September 14, 2022

By Courtney Wise

Good morning, MindSite News readers. In today’s edition: The Atlantic’s Ed Yong looks at the impact of long Covid on cognitive function. A new study brings more positive news about ketamine. And a law professor marshalls an argument against a still-potent form of stigma against young lawyers. And more. Read on!

“It feels like I am a void and I’m living in a void.”

Image: Shutterstock

The trouble with brain fog, it seems, is that although it existed long before the pandemic, it has never been appreciated in the medical community as the cognitive disorder that it is. Much more than thinking that’s been clouded a bit by stress, brain fog disrupts a person’s working memory and their ability to complete even the most banal tasks necessary for daily life. Hannah Davis, who once held a complex job in computer science, told The Atlantic’s Ed Yong that the brain fog of long COVID makes buying groceries, cooking them, and cleaning up behind herself incredibly arduous. The fog “is so encompassing, it affects every area of my life,” she said. Even her old memories feel disconnected: “Moments that affected me don’t feel like they’re part of me anymore,” she said. “It feels like I am a void and I’m living in a void.”

Affecting mostly women, a gender already saddled with a long history of “hysteria” by the medical establishment, Yong writes that people with brain fog are also often good at hiding it. It doesn’t help that the right tools for measuring brain fog haven’t been designed, said David Putrino, leader of a long-COVID rehabilitation clinic at Mount Sinai. The Montreal Cognitive Assessment, intended to reveal mental problems in people over age 55 with dementia, is easily passed by people with brain fog. But passing such tests can take a toll. “It’s only if you check in on them two days later that you’ll see you’ve wrecked them for a week,” Putrino said.

Despite the disturbance it causes to one’s working memory and executive function, brain fog is not a form of dementia, nor is it a mood disorder. “If anyone is saying that this is due to depression and anxiety, they have no basis for that, and data suggest it might be the other direction,” said Joanna Hellmuth, a UC San Francisco neurologist. 

Current research in cognitive neurology is almost solely focused on degenerative diseases like Alzheimer’s in elderly brains. As a result, few researchers know that viruses can cause cognitive disorders in younger people and “no one learns about it in medical school,” Hellmuth said, leaving lots of patients stuck and untreated. 

New study finds ketamine therapy effective against hard-to-treat depression

After 15 years of being drained by a depression so great that it left even the most benign joys beyond his comprehension, Jason Anthony shocked himself by spontaneously singing to his three yellow labradors after a workout at home. “All of a sudden, you wake up and realize what you haven’t been feeling for 15 years,” he told the Washington Post. What explained the change? Anthony credits ketamine therapy via infusion provided by MindPeace Clinics in Richmond, Virginia.

Approved by the FDA as an anesthetic, ketamine is enjoying a surge of use in clinics, as MindSite News reported last month. MindPeace, where Anthony is a patient, conducted a study of more than 400 people with depression who hadn’t improved on antidepressants or other medications. The study, published in the Journal of Clinical Psychiatry on Monday, found that 72 percent of patients had improvement in their mood and 38 percent were free of symptoms after 10 infusions. Butthe study didn’t have a control group and there was no way to systematically track adverse events among the patients. Nurses attempted to reach them by phone and learned of two suicide attempts.

With nearly 46,000 Americans lost to suicide in 2020, MindPeace Medical Director Patrick Oliver, the study’s lead author, said ketamine is poised to become a mainstream treatment. But Carlos Zarate Jr., a researcher at the National Institute of Mental Health, told the Post that while the study provided more evidence that ketamine is effective, the lack of long-term data will limit its use.

Is brain imaging useful in treating mental illness?

As vice president of research at the Child Mind Institute, psychiatrist Michael Milham is often asked to scan his young patients’ brains by parents desperate to help their kids. He may be as frustrated as they are that such scans aren’t yet clinically useful. “Every other part of medicine has laboratory tests,” he told Slate, but psychiatry does not. Milham hopes that one day brain scan research will help provide families with conclusive diagnoses to guide treatment – but many of his colleagues are dubious.

“[Brain imaging] is not ever going to be, in my opinion, useful for telling somebody whether or not they have a problem,” said Desmond Oathes, assistant professor of psychiatry at the University of Pennsylvania. What it might do is help identify the best treatment once a diagnosis is made, he said.

In other news…

Few things are more controversial than sex education in K-12 classrooms. Two NPR reporters spent time in classrooms where sex education was taught.

Their print story also quoted Eva Goldfarb, a researcher at Montclair State University in New Jersey, who co-authored a 2020 paper on the topic: “The major finding of the research is that comprehensive sex education scaffolded across grades, embedded in supportive school environments and across subject areas, can improve sexual, social and emotional health, as well as academic outcomes for young people,” she said. The story provides a map of what effective sex ed looks like, across grade levels. 

Jim Crow in the Asylum: Psychiatry and Civil Rights in the American South. That’s the title of a lecture by Kylie M. Smith, an associate professor at Emory University that the NIH will livestream this Thursday, September 15, at 2 pm EST. Circulating Now, a digital offering from the National Library of Medicine, engaged Smith in a Q+A preview discussing her research and discoveries. 

I am tired of watching my students suffer. Every year I have law students tell me they are afraid to seek counseling because they think it will hurt their chances of being admitted to the bar.”​​ So writes Fredrick E. Vars in a commentary in the Jurist. A law professor specializing in mental health law, he wants all state bar applications to remove questions related to mental health and substance use. It’s a matter of life and death, he says, since almost one-third of law students will contemplate suicide in their lifetimes. It’s also a flat-out violation of the American with Disabilities Act, he says.

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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Courtney Wise

Courtney Wise Randolph is a writer and creative based in Detroit, Michigan.