Tuesday, February 4, 2025

By Don Sapatkin

Plus: Dog owners get mental health benefits from exercising – just not with their pooches. Migraines are linked to higher suicide risks, and lifetime heavy cannabis use is (separately!) associated with poorer working memory.

But first: “Members of my family,” Robert F. Kennedy Jr. told the Senate Finance Committee, have “had a much worse time getting off of SSRIs than people have getting off heroin.” USA Today explains why the HHS nominee’s disparagement of the most common type of antidepressant matters.

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Key mental health crisis services have declined since 988’s launch

The 988 crisis hotline went live 2-1/2 years ago as an easy-to-remember number for anyone having a mental health meltdown to call and be connected, if necessary, to appropriate mental health services. The full goal, as advocates told MindSite News at the time, was to strengthen the nation’s underfunded patchwork of emergency mental health care and provide “someone to call, someone to come, and somewhere to go.”

A study published in JAMA Psychiatry suggests that following the hotline’s launch, we might be even further from that goal. While calls, texts and chats to 988 have steadily increased (with more than 5.7 million answered last year, according to federal data), the availability of key crisis services declined, at least in the hotline’s first year: Fewer mental health facilities are offering emergency psychiatric walk-in services, and the number with mobile response units and suicide prevention services also decreased slightly. Of the four services tracked, only peer support became more available. 

While those national trends are concerning, another urgent issue is inconsistent state-to-state availability. “988 isn’t going to reach its full potential until there’s a full system of crisis services in every single community,” Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness, told Stat.

All four trends predated 988’s launch in July 2022, and mental health emergency response systems may take years to change. How President Trump’s promises to slash federal spending will affect services is unknown. (Trump signed the bill that authorized 988, but it was launched during the Biden administration, which also increased implementation funding for the states.)

The study, led by researchers at the nonprofit Rand Corp., analyzed data reported to the federal government by more than 15,000 mental health treatment facilities between Nov. 1, 2021 and June 30, 2023. The hotline went live in July 2022, so the study covers a relatively short period either side of the launch. After the launch, availability of peer support services increased from 39% of facilities to 42%, psychiatric walk-in services dropped from 32% to 29%, mobile crisis response services declined from 22% to 21%, and suicide prevention services fell from 69% to 68%. 

Researchers also noted that crisis services generally were more likely to be offered by public facilities or by not-for-profit facilities – for-profit facilities consistently had the least. 

The authors emphasized the wide variation across states, speculating that differences in preparedness, state-level financing for 988 and other crisis services, and the “overarching state-level policy environment” may be among the root causes for the disparities.

And they noted that the lack of meaningful growth in most crisis services in most states could limit the hotline’s long-term success, particularly “if callers feel that reaching out to 988 fails to result in access to appropriate sources of care.”

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FDA approves first-in-its-class pain reliever without opioids’ drawbacks 

The FDA has approved the first new pain reliever in more than 25 years, CNN reports, a 12-hour pill that, unlike opioids, is nonaddictive and works only on nerves outside the brain.

The drug, suzetrigine, also does not induce the sense of euphoria or high that opioids sometimes do, so doctors believe there’s no potential for it to cause dependence or addiction. Clinical trial participants also reported fewer unpleasant side effects, like nausea and drowsiness.

Researchers expect suzetrigine to be the first of a new generation of powerful nonaddictive drugs to relieve pain. 

But it’s expensive. Suzetrigine – developed by Vertex Pharmaceuticals, to be sold under the brand name Journavx – carries a wholesale list price of $15.50 for a 50 mg. pill ($31 a day) compared to pennies for generic opioids. Insurers have not yet weighed in on coverage, but Vertex said that patient assistance programs would be available.

Clinical trial data submitted to the FDA that included suzetrigine, the opioid Vicodin (a combination of acetaminophen and hydrocodone) and a placebo showed that suzetrigine’s side effects were similar to the placebo’s, and that it relieved pain following surgery about as well as Vicodin did, although it was not a head-to-head comparison. 

Opioids tend to be more effective for acute pain and less so for chronic pain, and data from a small study suggested that suzetigrine also had a minimal effect on chronic pain, although the company believes that larger trials will find that it has more. The drug is approved for moderate to severe acute pain in adults.

Suzetrigine has its roots in a relatively recent discovery that a family of fire walkers in Pakistan lacked a gene allowing pain signals to fire in their skin, allowing them to walk over hot coals without flinching. Scientists spent the next 25 years trying to figure out how to exploit that pain-conducting mechanism to develop a medication.

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Is owning – and being active – with a dog actually good for your mental health?

Remember, dog-loving readers: I am only the messenger. 

Dog ownership is associated with better mental health (as we have long known), PsyPost reported, but not necessarily because of the dog. People who own dogs engage in more physical activity both with and without their pet – and only the exercise sans dog was associated with mental health benefits.

A study published in BMC Psychology included 588 owners of companion animals (dogs, cats, fish, etc.) ages 18 to 84 in Australia who answered survey questions online between November 2020 and January 2021. More than 75% were women.

The researchers, who said their study was the first to compare physical activity with and without participants’ pets, found that dog owners were more physically active than owners of other pets. Non-dog-related physical activities like running, playing sports, or going to the gym were significantly associated with less loneliness and better mental health outcomes. Walking the dog and related human-animal activities appeared not to have the same impact.

The researchers speculated that the intensity of playing fetch or walking a dog (at the dog’s pace, with frequent stops for sniffing or play) is lower than that of walking without a dog, strength training, and other types of petless exercise.

While the study’s aim was to examine dog-related physical activity, a secondary analysis found that among older adults, dog ownership was associated with lower levels of anxiety compared with ownership of other pets, but not depression or loneliness. Among younger adults, ownership of companion dogs was associated with lower depression and loneliness, but not anxiety.

Still, the researchers wrote, someone acquiring a dog “with the sole purpose of improving their mental health is unlikely to experience mental health benefits,” adding that overstating those benefits may also lead to significant welfare risks to dogs that may suffer neglect or relinquishment if their owners become ambivalent.

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In other news…

“Micro-retiring” for your mental health could hurt your career, People reports. The Gen Z trend – new to me, but then again I’m a Boomer – may indeed be good for your well-being, experts said. But micro-retirees should be aware that work breaks significantly longer than traditional vacations could slow down their career trajectory and lower their lifetime earning potential.

People with a history of migraines were twice as likely to attempt suicide compared to those without, and 40% more likely to die by suicide, according to a 15-year study in JAMA Neurology. A review of health system records in Denmark yielded 120,000 individuals over 15 (average age: 40) who had been diagnosed with migraine headaches. They were matched with 600,000 undiagnosed controls and followed from 1995 to 2020. 

Lifetime heavy cannabis users showed diminished brain activation and working memory in a study of 1,000 adults aged 22 to 36 that examined data from urine toxicology tests, long-term cannabis use, and functional magnetic resonance imaging (fMRI). Researchers used fMRI, which measures blood flow in the brain in real time, to assess brain activation in specific regions related to seven short tasks. Only lifetime users’ working memory was significantly affected, according to findings in JAMA Network Open. A smaller change was initially also found in recent users, but the association disappeared after technical corrections.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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