May 2024

This month's brainbuzz™ features research on the safety in Toronto’s shelter system; a recently launched supplement for postpartum blues/postpartum depression; and CTE research in military veterans. Please reach out if you have any questions or feedback.

Aristotle Voineskos
VP Research, CAMH
 

Shelter Safety Study

CAMH launched a study commissioned by the City and its partners to assess safety in Toronto’s shelter system

On Tuesday, April 30, Scientific Associate Dr. Nick Kerman presented to a Toronto City Council meeting on economic and community development The Shelter Safety Study: An examination of violence and service restriction in Toronto’s shelter system, a CAMH study commissioned by the City and its partners to assess safety in Toronto’s shelter system, with a focus on violence and service restrictions which prevent people from using certain shelters for a set period of time after an infraction of some kind. The report is the outcome of two years of comprehensive study and analysis, which included examining shelter data between 2011 and 2021, a literature review, and original data collection that included touchpoints with shelter staff and people experiencing homelessness.

Study findings observed a rate of incidents in the shelter system similar to issues experienced in other service settings, underscoring the far-reaching impacts of the broader mental health crisis. It also provides 22 recommendations to the City to address a number of key needs related to violence, safety, and service restrictions in the shelter system, including the creation of low barrier supports for people experiencing homelessness who use substances.

“Our research showed that, like many health and social service settings, violence and other critical incidents have risen in the shelter system over the past decade, exacerbated further by the COVID-19 pandemic,” said Dr. Kerman. “Structural inequalities and growing crises, including the lack of affordable housing, the overdose crisis, and an insufficient supply of mental health services to meet increasing demand, have downstream effects on safety in shelters for people experiencing homelessness and staff.”

Specifically, the study found that violence and service restrictions are serious issues in Toronto’s shelter system. These problems interact with other critical social issues, including the rise in unsheltered homelessness, the affordable housing crisis, a worsening toxic drug supply, and an insufficient supply of mental health services and housing-based supports. The study also found that a small group of service users accounts for a sizeable number of both critical incidents and service restrictions in the shelter system.

The study was first commissioned in January 2021 at a time when the City was observing an increase in challenging safety concerns, including violent incidents being reported across the shelter system. The COVID-19 pandemic exacerbated the rate of critical incidents, as does crowded shelters, the winter season and limited privacy.

“Our health and social support systems have reached a breaking point,” said Dr. David Gratzer, CAMH psychiatrist and co-chief of the General Adult Psychiatry and Health Systems Division. “We are experiencing an increase in demand for emergency services across the board related to psychosis and methamphetamine use, which absolutely will affect the conditions within City shelters. It is imperative that we take a multi-pronged approach to tackle this issue – addressing not only the immediate needs, but also the causes. CAMH continues to be committed to working with all partners at all levels and across the City to respond to homelessness, increase access to care, and address substance use and addictions.”

CAMH is grateful for this opportunity to collaborate with the City of Toronto to improve safety within the shelter system and will work closely with the City as they implement the recommendations presented in the study. 

Dr. Kerman added: “We now have a strong understanding of the safety-related issues that are occurring in the Toronto shelter system. To our knowledge, no other shelter system in Canada or the United States has such a robust evidence base on this important issue. The recommendations offer a roadmap for moving forward and position Toronto to be a potential leader in improving safety in shelters.
 

CAMH develops first ever
clinically validated natural supplement to
prevent postpartum blues

Product now available in the U.S. with global distribution planned

A new study published in the Lancet discovery science  journal eClinicalMedicine has confirmed that a novel natural supplement—invented, researched, developed and commercialized at the CAMH —prevents postpartum blues, and reduces symptoms of postpartum depression over the following six months after giving birth.

Up to 8 out of ten new mothers experience postpartum, or ‘baby,’ blues, characterized by mood swings, crying spells, anxiety and difficulty sleeping. The condition usually begins within the first few days after delivery and may last for up to two weeks. Postpartum blues strongly raises the risk of postpartum depression, a serious mental illness affecting 13 per cent of mothers. Postpartum depression has important health care consequences: impairing quality of life, increasing risk for future depressive episodes and suicide, and is associated with cognitive and emotional effects in children. Until now, options for widespread prevention have been lacking for either condition.

The study, entitled Dietary Supplement for Mood Symptoms in Early Postpartum: A Double-Blind Randomized Placebo Controlled Trial, involved more than 100 postpartum participants between January 2019 and December 2022 who either took four doses of the natural supplement several days after giving birth, or a matching placebo. Within the supplement group, two-thirds (66 per cent) experienced either no symptoms or only negligible symptoms of postpartum blues. Furthermore, in the following six months, participants who received the supplement experienced less symptoms of depression with none reaching the clinical threshold of postpartum depression six months after giving birth.

“Globally 140 million births take place every year. Most women then experience postpartum blues, which, when severe, increases the likelihood of getting full-blown postpartum depression at least fourfold. Our study showed that both postpartum blues and later symptoms of depression were lower in women who received the dietary supplement,” said Dr. Jeffrey Meyer, inventor of the nutraceutical and study senior author. “Providing this specialized dietary support in the first few days after giving birth is a crucial window to avoid depressive symptoms which is tremendously important given there is considerable risk that they may recur and have lifelong impact.”

Dr. Meyer has been investigating postpartum blues for more than 15 years. His previous imaging research found that a protein called MAO-A rises dramatically in the brains of postpartum women and this protein removes important brain chemicals—like serotonin and dopamine—that support normal mood. It also acts as an oxidant and is linked to the development and progression of certain mental illnesses. To combat this effect, the nutraceutical is made up of a patented unique combination of natural ingredients, including blueberry extract, which contain antioxidants, and amino acids that replenish essential neurochemicals in the brain to support healthy mood and the ability to concentrate under stress. The supplement was well tolerated and women who took it tended to report less symptoms, in part due to less drowsiness, headache and restlessness. The researchers previously showed that the amino acids in the supplement do not affect their total concentrations in breast milk, which was expected since these amino acids are already found in proteins in breast milk.     

CAMH has partnered with international women’s health supplement and pharmaceutical company Exeltis via a licensing agreement to bring the product to market under the name Blues Away®. Exeltis has maintained the natural health product approach in their preparations and manufacture for widespread distribution of the supplement. It is expected that the product will be available for sale in the U.S. beginning April 11, 2024.  It is also in the process of being brought to other global markets—including Canada—with the pace of approvals being dependent on each country’s regulatory requirements and reviews.  

“We are thrilled to unveil the culmination of years of dedication and collaboration in the form of our groundbreaking nutraceutical for postpartum blues prevention. It is great that we are able to simultaneously share our clinical research around this product while also partnering with a  global women’s health industry leader to make it available to the new mothers who need it,” said Klara Vichnevetski, Director of Industry Partnerships and Technology Transfer. CAMH has nurtured this innovation from its inception, guiding it from bench to bedside where it can make an immediate and profound difference in the lives of millions of women and their families.” 

A limitation of the study was that, of the several measures of depression in the study, the supplement did not demonstrate the expected protective effect in an experimental test that involves inducing low mood with sad stimuli, although it is possible that the stress of the COVID-19 pandemic and moving the setting of the study to participant’s homes during the pandemic may have influenced the results of this particular test.

Aristotle Voineskos, Vice President of Research, added: “Two major pillars of our CAMH approach to research are the importance of integrating scientific findings into advancing mental health care and the value of early intervention. Through the perseverance and dedication of our researchers and technology transfer team, this novel preventative therapy may contribute to best practice when it comes to postpartum care and help women around the world avoid more serious and chronic mental illness.” 

This research was funded by CAMH, with some additional funding from Exeltis. 
 

Researchers believe widespread brain injury may contribute to veteran suicide rate

CAMH is working with Canada's Department of National Defence on a study into whether some military training exercises could be negatively impacting long-term brain health.

Associate Director of the CAMH Brain Health Imaging Centre, Dr. Isabelle Boileau, joined CTV National News to discuss how brain trauma like chronic traumatic encephalopathy may increase suicidal thoughts in military veterans. Read and watch here.

“We are looking for evidence of tau accumulation in the brain, which is common in people at high-risk for developing dementia,” says Boileau. “If we find evidence of tau in blast-exposed military personnel that may explain some of the neurological signs and symptoms we see in this population. The goal of this study is to see if training habits need to be shifted a bit to minimize the potential long-term neurological effects."
 

Buzz-worthy News

• Read Dr. Alex Abramovich's recent PLOS ONE publication on research using Street Needs Assessment data to understand needs/experiences among 2SLGBTQ+ people experiencing homelessness in Toronto.
  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0298252

• Congrats to the staff, volunteers + speakers who made the inaugural CAMH womenmind™ conference exploring groundbreaking research on women's mental health a success with 460 attendees! 
  https://twitter.com/CAMHnews/status/1782858160329404473

• Join the June 5th webinar to learn about the importance of family history and genetics in bipolar disorder and about the value of integrating families in the treatment of youth with bipolar disorder! Register here:
  https://kmb.camh.ca/eenet/events/webinar-family-history-and-genetics-in-youth-bipolar-disorder