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"Ilardi, Stephen S."
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The anxiolytic effect of probiotics: A systematic review and meta-analysis of the clinical and preclinical literature
Probiotics have generated intensive research interest in recent years as a novel mode of treatment for physical and mental illness. Nevertheless, the anxiolytic potential of probiotics remains unclear. The present systematic review and meta-analysis aimed to evaluate the clinical and preclinical (animal model) evidence regarding the effect of probiotic administration on anxiety.
The PubMed, PsycINFO, and Web of Science databases were reviewed for preclinical and clinical studies that met the defined inclusion and exclusion criteria. The effects of probiotics on anxiety-like behavior and symptoms of anxiety were analyzed by meta-analyses. Separate subgroup analyses were conducted on diseased versus healthy animals, specific preclinical probiotic species, and clinical versus healthy human samples.
Data were extracted from 22 preclinical studies (743 animals) and 14 clinical studies (1527 individuals). Overall, probiotics reduced anxiety-like behavior in animals (Hedges' g = -0.47, 95% CI -0.77 --0.16, p = 0.004). Subgroup analyses revealed a significant reduction only among diseased animals. Probiotic species-level analyses identified only Lactobacillus (L.) rhamnosus as an anxiolytic species, but these analyses were broadly under-powered. Probiotics did not significantly reduce symptoms of anxiety in humans (Hedges' g = -0.12, 95% CI -0.29-0.05, p = 0.151), and did not differentially affect clinical and healthy human samples.
While preclinical (animal) studies suggest that probiotics may help reduce anxiety, such findings have not yet translated to clinical research in humans, perhaps due to the dearth of extant research with clinically anxious populations. Further investigation of probiotic treatment for clinically relevant anxiety is warranted, particularly with respect to the probiotic species L. rhamnosus.
Journal Article
The Acute Side Effects of Bright Light Therapy: A Placebo-Controlled Investigation
Despite the emergence of numerous clinical and non-clinical applications of bright light therapy (LT) in recent decades, the prevalence and severity of LT side effects have not yet been fully explicated. A few adverse LT effects-headache, eye strain, irritability, and nausea-have been consistently reported among depressed individuals and other psychiatric cohorts, but there exists little published evidence regarding LT side effects in non-clinical populations, who often undergo LT treatment of considerably briefer duration. Accordingly, in the present study we examined, in a randomized sample of healthy young adults, the acute side effects of exposure to a single 30-minute session of bright white light (10,000 lux) versus dim red light (< 500 lux). Across a broad range of potential side effects, repeated-measures analyses of variance revealed no significant group-by-time (Pre, Post) interactions. In other words, bright light exposure was not associated with a significantly higher incidence of any reported side effect than was the placebo control condition. Nevertheless, small but statistically significant increases in both eye strain and blurred vision were observed among both the LT and control groups. Overall, these results suggest that the relatively common occurrence of adverse side effects observed in the extant LT literature may not fully extend to non-clinical populations, especially for healthy young adults undergoing LT for a brief duration.
Journal Article
The antidepressant impact of minocycline in rodents: A systematic review and meta-analysis
Evidence from recent animal studies suggest that minocycline, a broad-spectrum antibiotic capable of regulating immune processes, may possess antidepressant properties. These studies, however, have yet to be comprehensively reviewed. Accordingly, this systematic review and meta-analysis summarizes the extant literature examining the effect of minocycline on depressive-like behavior in rodent models. PubMed, PsycINFO, and Web of Science databases were systematically searched for articles that met prespecified inclusion and exclusion criteria, and standardized mean differences (SMDs) were calculated for each continuous measure of depressive-like behavior. The overall effect of minocycline on depressive-like behavior was estimated using robust variance estimation meta-analysis. Separate subgroup analyses were conducted on diseased vs healthy animal models, different rodent species, and immobility-based vs anhedonia-based measures of depressive-like behavior. A total of 22 preclinical studies (816 animals) were included. Overall, minocycline reduced depressive-like behavior in rodents (SMD = −1.07, 95% CI −1.41–−0.74,
p
< 0.001). Subgroup analyses revealed that minocycline reduced depressive-like behavior in diseased, but not healthy, animal models. Finally, minocycline was found to reduce both immobility-based and anhedonia-based outcomes. These findings suggest that minocycline may be an effective treatment of core depressive symptoms, and that further investigation of minocycline treatment for clinically relevant depression in humans is warranted.
Journal Article
A semi-structured interview is associated with bariatric surgery outcomes
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (ð>½ = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (ð>½ = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (ð>½ = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
Journal Article
Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery
How clinicians perform pre-surgical psychological evaluations (PSPE) for bariatric surgery remains variable across institutions. Bariatric PSPE guidelines state that self-report measures should be incorporated in the PSPE procedure, yet only 50–60% of PSPEs utilize patient self-report measures. Previous studies describing the presurgical psychological evaluation report a range of measures, however a gold standard in PSPE has yet to be agreed upon. Given this gap in how a presurgical psychological evaluation for bariatric patients is defined, incorporating more objective measures into this process may help clinicians identify specific areas in which a patient is struggling and benefit from additional psychosocial support. The present study proposes the use of the SIPAT, a semi-structured interview initially developed to assess organ transplant candidates, as part of this evaluation. A total of 292 adult patients underwent a pre-surgical psychological evaluation for bariatric surgery between November 2017 and February 2020 at a Midwest medical center. Patient average age was 45.2 (11.3) years and 83.3% were female. At time of analysis, 160 patients received bariatric surgery. Logistic regression and analyses of bivariate associations were conducted in R. The SIPAT exhibited good convergent validity via correlations with analogous scales on the PROMIS 43, and it yielded a small effect size predicting patients who ultimately received surgery. Accordingly, this semi-structured interview may be a useful tool to help differentiate patients for surgical candidacy.
Journal Article
The Depression Cure
The goâto, revelatory guide based on Dr.Stephen Ilardi's proven Therapeutic Lifestyle Change (TLC) program--a practical plan for natural ways to treat depression without medication.Now updated with new research.The Depression Cure will change the way we think about and manage depression. Dr.
eBook
The Role of Hope in Cognitive-Behavior Therapies
A cognitive, two-component model of hope proposed by Snyder and colleagues is reviewed. Hope is defined as the perceived capability to (1) derive pathways to desired goals and (2) motivate oneself via agentic thinking to initiate and sustain movement along those pathways. The roles of these pathways and agency components of hope theory are described along with similarities and differences relative to other motivational and emotional theories, including optimism, self-efficacy, self-esteem, and problem solving. The goal focus, agentic thought, and pathways thought of hope theory are used as a framework for understanding the adaptive processes in the various phases of cognitive-behavior therapies, including relapse prevention. It is concluded that hope theory offers a valuable overarching framework for understanding common factors in behavior therapies.
Journal Article
On the Integration of Cognitive-Behavioral Therapy for Depression and Positive Psychology
Cognitive-behavior therapy (CBT) has received extensive empirical support as an efficacious intervention for the acute treatment of major depressive disorder and the prevention of depressive relapse. Nevertheless, many patients do not respond favorably to CBT, and the specific active ingredients of CBT remain unclear. With its emphasis on identifying and cultivating individual strengths, however, positive psychology appears to have considerable potential to enhance the efficacy of CBT and to help clarify the processes that mediate its salubrious effects. We outline existing areas of conceptual and technical overlap between CBT and positive psychology, and discuss how CBT may be extended and improved through the incorporation of positive psychological principles.
Journal Article
Disentangling Attentional Biases and Attentional Deficits in Depression: An Event-Related Potential P300 Analysis
Electroencephalographic event-related potentials (ERPs) were used to investigate maladaptive attentional processes in depression. Specifically, we measured the ERP P300 component--a waveform that reflects the real-time allocation of attention to stimuli of high informational salience--as it was elicited by neutral and negatively valent words among currently depressed, previously depressed, and never-depressed participants. The study design allowed us to clarify the degree to which the oft-reported attenuation of P300 response in depression should be regarded as evidence of: (a) a general, pervasive impairment in depressive attentional function; or (b) the operation of depressotypic attentional biases, which may give rise to attentional deficits only regarding stimuli of non-negative emotional valence. Consistent with the latter possibility, depressed individuals were observed in this study to experience, on average, a robust P300 response to negatively valent target words--a response of larger magnitude than that observed among previously depressed and never-depressed controls. This enhanced P300 response to negative stimuli in depression appears to be a statelike, rather than traitlike, phenomenon.
Journal Article