Saturday, January 26, 2019

A pill to stop loneliness

If the pharmacological industry can come up with a pill to treat social pains like depression and anxiety, why not loneliness? A number of clinical trials are under way, targeting the ways in which chronic loneliness changes the brain.

Anxiety is considered a disorder only when it causes enough distress or impairment to interfere with a person’s life. Some see the same distinction working for loneliness: “Maybe we’ll call this social isolation syndrome.” 

Given all the ways modern life is designed to make us feel untethered, how do we determine who needs a medical intervention versus who is simply in a social rut? Just as thirst is a signal that you are dehydrated, loneliness is an indication that you are already suffering from a lack of connection
Loneliness, according to Stephanie Cacioppo, is the result of biological signals that push us to reach out to others interacting with a dysfunctional mind that perceives social danger everywhere. She’s focused on a promising intervention: a neurosteroid called pregnenolone, which has been shown to improve stress-related disorders
and ease the hypervigilance in the brain that arises when a person is exposed to social threats. Cacioppo’s goal is not to make people stop feeling lonely altogether, but to interfere with the ways loneliness affects the brain and body. Cacioppo started focusing on pregnenolone and allopregnanolone after preclinical trials showed that the compound could counteract some of the loneliness-related biological changes in brain and was well-tolerated in humans. Some antidepressants provide a similar effect but come with undesirable side effects, like drowsiness, nausea, and insomnia.

“If we could successfully reduce the alarm system in the minds of lonely individuals, then we could have them reconnect, rather than withdraw from others,” Stephanie says. That’s the basis for her most recent study, in which researchers administered 400mg oral doses of pregnenolone to lonely but otherwise healthy individuals. The trial ran from May 2017 to June 2019; Stephanie and her team are now in the process of analyzing the data. She’s cautiously optimistic that the results will show significantly reduced perceived loneliness among the people who received pregnenolone versus those who received a placebo. She argues that we could benefit from a pharmacological intervention to prevent descent into social isolation.

A 2016 review of pharmacological treatments co-authored by the Cacioppos explored the possibility of giving people the hormone oxytocin to combat chronic loneliness. Associated with breastfeeding, giving birth, and physical contact, the release of oxytocin in humans has been shown to “promote pro-social behaviors, affiliation, and trust”, the authors wrote.
When mice are socially isolated, their levels of pregnenolone decrease, a shift that also occurs in lonely humans. In a 2013 study a research team found that giving people oral doses of a compound called allopregnanolone – derived from pregnenolone – had a calming effect on the participants’ amygdala and insula, which are the regions of the brain responsible for threat detection, emotional recall, and the anticipation of unpleasant reactions.

Steve Cole, a professor of medicine, psychiatry, and behavioral sciences at the UCLA School of Medicine is exploring how to mitigate the way loneliness makes the body susceptible to a host of diseases. Beta blockers, heart medications developed in the 1960s, inhibit the body’s response to adrenaline and may also “turn out to be great at disconnecting the psychological experience of social threat and uncertainty from its biological consequences in the periphery”, Cole says. “Even if we can’t stop loneliness with a brain-targeted drug, we might still be able to protect lonely people from the adverse health consequences.” Cole is hoping to validate the drug’s ability to reduce the impact of stress on the body. At the moment, he is studying the impact of beta blockers on cancer patients, as stress has been shown to exacerbate the spread of the disease. If it is effective, there’s reason to believe beta blockers could alleviate the destructive biological consequences of loneliness.

Julianne Holt-Lunstad, a psychologist at Brigham Young University who has studied social isolation, explained, technology has taken away the necessity and inconvenience of interacting with other human beings: we can work from home, order groceries online, stream movies from bed. At the same time, the percentage of Americans who participate in social groups – whether they be social clubs, sports teams, community centers, volunteer organizations, or religious groups – has fallen. 

Modern life is designed to disengage us from one another. And with such obvious barriers to connection, it may not seem worthwhile to pursue a pharmaceutical solution.

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