Tag Archives: Depression

Wednesday Links

Wednesday Links

genebrain

Genetic research has a meaningful place in psychiatry, as a major study has just found out. Thomas Insel of the NIMH blogs about the impact of a study on schizophrenia and explains its importance. 108 gene regions, put together, show a significant increase in the risk for the condition, and with 37,000 affected participants and over a hundred thousand controls, this is pretty big. Thank goodness several hundred million dollars have just been donated to psychiatric research.

What is complex about complex disorders? A paper by Kevin Mitchell explains what’s involved in finding the genes that contribute to polygenic disorders like ” schizophrenia, autism, depression, asthma, epilepsy, diabetes, rheumatoid arthritis, hypertension, coronary artery disease, obesity, Crohn’s disease, Alzheimer’s and Parkinson’s disease, multiple sclerosis and probably hundreds of other conditions”. Perhaps some of these will be discovered now that more funding is available!

Is “reductionism” in behavioral genetics a boon or curse? asks if and when reductionism is a bad thing. In behavioral genetics, most scientists are looking for complex genetics behind complex traits, but they need to be careful of how their public statements can be read. The author points out, “There is a difference between methodological reductionism, a tool, and philosophical reductionism, a guiding principle.”

Evan Thompson on core theories of neurophenomenology and time-consciousness opens, “Evan Thompson, one of the authors of 1991′s The Embodied Mind: Cognitive Science and Human Experience, in 2010 authored a sweeping, dare I say even magisterial, account of how science and philosophy should understand consciousness, embodiment, evolution, and neuroscience.” The piece that follows is brief but covers a lot of ground – and makes me interested in reading the book.

An interesting neurological phenomenon is auditory pareidolia – She’s Hearing Voices talks about this symptom that’s common in certain mental disorders and how even ordinary people can be prompted to hear things that aren’t there. In schizophrenia and OCD and certain types of depression and personality disorders, this may be a magnification of what is normally an adaptive trait, IMO.

Shakespeare, Vermeer, and the “Secrets” of Genius takes the almost revolutionary position that practice does not necessarily make perfect – sometimes you have to be born with talent.

Most of Us Still Don’t Get It: Addiction Is a Learning Disorder questions the idea that we have genes or areas in our brain that predispose us to certain addictions. I read it and thought that perhaps all addiction could be characterized as a salience disorder, because it takes the position that it’s a maladaptive state of a survival trait. Just read.

Wednesday Links

Wednesday Links

I’m going to try to start up with this again, because I’ve lost track of some of the neat things I’ve found. This is going to be a slightly different format, just because the easier I make it, the more likely it is that I’ll be able to keep up with it. It’s also short, because I threw it together in just a couple of days.

Brain stuff:

NIH scientists take totally tubular journey through brain cells I haven’t gotten far enough in DD#2’s Neuroscience textbook to read about microtubules, but now I think I have to. Cool stuff.

DARPA is a US government run defense program that is working on a lot of cool technology, and some of that is on the brain. There’s a lot of potential for electronic stimulation to treat mental illness in a way that is more targeted than medications. New venture aims to heal disrupted brain circuitry to treat mental illnesses looks at some of what they hope to be able to do.

MIT is doing some fascinating research at the molecular level into mental illness. Shining Light on Madness is a somewhat long article, but well worth reading to the end if you want to know what’s being tested, why, and how it’s going to be examined. h/t to Antonei B. Csoka for linking it on Twitter.

In the meantime, The Brain Initiative is finding fascinating information about how the brain works.

Pseudoscience

Lynn Stuart Parramore has an excellent article, Excuse me, is that snake oil gluten free? that explores some of the magical thinking behind the free pass we give Big Placebo, and why we need a little more skepticism.

Deepak Chopra has issued a “challenge” to, essentially, disprove every single claim he’s ever made in a single paper. Steve Novella explains it brilliantly. Easily movable goalposts included.

Video:

Science Education – How I Would Do It.

Science Education – How I Would Do It.


Of course, this is assuming that the world was a sensible place and I was in charge of all the important decision-making. Heh.

Over time, I’ve come to realize that a lot of the things I was taught in school didn’t stick because they weren’t interesting. They weren’t interesting because they were unrelated to my life, and I couldn’t see how they could possibly be important to me. I memorized things for tests, and I did a darn good job of it, good grades, good standardized test scores, but only because I had to, not because I wanted to.

As I got older some of it came back – and it stuck better because I had context to put it in. Before kids and before antidepressants, I read a lot of romance novels for escape (I know. . .I’m not proud, but I had an excuse.) Soon I discovered that there was a sub-genre of Historical Fiction – and some of these authors were real history buffs who included a lot of factual information. In the context of a story, with characters and plots that engaged me, I was finally learning something about history, which had bored me to tears in High School.

Later, I started reading some of the books and papers that had been assigned back then. . .suddenly they were interesting and made sense – because I now had a context for them. The context continued to expand, and more information became part of what I knew.

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For me, possibly moreso than for many people, context is essential. My ADHD mental filing system demands context and associations not only for learning, but for retrieving that learning. So when I teach people what I know, I teach it in context. I learn a lot by making mistakes, so I teach “do it this way because this other way doesn’t work,” and “we do it this way because otherwise we break this piece and the whole thing is ruined.” I teach “This part seems boring, but here are all the cool things we can do with it later.”

I also learned a lot from raising my own kids and volunteering in their schools, helping all kinds of other kids learn. You need to be able to express a single piece of information many different ways in order to get different kids to understand it. As a volunteer, I was able to sit with individual children and small groups. The kids who didn’t understand things when they were taught the same way to all 30-something students would get it if I spent some time with them and figured out what their individual contexts were.

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Fast forward to the mid 90s – I started antidepressants, and then I discovered that my ADHD had not actually gone away as the experts had told my parents it would, and as my parents told me it had. Now I had a reason to learn about the brain, starting with disorders and injuries, and what they taught us about the functions of various structures. That gave me a context to learn about brain development and genetics. This led to investigating epigenetics. Along the way, it also tied in to reading medical and science blogs and books, and any time a piece of knowledge stuck to something that was relevant to something I already knew, it also became relevant.

So why do you want to listen to someone who doesn’t have a degree in science or medicine when it comes to science or medicine? Because of the way I’m learning it. That whole “Translating Science into English” thing I mentioned a few posts back. Scientists have their own language, and it’s important that they do so they speak with clarity and precision. But if you don’t have the context that they do, it’s hard to understand – and easy to misinterpret. I didn’t learn this in the linear fashion that they did.

If you were to teach me vocabulary and facts and mechanisms, I’d remember it just as well as I did in high school. But give me a study of something that relates to something that interests me, and I will look up all those words and facts and mechanisms, and they’ll make sense because they’re part of something else. They have more meaning when they’re in context.

The other thing I learned came from watching scientists argue with one another. While they’re not always polite, they always present evidence. Most of them are critical thinkers, when someone says something that is questionable, they will (sometimes very methodically and in great detail) explain the flaws in the reasoning. Following along with this taught me the scientific method and why it’s important, how to evaluate how robust the data is by looking at the size of the study, the quality of the blinding, the strength of the variables and controls, how well it integrates existing evidence (and how strong that evidence is) and, most importantly, no matter how good a study may be, it’s never PROOF. It also doesn’t prove other things that weren’t part of the study. It’s also probably not a major breakthrough.

I learned about p-values, journal impact factors, the good and bad of peer review, the pros and cons of open access. I learned that not all “evidence” is actually evidence.

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The problem that many, many scientists have, though, is that they forget what it’s like to not know this. Sometimes they present what they know in a way that is off-putting to laypeople. Sometimes they present a press-release version of their findings, breathless with excitement and full of hyperbole, and that’s even worse. (That’s what we have The Daily Mail and Huffington Post for. Let them do their job.)

So if I were a science teacher, or I were designing a science education program, I’d throw out teaching the basics as freestanding facts. Get rid of the rote learning. Give the students just enough information to dive into a challenge and figure out the rest. Give the kindergarteners a bowl of cream and some food coloring and dish soap – let them play and then tell them how it works. Let the older kids listen to each others’ heartbeats, check each others’ blood pressure, draw pictures of hearts and veins and arteries, and use that to introduce the circulatory system. Make everything part of an experiment that related directly to them so that it was important. Let them figure out what’s correct and what’s incorrect as much as you can on their own by giving them questions as much as answers. Make the science interesting and integrate critical thinking into the lessons, and get them excited. This will be good for them, and good for society, because they’ll question everything – and come up with their answers based on what evidence is best supported.

My Brain Diary, Part 11

My Brain Diary, Part 11

Right now is not so good. I’m going to be pretty frank, but I don’t want people to worry. I’ve been through some bad brain stuff even before Roscoe took over my life, and even when I’m close to the bottom of the deep well of suckitude, I can still remember to look up to the light at the top and know there’s a way up as well as a way down.

My medications aren’t working the same way as they did before, which is no surprise. If you look at the early MRIs, there was a lot of compression. Blood supply was rerouted or restricted. Neurons were obviously going to be moving around trying to get past blockages. And the limbic system, where most of our emotions are seated, was pretty wonky from getting pushed out of shape. So this is just like starting all over again from scratch. Cymbalta is too stimulating an antidepressant because it’s a norepinephrine reuptake inhibitor, meaning that my whole “fight or flight” reaction is on higher alert than it should be. I also had to discontinue Adderall for the same reason, and add in Klonopin because my life had become all panic, all the time.

When you’re transitioning from one antidepressant to another, there’s this horrible period during which you’re getting too little of both of them. That’s where I’m at right now. I’m titrating down on Cymbalta – 15mg per day. This is enough to reduce the panic and keep the brain zaps to a minimum, but not enough to affect my depression. At the same time, I’m beginning sertraline (Zoloft) but only a measly dose of 25mg. Not only not enough to even tickle the edges of depression, but also only starting the 4-6 week journey before it shows any effect whatsoever. In a few days I’ll be off the Cymbalta (protip – it’s a capsule full of beads, so if you feel a brain zap, and ONLY if you feel a brain zap, take one or two BEADS. Makes it less awful.) and up to 50mg of sertraline. Still a baby dose, and still at least two weeks away from making even a tiny bit of difference.

So, yeah, I’m in a pretty bad way right now. Fortunately, even when a smidgen of suicidal ideation pops up, it’s easily quashed by reminding myself of the light at the top of the well of suckitude and by making a plan so elaborate (typical ADHD) that I’d decide it was too much effort before I even came close to doing anything about it. No matter what I might say in the throes of depressive misery, you’re not going to get rid of me that easily. Heh.

The whipped cream and cherry on top is the visit to the neurosurgeon. My brain, right now, is about as good as it’s going to get. I’m going to see a neuropsychologist for an evaluation, and probably end up with some kind of therapy to help me adapt to my new neurological paradigm, but I was kind of hoping for normal. Having that hope dashed is not helping with my mood. Yes, I’m way, way better than I was two years ago, but there are things that are a struggle still.

My spatial relations are vastly improved – I have a much better concept of where I am in the space that surrounds me, I have my sense of direction back, and I’m aware of objects around me, both moving and stationary. However, “mirror images,” both literally (myself in the mirror) and figuratively (looking at pictures or looking at other people) are bizarre and confusing. I have trouble telling right from left, and forwards from backwards. Up and down are intact, thank goodness. Blow drying my hair has been an adventure, and I still haven’t quite mastered the art of flossing my teeth without hurting myself. If I look at my MRIs, I have to pretend that they are someone else’s, because their orientation is like a mirror, and they start from the far side and come forward. If I think of them as mine, I can’t get past the idea that my left side is on the right of the image, and the coronal slices as they move from the back of my head to the front are coming towards me instead of moving away from me.

I don’t lose my balance all that much anymore, either. . .but it still happens.

Since the tumor smooshed my left occipital lobe and left temporal lobe, I also have some problems that are related to vision and vision-related language performance. I don’t have any consistent object or color blindness, but sometimes I will look at things, see them, but not really “recognize” them, or know what they are. Quick example – we were at a food kiosk, and I wanted to leave a tip. There was a bright blue tip cup by each cash register. On the one that was right in front of my face, I couldn’t see the word “tips” written on it. I saw only the “s” and thought for some reason that it meant that was a cup for straws. So I reached over and put the tip in the cup on the other side of the kiosk, because I could perceive the whole word on that one. Other times, I won’t see things outside of what I’m looking at because I simply don’t understand why the thing I’m looking at isn’t the thing I want. Really. I look at it, and I think “this isn’t what I want? Why isn’t it what I’m looking for?” and the thing I want is right there above it or below it or next to it.

The most frustrating thing, though, is the anomia. This is where the temporal lobe gets involved. Most of your language processing occurs in your left temporal lobe, and the normal loop between seeing something and saying it involves the visual image that’s processed somewhere in your right hemisphere (depending on what it is) being “translated” by your left occipital lobe and sent into the language loop in your temporal lobe. That’s not happening for me. But only in one direction. If I see an object or a person (or picture an object or person in my head) there’s a good chance that I will not be able to name that object or person. I could tell you everything about that object or person that I knew, except for what that object or person is called. And the name I remember this morning may well be completely inaccessible in a few hours. No amount of prompting, besides actually telling me the word, is going to bring that name into my conscious thoughts.

In the other direction, no problem. If I hear or read a noun or a name, I have no trouble whatsoever picturing that object or person in my mind. But it is kind of a problem – because when I’m circumlocuting to try to use the words I have to describe the word I don’t, people try to be helpful and finish my sentences for me. And once they say the word that isn’t the one I’m looking for, it creates a new mental image that supersedes the one I’m trying to describe, and all is lost. I know they’re trying to be helpful, and I know it’s awfully difficult to listen to me when I’m struggling through this, but really, the only thing it accomplishes effectively is to make me feel like crap and maybe even start crying. Just a heads up. I won’t hold it against you, I promise, but I will probably start to cry.

So. . .I see the psychiatrist in another couple of weeks and we’ll ramp up the sertraline if it’s working OK. I may even be able to go back on Adderall once my dose is stabilized. We’re looking at mid-March here. If you’re worried about my mood, look at your calendar. If it isn’t halfway through March, stop worrying. I’m just transitioning between medications.

February 11th, I go for a consult with the neuropsychologist, and get another dose of reality about how much improvement, if any, I can expect with therapy. Until then, I have regressed to the mean, and everything I just described above is SOP. And that’s just the way it is.

Wednesday Links

Wednesday Links

A new study was published in the Journal of the American Medical Association about neuroimaging to determine response to medication or therapy in Major Depressive Disorder. It seems much more exciting if you don’t actually read it. Fortunately, Neurocritic did, so you have someone to explain what’s hope and what’s hype.

Paul Offit explains why we shouldn’t take multivitamins.

He also has a book coming out soon called “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine” and USA Today covers some of the issues that make this stuff such a dangerous alternative.

And Darshak Sanghavi at Slate wonders why so many of us think we need to avoid gluten

Now, if you happen to be near Washington, DC, and you want to see some cool genetics stuff, hit the Smithsonian Museum of Natural History for an exhibit called Genome: Unlocking Life’s Code.

Teaching otters to use vending machines might not be the best idea, but it sure is cute to watch.

Antidepressants – A Primer

Antidepressants – A Primer

Antidepressants have come a long way. Our understanding of the biological and neurological bases for depression has expanded vastly, and the number of treatment options have increased and improved so that they can be better targeted towards individual symptoms. Public knowledge has not kept pace; thanks to poor science education and journalism and the dissemination of false information by special interests, people understand much less about depression and its treatment than they should.

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Amino Acid Supplements – Do They Work?

Amino Acid Supplements – Do They Work?

Supplements
Well, if you’re taking them for a deficiency in your diet, then yeah. But if you’re taking them for your brain, then no. Really, no. Despite what claims are made by sites that tell you the benefit of “natural amino acid supplements” or “organic amino acid supplements,” you need to keep in mind that these sites are also selling amino acid supplements. They are not selling them to you for dietary deficiencies, they are selling them as “natural supplements for depression.”

Amino acid supplements do not work the way their purveyors say they do. Oh, yeah, they’ll cite scientific studies, sometimes even link to those studies, but they’re counting on a few things. . .First, you probably won’t check the actual studies to see what they say. Second, you probably don’t have access to the full text of the study, and the abstract is more like a press release than an accurate summation of results. Third, even if you can get more information about the study, you probably won’t understand the methodology – and that’s crucial to understanding whether the results have any relevance whatsoever to what the supplement pusher is telling you.

Let me explain. . .
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