Friday, 30 January 2015

Depressed? Try popping an aspirin.

It's a sad reality that depression is now being diagnosed in epidemic proportions, and equally sad that we seem so relatively helpless to treat it. According to popular figures, more than 50% of those who suffer from major depression do not respond to treatment.

That's why the latest piece of research from the Centre for Addiction and Mental Health (CAMH) in Canada is bound to attract interest from those who suffer from depression and those who treat it.

Published in JAMA Psychiatry this week, the study found that the measure of brain inflammation in people with clinical depression was much greater than for those without depression. Where previous studies have shown a correlation between depression and the level of inflammatory markers in the blood, this is the first study to show a definitive link with markers in the brain itself.

The team conducted brain scans on 20 patients with clinical depression and 20 non-depressed control participants, using a technique called Positron Emission Tomography (PET). Using this method, rates of brain inflammation were shown to be elevated by a remarkable 30% among the depressed patients, and were highest among those with severe depression.

Senior author Dr Jeffrey Myer of CAMH's Campbell Family Mental Health Research Institute rightly observes:
"This discovery has important implications for the development of new treatments for a significant group of people who suffer from depression. It provides a potential new target to either reverse brain inflammation or shift to a more positive repair role, with the idea that it would alleviate the symptoms."
Imagine that. Good old aspirin as a possible solution to (or perhaps a reliever of) depression. Is there anything the humble son of willow bark (for aspirin is a natural derivative of willow bark) cannot turn its hand to?

Now I'm making a leap here, of course, but wouldn't it be wonderful if aspirin, known for its anti-inflammatory effects from the time of the ancient Greeks, were to give us a very real solution to one of the most significant and intractable diseases of our modern time?

Perhaps we would be well advised to look to the past for solutions to depression - and yes, I mean that in more ways than one.

Written by Jacqui Hogan

Friday, 23 January 2015

STOP PRESS: Men and women are different!

We live in confusing times. So much so, that sometimes we lose track of the obvious. New research from the University of Basel is reassuringly supportive of something we women instinctively know to be true - that women experience a more potent response to emotional stimuli than men.

This large scale study, the results of which will be published in the latest issue of the Journal of Neuroscience, set about establishing the gender-dependent relationship between emotions, brain activity and memory performance.

While it is generally known that women consider emotional events to be more impactful than men, research supporting this and linking it to gender-based recall has been relatively thin on the ground.

Almost 3,400 male and female subjects were asked to rate emotionally charged content, some positive and some negative, for the size of the emotional reaction they evoked.

Women rated the content (especially the negative) as being more emotionally impacting than their male counterparts and, in a subsequent memory test, women could freely recall more of the images than men. Women demonstrated particular facility with recalling positive images.

Dr. Annette Milnik, leader of the team from the University of Basel's Molecular and Cognitive Neurosciences Transfaculty Research Platform noted:
"This would suggest that gender-dependent differences in emotional processing and memory [i.e. the difference between men and women when it comes to emotional processing and memory], are due to different mechanisms."
To further probe the findings, MRI data from almost 700 of the subjects showed that womens' stronger reaction to negative emotional content is linked to increased activity in the motor regions of the brain, supporting the common observation that women are more emotionally expressive than men.

Now, I don't know about you, but I would have been surprised by any other result. Logic tells me that women have babies and, biologically, that makes a difference. As the bearers of children we are fundamentally programmed for nurture, which, of course, has a profound effect on both our biology and our psychology. How could it be otherwise?

That's not to say that men are not moved by emotional stimuli; nor to say that some male individuals do not emote in the same way that women do (or some women do!). It is simply to say that, as a general rule, emotional processing and memory of emotional content occur differently for women and men.

Do you have any thoughts on this topic? If so, we'd love to hear from you, men and women alike!

Written by Jacqui Hogan

Friday, 16 January 2015

Of mice and men (and empathy)

Anyone who has trained in counselling knows that empathy is one of the most basic tenets of the therapeutic relationship. Psychologist Carl Rogers identified empathy and two other principles, congruence and unconditional positive regard, as the three essential pillars of his client-centred approach to psychotherapy.

Empathy has recently been enjoying a relative resurgence of interest among researchers and clinicians, owing to its known relationship with disorders such as autism and those on the psychopathic spectrum.

A new study published this week in the journal Current Biology digs down deeper into the conditions under which empathy arises and reveals some interesting findings about the role of 'strangers'.

Student participants were asked to immerse one arm in ice cold water and rate their level of discomfort. These scores remained exactly the same when the task was performed sitting opposite a stranger who was also performing the task. However, when sitting opposite a friend, participants' pain ratings increased, suggesting that familiarity was having a bearing on the results. One of the authors commented:
"It would seem like more pain in the presence of a friend would be bad news, but it's in fact a sign of a strong bond of empathy between individuals - they are indeed feeling each others' pain."
Funnily enough, such findings have already been demonstrated in mice, who experience more pain from a stimulus when being stimulated with 'cage mates' than when being stimulated alone.

Going back to the study at hand, to test the validity of the initial findings, student participants were then paired up with strangers and given the opportunity to play a video game together in advance of the ice water pain stimulus. After just 15 minutes of playing together, the strangers demonstrated empathy towards each other when subjected to the original stimulus.

Aside from the fascinating observation that empathy appears to operate in the same way in both mice and men, this study makes for very interesting psychosocial speculation.

Knowing that the inability to feel empathy is linked to various psychological disorders, we can ask the question: could such findings be used to treat these (often intractable) conditions? Could stimulating friendships and social interaction (in autism, for example) be used as a formal treatment or as part of a treatment approach? Is it even possible to stimulate friendship or must therapeutically valuable friendships arise organically?

At the societal level, does the melting pot of strangers created by open border policy have a dumbing down effect on our collective capacity for empathy? If so (and common sense, if nothing else, tells you there must be something to this), how do we reach out to others and form bonds of friendship in ways that increase our empathy?

Ah, so many questions, so little time. Perhaps you have experience of working with cultivating empathy, either in the one-to-one clinical environment or in the group setting. As ever, we'd welcome your feedback.

Written by Jacqui Hogan

Friday, 9 January 2015

New Year's resolutions and mental health

It's a bit of a cliche, isn't it, the whole new year's resolution game? As natural as it is to start a brand new, shiny year with edifying intentions, does anyone ever persist for longer than it takes for the afterglow of the silly season (or possibly even the hangover) to wear off?

According to popular reports, about 50% of us engage in this ill-fated pastime and 90% of us fail to achieve what we earnestly set out to do. Among the top resolutions for 2014 were: to lose weight; to become more organised; to save money; to live life more fully and to get fitter. Who can blame anyone for such lofty ideals?

So why the high failure rate and is there, perhaps, a more effective approach to behavioural change?

Perhaps one of the problems is that we set ourselves up for failure by, first of all, attaching the desired change to a big, dramatic, external event (New Year's) and, secondly, by conceiving the change required in grand terms.

We live in a culture that tells us we can do anything we set our minds to (which may or may not be true) and then overestimate our potency within this self-sufficient world view. We make sweeping gestures which seriously encroach on our daily routine and then, when we run out of puff, berate ourselves for messing up. We become discouraged, negative, and view ourselves as ineffectual, revving up that inner critic (who, as we know, needs very little encouragement). We resign ourselves to the fact that we are weak and tell ourselves that change is impossible, after all. Indeed, making new year's resolutions can potentially compromise our mental health!

Personally, I like the approach taken by the 12-Step movement, pioneered by Alcoholics Anonymous. It has a remarkable track record for bringing about sustained behavioural change.

The 12-Step system acknowledges our weakness, simply by virtue of being human, and calls upon our need for humility in the face of it. Ironically, recognising our own ineptitude is a strength in and of itself, and leads on to building a positive, more realistic image of self.

Maxims used in the 12-Step environment include 'Easy does it' and 'One day at a time', which drain activity of its intensity and orient the mind towards staying in the moment and taking the actions which are necessary and appropriate to each individual and unique day.

This, it seems to me, is at least part of the solution to bringing about effective change in line with our desire to be better persons. That is, a moment by moment, day by day choosing of actions consistent with the virtues we wish to acquire, while understanding our shortcomings and forgiving ourselves the inevitable lapses that occur along the way.

New Year is the obvious time to identify changes we would like to make and set in train the 'baby steps' that will predispose to their achievement. But let's not imagine we can do it alone in a blaze of glory - let's be realistic and kind!

Written by Jacqui Hogan