Where does the magic come from?

Psilocybin can cure — or at least treat — depression, often quickly, and when combined with therapy it can make a huge and long-lasting difference.

How, though? The mechanism hasn’t been clear, but now Yale researchers think they know at least part of the answer. The drug causes neurons to make new, strong connections — essentially opening up new pathways in the brain.

[T]hese compounds increase the density of dendritic spines, small protrusions found on nerve cells which aid in the transmission of information between neurons. Chronic stress and depression are known to reduce the number of these neuronal connections.

Wait, “these,” plural? Yep, the research also seems to apply to ketamine, another fast-acting treatment for depression. Speaking of which…

Bringing back the flex

When brains are young, they’re more flexible, more plastic — like Play-Doh but with ideas. But after childhood the brain becomes set in its ways. It builds what’s called the perineuronal net — a structure “that protects and stabilizes the connections between neurons.”

Austrian neuroscientists working with mice found that giving mice ketamine causes the brain’s immune cells — the microglia — to eat that perineuronal net. And that, it seems, gives the brain back its plasticity for about a week. That’s long enough, in theory, for the mind to break out of ruts in thinking and help it break out of depression.

But wait, there’s more!

Knowing that light flickering at 40 hertz can help break up Alzheimer’s proteins, the researchers experimented and found that lights at 60 hertz “had a similar effect as the ketamine treatments,” and can be used in conjunction with the drugs as a potential new, powerful treatment for a variety of brain issues. “There is a lot to explore.”

FTC to target PBMs

Yesterday we told you that the FTC held a hearing on authorizing investigations into, among other things, PBMs.

Today: Good news. The agency voted to approve a series of resolutions authorizing investigations into key law enforcement priorities for the next decade, and among those “priority targets” are … pharmacy benefits managers. This could be a story that keeps on giving.

Speaking of PBMs….

PBMs cost Medicare a lot

The headline from USC economists was that Costco’s pharmacy business paid a heck of a lot less for generic medications than Medicare. (We’re talking a potential Medicare savings of $2.6 billion in one year.)

But the bigger story was why. Spoiler:

It had nothing to do with Medicare’s inability to negotiate prices. In fact, they found, it was PBMs that caused the huge excess cost. Costco bypasses them, but Medicare uses them, and as the authors put it, “[E]xcess profits retained by intermediaries in the generic supply chain could be substantial.”

Can PBMs require you to use their specialty pharmacy?

In its next session — starting in October — the Supreme Court will hear the case of CVS Pharmacy Inc. v. Doe.

The gist: A plaintiff with HIV/AIDS has an employer health plan with CVS as the PBM. That CVS plan requires them to get their specialty meds at CVS (the pharmacy). That, the plaintiff says, violates section 504 of the Rehabilitation Act as well as the Affordable Care Act — which prohibits discrimination based on disability by any program receiving federal funds.

The key phrase is “disparate impact”: Even if the policy itself isn’t discriminatory, does it adversely affect people in a protected class — namely, those with HIV/AIDS? Eventually we’ll find out….

Of Mice fruit flies and women

There are plenty of stories of such-and-such a treatment working on, say, mice but not in humans. But now a UConn researcher has proven a useful — and surprising — connection.

If a drug prevents a fruit fly from ovulating, it will probably do the same for humans. That’s good news on multiple levels: It makes testing new compounds much easier, and, by preventing ovulation, it’s a birth-control method that works before fertilization, avoiding at least some religious objections.

Hold my beer

“Why do men take more risks than women?” the headline asks. The answer, surprisingly, is not “Because we’re idiots.”

Gentlemen, the next time a woman asks, “Why would you do such a stupid thing?” the correct answer is “The theta rhythms in my anterior cingulate cortex are just more variable today.”

“Men being stupid” — about 307,000,000 results (0.41 seconds)

Two tidbits to bring to the water cooler

“Smokers of menthol cigarettes have a harder time quitting” according to a study out of USC that used data from 49,000 people surveyed over five years.

Use of menthol cigarettes prior to attempting to quit decreased the probability of a smoker being able to abstain for more than one month by 28%, and for more than one year by 53%, compared to those who didn’t smoke menthol cigarettes.

=AND=

“Trout Appear to Get Hooked on Meth” according to a paper by behavioral ecologists in the Czech Republic. They looked at fish in the lab, but the meth concentrations they used weren’t that high.

After prolonged exposure to concentrations seen in nature, the fish chose meth-laced water over water without the drug, a shift that could have ecological consequences if contamination with the drug similarly shifts habitat preference in the wild.