Paul Gleason, PhD

Researchers at Yale University have found that prazosin, a drug developed to treat high blood pressure, can also reduce alcohol use in patients with 

“There has been no treatment readily available for people who experience severe withdrawal symptoms,” 

, an author on the study and director of the Yale Stress Center. “These are the people at the highest risk of relapse and are most likely to end up in hospital emergency rooms.”

Alcohol withdrawal symptoms include shakes, heightened cravings, anxiety, and difficulty sleeping, which can easily lead to poor treatment outcomes.

In order to study the possible effects of prazosin on alcohol use, Sinha and her co-authors designed a 12-week, double-blind trial, recruiting 100 patients with alcohol dependence. The researchers collected information on the participants’ self-reported drinking habits (including average drinks per day) and their moods, levels of anxiety, alcohol cravings, and sleep quality ratings.

At the end of the 12-week study, researchers found that participants with high alcohol withdrawal symptoms who received prazosin reported fewer “drinking” and “heavy drinking” days than patients who received a placebo.

 Patients with high withdrawal symptoms also reported decreased anxiety, depression, and alcohol cravings. Patients with no or low withdrawal symptoms did not receive a similar benefit from prazosin.

Originally developed to treat high blood pressure, prazosin has also been shown to affect stress centers in the brain, improving memory while reducing anxiety and cravings.

 Sinha’s lab has previously found that the recovery process disrupts stress centers in the brain, especially in patients with severe withdrawal symptoms.

Fortunately, these disruptions decrease over time. The hope, Sinha said, is that prazosin could bridge the gap between patients’ initial withdrawal symptoms and long-term recovery.

Share comments with your colleagues by emailing 

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1. Sinha R, Wemm S, Fogelman N, et al. Moderation of prazosin’s efficacy by alcohol withdrawal symptoms. 

2. Drug eases recover for those with severe alcohol withdrawal. 

. November 19, 2020. Accessed November 25, 2020. 

https://www.sciencedaily.com/releases/2020/11/201119124716.htm

Articles

A drug developed to treat high blood pressure has unexpected benefits for patients with severe withdrawal symptoms.

Blood Pressure Drug Benefits Patients Recovering From Alcohol Addiction

Spare a thought for anyone spending Thanksgiving all alone. 

 suggests that isolated individuals may long for company in the same way that hungry children long for that apple pie in the oven.

“People who are forced to be isolated crave social interactions similarly to the way a hungry person craves food,” Rebecca Saxe, a senior author of the study, 

. “Our finding fits the intuitive idea that positive social interactions are a basic human need, and acute loneliness is an aversive state that motivates people to repair what is lacking, similar to hunger.”

For the study, Saxe and her co-authors collected 40 participants, individuals aged 18 to 40. The participants underwent a pair of 10-hour test periods. One required a 10-hr fast, and the other required 10 hours of strict social isolation, alone in a windowless room on the campus of the Massachusetts Institute of Technology. After the test periods, the participants were scanned by a magnetic resonance imaging (MRI) scanner and shown pictures of either food or individuals interacting.

“We wanted to see if we could experimentally induce a certain kind of social stress,” Saxe explained to the press. “It’s a stronger intervention of social isolation than anyone had tried before.”

The researchers focused on the substantia nigra, a structure located in the midbrain and associated with hunger pangs. Sure enough, both fasting and isolated participants showed “craving signals.” The strength of the signal also correlated with the participants reports of how hungry or lonely they felt.

Additionally, participants who reported high levels of satisfaction with their social lives outside of the study experienced higher levels of social hunger. “For people who reported that their lives were really full of satisfying social interaction, this intervention had a bigger effect on their brains and on their self-reports,” Saxe said.

At the end of the published study, the authors raised the issue of how much “positive social interaction is sufficient to fulfill our social needs and thus eliminate the neural craving response.”

Whether digital communication alone can satisfy social hunger is an open question, they noted, and an important one.

“In early 2020 millions of humans experienced a sudden, externally mandated period of relative or complete physical isolation from others,” the authors concluded. “This unprecedented upheaval in people’s social routines emphasized the need for a better understanding of human social needs and the neural mechanisms underlying social motivation.”

What do you think? Are you craving company? 

1. Tomova L, Wang KL, Thompson T, et al. Acute social isolation evokes midbrain craving responses similar to hunger. 

Trafton A. Neuroscientists find that isolation provokes brain activity similar to that seen during hunger cravings. Medical Press. November 23, 2020. Accessed November 25, 2020. 

A new study finds that isolation makes us want company on a neural level, in much the same way that hunger makes us want food. 

Craving Company  

Pear Therapeutics has announced the availability of Somryst, the only US Food and Drug Administration-authorized digital therapeutic for chronic insomnia to date. (Read 

, MD, chief medical officer at Pear Therapeutics.)

“We’re excited to offer patients who have been struggling to find a long-term solution for chronic insomnia with a meaningful, first-line treatment,” Corey McCann, president and chief executive officer of Pear Therapeutics, said in a statement.

A prescription digital therapeutic (PDT), Somryst offers 6 to 9 weeks of cognitive behavioral therapy (CBT) via a tablet or smartphone. Clinical studies on the efficacy of this therapeutic have appeared in 

The prescription reduced the time needed to fall asleep by 45%, time spent awake during the night by 52%, and the severity of insomnia symptoms by 45%. Improvement continued 6 and 12 months after treatment.

At present 30 million Americans suffer from chronic insomnia, but McCann noted that treatment options are especially “important now, more than ever, as we continue to navigate the COVID-19 pandemic.”

Indeed, sleep disorders have soared during the pandemic. Nearly half of respondents to a Pear Therapeutics survey reported pandemic-related sleep loss. The number reporting poor sleep almost doubled (from 15% to 27%), and younger generations have been especially affected, with nearly one-third of Gen Z and Millennials admitting to poor sleep quality.

Digital prescriptions may be good options for patients who cannot access a clinician. “Despite CBTi being the recommended first line treatment for chronic insomnia, there aren’t enough clinicians who are trained to deliver CBTi therapy,” Michelle Primeau, MD, medical director of the Palo Alto Medical Foundation Sleep Medicine Center in San Carlos, CA, told the press. “Somryst has been shown to address the underlying issues of chronic insomnia by training the brain and body to fall asleep faster and stay asleep longer.”

Are your patients experiencing increased insomnia? 

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Ritterband LM, Thorndike FP, Ingersoll KS, et al. Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year follow-up: a randomized clinical trial

Christensen H, Batterham PJ, Gosling JA, et al. Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. 

Batterham P, Christensen H, Mackinnon A, et al. Trajectories of change and long-term outcomes in a randomized controlled trial of internet-based insomnia treatment to prevent depression. 

Potential relief for millions of Americans with pandemic-related sleep issues. 

A New Digital Therapeutic for Chronic Insomnia

The presidential election is not over. But around the nation, voters have made their voices heard on numerous down-ballot issues directly related to psychiatry and mental health. In this election round-up, 

 highlights a sampling of propositions, measures, and initiatives that may change mental health treatment for years to come. 

Voters in Colorado passed Proposition 118. One of the most progressive laws of its kind in the country, it requires that employers offer 12 weeks of paid time off for childbirth, emergencies, and other 

“I’m so proud that Colorado is the first state to do this on the ballot,” said Colorado State Senator 

. “We’ve always had stories of moms going back to work within two weeks of giving birth and cancer patients skipping chemotherapy to keep their jobs.” This law could reduce financial stressors for many patients, and eligible clinicians who can take advantage of family and medical leave may be 

The use of cannabis for mental health purposes 

 among psychiatrists, but 2 additional states have approved cannabis use for medical use. The state of Mississippi appears to have passed a medical marijuana measure by more than a 

. South Dakota voters passed a ballot measure that authorizes medical marijuana and, at the same time, an amendment that also allows 

The adoption of both at once is unprecedented, noted Erik Altieri, executive director of the National Organization for the Reform of Marijuana Laws (NORML). “No state has ever moved from marijuana prohibition to allowing both medical use and adult-use access, quite literally, overnight,” 

Oregon appears to be the first state that will allow the use of psilocybin (the active ingredient in so-called “magic mushrooms”) for 

. Ronan Levy of Field Trip Health, a Canadian company that uses psychedelics in psychotherapy, imagined that the new law could open doors to many new treatments. “There’s almost no mental health condition right now that’s not being looked at,” he said.

 on hallucinogenic psychedelics and their potential efficacy.

Former president of the American Psychiatric Association, Nada Stotland, MD, MS, has argued that abortion should be a real 

. “Access to this important aspect of women’s health care is vital not only to all women around the world,” she said, “but particularly to our patients.”

Colorado voters rejected Proposition 115, which would have outlawed abortions after 22 weeks. In Louisiana voters amended the state constitution, saying that the state neither protects abortion rights nor requires 

In addition to choosing a president and other political leaders, Americans cast their votes on a host of issues relevant to psychiatrists. 

Paul Gleason, PhD

Articles

Blood Pressure Drug Benefits Patients Recovering From Alcohol Addiction

Craving Company

A New Digital Therapeutic for Chronic Insomnia

Beyond the Presidential Race: Voters Address Mental Health Issues