Importance Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management.

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Importance It has been observed that suicidal behavior is influenced by sunshine and follows a seasonal pattern. However, seasons bring about changes in several other meteorological factors and a seasonal rhythm in social behavior may also contribute to fluctuations in suicide rates. Objective To investigate the effects of sunshine on suicide incidence that are independent of seasonal variation.

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Importance Reward-related disturbances after withdrawal from nicotine are hypothesized to contribute to relapse to tobacco smoking but mechanisms underlying and linking such processes remain largely unknown. Objective To determine whether withdrawal from nicotine affects reward responsiveness (ie, the propensity to modulate behavior as a function of prior reinforcement experience) across species using translational behavioral assessments in humans and rats. Design, Setting, Participants Experimental studies used analogous reward responsiveness tasks in both humans and rats to examine whether reward responsiveness varied in (1) an ad libitum smoking condition compared with a 24-hour acute nicotine abstinence condition in 31 human smokers with (n = 17) or without (n = 14) a history of depression; (2) rats 24 hours after withdrawal from chronic nicotine (n = 19) or saline (n = 20); and (3) rats following acute nicotine exposure after withdrawal from either chronic nicotine or saline administration

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Director’s Blog The Research!America awards dinner is like a lot of DC galas, complete with members of Congress, celebrities, and speeches to honor those who have contributed to a cause.  For Research!America, the cause is biomedical research and this year, as in each of the past 25 years, there were honors bestowed on advocates for cancer and rare diseases.  Kathy Giusti, diagnosed with multiple myeloma in 1998, spoke passionately about the lack of research on this blood cancer and her singular fight to create a registry and clinical trials, leading to new treatments that have extended her own life and the lives of many others well beyond all predictions.  The parents of Sam Berns, an icon for the rare disease progeria, spoke of their son’s commitment to find a cure for this disorder in which children age rapidly and die early.  Sam died last month at age 17, but during his brief life, and partly through his efforts working with the world’s foremost genetics labs, the genetic cause was found and new treatments were developed that will almost certainly extend life for others with this rare mutation (see Sam’s inspirational Ted talk ).  For me, what made this event different from previous years was the recognition of advocates for people with mental illness.  The actress Glenn Close was recognized for co-founding BringChange2Mind, a campaign to reduce negative attitudes toward those with mental illness.  In her eloquent remarks accepting the award, Glenn introduced her sister, Jessie Close, and her nephew, Calen Pick, who each battle serious mental illness.  Jessie has struggled with bipolar disorder and Calen with schizophrenia.  When Glenn invited Jessie and Calen to make a few remarks, the evening really became historic.  Together, they described a journey undertaken with Deborah Levy and her colleagues at McLean Hospital and elsewhere over the past 3 years.   The research team found that Calen and Jessie shared a rare genomic copy number variant resulting in extra copies of the gene for glycine decarboxylase.  This gene encodes the enzyme that degrades glycine, a key modulator of the NMDA receptor, which has been implicated in psychosis.  Having extra copies of this gene, it seemed possible that Jessie and Calen would be deficient in glycine, with less activity of the NMDA receptor.   When Dr. Levy and her colleagues gave glycine to Jessie and Calen under double blind conditions (in which neither doctor nor patient know whether glycine or placebo is being given), the response was like giving insulin to a person with diabetes—their psychiatric symptoms largely resolved.  When the drug was stopped, their symptoms returned. When they received glycine again under non-blind conditions, the same improvements were observed.

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Director’s Blog Despite careful monitoring and daily insulin, many people with type I diabetes experience emergencies like diabetic coma that require hospital care. Imagine a dystopic world where this care was not given in hospitals but in jails alongside inmates convicted of violent crimes.

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Director’s Blog *Dr. Insel was one of several innovative leaders invited to present at the 2014 National Council for Behavioral Health Conference. Download his presentation: Quest for the Cure: Scientific Breakthroughs in Treating Mental Illness

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Director’s Blog I don’t know why or how April 25th, the day after Earth Day and the day before Save the Frogs Day (really), was named National DNA Day, but once again we have a reason to celebrate the basic language of biology. In fact, this has been a good year for DNA—that 3 billion base-pair long sequence of nucleotides which constitute the building blocks for the 23 pairs of chromosomes found in almost every human cell.

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Director’s Blog When the Mental Health Parity and Addiction Equity Act was signed into law in 2008, after decades of debate, advocates for mental health celebrated what was arguably their most important legislative achievement in 50 years. The new law, with the cumbersome acronym of MHPAEA, had a simple, ambitious goal: treatment for mental illness and substance abuse disorders would be on a par with treatment for all other medical disorders. If insurance companies covered treatments for depression and diabetes, they could not have different requirements or different deductibles or different reimbursement schedules for the two conditions.

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Director’s Blog Imagine for a moment that we had the magic bullet for depression or schizophrenia or anorexia or autism. A single pill, taken once a day, safe and effective, that would immediately and continually keep all of the symptoms at bay.

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Director’s Blog Released today, the World Health Organization (WHO)'s report, ” Preventing Suicide: A global imperative ,” provides the first global view of how often suicide attempts and deaths occur, and how suicide-related behaviors affect all ages, nationalities, economic levels, and cultures. Every year around the world more than 800,000 people die by suicide. Globally, suicide is the second leading cause of death in 15- to 20-year-olds.

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