical trials that faecal transplant could help a large proportion of people with serious mental illness, the social impact will be huge, but also the financial impact," she says. Jane says she believes the faecal transplant has saved the government at least $250,000. No longer is she on medication, no longer does she need the disability support pension, no longer is she being hospitalised every year. "By resolving my bipolar symptoms, we have saved the government potentially millions of dollars," Jane says. "And I'm one person." The way Jane sees it, this is an epic love story that "just happens to involve a bit of poo". "The reason I am alive and well and can feel joy for no reason and like myself is because of one man, Alex," she says. "He has saved me … in every way that another human being can be saved." The weight she gained from bipolar medication has fallen away and she is now focused on a healthy diet to "keep my gut bugs happy". The couple grow their own vegetables and cook predominantly plant-based food from scratch, eschewing processed food. "In a very real way, the number twos cured my blues," she says. Her university ambitions returned and, having completed high school at TAFE, she is now in the second year of an environmental science degree, with plans to become a field ecologist. Jane calls Alex the hero of her fairytale, a man whose unshakeable love for a broken woman led to a radical hypothesis that, in Jane's case, set her free. "Woman meets frog, frog leads woman to man, man and woman fall in love," she says. "Man cures woman's incurable illness with his magic poo, thus breaking the curse."
Irish Times
5 days ago
- Business
- Irish Times
Widow of noted psychiatrist Michael Mulcahy left more than €5m in will
Joan Mulcahy, the widow of noted psychiatrist Dr Michael Mulcahy , left estate valued at €5.5 million when she died in October last year, according to papers lodged with the Probate Office. The couple met when sailing to New York in 1956. When their paths crossed again two years later they married just a month afterwards in New York in April 1958. Dr Mulcahy became one of the most eminent psychiatrists of his generation and was an internationally renowned figure in the specialism of intellectual disability. He also spearheaded the move from institutional care to community houses in Ireland. The couple lived at Merrion Road, Ballsbridge, Dublin. He died in January 2021. READ MORE In other wills, Kevin Doherty, former solicitor and Leitrim county registrar, of Cootehall, Boyle, Co Roscommon, who died in May last year, left an estate valued at €2.5 million. Mr Doherty was a member of the well-known Co Roscommon family and a brother of the late Fianna Fáil politician, Seán. Margaret Goor, of Annacrivey House, Enniskerry, Co Wicklow, who was noted for sailing the world with her husband John, a former managing director of Blackwood Hodge, left an estate valued at €8.4 million when she died last October . Co Wicklow farmer Martin Patrick Carr, with an address at Ashtown Farm, Ashtown Lane, Wicklow town, died in August 2023 and left more than €9.5 million. Marie Crosbie, of Killeen House, Kill, Co Kildare, and formerly of The Grange, Lucan, Co Dublin, left estate valued at €8.5 million when she died in May last year. Businessman Terence Crawford Johnson, of Stratmore Road, Killiney, Co Dublin, who died last December, left estate valued at €7.79 million. Mr Johnson was a member of the Johnston family, which owned the distribution company Johnson Brothers. John (Sean) Lyons of Mount Alto, Ashford, Co Wicklow, who died in January, left estate valued at €6.9 million. James J Swan, of Skryne Hill, Tara, Co Meath, who died in March 2023, left estate valued at €4.09 million. Catherine Boylan, of Primrose Hill, Celbridge, Co Kildare, who died in September 2021, left estate valued at more than €3.1 million. Michael Behan, of Ormond Road South, Rathgar, Dublin, who died in June last year, left estate valued at more than €3.6 million. The values quoted above include all assets, typically including the value of a home and other holdings such as land or investments
New York Times
22-07-2025
- Health
- New York Times
What Happened in This Doctor's ‘Sleep Room' Might Give You Nightmares
THE SLEEP ROOM: A Sadistic Psychiatrist and the Women Who Survived Him, by Jon Stock Tales of predatory men performing reprehensible acts on unconscious women are as old as human history (see 'Sleeping Beauty,' the 14th-century version) and as recent as yesterday's news (see the Frenchman who invited dozens of strangers to rape his drugged wife). But in the case of the British psychiatrist William Sargant (1907-88), his ministrations to slumbering female patients were for the most part perfectly legal, undertaken in the name of medical science with the aim of curing severe distress. As Jon Stock recounts in 'The Sleep Room,' his disturbing chronicle of Sargant's career, between 1964 and 1972, the psychiatrist, by then an eminence in his field, subjected hundreds of patients — the vast majority of them women — to what he called 'continuous narcosis,' in a twilit, bed-lined garret on the top floor of London's Royal Waterloo Hospital, his 'sleep room.' For up to four months at a time, girls as young as 14 were kept knocked out on cocktails of antipsychotics, sedatives and antidepressants while administered risky experimental therapies — typically one or the other of Sargant's favorites: electroshock (ECT) and insulin coma (in which huge doses of insulin induced a hypoglycemic stupor). 'Under sleep,' he explained in a textbook for fellow practitioners, 'one can now give many kinds of physical treatment, necessary, but often not easily tolerated.' (Conveniently for him, patient consent wasn't British law until 1983, long after he'd retired.) 'Physical' is the key word here. Deploring psychiatry's lack of effective therapies for serious mental illness, Sargant had no patience with the ruling Freudian 'sofa merchants' and 'talkers,' who trafficked in poetic intangibles like the unconscious and sublimation. Instead, he saw the mind, 'conceived merely as the brain,' as no different from any other organ and requiring the same concrete interventions as a burst appendix or broken arm. The theory behind this approach was nearly as crude as the treatments themselves: A dramatic jolt to the system would disrupt negative patterns of thought and behavior and produce what Stock calls 'a factory reset.' Want all of The Times? Subscribe.
Forbes
22-07-2025
- Health
- Forbes
Is The Mental Health System Broken Or Was It Never Built To Work?
Five years ago, a research team at Stanford achieved what many in psychiatry had long hoped for: A treatment for severe depression that worked rapidly, reliably, and without medication. In their 2020 SAINT trial, 19 out of 21 participants with treatment-resistant depression achieved remission after just five days of transcranial magnetic stimulation (TMS). It was a landmark moment. Yet today, the treatment remains almost entirely inaccessible to the average patient. Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) is still paid for out of pocket, costing roughly $20,000, and insurers have been slow to move. A paradox at the heart of American mental healthcare: as innovation accelerates, access stalls. Over the last five years, more than $13 billion has been invested in the sector, but outcomes haven't improved in kind. Patients still cycle through multiple failed treatments. Clinicians are burnt out, and payers are stuck making decisions with no data. It's tempting to say the system is broken. But perhaps it was never built to do what we're now asking of it. A System Built for Simplicity, Not Reality Modern mental healthcare still relies on a medical model designed for acute illness: assess symptoms, assign a diagnosis, and prescribe a standard treatment. It's a linear approach that works well for infections and injuries. But mental illness is not linear. A messy intersection of biology, trauma, environment, and social context shapes conditions like depression, PTSD, and OCD. There's no single cause, no universal treatment. And yet, the system continues to reduce people to diagnosis codes and protocol templates, often leaving naivety at the door. This reductionist model doesn't reflect the complexity of the human experience, and it leaves patients, clinicians, and payers with more questions than answers. The system doesn't work for anyone. Yet, the misalignment of incentives means that all stakeholders are working against one another. Payers prioritize risk management—and in the absence of meaningful data, default to spending as little as possible. Providers focus on individual outcomes. Pharma chases scalable efficacy. Patients just want relief. But it seems no one is working with the correct information, and the frustration and disappointment are palpable. Data alone doesn't matter, because it's about how you use the data to drive change, according to Brayden Efseroff, psychiatrist and Chief Medical Officer at Allia Health. 'When patients cycle through multiple failed treatments before finding relief, it's not just frustrating - it's a sign of systemic dysfunction. Decisions are being made without context.' Ariel Ganz, PhD, a precision mental health researcher at Stanford, agrees, 'The same data clinicians need to design effective treatment plans is also critical for payers to manage risk, researchers to improve understanding, and patients to advocate for themselves on their health journey. 'Without more high-quality data, none of these parties can effectively improve patient outcomes.' Precision Mental Health Company is addressing this issue at its core. Their AI-native electronic health record (EHR) isn't designed to replace therapists or psychiatrists, but to support them by capturing, organizing, and translating real-world data into usable, structured insights. This innovative solution holds the promise of a brighter future for mental healthcare. Instead of extracting revenue from clinicians through software subscriptions or taking a percentage of their reimbursement, payers partner directly with Allia on value-based contracts. They're paid only when patients achieve measurable improvements, a stark contrast to the fee-for-service model that rewards volume over outcomes. Amie Leighton, CEO of Allia Health, discovered the need for better data firsthand during years of cycling through hospitals and treatment before finally receiving adequate care. The turning point came when her clinicians had access to complete information about her and were able to communicate with each other - something that had been missing throughout her previous treatments. This personal experience, and the empathy it engenders, shaped the company's mission: to build the infrastructure that allows for context-rich, coordinated, and personalised care. The Bigger Picture How do you fix a system that was never designed to work in the first place? We still have a long way to go, but for the millions of Americans struggling with mental health challenges, finally, an infrastructure-first approach offers something that's been missing: a system designed to actually help people recover. In an industry where patients commonly endure multiple failed treatments before finding relief, this represents a significant shift toward care that prioritizes outcomes.
