Locus Coeruleus in mania

From all the mental disorders, bipolar disorder, a.k.a. manic-depressive disorder, has the highest risk for suicide attempt and completion. If the thought of suicide crosses your mind, stop reading this, it’s not that important; what’s important is for you to call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

The bipolar disorder is defined by alternating manic episodes of elevated mood, activity, excitation, and energy with episodes of depression characterized by feelings of deep sadness, hopelessness, worthlessness, low energy, and decreased activity. It is also a more common disease than people usually expect, affecting about 1% or more of the world population. That means almost 80 million people! Therefore, it’s imperative to find out what’s causing it so we can treat it.

Unfortunately, the disease is very complex, with many brain parts, brain chemicals, and genes involved in its pathology. We don’t even fully comprehend how the best medication we have to lower the risk of suicide, lithium, works. The good news is the neuroscientists haven’t given up, they are grinding at it, and with every study we get closer to subduing this monster.

One such study freshly published last month, Cao et al. (2018), looked at a semi-obscure membrane protein, ErbB4. The protein is a tyrosine kinase receptor, which is a bit unfortunate because this means is involved in ubiquitous cellular signaling, making it harder to find its exact role in a specific disorder. Indeed, ErbB4 has been found to play a role in neural development, schizophrenia, epilepsy, even ALS (Lou Gehrig’s disease).

Given that ErbB4 is found in some neurons that are involved in bipolar and mutations in its gene are also found in some people with bipolar, Cao et al. (2018) sought to find out more about it.

First, they produced mice that lacked the gene coding for ErbB4 in neurons from din locus coeruleus, the part of the brain that produces norepinephrine out of dopamine, better known for the European audience as nor-adrenaline. The mutant mice had a lot more norepinephrine and dopamine in their brains, which correlated with mania-like behaviors. You might have noticed that the term used was ‘manic-like’ and not ‘manic’ because we don’t know for sure how the mice feel; instead, we can see how they behave and from that infer how they feel. So the researchers put the mice thorough a battery of behavioral tests and observed that the mutant mice were hyperactive, showed less anxious and depressed behaviors, and they liked their sugary drink more than their normal counterparts, which, taken together, are indices of mania.

Next, through a series of electrophysiological experiments, the scientists found that the mechanism through which the absence of ErbB4 leads to mania is making another receptor, called NMDA, in that brain region more active. When this receptor is hyperactive, it causes neurons to fire, releasing their norepinephrine. But if given lithium, the mutant mice behaved like normal mice. Correspondingly, they also had a normal-behaving NMDA receptor, which led to normal firing of the noradrenergic neurons.

So the mechanism looks like this (Jargon alert!):

No ErbB4 –> ↑ NR2B NMDAR subunit –> hyperactive NMDAR –> ↑ neuron firing –> ↑ catecholamines –> mania.

In conclusion, another piece of the bipolar puzzle has been uncovered. The next obvious step will be for the researchers to figure out a medicine that targets ErbB4 and see if it could treat bipolar disorder. Good paper!

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P.S. If you’re not familiar with the journal eLife, go and check it out. The journal offers for every study a half-page summary of the findings destined for the lay audience, called eLife digest. I’ve seen this practice in other journals, but this one is generally very well written and truly for the lay audience and the non-specialist. Something of what I try to do here, minus the personal remarks and in parenthesis metacognitions that you’ll find in most of my posts. In short, the eLife digest is masterly done. As my continuous struggles on this blog show, it is tremendously difficult for a scientist to write concisely, precisely, and jargonless at the same time. But eLife is doing it. Check it out. Plus, if you care to take a look on how science is done and published, eLife publishes all the editor’s rejection notes, all the reviewers’ comments, and all the author responses for a particular paper. Reading those is truly a teaching moment.

REFERENCE: Cao SX, Zhang Y, Hu XY, Hong B, Sun P, He HY, Geng HY, Bao AM, Duan SM, Yang JM, Gao TM, Lian H, Li XM (4 Sept 2018). ErbB4 deletion in noradrenergic neurons in the locus coeruleus induces mania-like behavior via elevated catecholamines. Elife, 7. pii: e39907. doi: 10.7554/eLife.39907. PMID: 30179154 ARTICLE | FREE FULLTEXT PDF

By Neuronicus, 14 October 2018

The Mom Brain

Recently, I read an opinion titled When I Became A Mother, Feminism Let Me Down. The gist of it was that some feminists, while empowering women and girls to be anything they want to be and to do anything a man or a boy does, they fail in uplifting the motherhood aspect of a woman’s life, should she choose to become a mother. In other words, even (or especially, in some cases) feminists look down on the women who chose to switch from a paid job and professional career to an unpaid stay-at-home mom career, as if being a mother is somehow beneath what a woman can be and can achieve. As if raising the next generation of humans to be rational, informed, well-behaved social actors instead of ignorant brutal egomaniacs is a trifling matter, not to be compared with the responsibilities and struggles of a CEO position.

Patriarchy notwithstanding, a woman can do anything a man can. And more. The ‘more’ refers to, naturally, motherhood. Evidently, fatherhood is also a thing. But the changes that happen in a mother’s brain and body during pregnancy, breastfeeding, and postpartum periods are significantly more profound than whatever happens to the most loving and caring and involved father.

Kim (2016) bundled some of these changes in a nice review, showing how these drastic and dramatic alterations actually have an adaptive function, preparing the mother for parenting. Equally important, some of the brain plasticity is permanent. The body might spring back into shape if the mother is young or puts into it a devilishly large amount of effort, but some brain changes are there to stay. Not all, though.

One of the most pervasive findings in motherhood studies is that hormones whose production is increased during pregnancy and postpartum, like oxytocin and dopamine, sensitize the fear circuit in the brain. During the second trimester of pregnancy and particularly during the third, expectant mothers start to be hypervigilent and hypersensitive to threats and to angry faces. A higher anxiety state is characterized, among other things, by preferentially scanning for threats and other bad stuff. Threats mean anything from the improbable tiger to the 1 in a million chance for the baby to be dropped by grandma to the slightly warmer forehead or the weirdly colored poopy diaper. The sensitization of the fear circuit, out of which the amygdala is an essential part, is adaptive because it makes the mother more likely to not miss or ignore her baby’s cry, thus attending to his or her needs. Also, attention to potential threats is conducive to a better protection of the helpless infant from real dangers. This hypersensitivity usually lasts 6 to 12 months after childbirth, but it can last lifetime in females already predisposed to anxiety or exposed to more stressful events than average.

Many new mothers worry if they will be able to love their child as they don’t feel this all-consuming love other women rave about pre- or during pregnancy. Rest assured ladies, nature has your back. And your baby’s. Because as soon as you give birth, dopamine and oxytocin flood the body and the brain and in so doing they modify the reward motivational circuit, making new mothers literally obsessed with their newborn. The method of giving birth is inconsequential, as no differences in attachment have been noted (this is from a different study). Do not mess with mother’s love! It’s hardwired.

Another change happens to the brain structures underlying social information processing, like the insula or fusiform gyrus, making mothers more adept at self-motoring, reflection, and empathy. Which is a rapid transformation, without which a mother may be less accurate in understanding the needs, mental state, and social cues of the very undeveloped ball of snot and barf that is the human infant (I said that affectionately, I promise).

In order to deal with all these internal changes and the external pressures of being a new mom the brain has to put up some coping mechanisms. (Did you know, non-parents, that for the first months of their newborn lives, the mothers who can breastfeed must do so at least every 4 hours? Can you imagine how berserk with sleep deprivation you would be after 4 months without a single night of full sleep but only catnaps?). Some would be surprised to find out – not mothers, though, I’m sure – that “new mothers exhibit enhanced neural activation in the emotion regulation circuit including the anterior cingulate cortex, and the medial and lateral prefrontal cortex” (p. 50). Which means that new moms are actually better at controlling their emotions, particularly at regulating negative emotional reactions. Shocking, eh?

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Finally, it appears that very few parts of the brain are spared from this overhaul as the entire brain of the mother is first reduced in size and then it grows back, reorganized. Yeah, isn’t that weird? During pregnancy the brain shrinks, being at its lowest during childbirth and then starts to grow again, reaching its pre-pregnancy size 6 months after childbirth! And when it’s back, it’s different. The brain parts heavily involved in parenting, like the amygdala involved in the anxiety, the insula and superior temporal gyrus involved in social information processing and the anterior cingulate gyrus involved in emotional regulation, all these show increased gray matter volume. And many other brain structures that I didn’t list. One brain structure is rarely involved only in one thing so the question is (well, one of them) what else is changed about the mothers, in addition to their increased ability to parent?

I need to add a note here: the changes that Kim (2016) talks about are averaged. That means some women get changed more, some less. There is variability in plasticity, which should be a pleonasm. There is also variability in the human population, as any mother attending a school parents’ night-out can attest. Some mothers are paranoid with fear and overprotective, others are more laissez faire when it comes to eating from the floor.

But SOME changes do occur in all mothers’ brains and bodies. For example, all new mothers exhibit a heightened attention to threats and subsequent raised levels of anxiety. But when does heightened attention to threats become debilitating anxiety? Thanks to more understanding and tolerance about these changes, more and more women feel more comfortable reporting negative feelings after childbirth so that now we know that postpartum depression, which happens to 60 – 80% of mothers, is a serious matter. A serious matter that needs serious attention from both professionals and the immediate social circle of the mother, both for her sake as well as her infant’s. Don’t get me wrong, we – both males and females – still have a long way ahead of us to scientifically understand and to socially accept the mother brain, but these studies are a great start. They acknowledge what all mothers know: that they are different after childbirth than the way they were before. Now we have to figure out how are they different and what can we do to make everyone’s lives better.

Kim (2016) is an OK review, a real easy read, I recommend it to the non-specialists wholeheartedly; you just have to skip the name of the brain parts and the rest is pretty clear. It is also a very short review, which will help with reader fatigue. The caveat of that is that it doesn’t include a whole lotta studies, nor does it go in detail on the implications of what the handful cited have found, but you’ll get the gist of it. There is a vastly more thorough literature if one would include animal studies that the author, curiously, did not include. I know that a mouse is not a chimp is not a human, but all three of us are mammals, and social mammals at that. Surely, there is enough biological overlap so extrapolations are warranted, even if partially. Nevertheless, it’s a good start for those who want to know a bit about the changes motherhood does to the brain, behavior, thoughts, and feelings.

Corroborated with what I already know about the neuroscience of maternity, my favourite takeaway is this: new moms are not crazy. They can’t help most of these changes. It’s biology, you see. So go easy on new moms. Moms, also go easy on yourselves and know that, whether they want to share or not, the other moms probably go through the same stuff. You’re not alone. And if that overactive threat circuit gives you problems, i.e. you feel overwhelmed, it’s OK to ask for help. And if you don’t get it, ask for it again and again until you do. That takes courage, that’s empowerment.

P. S. The paper doesn’t look like it’s peer-reviewed. Yes, I know the peer-reviewing publication system is flawed, I’ve been on the receiving end of it myself, but it’s been drilled into my skull that it’s important, flawed as it is, so I thought to mention it.

REFERENCE: Kim, P. (Sept. 2016). Human Maternal Brain Plasticity: Adaptation to Parenting, New Directions for Child and Adolescent Development, (153): 47–58. PMCID: PMC5667351, doi: 10.1002/cad.20168. ARTICLE | FREE FULLTEXT PDF

By Neuronicus, 28 September 2018

The superiority illusion

Following up on my promise to cover a few papers about self-deception, the second in the series is about the superiority illusion, another cognitive bias (the first was about depressive realism).

Yamada et al. (2013) sought to uncover the origins of the ubiquitous belief that oneself is “superior to average people along various dimensions, such as intelligence, cognitive ability, and possession of desirable traits” (p. 4363). The sad statistical truth is that MOST people are average; that’s the whole definitions of ‘average’, really… But most people think they are superior to others, a.k.a. the ‘above-average effect’.

Twenty-four young males underwent resting-state fMRI and PET scanning. The first scanner is of the magnetic resonance type and tracks where you have most of the blood going in the brain at any particular moment. More blood flow to a region is interpreted as that region being active at that moment.

The word ‘functional’ means that the subject is performing a task while in the scanner and the resultant brain image is correspondent to what the brain is doing at that particular moment in time. On the other hand, ‘resting-state’ means that the individual did not do any task in the scanner, s/he just sat nice and still on the warm pads listening to the various clicks, clacks, bangs & beeps of the scanner. The subjects were instructed to rest with their eyes open. Good instruction, given than many subjects fall asleep in resting state MRI studies, even in the terrible racket that the coils make that sometimes can reach 125 Db. Let me explain: an MRI is a machine that generates a huge magnetic field (60,000 times stronger than Earth’s!) by shooting rapid pulses of electricity through a coiled wire, called gradient coil. These pulses of electricity or, in other words, the rapid on-off switchings of the electrical current make the gradient coil vibrate very loudly.

A PET scanner functions on a different principle. The subject receives a shot of a radioactive substance (called tracer) and the machine tracks its movement through the subject’s body. In this experiment’s case, the tracer was raclopride, a D2 dopamine receptor antagonist.

The behavioral data (meaning the answers to the questionnaires) showed that, curiously, the superiority illusion belief was not correlated with anxiety or self-esteem scores, but, not curiously, it was negatively correlated with helplessness, a measure of depression. Makes sense, especially from the view of depressive realism.

The imaging data suggests that dopamine binding to its striatal D2 receptors attenuate the functional connectivity between the left sensoriomotor striatum (SMST, a.k.a postcommissural putamen) and the dorsal anterior cingulate cortex (daCC). And this state of affairs gives rise to the superiority illusion (see Fig. 1).

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Fig. 1. The superiority illusion arises from the suppression of the dorsal anterior cingulate cortex (daCC) – putamen functional connection by the dopamine coming from the substantia nigra/ ventral tegmental area complex (SN/VTA) and binding to its D2 striatal receptors. Credits: brain diagram: Wikipedia, other brain structures and connections: Neuronicus, data: Yamada et al. (2013, doi: 10.1073/pnas.1221681110). Overall: Public Domain

This was a frustrating paper. I cannot tell if it has methodological issues or is just poorly written. For instance, I have to assume that the dACC they’re talking about is bilateral and not ipsilateral to their SMST, meaning left. As a non-native English speaker myself I guess I should cut the authors a break for consistently misspelling ‘commissure’ or for other grammatical errors for fear of being accused of hypocrisy, but here you have it: it bugged me. Besides, mine is a blog and theirs is a published peer-reviewed paper. (Full Disclosure: I do get editorial help from native English speakers when I publish for real and, except for a few personal style quirks, I fully incorporate their suggestions). So a little editorial help would have gotten a long way to make the reading more pleasant. What else? Ah, the results are not clearly explained anywhere, it looks like the authors rely on obviousness, a bad move if you want to be understood by people slightly outside your field. From the first figure it looks like only 22 subjects out of 24 showed superiority illusion but the authors included 24 in the imaging analyses, or so it seems. The subjects were 23.5 +/- 4.4 years, meaning that not all subjects had the frontal regions of the brain fully developed: there are clear anatomical and functional differences between a 19 year old and a 27 year old.

I’m not saying it is a bad paper because I have covered bad papers; I’m saying it was frustrating to read it and it took me a while to figure out some things. Honestly, I shouldn’t even have covered it, but I spent some precious time going through it and its supplementals, what with me not being an imaging dude, so I said the hell with it, I’ll finish it; so here you have it :).

By Neuronicus, 13 December 2017

REFERENCE: Yamada M, Uddin LQ, Takahashi H, Kimura Y, Takahata K, Kousa R, Ikoma Y, Eguchi Y, Takano H, Ito H, Higuchi M, Suhara T (12 Mar 2013). Superiority illusion arises from resting-state brain networks modulated by dopamine. Proceedings of the National Academy of Sciences of the United States of America, 110(11):4363-4367. doi: 10.1073/pnas.1221681110. ARTICLE | FREE FULLTEXT PDF 

The FIRSTS: The roots of depressive realism (1979)

There is a rumor stating that depressed people see the world more realistically and the rest of us are – to put it bluntly – deluded optimists. A friend of mine asked me if this is true. It took me a while to find the origins of this claim, but after I found it and figured out that the literature has a term for the phenomenon (‘depressive realism’), I realized that there is a whole plethora of studies on the subject. So the next following posts will be centered, more or less, on the idea of self-deception.

It was 1979 when Alloy & Abramson published a paper who’s title contained the phrase ‘Sadder but Wiser’, even if it was followed by a question mark. The experiments they conducted are simple, but the theoretical implications are large.

The authors divided several dozens of male and female undergraduate students into a depressed group and a non-depressed group based on their Beck Depression Inventory scores (a widely used and validated questionnaire for self-assessing depression). Each subject “made one of two possible responses (pressing a button or not pressing a button) and received one of two possible outcomes (a green light or no green light)” (p. 447). Various conditions presented the subjects with various degrees of control over what the button does, from 0 to 100%. After the experiments, the subjects were asked to estimate their control over the green light, how many times the light came on regardless of their behavior, what’s the percentage of trials on which the green light came on when they pressed or didn’t press the button, respectively, and how did they feel. In some experiments, the subjects were wining or losing money when the green light came on.

Verbatim, the findings were that:

“Depressed students’ judgments of contingency were surprisingly accurate in all four experiments. Nondepressed students, on the other hand, overestimated the degree of contingency between their responses and outcomes when noncontingent outcomes were frequent and/or desired and underestimated the degree of contingency when contingent outcomes were undesired” (p. 441).

In plain English, it means that if you are not depressed, when you have some control and bad things are happening, you believe you have no control. And when you have no control but good things are happening, then you believe you have control. If you are depressed, it does not matter, you judge your level of control accurately, regardless of the valence of the outcome.

Such illusion of control is a defensive mechanism that surely must have adaptive value by, for example, allowing the non-depressed to bypass a sense of guilt when things don’t work out and increase self-esteem when they do. This is fascinating, particularly since it is corroborated by findings that people receiving gambling wins or life successes like landing a good job, rewards that at least in one case are demonstrably attributable to chance, believe, nonetheless, that it is due to some personal attributes that make them special, that makes them deserving of such rewards. (I don’t remember the reference of this one so don’t quote me on it. If I find it, I’ll post it, it’s something about self-entitlement, I think). That is not to say that life successes are not largely attributable to the individual; they are. But, statistically speaking, there must be some that are due to chance alone, and yet most people feel like they are the direct agents for changes in luck.

Another interesting point is that Alloy & Abramson also tried to figure out how exactly their subjects reasoned when they asserted their level of control through some clever post-experiment questioners. Long story short (the paper is 45 pages long), the illusion of control shown by nondepressed subjects in the no control condition was the result of incorrect logic, that is, faulty reasoning.

In summary, the distilled down version of depressive realism that non-depressed people see the world through rose-colored glasses is slightly incorrect. Because only in particular conditions this illusion of control applies, and that is overestimation of control only when good things are happening and underestimation of control when bad things are happening. But, by and large, it does seem that depression clears the fog a bit.

Of course, it has been over 40 years since the publication of this paper and of course it has its flaws. Many replications and replications with caveats and meta-analyses and reviews and opinions and alternative hypotheses have been confirmed and infirmed and then confirmed again with alterations, so there is still a debate out there about the causes/ functions/ ubiquity/ circumstantiality of the depressive realism effect. One thing seems to be constant though: the effect exists.

I will leave you with the ponders of Alloy & Abramson (1979):

“A crucial question is whether depression itself leads people to be “realistic” or whether realistic people are more vulnerable to depression than other people” (p. 480).

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REFERENCE: Alloy LB, & Abramson LY (Dec. 1979). Judgment of contingency in depressed and nondepressed students: sadder but wiser? Journal of Experimental Psychology: General, 108(4): 441-485. PMID: 528910. http://dx.doi.org/10.1037/0096-3445.108.4.441. ARTICLE | FULLTEXT PDF via ResearchGate

By Neuronicus, 30 November 2017

Video games and depression

There’s a lot of talk these days about the harm or benefit of playing video games, a lot of time ignoring the issue of what kind of video games we’re talking about.

Merry et al. (2012) designed a game for helping adolescents with depression. The game is called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) and is based on the cognitive behavioral therapy (CBT) principles.

CBT has been proven to be more efficacious that other forms of therapy, like psychoanalysis, psychodynamic, transpersonal and so on in treating (or at least alleviating) a variety of mental disorders, from depression to anxiety, form substance abuse to eating disorders. Its aim is to identify maladaptive thoughts (the ‘cognitive’ bit) and behaviors (the ‘behavior’ bit), change those thoughts and behaviors in order to feel better. It is more active and more focused than other therapies, in the sense that during the course of a CBT session, the patient and therapist discuss one problem and tackle it.

SPARX is a simple interactive fantasy game with 7 levels (Cave, Ice, Volcano, Mountain, Swamp, Bridgeland, Canyon) and the purpose is to fight the GNATs (Gloomy Negative Automatic Thoughts) by mastering several techniques, like breathing and progressive relaxation and acquiring skills, like scheduling and problem solving. You can customize your avatar and you get a guide throughout the game that also assess your progress and gives you real-life quests, a. k. a. therapeutic homework. If the player does not show the expected improvements after each level, s/he is directed to seek help from a real-life therapist. Luckily, the researchers also employed the help of true game designers, so the game looks at least half-decent and engaging, not a lame-worst-graphic-ever-bleah sort of thing I was kind of expecting.

To see if their game helps with depression, Merry et al. (2012) enrolled in an intervention program 187 adolescents (aged between 12-19 years) that sought help for depression; half of the subjects played the game for about 4 – 7 weeks, and the other half did traditional CBT with a qualified therapist for the same amount of time.  The patients have been assessed for depression at regular intervals before, during and after the therapy, up to 3 months post therapy. The conclusion?

SPARX “was at least as good as treatment as usual in primary healthcare sites in New Zealand” (p. 8)

Not bad for an RPG! The remission rates were higher for the SPARX group that in treatment as usual group. Also, the majority of participants liked the game and would recommend it. Additionally, SPARX was more effective than CBT for people who were less depressed than the ones who scored higher on the depression scales.

And now, coming back to my intro point, the fact that this game seems to be beneficial does not mean all of them are. There are studies that show that some games have deleterious effects on the developing brain. In the same vein, the fact that some shoddy company sells games that are supposed to boost your brain function (I always wandered which function…) that doesn’t mean they are actually good for you. Without the research to back up the claims, anybody can say anything and it becomes a “Buyer Beware!” game. They may call it cognitive enhancement, memory boosters or some other brainy catch phrase, but without the research to back up the claims, it’s nothing but placebo in the best case scenario. So it gives me hope – and great pleasure – that some real psychologists at a real university are developing a video game and then do the necessary research to validate it as a helping tool before marketing it.

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Oh, an afterthought: this paper is 4 years old so I wondered what happened in the meantime, is it on the market or what? On the research databases I couldn’t find much, except that it was tested this year on Dutch population with pretty much similar results. But Wikipedia tells us that is was released in 2013 and is free online for New Zealanders! The game’s website says it may become available to other countries as well.

Reference: Merry SN, Stasiak K, Shepherd M, Frampton C, Fleming T, & Lucassen MF. (18 Apr 2012). The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. The British Medical Journal, 344:e2598. doi: 10.1136/bmj.e2598. PMID: 22517917, PMCID: PMC3330131. ARTICLE | FREE FULLTEXT PDF  | Wikipedia page | Watch the authors talk about the game

By Neuronicus, 15 October 2016

Tryptophan-rich foods and happiness

angry-woman public domainThe paper I feature today is not an experimental study, but an editorial written as a short review (5 pages). A not very good one, I’m afraid.

Neurochemical imbalances are to be found in virtual any brain disorder. Probably the most known is the serotonin depletion associated to depression, which is the main reason why SSRIs (selective serotonin reuptake inhibitors) are so widely prescribed for the disorder. With the caveats that serotonin is but one player, that it has many receptors involved in different aspects of the disease and “depression” is an umbrella term for a host of behaviors, this editorial focuses on non-pharmacological ways to address the depletion of serotonin. Noble goal, poor execution.

In a nutshell, Young (2007) argues that there are 4 ways to increase serotonin availability in the brain:
1) effortful focusing on positive things, either via psychotherapy, talk, social interactions, mediation or just mental exercises to consciously improve mood. I’m sure that the thought of trying to focus on the positive thoughts never crossed the minds of depressed people! Of course that this is how healthy people regulate their moods, everybody is sad or suffers loss at some point in their life and a lot of people snap out of it by engaging in those suggested behaviors, but the trouble with depression is that it persists despite efforts to be positive. The author should know that crying “Cheer up!” to a depressed person never works, but chances are they would feel even more alienated because they’ve tried that already!
2) exposure to bright light (3000 lux). No contention here. Light therapy is successful in treating seasonal depression. We should all get more light.
3) exercise. It’s unclear which kind, aerobic or to fatigue, but probably either would work.
4) eating tryptophan-rich foods (like meat, cheeses or eggs). Why tryptophan? Because the brain can make serotonin out of tryptophan, but serotonin itself is too big of a molecule to enter the brain (i.e. doesn’t cross the brain blood barrier). But the author admits that “although purified tryptophan increases brain serotonin, foods containing tryptophan do not” (p. 396) soooo,… then eating tryptophan-rich foods will NOT increase the serotonin. But then he goes on saying that drinking milk or eating nixtamalized corn increases serotonin (verbatim: “Acute ingestion of alpha-lactalbumin by humans can improve mood and cognition in some circumstances, presumably owing to increased serotonin” and “Breeding corn with a higher tryptophan content was shown in the 1980s to prevent pellagra; presumably, it also raised brain serotonin” p. 396-397). Utterly confusing and self-contradictory.

I also want to make a big note here:
a) there is no reliable evidence that eating tryptophan-rich foods increases the brain serotonin. Otherwise, instead of paying for Prozac, you would buy a huge bottle of tryptophan pills from the nearest dietary supplements store. Which brings me to my second point:
b) why don’t we give tryptophan supplements instead of SSRIs? Tryptophan is sold in USA as a dietary supplement which I think is a tremendously dangerous thing to allow (in most EU countries is considered a drug, so you can’t buy it from the shoddy dietary supplements stores). Because its efficacy in depression is inconclusive at best, i.e. most studies did not find significant improvements, while others showed improvement only in a subpopulation of depression sufferers. But it can induce nausea, sleepiness, confusion, depression, and even dementia symptoms and death. And interacts badly with other drugs or even with carbohydrate-rich foods, like pizza or pasta.

This is definitely not among the best papers I have read. It has many speculations supported by un-replicated studies. Or, when such studies are sparse, the reasoning relies on evolutionary speculations elevated to the rank of causal explanations (e.g. we spend so much time indoors, therefore depression is on the rise; conversely, our ancestors spent more time outside, therefore they were happier). Although I agree with Young that we should invest more research into non-pharmacological ways to improve brain dysfunctions, we need to do so in a more pragmatical manner that just telling people to think positive. Ok, rant over.

Reference: Young SN (Nov 2007). How to increase serotonin in the human brain without drugs. Journal of Psychiatry and Neuroscience, 32(6):394-399. PMID:18043762, PMCID:PMC2077351. Article | FREE FULLTEXT PDF

By Neuronicus, 3 December 2015

Putative mechanism for decreased spermatogenesis following SSRI

fishThe SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed antidepressants around the world. Whether is Prozac, Zoloft or Celexa, chances are that 1 in 4 Americans (or 1 in 10, depending on the study) will be making a decision during their lifetime to start an antidepressant course or not. And yet adherence to treatment is significantly low, as many people get off the SSRI due to their side effects, one of the main complains being sexual dysfunction in the form of low libido and pleasure.

Now a new study finds a mechanism for an even more worrisome effect of citalopram, (Celexa), an SSRI: the reduction of spermatogenesis. Prasad et al. (2015) used male zebrafish as a model and exposed them to citalopram in 3 different doses for 2- or 4-weeks period. They found out that the expression in the brain of the serotonin-related genes (trp2 and sert) and gonadotropin genes (lhb, sdhb, gnrh2, and gnrh3) were differently affected depending on the dose and durations of treatment. In the testes, the “long-term medium- and high-dose citalopram treatments displayed a drastic decrease in the developmental stages of spermatogenesis as well as in the matured sperm cell count” (p. 5). The authors also looked at how the neurons are organized and they found out that the serotonin fibers are associated with the fibers of the neurons that release gonadotropin-releasing hormone 3 (GnRH3) in preoptic area, a brain region in the hypothalamus heavily involved in sexual and parental behavior in both humans and fish.

Shortly put, in the brain, the citalopram affects gene expression profiles and fiber density of the serotonin neurons, which in turn decreases the production of GnRH3, which may account for the sexual dysfunctions that follow citalopram. In the testes, citalopram may act directly by binding to the local serotonin receptors and decrease spermatogenesis.

Reference: Prasad P, Ogawa S, & Parhar IS. (Oct 2015, Epub 8 Jul 2015). Serotonin Reuptake Inhibitor Citalopram Inhibits GnRH Synthesis and Spermatogenesis in the Male Zebrafish. Biololy of Reproduction. 93(4):102, 1-10. doi: 10.1095/biolreprod.115.129965. Article | FREE FULLTEXT PDF

By Neuronicus, 11 November 2015

How long does it take for environmental enrichment to show effects?

From funnyvet.
From funnyvet.

Environmental enrichment is a powerful way to give a boost to neurogenesis and alleviate some anxiety and depression symptoms. For the laboratory rodents, who spend their lives in cages with water and food access, environmental enrichment can refer to as little as a toy or two or as much as large room colonies with different size tubes, different levels to explore, nesting materials, plenty of toys with various shapes, textures, and colors, exercise wheels, and even the occasional fruit or peanut butter snack. But for how long does a mouse need to be exposed to enrichment to show cognitive and emotional improvement?

Leger et al. (2015) ran several anxiety, depression, and long-term memory tests in mice who have been exposed to environmental enrichment for 24 h, 1, 3, or 5 weeks. Although 24 h exposure was enough to improve memory, only after 3-week exposure some anxiety behaviors were attenuated. No effect on depressive behaviors or coticosterone levels, which may be due to that particular strain of mouse (several other studies found that environmental enrichment ameliorates depressive symptoms in other mice strains and rats). The 3-week exposure also increased the levels of serotonin in the frontal cortex. Only after 5-eweek exposure there was a significant survival rate of the hippocampal new cells. Of note, these were normal mice, i.e. they were not suffering from any disorder prior to exposure.

Mice raised in an impoverished environment (a) show less dendrite growth (c) than do mice raised in an enriched environment (b, d). Copyright: BSCS.
Mice raised in an impoverished environment (a) show less dendrite growth (c) than do mice raised in an enriched environment (b, d). Copyright: BSCS.

The findings give us a nice timeline for environmental enrichment to show its desired effects. But… if there are differences in the timeline and effects of environmental enrichment exposure from mouse strain to mouse strain, then what can we say for humans? Probably not much, unfortunately. As the ad nauseam overused phrase goes at the end of so many papers, ‘more research is needed to elucidate this problem’.

Reference: Leger M, Paizanis E, Dzahini K, Quiedeville A, Bouet V, Cassel JC, Freret T, Schumann-Bard P, & Boulouard M. (Nov 2015, Epub 5 Jun 2014). Environmental Enrichment Duration Differentially Affects Behavior and Neuroplasticity in Adult Mice. Cerebral Cortex, 25(11):4048-61. doi: 10.1093/cercor/bhu119. Article | FREE PDF

By Neuronicus, 1 November 2015

Giving up? Your parvalbumin neurons may have something to do with it

Cartoon from http://i393.photobucket.com/albums/pp20/saisi24/dontgivedup.jpg, licensing unknown
Cartoon from Photobucket, licensing unknown.

One of the most ecologically-valid rodent models of depression is the learned helplessness paradigm. You get a rat or a mouse and you confine it in a cage with an electrified grid. Then you apply mild foot shocks at random intervals and of random duration for an hour (which is one session). The mouse initially tries to escape, but there is no escape; the whole floor is electrified. After a couple of sessions, the mouse doesn’t try to escape anymore; it gives up. Even when you put the mouse in a cage with an open door, so it can flee to no-pain freedom, it doesn’t attempt to do so. The interpretation is that the mouse has learned that it cannot control the environment, no matter what he does, he’s helpless, so why bother? Hence the name of the behavioral paradigm: learned helplessness.

All antidepressants on the market have been tested at one point or another against this paradigm; if the drug got the mouse to try to escape more, then the drug passed the test.

Just like in the higher vertebrate realm, there are a few animals who keep trying to escape longer than the others, before they too finally give up; we call these resilient.

Perova, Delevich, & Li (2015) looked at a type of neuron that may have something to do with the capacity of some of the mice to be resilient; the parvalbumin interneurons (PAI) from the medial prefrontal cortex (mPFC). These neurons produce GABA, the major inhibitory neurotransmitter in the brain, and modulates the activity of the nearby neurons. Thanks to the ability to genetically engineer mice to have a certain kind of cell fluoresce, the researchers were able to identify and subsequently record from and manipulate the function of the PAIs. These PAIs’ response to stimulation was weaker in helpless animals compared to resilient or controls. Also, inactivation of the PAI via a designer virus promotes helplessness.

Reference: Perova Z, Delevich K, & Li B (18 Feb 2015). Depression of Excitatory Synapses onto Parvalbumin Interneurons in the Medial Prefrontal Cortex in Susceptibility to Stress. The Journal of Neuroscience, 35(7):3201–3206. doi: 10.1523/JNEUROSCI.2670-14.2015. Article | FREE FULLTEXT PDF

By Neuronicus, 21 October 2015

Cell phones give you hallucinations

A young businessman in a suit screaming at a cell phone. By: Benjamin Miller. License FSP Standard FreeStockPhotos.biz
Photo by Benjamin Miller. License: FSP Standard FreeStockPhotos.biz

Medical doctors (MD) are overworked, particularly when they are hatchlings (i.e. Medical School students) and fledglings (interns and residents). So overworked, that in many countries is routine to have 80-hour weeks and 30-hour shifts as residents and interns. This is a concern as it has been shown that sleep deprivation impairs learning (which is the whole point of residency) and increases the number of medical mistakes (the lack of which is the whole point of their profession).

Lin et al. (2013) show that it can do more than that. Couple internship and cell phones and you get… hallucinations. That’s right. The authors asked 73 medical interns to complete some tests before their internship, then every third, sixth, and twelfth months of their internship, and after the internship. The questionnaires were on anxiety, depression, personality, and cell phone habits and hallucinations. That is: the sensation that your cell phone is vibrating or ringing when, in fact, it is not (which fully corresponds to the definition of hallucination). And here is what they found:

 Before internship, 78% of MDs experienced phantom vibration and 27% experienced phantom ringing.
 During their 1-year internship, about 85 to 95% of MDs experienced phantom vibration and phantom ringing.
 After the internship when the MDs did no work for two weeks, 50% still had these hallucinations.

Composite figure from Lin et al. (2015) showing the interns' depression (above) and anxiety (below) scores before, during, and after internship. The differences are statistically significant.
Fig. 1. Composite figure from Lin et al. (2015) showing the interns’ depression (above) and anxiety (below) scores before, during, and after internship. The differences are statistically significant.

The MDs’ depression and anxiety were also elevated more during the internship than before or after (see Fig. 1), but there was no correlation between the hallucinations and the depression and anxiety scores.

These findings are disturbing on so many levels… Should we be worried that prolonged exposure to cell phones can produce hallucinations? Or that o good portion of the MDs have hallucinations before going to internship? Or that 90% the people in charge with your life or your child’s life are so overworked that are hallucinating on a regular basis? Fine, fine, believing that your phone is ringing or vibrating may not be such a big deal of a hallucination, compared with, let’s say, “the voices told me to give you a lethal dose of morphine”, but as a neuroscientist I beg the question: is there a common mechanism between these two types of hallucinations and, if so, what ELSE is the MD hallucinating about while reassuring you that your CAT scan is normal? Or, forget about the hallucinations, should we worry that your MD is probably more depressed and anxious than you? Or, the “good” news, that the medical interns provide “a model of stress-induced psychotic symptoms” better that previous models, as the authors put it (p. 5)? I really wish there was more research on positive things (… that was a pun; hallucinations are a positive schizophrenic symptom, look it up 🙂 ).

Reference: Lin YH, Lin SH, Li P, Huang WL, & Chen CY. (10 June 2013). Prevalent hallucinations during medical internships: phantom vibration and ringing syndromes. PLoS One, 8(6): e65152. doi: 10.1371/journal.pone.0065152. Article | FREE PDF | First time the phenomenon was documented in press

By Neuronicus, 14 October 2015