Archive for category Depression

[Abstract] Depression in the First Year after Traumatic Brain Injury

Abstract

The aims of this study were to document the frequency of major and minor depressive episodes in the first year after traumatic brain injury (TBI), taking into account TBI severity and pre-morbid history of major depression, and to describe trajectories of depressive episodes. Participants were 227 adults who were hospitalized post-TBI (76% male; mean age = 41 years; 50% mild, 33% moderate, and 17% severe TBI). Major and minor depressive episodes were assessed with the Mini International Neuropsychiatric Interview at three time points (4, 8, and 12 months after TBI). Overall, 29% of participants had a major depressive episode in at least one of the three assessments, with fairly stable rates across assessments. Participants with mild TBI were more likely than those with moderate/severe TBI to be diagnosed with major depression, as were individuals with a positive pre-morbid history of depression compared to those without such history. In addition, 13% of participants had a minor depressive episode in at least one of the three assessments. Rates of minor depression significantly decreased from 4 to 8–12 months post-injury. Results also revealed a wide variety of trajectories of depressive episodes across assessments. Of note, 52% of major depression cases still fulfilled diagnostic criteria 4 months later, whereas 38% of minor depression cases deteriorated to major depression at the following assessment. These findings suggest that depression is highly prevalent after TBI, and monitoring of patients with subthreshold depressive symptoms is warranted in order to prevent the development of full-blown major depressive episodes.

 

via Depression in the First Year after Traumatic Brain Injury | Journal of Neurotrauma

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[Abstract] Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study

The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18–67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.

 

via Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study | Journal of Neurotrauma

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[WEB SITE] Cognitive Behavioral Therapy (CBT) and Transcranial Magnetic Stimulation (TMS): What Are These Therapies and How Are They Used?

Published 7 Feb 2018  – Reviewed 7 Feb 2018 – Author Melissa Galinato  – Source BrainFacts/SfN

When you have a cold, you might have a runny nose, a headache, and a cough. You may take different medications to treat each symptom to soothe your throat or ease your sneezing. Like treating a cold with multiple symptoms, there are different types of therapies to treat the multiple symptoms of depressive disorder, widely known as depression. Cognitive Behavioral Therapy (CBT) and Transcranial Magnetic Stimulation (TMS) are two therapy types that address specific symptoms of depression.

More than 300 million people around the world have depression, which is a common mental illness with multiple symptoms such as persistent sadness, irritability, a feeling of worthlessness, and loss of interest in activities—especially in things that previously brought joy or excitement.

With Cognitive Behavioral Therapy (CBT), a therapist helps a patient with depression to focus on understanding how three things – thoughts, feelings, and behavior – affect each other. “The goal of CBT for depression is to start targeting problematic thoughts and actions that are occurring in the present – as opposed to looking back in the past for a cause – teaching patients skills that they can use to become more aware of their negative thoughts, evaluate their validity and, when not accurate, replace them with more realistic/balanced ways of thinking,” says Simon Rego, Chief Psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York.

“At the same time, the other goal of CBT is to help patients change maladaptive patterns of behavior, gradually increasing activities of pleasure and accomplishment, which are known to enhance mood. Taken together, changing how you think and what you do can have a powerful positive impact on your mood.”

Imagine setting a goal – like running a marathon for the first time. A running coach could help you reach that goal by giving you tips and developing a training to slowly build up your strength. In CBT, the therapist acts like a coach and helps people identify goals such as driving a car or giving a speech. Then the therapist helps to figure out actions to reach those goals such as practicing thinking strategies, writing in journals, and doing homework assignments between appointments. Doing these activities in CBT can help people learn coping skills, build self-confidence, and have a sense of control, and a growing number of studies show that CBT works very well for treating depression and several other mental health conditions.

“CBT is an effective treatment for depression because it targets the two main areas where people with depression struggle: negative thoughts and unhelpful behaviors,” said Rego. “The main theory in CBT is that how we feel is directly influenced by how we think and what we do (or don’t do). In the case of depression, we know that people tend to have many negative thoughts about themselves, the world, and the future (e.g., I am a failure, I’ll never get better, no one cares about me, I don’t have the energy to do anything, etc.) which only serve to perpetuate their negative mood.”

Another therapy called Transcranial Magnetic Stimulation (TMS) can be used for some patients with depression who do not get better with antidepressant medications or other treatments. “In our experience, TMS is an appropriate treatment for major depressive disorder, moderate in severity and who are still functioning in the home, community, and who have failed multiple antidepressant medications,” said Ananda Pandurangi, medical director and chair of inpatient psychiatry in the Department of Psychiatry at Virginia Commonwealth University School of Medicine. “It is not appropriate for patients with either “mild” depression or those with severe depression including those with psychosis or catatonia,” said Pandurangi, noting that psychotherapy and medications may be more appropriate for patients with mild to severe depression.

TMS aims to alter brain circuitry. Using an electromagnetic coil, called a stimulator, to affect brain activity and treat depression, TMS treatment involves a doctor placing the stimulator near the forehead against the scalp. This activates brain cells in an area of the brain that includes the prefrontal cortex and controls mood and depression.

Sessions typically use repetitive TMS (rTMS) where recurrent magnetic pulses stimulate the brain. In 2008, the FDA approved rTMS for depression treatment after several research studies showed this TMS treatment lowers signs of depression and improves mood in people with treatment-resistant depression.

REFERENCES

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Publishing; 2013. 

Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review. 26(1), 17-31 (2006).

Depression. National Alliance on Mental Illness. Accessed 2/7/2018.

Depression. World Health Organization. February 2017.

Dobson D, Dobson KS. Evidence-based practice of cognitive-behavioral therapy. Guilford Publications. 2016. 

Gaynes BN, Lloyd SW, Lux L, Gartlehner G, Hansen RA, et al. Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis. The Journal of Clinical Psychiatry. 75(5), 477-89 (2014).

Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, et al. A systematic review of cognitive behavioral therapy and behavioral activation apps for depression. PLoS One. 11(5), e0154248 (2016). 

Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology. 125(11), 2150-2206 (2014). 

Levkovitz Y, Isserles M, Padberg F, Lisanby SH, Bystritsky A, et al. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 14(1), 64-73 (2015). 

Pascual-Leone A, Rubio B, Pallardó F, Catalá MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. The Lancet. 348(9022), 233-237 (1996). 

Psychotherapy. National Alliance on Mental Illness. Accessed 2/7/2018.

Wassermann EM, Williams WA, Callahan A, Ketter TA, Basser P, et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in. Neuroreport. 6, 1853-1856 (1995). 

via Cognitive Behavioral Therapy Transcranial Magnetic Stimulation what are these therapies 020718

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[BLOG] Food for Brain: Cognitive Enhancement via Diet

by  | January 15, 2018

It is often said that we are what we eat. The food we eat is used not only to fuel our body, but also to build it. This applies to the brain as well. Food choices can influence our brain functions in both positive and negative ways. The right food may enhance brain functioning and ameliorate the cognitive decline associated with aging. In addition, some foods can improve our emotional status and prevent conditions like depression.

Lipids are good for brain—myth or reality?

It is a fact that some lipids, including unsaturated fatty acids, are necessary for brain developmentand functioning. This is not surprising if we consider that the brain is the second richest organ in lipids. Approximately 50–60% of the brain is made of lipids. But not all the fatty acids are equally good for the brain. Omega-3 fatty acids found in fatty fish (salmon, mackerel, herring) and seafood are essential for the brain. These fatty acids constitute brain cell membranes. Also, they are main compounds of myelin, a fatty coat that insulates neurons (brain and ensures transmission of signals.

Omega-3 fats play vital functions in improving cognitive functions, providing proper neuronal communication and securing adequate attention. Interestingly, consumption of just one fish meal per weak is believed to decrease the risk of Alzheimer’s disease by up to 60%. Human clinical trials showed that supplementation with omega-3 fatty acids might improve mood, cooperation and cognitive score in subjects with dementia. Omega-3 fatty acids are extremely important for neonatal development as well. A deficit in these fats in pregnant and breastfeeding women, as well as in early childhood, may lead to conditions like autism and attention deficit hyperactivity disorder (ADHD).

Polyunsaturated (omega-3) and monounsaturated fatty acids also regulate the brain’s dopamine system. This is how they improve levels of dopamine and serotonin—the chemicals that make us feel happy. This is why diets with high fish consumption are associated with a low prevalence of depression. Cross-national analyses declared Japan as a country with the highest fish intake on the one hand and the lowest depression score on the other.

Apart from fish meals, walnuts (and nuts in general) are rich sources of omega-3 fatty acids. They contain essential alpha-linolenic fatty acids that cannot be synthesized inside our body and need to be obtained from our diet. Flaxseed and flaxseed oils are other valuable sources of this fatty acid.  In addition to omega-3 fats, walnuts contain potential brain antioxidants—vitamin E and polyphenols.

Olive oil is an especially rich source of monounsaturated fatty acids, with oleic acid as the main representative. Like omega-3, monounsaturated fatty acids help to improve cognitive functions and prevent age-related cognitive decline. These fats are also found in avocados. This is why avocado is commonly labeled as a brain superfood. It is assumed that eating just a quarter or half of a avocado daily can help maintain brain health.

Antioxidants: food for thought

Brain membranes are rich in polyunsaturated fatty acids that are highly susceptible to oxidation. The oxidation of fatty acids leads to changes in membrane structure that can jeopardize brain functioning. When fatty acids are oxidized, membranes are damaged or even ruptured. This makes the intake of nutrients into brain cells quite difficult. The lack of nutrients stops normal functions of brain cells and eventually causes their death.

Oxidation of brain lipids occurs when the production of free radicals is greater than their removal by antioxidants present in the body. Thus, the adequate intake of antioxidants can prevent oxidation of brain lipids and slow down the loss of brain functions. This is why berries and fruits with high antioxidant potential are often recommended as good foods for the brain. Some findings suggest that high intake of blueberries and strawberries can halt the onset of age-related cognitive decline by up to 2.5 years. What makes berries powerful antioxidants is the presence of polyphenols, chemicals that give color to these fruits. Berries can decrease aging-related vulnerability to oxidative stress. These decrease further manifests with improvements in behavior. Human trials in people with mild cognitive impairments suggested the positive impact of berries on verbal memory performance. Apart from combating oxidative stress in the brain, polyphenols can also improve microcirculation. By enhancing blood flow, polyphenols help the proper nourishment of the brain that is important for its functioning.

Another food rich in polyphenols (more precisely epicatechin) that is believed to enhance cognition is dark chocolate. It is assumed that by decreasing oxidative stress and inflammation, dark chocolate improves memory and confers neuroprotection. Still, human trials are required to establish if dark chocolate can be considered as a brain superfood.

Curcuminoids are phenolic compounds from turmeric (popular curry spice) that can enhance memory and protect from neurodegenerative diseases, like Alzheimer’s. Although this opinion is mostly based on animal studies, it is likely that prevalence of Alzheimer’s disease in India is very low due to the common consumption of curry.

A diet rich in vitamins, minerals, and antioxidants, such as polyphenols and their subclass flavonoids, is assumed to suppress the incidence of Alzheimer’s disease. One of the foods containing all of these components is spinach. Spinach, like other leafy green vegetables, contains folic acid and vitamin K that are believed to help keep the brain sharp. Although vitamin K is important for producing myelin, the substance that insulates neurons, the effects of dietary vitamin K supplementation on the function of brain myelin have not been tested so far.

Other cognitive enhancers

Another possible brain stimulator representing one of the most popular drinks worldwide is tea. An interesting study in Chinese adults tracked the association between tea consumption and cognitive decline. The higher tea intake was associated with lower prevalence of cognitive impairments, suggesting that regular tea consumption may slow down cognitive decline. Interestingly, the association was most evident for black tea. The same study showed no association between coffee intake and cognitive status.

Extracts from herb Ginkgo biloba have been traditionally used for memory and concentration problems, but also for dealing with depression and anxiety. A recent meta-analysis found no impact of ginkgo on cognitive functions in healthy subjects, suggesting that the effects of Ginko may be rather minor. Nonetheless, some earlier studies showed that ginkgo together with ginseng may acutely enhance memory in a dose-dependent manner. Unlike ginkgo, human trials with ginseng showed that its consumption can improve working memory performance and mood in terms of calmness.

Although further clinical trials are needed to confirm the cognitive enhancement by many foods, it is evident that diet represents a promising tool for maintaining and improving brain health.

References

Muldoon, M.F., Ryan, C.M., Sheu, L., Yao, J.K., Conklin, S.M., Manuck, S.B. (2010). Serum phospholipid docosahexaenonic acid is associated with cognitive functioning during middle adulthood. Journal of Nutrition. 140(4): 848-853. doi: 10.3945/jn.109.119578

Terano, T., Fujishiro, S., Ban, T., Yamamoto, K., Tanaka, T., et al. (1999). Docosahexaenoic acid supplementation improves the moderately severe dementia from thrombotic cerebrovascular diseases. Lipids. 34 Supplement: S345-S346. PMID: 10419198

Gómez-Pinilla, F. (2008). Brain foods: the effects of nutrients on brain function. Nature Reviews. Neuroscience. 9(7): 568-578. doi: 10.1038/nrn2421

Joseph, J.A., Shukitt-Hale, B., Willis, L.M. (2009). Grape juice, berries, and walnuts affect brain aging and behavior. Journal of Nutrition. 139(9): 1813S-1817S. doi: 10.3945/jn.109.108266

Ahmed, T., Enam, S.A., Gilani, A.H. (2010). Curcuminoids enhance memory in an amyloid-infused rat model of Alzheimer’s disease. Neuroscience. 169(3): 1296-1306. doi: 10.1016/j.neuroscience.2010.05.078

Ng, T.P., Feng, L., Niti, M., Kua, E.H., Yap, K.B. (2008). Tea consumption and cognitive impairment and decline in older Chinese adults. American Journal of Clinical Nutrition. 88(1): 224-231. PMID: 18614745

Laws, K.R., Sweetnam, H., Kondel, T.K. (2012). Is Ginkgo biloba a cognitive enhancer in healthy individuals? A meta-analysis. Human Psychopharmacology. 27(6):527-533. doi: 10.1002/hup.2259

via Food for Brain: Cognitive Enhancement via Diet | Brain Blogger

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[TED Talks] 5 Must watch TED Talks About Depression

Hello, my name is Faith and I’ve been managing depression and anxiety for as long as I can remember. I started this blog to share my tips and tricks and help other bad ass babes kick ass on their mental health journey. I have an online support group you can join for free here. If you need help finding a mental health care provider call 1-800-662-HELP (4357) or visit BetterHelp to talk to a certified therapist online at an affordable price.

This post contains affiliate links, you can read my full disclosure policy here.

I went down the rabbit hole of TED talks again and I thought I would share these awesome TED talks about depression. These aren’t all uplifting but sometimes you need to hear some realness. Positivety kind of feels like a big pile of garbage when you’re depressed anyways (if you’ve ever tried to watch a motivational talk when you’re depressed you probably know what I’m talking about). If you’re depressed and looking for resources checkout my articles on depression and download my free mental health planner.

David Burns talks about using cognitive therapy to treat his depressed patients. He helps his clients to change how they think in order to change how they feel.

Kevin Breel talks about breaking the stigma of depression. If you are feeling depressed and feel like you are along trust me you’re not. There are lots of us out here struggling with depression. I have a mental health support group on Facebookthat you can join if you are looking to connect with other people who are struggling with mental health.

Zindel Segal has been treating his depressed clients by teaching them to appreciate the present moment. Try out the techniques in his talk and see if you think they can help you.

I love her story about communicating with her 2 year old in a positive way. She started trying to practice unconditional positive regard with her kids and then started trying to practice giving unconditional positive regard on herself.

Here’s a kids TED talk from a girl that was hospitalized from depression and anxiety.

Thanks for checking out my post. If you’re looking for more motivation checkout my post of bad ass commencement speeches. I have a ton of mental health resources on my site that I hope you’ll checkout like my free mental health planner or my posts related to anxiety and depression.

 

via TED Talks About Depression – Radical Transformation Project

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[WEB SITE] Dopamine deficiency: Symptoms, causes, and treatment

    1. Symptoms
    2. Causes
    3. Diagnosis
    4. Treatment
    5. Dopamine vs. serotonin
    6. Outlook

 

 

Dopamine is a chemical found naturally in the human body. It is a neurotransmitter, meaning it sends signals from the body to the brain.

Dopamine plays a part in controlling the movements a person makes, as well as their emotional responses. The right balance of dopamine is vital for both physical and mental wellbeing.

Vital brain functions that affect mood, sleep, memory, learning, concentration, and motor control are influenced by the levels of dopamine in a person’s body. A dopamine deficiency may be related to certain medical conditions, including depression and Parkinson’s disease.

A dopamine deficiency can be due to a drop in the amount of dopamine made by the body or a problem with the receptors in the brain.

Symptoms

 

Sad and depressed woman with low dopamine levels. alone in thought.

A dopamine deficiency is associated with depression, but researchers are still investigating this complex link.

 

The symptoms of a dopamine deficiency depend on the underlying cause. For example, a person with Parkinson’s disease will experience very different symptoms from someone with low dopamine levels due to drug use.

Some signs and symptoms of conditions related to a dopamine deficiency include:

  • muscle cramps, spasms, or tremors
  • aches and pains
  • stiffness in the muscles
  • loss of balance
  • constipation
  • difficulty eating and swallowing
  • weight loss or weight gain
  • gastroesophageal reflux disease (GERD)
  • frequent pneumonia
  • trouble sleeping or disturbed sleep
  • low energy
  • an inability to focus
  • moving or speaking more slowly than usual
  • feeling fatigued
  • feeling demotivated
  • feeling inexplicably sad or tearful
  • mood swings
  • feeling hopeless
  • having low self-esteem
  • feeling guilt-ridden
  • feeling anxious
  • suicidal thoughts or thoughts of self-harm
  • low sex drive
  • hallucinations
  • delusions
  • lack of insight or self-awareness

Causes

 

Dopamine model 3D render.

 Dopamine deficiency may be influenced by a number of factors. Existing conditions, drug abuse, and an unhealthy diet may all be factors.

 

Low dopamine is linked to numerous mental health disorders but does not directly cause these conditions.

The most common conditions linked to a dopamine deficiency include:

In Parkinson’s disease, there is a loss of the nerve cells in a specific part of the brain and loss of dopamine in the same area.

It is also thought that drug abuse can affect dopamine levels. Studies have shown that repeated drug use could alter the thresholds required for dopamine cell activation and signaling.

Damage caused by drug abuse means these thresholds are higher and therefore it is more difficult for a person to experience the positive effects of dopamine. Drug abusers have also been shown to have significant decreases in dopamine D2 receptors and dopamine release.

Diets high in sugar and saturated fats can suppress dopamine, and a lack of protein in a person’s diet could mean they do not have enough l-tyrosine, which is an amino acid that helps to build dopamine in the body.

Some studies have found that people who are obese are more likely to be dopamine deficient too.

Diagnosis

There is no reliable way to measure levels of dopamine in a person. However, a doctor may look at a person’s symptoms, lifestyle factors, and medical history to determine if they have a condition related to low levels of dopamine.

Treatment

 

Omega-3 fatty acid supplements.

Omega-3 fatty acid supplements may help to boost dopamine levels naturally.

 

 Treatment of dopamine deficiency depends on whether an underlying cause can be found.

If a person is diagnosed with a mental health condition, such as depression or schizophrenia, a doctor may prescribe medications to help with the symptoms. These drugs may include anti-depressants and mood stabilizers.

Ropinirole and pramipexole can boost dopamine levels and are often prescribed to treat Parkinson’s disease. Levodopa is usually prescribed when Parkinson’s is first diagnosed.

Other treatments for a dopamine deficiency may include:

  • counseling
  • changes in diet and lifestyle
  • physical therapy for muscle stiffness and movement problems

Supplements to boost levels of vitamin Dmagnesium, and omega-3 essential fatty acids may also help to raise dopamine levels, but there needs to be more research into whether this is effective.

Activities that make a person feel happy and relaxed are also thought to increase dopamine levels. These may include exercise, therapeutic massage, and meditation.

Dopamine vs. serotonin

Dopamine and serotonin are both naturally occurring chemicals in the body that have roles in a person’s mood and wellbeing.

Serotonin influences a person’s mood and emotions, as well as sleep patterns, appetite, body temperature, and hormonal activity, such as the menstrual cycle.

Some researchers believe that low levels of serotonin contribute to depression. The relationship between serotonin and depression and other mood disorders is complex and unlikely to be caused by a serotonin imbalance alone.

Additionally, dopamine affects how a person’s moves, but there is no clear link to the role of serotonin in movement.

Outlook

Dopamine deficiency can have a significant impact on a person’s quality of life, affecting them both physically and mentally. Many mental health disorders are linked to low levels of dopamine. Other medical conditions, including Parkinson’s disease, have also been linked to low dopamine.

There is limited evidence that diet and lifestyle can affect the levels of dopamine a person creates and transmits in their body. Certain medications and some therapies may help relieve symptoms, but a person should always speak to a doctor first if they are concerned about their dopamine levels.

 

via Dopamine deficiency: Symptoms, causes, and treatment

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[WEB PAGE] Excitatory magnetic brain stimulation reduces emotional arousal to fearful faces, study shows

February 6, 2018

A new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging looks at the modulation of emotion in the brain

A new study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reports that processing of negative emotion can be strengthened or weakened by tuning the excitability of the right frontal part of the brain.

Using magnetic stimulation outside the brain, a technique called repetitive transcranial magnetic stimulation (rTMS), researchers at University of Münster, Germany, show that, despite the use of inhibitory stimulation currently used to treat depression, excitatory stimulation better reduced a person’s response to fearful images.

The findings provide the first support for an idea that clinicians use to guide treatment in depression, but has never been verified in a lab. “This study confirms that modulating the frontal region of the brain, in the right hemisphere, directly effects the regulation of processing of emotional information in the brain in a ‘top-down’ manner,” said Cameron Carter, M.D., Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, referring to the function of this region as a control center for the emotion-generating structures of the brain. “These results highlight and expand the scope of the potential therapeutic applications of rTMS,” said Dr. Carter.

In depression, processing of emotion is disrupted in the frontal region of both the left and right brain hemispheres (known as the dorsolateral prefrontal cortices, dlPFC). The disruptions are thought to be at the root of increased negative emotion and diminished positive emotion in the disorder. Reducing excitability of the right dlPFC using inhibitory magnetic stimulation has been shown to have antidepressant effects, even though it’s based on an idea-that this might reduce processing of negative emotion in depression-that has yet to be fully tested in humans.

Co-first authors Swantje Notzon, M.D., and Christian Steinberg, Ph.D, and colleagues divided 41 healthy participants into two groups to compare the effects of a single-session of excitatory or inhibitory magnetic stimulation of the right dlPFC. They performed rTMS while the participants viewed images of fearful faces to evoke negative emotion, or neutral faces for a comparison.

Excitatory and inhibitory rTMS had opposite effects-excitatory reduced visual sensory processing of fearful faces, whereas inhibitory increased visual sensory processing. Similarly, excitatory rTMS reduced participants’ reaction times to respond to fearful faces and reduced feelings of emotional arousal to fearful faces, which were both increased by inhibitory rTMS.

Although the study was limited to healthy participants, senior author Markus Junghöfer, Ph.D., notes that “…these results should encourage more research on the mechanisms of excitatory and inhibitory magnetic stimulation of the right dlPFC in the treatment of depression.”

 

via Excitatory magnetic brain stimulation reduces emotional arousal to fearful faces, study shows

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[WEB SITE] How Doctors Are Using Brain Imaging to Treat Depression

Typically, depression is diagnosed based on what a patient describes about their emotional and mental state. People who suffer from depression often state that they’re sad more often than not and that things they used to enjoy are no longer enjoyable.

The biggest hurdle in diagnosing depression is overcoming the stigma and embarrassment of possibly having a mental health disorder. It’s hard to talk about such raw, emotional, and personal details. Another issue is the fact that depression manifests itself in different ways. Some patients stop eating, others gain weight and suffer from anxiety. There’s no one-size-fits-all when it comes to depression symptoms.

While there aren’t many biological indicators that can be used to diagnose someone with depression, brain imaging has proven to be useful in diagnosing and helping to shape a treatment plan.

What Does Brain Imaging Show?

A recent study that was published in Nature Medicine discuss biological markers that can be used to distinguish different types of depression. To get a better look at the brain, functional magnetic resonance imaging was used to measure the connection strength between the brain and neural circuits. From these images researchers were able to pinpoint four types of depression.

While further research is needed to confirm initial findings, the potential of using biological indicators paves the way for clearer diagnoses and more personalized and effective therapies that treat the brain.

Based on the research, it was observed that certain patients experienced higher levels of fatigue while others discussed a lack of pleasure. In the future there is hope that certain treatment types can be matched to a type of depression. For example, those who report a lack of pleasure may benefit from a treatment known as transcranial magnetic stimulation (TMS). Because TMS uses a magnet to create small electric currents in the brain, the under-functioning reasons can be restored through TMS therapy.

The Next Steps

Though several studies have been conducted to compare depressed brains to those who don’t have the condition, it will take some time before brain imaging becomes a fool-proof way of diagnosing depression. Doctors and researchers will need to find common ground and patterns between the various types of depression so there is one unified method of determining if a patient has depression and the type.

In the future, it’s hoped that brain imaging can not only be used to diagnose depression but also to:

  • Determine treatment options
  • Determine the success rate of treatment
  • Understand other mental health disorders
  • Diagnose other conditions that may impact depression symptoms

While there is still a way to go in using brain imaging to diagnose and treat depression, the future is bright in this health arena.

Treatment Options

There are several forms of brain treatment that can be used to treat depression. The top two options include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Electroconvulsive Therapy (ECT)

The use of ECT dates back hundreds of years. In fact, ECT is the most commonly used brain treatment for those who suffer from depression. When undergoing ECT treatment, an electric current is formed in the brain that creates a spurt of energy. This causes the patient to have a seizure. Though seizures can be quite scary to experience and even scarier to watch, patients are given anesthesia and a muscle relaxant to avoid the convulsions that are often seen in someone who is having a seizure.

The biggest drawback to ECT is memory loss. Patients often have a hard time remembering past memories so doctors encourage people to create new memories to get that functionality in the brain back up and running.

Transcranial Magnetic Stimulation (TMS)

While electroconvulsive therapy (ECT) is often the go-to procedure for those with severe, long-term, or treatment resistant depression, TMS has proven to be an effective brain treatment for depression. As we better understand how depression impacts regions of the brain, especially the prefrontal cortex, doctors will be able to pinpoint which treatment of combination thereof will produce the best results for a patient.

TMS is beneficial in that it is safe, non-invasive, has minimal side effects, and is designed to target and restore those abnormal connections in the brain. Unlike ECT and other forms of brain treatment options, TMS typically produces minimal to no side effects. Some patients have complained of headache and scalp discomfort but nothing as serious as the memory loss that is often found in those who undergo ECT.

Conclusion

As it stands physical symptoms are the best indicators of whether or not someone has depression. But, with the continued research of using brain imaging to diagnose and determine treatment brings new hope and ideas into the mental health realm.

via How Doctors Are Using Brain Imaging to Treat Depression

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[VIDEO] NeuroStar TMS Therapy – The Complete Clinical Solution for Depression – YouTube

NeuroStar TMS Therapy is an FDA-cleared safe and effective non-drug depression treatment for patients who are not satisfied with the results of standard drug therapy. This novel treatment option provides benefits without the side effects often associated with antidepressant medication. NeuroStar TMS Therapy is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode. The most common side effect is pain or discomfort at or near the treatment site. These events are transient; they occur during the TMS treatment course and do not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of NeuroStar TMS (less than 0.1% per patient).

via NeuroStar TMS Therapy – The Complete Clinical Solution for Depression – YouTube

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[BLOG POST] Tryptophan in Mood, Anxiety, and Depression

 

Deficiency of monoamines, such as dopamine, epinephrine, and serotonin, is the most widely accepted theory explaining mood disorders. Among these neuromediators, serotonin deficiency is considered as most significant in relation to anxiety and depression. This theory has been proven by the effectiveness of drugs that help to increase monoamines levels in the brain, although research in this direction has been hampered by the limitations of present-day technology in measuring the levels of specific monoamines and their properties. However, studies do indicate that their deficiency plays a role in individuals prone to mood swings.

Tryptophan as precursor for serotonin

Tryptophan is one of the essential amino acids. It can’t be produced by our body and has to come through food products rich in proteins. It is required for both anabolic processes and production of various hormones. Tryptophan is a chemical precursor for the synthesis of the neurotransmitter serotonin. This means that the amount of serotonin produced in our body is dependent on the dietary intake of tryptophan. Since serotonin is related to mood regulation, it is entirely possible that tryptophan deficits may have a negative effect on our mood state. On the other hand, its supplementation may be helpful in disorders like anxiety or depression. Multiple investigations seem to support the idea that decreased levels of tryptophan lead to a reduction in serotonin and changes in mood. Some studies have indicated that higher intake of tryptophan may improve social interactions by improving mood and decreasing aggression and dominant behavior.

Serotonin in mood and cognition

Serotonin is important for both mood regulation and regulation of cognitive functions like learning and memory. The effect of monoamine inhibitors called serotonin reuptake inhibitors in various disorders of mood supports this theory. However, it is important to keep in mind that antidepressants are only partially effective in treating mood disorders since monoamine deficits are just one of the factors influencing mood. Most of the serotonin in our body is produced outside the brain, indicating that this compound has a much broader role in our normal physiology. It is possible that many functions of serotonin are still not understood.

Tryptophan depletion and mood regulation

To understand the role of serotonin, and more specifically tryptophan, many tryptophan-depletion studies have been done in recent times. In one simple crossover study, 25 healthy adults were studied for mood changes like anxiety and depression after consuming either a high tryptophan diet or a low tryptophan diet for four days. Tryptophan consumption seems to affect mood even in such a short interval. The study showed that those on a high tryptophan diet had much better mood as compared to those on a low tryptophan diet, although the negative effects of a low tryptophan diet were less pronounced. If such a quick and straightforward analysis can show the difference, it is entirely possible that long-term low tryptophan consumption or depletion may have much graver consequences for mental health.

Tryptophan and gut-brain axis

When we talk about the gut-brain axis we are not just discussing the digestive role of the gut and its effect on overall health, something that has been well known for many years. Our digestive system is also involved in neuro-hormonal signaling, through which it can have an impact on brain functioning. Recently, the influence of gut health on the brain has been the subject of many studies and for good reason. Our gut has more nerve cells than our spine, and it produces many hormones that have various implications for health. Further, it is now well understood that the neural relationship between the gut and brain is dual-sided, and there are more nerve fibers sending information from the gut to the brain rather than from the brain to the gut. Thus, due to the effect of nerves, hormones, and other neurologically active compounds, the gut plays a prominent role in mental wellbeing. Even small changes in the gut could directly affect our behavior. Gut microbiota and their relationship to mood have also recently received lots of attention.

When it comes to tryptophan, the digestive system is not solely involved in its absorption or metabolism. Now it is well-established that serotonin is mostly produced in the gut rather than in the brain, further strengthening the theory of gut-brain interrelation. This theory explains the mood alterations in irritable bowel syndrome (IBS). Further, the development of IBS has been shown to be connected to tryptophan depletion.

The studies show that tryptophan depletion, due to its relationship with serotonin, is undoubtedly one of the most essential elements to consider when analyzing altered mood and cognition. Low serotonin could generally cause a state of lowered mood, impaired cognition, poor working memory, and lower reasoning. Conversely, high tryptophan supplementation could have a positive effect on mood, memory, energy level, and emotional processing.

Low dietary consumption of tryptophan could be one of the elements leading to chronic conditions like depression and anxiety. Bowel conditions like IBS that disturb tryptophan metabolism and alter serotonin levels may also modify our behavior and feelings.

The search for effective therapeutic approaches to the treatment of mood disorders, anxiety, and depression has gained lots of attention in the last few decades. Understanding the role of tryptophan may open up new possibilities for managing mood and cognition problems. It is quite possible that a high tryptophan diet may not only help to prevent mood disorders but also increase the effectiveness of existing drug therapies.

References

Delgado, P. L. (2000) Depression: the case for a monoamine deficiency. The Journal of Clinical Psychiatry61 Suppl 6, 7–11. PMID: 10775018

Jenkins, T. A., Nguyen, J. C. D., Polglaze, K. E., & Bertrand, P. P. (2016) Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients8(1). doi: 10.3390/nu8010056

Lindseth, G., Helland, B., & Caspers, J. (2015). The Effects of Dietary Tryptophan on Affective Disorders. Archives of Psychiatric Nursing29(2), 102–107. doi: 10.1016/j.apnu.2014.11.008

Young, S. N., & Leyton, M. (2002) The role of serotonin in human mood and social interaction. Insight from altered tryptophan levels. Pharmacology, Biochemistry, and Behavior71(4), 857–865. PMID: 11888576

Young, S. N., Smith, S. E., Pihl, R. O., & Ervin, F. R. (1985) Tryptophan depletion causes a rapid lowering of mood in normal males. Psychopharmacology87(2), 173–177. doi: 10.1007/BF00431803

Image via freeGraphicToday/Pixabay.

via Tryptophan in Mood, Anxiety, and Depression | Brain Blogger

 

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