In a first, health panel calls for routine anxiety screening in adults

[BumRushDaShow]

Last edited Tue Sep 20, 2022, 12:29 PM - Edit history (1)

Source: Washington Post

In a nod to the nation’s pressing mental health crisis, an influential group of medical experts for the first time is recommending that adults under age 65 get screened for anxiety. The draft recommendations, from the U.S. Preventive Services Task Force, are designed to help primary care clinicians identify early signs of anxiety during routine care, using questionnaires and other screening tools. Anxiety disorders are often unrecognized and underdetected in primary care: One study cited by the task force found the median time for initiating treatment for anxiety is a staggering 23 years.

While the task force’s initial deliberations on anxiety screening predated the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School in Worcester, Mass. “Covid has taken a tremendous toll on the mental health of Americans,” Pbert said. “This is a topic prioritized for its public health importance, but clearly there’s an increased focus on mental health in this country over the past few years.”

In April, the task force made similar recommendations to begin anxiety screening in children and teens, ages 8 to 18. The proposal announced Tuesday focuses on young and middle-aged adults, including those who are pregnant or postpartum, citing research showing that screening and treatment can improve anxiety symptoms in those younger than 65. But the guidance, somewhat surprisingly, stops short of recommending anxiety screening for people 65 and older. One reason: many common symptoms of aging, such as trouble sleeping, pain and fatigue, can also be symptoms of anxiety.

The task force said there wasn’t enough evidence to determine the accuracy of screening tools in older adults, which may not be sensitive enough to distinguish between anxiety symptoms and conditions of aging. The task force advised clinicians to use their judgment in discussing anxiety with older patients. The task force also reiterated an earlier recommendation that adults of all ages undergo routine screening for depression. The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, wields enormous influence, and while its advice isn’t mandatory, the panel’s recommendations often change the way doctors practice medicine in the United States.

Read more: https://www.washingtonpost.com/wellness/2022/09/20/mental-health-anxiety-screening/

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No paywall link

[XanaDUer2]

1. GOOD! nt

[SheltieLover]

2. Excellent! 👏👏👏👏

[RKP5637]

3. Excellent! n/t

[jmbar2]

4. Isn't everyone anxious?

Seems to be a normal response to all that is going on in the world.

[Irish_Dem]

8. We would be looking for symptoms which interfere with daily living.

Sleeping, eating, work, etc.

Yes some anxiety is normal, but when it crosses a line into disrupting a person's functional level, then it is a problem.

[Farmer-Rick]

5. What about people over 65?

Huh, my doctor does a suicide screening every year but it's the VA and they screen everyone for suicide. They even give you suicide prevention numbers when you call them.

But that's typically associated with depression and not anxiety.

[karynnj]

12. They do cite that they are not sure the tool works, but I think Medicare requires that you

Answer some mental health questions at any medical visit. I do not know if those questions would be sufficient to pick up anxiety and I don't know what if anything is done with them.

[chowmama]

22. I suspect for over 65

a screening isn't needed - it's just a given.

[Farmer-Rick]

23. They don't get anxious?

[Peregrine Took]

6. Plenty of anxiety over 65, too! n/t

[Hugh_Lebowski]

7. Xanax and Klonopin for everyone, woot!

Probably work out as well as the 'we need to treat pain with strong drugs' attitude in the late 90's that led to the opioid crisis.

Kicking anti-anxiety meds is no friggin' picnic, for some people it's worse than kicking dope.

Hope that isn't where this is going, but it sounds like the same lead-up for anxiety as was seen for pain back then.

Just sayin'.

[Irish_Dem]

9. Antidepressants work well on anxiety.

No need for addictive tranquilizers.

[jmbar2]

10. Can't remember who said it...Woody Allen?

Many of us would be better off talking to philosophers than therapists. So much of our angst comes from existential "what is the meaning of life" questions.

[Irish_Dem]

14. Some people have severe crippling anxiety disorders.

Due to a chemical imbalance in the brain.

Meds work very well for them.

[blue neen]

24. Meds do not always work.

There are genetic reasons why some people cannot metabolize anti-depressants. They can actually make some patients worse. SSRI's can be notorious for this.

When the meds work, it's wonderful but not everyone can count on that.

[littlemissmartypants]

34. It has also been discovered that there's a possible link between a healthy gut

microbiome and some psychiatric disorders. There's so much we don't know about the brain and this suggests that a healthy gut may support a healthy mind. I find this fascinating. It has to provide some kind of hope for those who find limited relief from drug therapy, psychotherapy or some combination of both. At least I'd like to think it does.

❤️ pants

~Scholarly articles~

1) Gut microbiome and depression: what we know and what we need to know
Gal Winter et al. Rev Neurosci. 2018.
https://pubmed.ncbi.nlm.nih.gov/29397391/
Abstract
Gut microbiome diversity has been strongly associated with mood-relating behaviours, including major depressive disorder (MDD). This association stems from the recently characterised bi-directional communication system between the gut and the brain, mediated by neuroimmune, neuroendocrine and sensory neural pathways. While the link between gut microbiome and depression is well supported by research, a major question needing to be addressed is the causality in the connection between the two, which will support the understanding of the role that the gut microbiota play in depression. In this article, we address this question by examining a theoretical 'chronology', reviewing the evidence supporting two possible sequences of events. First, we discuss that alterations in the gut microbiota populations of specific species might contribute to depression, and secondly, that depressive states might induce modification of specific gut microbiota species and eventually contribute to more severe depression. The feasibility of both sequences is supported by pre-clinical trials. For instance, research in rodents has shown an onset of depressive behaviour following faecal transplantations from patients with MDD. On the other hand, mental induction of stress and depressive behaviour in rodents resulted in reduced gut microbiota richness and diversity. Synthesis of these chronology dynamics raises important research directions to further understand the role that gut microbiota play in mood-relating behaviours, which holds substantial potential clinical outcomes for persons who experience MDD or related depressive disorders.

Keywords: anxiety; depressive disorder; gut microbiota; gut-brain axis; stress.

2) Gutted! Unraveling the Role of the Microbiome in Major Depressive Disorder
Thomaz F S Bastiaanssen et al. Harv Rev Psychiatry. 2020 Jan/Feb.
https://pubmed.ncbi.nlm.nih.gov/31913980/
Abstract
Microorganisms can be found in virtually any environment. In humans, the largest collection of microorganisms is found in the gut ecosystem. The adult gut microbiome consists of more genes than its human host and typically spans more than 60 genera from across the taxonomic tree. In addition, the gut contains the largest number of neurons in the body, after the brain. In recent years, it has become clear that the gut microbiome is in communication with the brain, through the gut-brain axis. A growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder (MDD). In this review, the interplay between the microbiome and MDD is discussed in three facets. First, we discuss factors that affect the onset/development of MDD that also greatly impinge on the composition of the gut microbiota-especially diet and stressful life events. We then examine the interplay between the microbiota and MDD. We examine evidence suggesting that the microbiota is altered in MDD, and we discuss why the microbiota should be considered during MDD treatment. Finally, we look toward the future and examine how the microbiota might become a therapeutic target for MDD. This review is intended to introduce those familiar with the neurological and psychiatric aspects of MDD to the microbiome and its potential role in the disorder. Although research is in its very early days, with much yet to be the understood, the microbiome is offering new avenues for developing potentially novel strategies for managing MDD.
More at the link.

3) Role of the gut microbiome in three major psychiatric disorders
Jenny Borkent et al. Psychol Med. 2022 May.
https://pubmed.ncbi.nlm.nih.gov/35506416/
Abstract
Major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia-spectrum disorders (SSD) are heterogeneous psychiatric disorders, which place significant burden on patient's well-being and global health. Disruptions in the gut-microbiome may play a role in these psychiatric disorders. This review presents current data on composition of the human gastrointestinal microbiota, and its interaction mechanisms in the gut-brain axis in MDD, BD and SSD. Diversity metrics and microbial relative abundance differed across studies. More studies reported inconsistent findings (n = 7) or no differences (n = 8) than studies who reported lower α-diversity in these psychiatric disorders (n = 5). The most consistent findings across studies were higher relative abundances of the genera Streptococcus, Lactobacillus, and Eggerthella and lower relative abundance of the butyrate producing Faecalibacterium in patients with psychiatric disorders. All three increased genera were associated with higher symptom severity. Confounders, such as medication use and life style have not been accounted for. So far, the results of probiotics trials have been inconsistent. Most traditional and widely used probiotics (consisting of Bifidobacterium spp. and Lactobacillus spp.) are safe, however, they do not correct potential microbiota disbalances in these disorders. Findings on prebiotics and faecal microbiota transplantation (FMT) are too limited to draw definitive conclusions. Disease-specific pro/prebiotic treatment or even FMT could be auspicious interventions for prevention and therapy for psychiatric disorders and should be investigated in future trials.

Keywords: Bipolar disorder; gastrointestinal permeability; gut-microbiome; major depressive disorder; probiotics; schizophrenia-spectrum disorders.

[Irish_Dem]

36. Yes but with a seriously suicidal or homicidal patient, rapid acting meds are considered first.

The research on the healthy gut is promising, but not yet substantiated in terms of diagnosis and treatment.

But it would be wonderful indeed if this would be the long term treatment of choice.

[KPN]

13. Antidepressants have their own problems. I had a friend who killed himself a week or so after

being prescribed antidepressants. He was suffering from anxiety/stress related to work.

[Irish_Dem]

15. The antidepressants take weeks to kick in.

We'd have to take a look at his history to see what happened, but he was not up to therapeutic level after a week or so.

[KPN]

17. Well, maybe it was weeks. It was long ago now so I'm relying on an

aging brain. At any rate, there are plenty of studies as I recall about risks associated with antidepressants, including suicide. I’m just pointing out that antidepressants aren’t the solution for everyone and could have a significant downsides equal to other pharmaceuticals for anxiety treatment depending on the individual.

[Irish_Dem]

18. Antidepressants have prevented a huge number of suicides.

They have vastly improved the lives of millions of people.

And we don't know if some suicides are linked to the meds or depression.

Yes there is a cost-benefit ratio to every medical treatment.

But for depressed people who cannot get out of bed and every day is a living nightmare, they are running
out of good options.

[ShazzieB]

37. Antidepressants (SSRIs) have saved MY life, in the sense of making it worth living.

I never got to the point of being seriously suicidal, fortunately, but you can be pretty damned miserable without actually wanting to off yourself (ask me how I know).

I've been on them for over 20 years now, and I don't ever want to go back. They're not a perfect panacea, but for some of us they make a huge difference in our quality of life. I'm sure there are millions of people like me, but you don't read about us in the papers, because we're just living our lives like everybody else.

The risks of suicidality, etc., with SSRIs mostly pertain to very young people, which I am decidedly not. And even with younger folks, they are just that: risks, that pertain to a few people, not most. You hear a lot about the cases that go wrong, just like you hear about the trains that derail and the planes that crash. Meanwhile, you don't hear about the vast majority of trains and planes that travel safely and uneventfully to their destinations every single damned day.

If I sound a little irritable, it's because it does irritate me when people over-exaggerate the suposed perils of drugs that millions of people like me use safely for years and even decades to treat disorders that can be crippling otherwise.

Thank you, Irish_Dem, for being a voice of reason in this thread.

[Irish_Dem]

38. Antidepressant meds are a modern day miracle.

As are all the psychotropics for other disorders.

They have saved lives and vastly improved the day to day quality of life.

My mother was an R.N. who as a young nurse in training worked in a psych hospital for a period of time.
It was a house of horrors, people receiving all kinds of brutal treatments.

With the modern psychiatric medications that is all gone. People can lead normal lives now.

We know that severe mood disorders (depression and anxiety) are due to a chemical imbalance in the brain
and are very easily treated these days with antidepressants.

I am a retired psychologist with 40 yrs clinical experience in various mental health settings.
Every day, I saw first hand the incredible improvement psych meds make.

In the four decades I worked in the mental health field, I never had one patient
who became more suicidal while on meds.

Shazzie I am so glad you are doing well on the meds and have a good quality of life.

[bucolic_frolic]

11. Is there narcissist anxiety? To be treated by narcissist therapists?

There is no screening for licensing narcissist therapists. They please themselves, at patients' expense. Beware.

[Marthe48]

16. I have an anxiety disorder I live with

I decided I didn't want to take medicine for it, although I asked for a prescription a few years ago to help me through some anxiety provoking dr. appointments that made my anxiety really bad. I bet most people would feel anxious if they were getting a needle poked in their eyeball every 4-6 weeks. :/

I get an annual well check and the form I fill out asks mental health questions, which the dr. asks me during the exam. Also physical well-being because I'm over 65. I think have 2 apporaches to the mental health questions can be helpful if people find it hard to discuss.

[Karma13612]

20. Yea, my doc has had

Mental Health questions on the yearly form I fill out when I go for my wellness/women’s exam. I’m 68 so the questionnaire also includes things about falling, etc. Been like that for several years now.

I had always been very honest about my stress and feeling hopeless etc on the forms.

But, until I actually brought it up, my self, during the docs exam, nothing was being done. I am convinced they were not doing anything with the questionnaire. Made me wonder just how bad it has to be for them to take it seriously.

Last year, at my yearly exam, I told my doc point blank that if I didn’t get help with my marital problems, and how hopeless I was feeling, I told them I would be looking at a divorce.

Interesting. THAT got their attention. So, I was referred to a Psych-Social worker who sat with me for 3-4 visits. She concluded that my husband is a narcissist, with a temper and we discussed options and coping. The lawyer who I went to subsequently told me, based on my financial situation ( I would lose half my savings and pension ‘cause it is split evenly-OMFG-he sat on his ass while I supported us), that I should ‘simply’ outlive him if I want to not be destitute.

[Marthe48]

21. Sounds like a tough situation for you

Would you be able to reach out to support groups? If not locally, then online? In our area, we have EVE, for abused women, and the state has elder abuse, but I'm not sure how encompassing they are.

Can you possibly work on changing your finances, so you are entitled to more? Hope you can change your situation for the better.

[Karma13612]

25. Thanks for your concern...

Yea, it seems I’m stuck right now.

I keep racking my brain for alternatives and try to make the best of things.

Don’t rock the boat, and just look for opportunities as they may come up.

Thanks again for your thoughts!

[Delphinus]

31. I'm sorry

I hope you can find peace.

[Karma13612]

33. Thank you..

Wish I could go back 22 years….

I know it’s what ‘girls’ are taught: be good, good things come to those who wait.

I’m looking for opportunities, and I watch my step. Many have it worse. He’s temperamental and lacks compassion and has a bad temper. My skin has gotten really thick. I’m strong and know that there is still a chance for a new beginning.



Thank you….

[NullTuples]

19. Oh, great. My anxiety says this means SCOTUS is going to repeal the pre-existing clause of the ACA

[fanfanois]

26. important. Anxiety contribute to heart disease

It matters.

[live love laugh]

27. Welcome to DU

[marble falls]

28. How do you deal with anxiety?

[fanfanois]

29. Coffee, avoiding people

Sometimes alcohol but i don't overdo it.

[marble falls]

30. All it needs to do is work for you. It's all good.

[fanfanois]

32. Thanks

😊

[littlemissmartypants]

35. ❤