Month: January 2012

Is depression and anxiety best treated with medication or psychotherapy?

What is the best treatment for depression?

I attended a lecture last week by leading clinical psychologist and head of the counselling service in the University of Limerick, Dr. Declan Aherne, entitled

“Medication or psychotherapy in the treatment of depression and anxiety.”

The lecture discussed research results – from 1995 to 2011 – which examined the effects of medication and psychotherapy – given alone and in combination – on depression and anxiety. I was impressed by the lecture and by the question from the audience – many of whom were Psychiatrists, GPs, sufferers themselves and others working the area of depression and anxiety.

Let me explain some definitions and summarize a few points raised in this excellent lecture.

Some definitions:

Psychotherapy: The treatment of a behaviour disorder, mental illness, or any other condition by psychological means.

Medication (psychopharmacology): The scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior.

Some interesting points I took from the lecture include:

  1. Incidence – anxiety affects 66 million and depression affects 31 million each year in Europe alone.
  2. Treatment – medication is only beneficial in severe but not moderate or mild depression while up to 30% of patients take both psychotherapy and medication.
  3. Delivery – in Europe, psychotherapy is delivered mainly by non-psychiatrists (mostly psychotherapists) however there is a lack of communication between the psychotherapist and medical doctor in 22% of patients taking both psychotherapy and medication.
  4. Trends – between 1998 and 2007 – the use of psychotherapy decreased from 16% to 10% and combined treatment from 40% to 32%, while the use of medication actually increased from 44% to 57% – possibly reflecting a shift in away from psychotherapy and toward medication.
  5. Cost – it is estimated that the same therapeutic effect can be achieved with €70 for psychotherapy compared with €100 with medication (Prozac) over a 24 month period.
  6. What actually works – the efficacy of psychotherapy is best seen using practice based evidence – while the effects of medication are seen using evidence based practice. Psychotherapy therefore, cannot be reduced to a product resembling a drug.

Neuropsychotherapy

Having been involved in this research area since I earned a Ph.D. on the psychopharmacology of depression over 25 years ago I am convinced that far from there being a debate over which of the two treatments are best – psychotherapy and medication are in fact two sides of the same coin. The recent discovery that what we experience changes the shape of the brain – allowing discrete areas in the brain to grow or change – by adding a tiny fraction of the brain’s neural circuitry and eliminating old ones. As more findings from the neurosciences inform best practices in psychotherapy a new field of neuropsychotherapy will help develop better, more effective therapies to improve brain function and mental health.

What we already know

Nerve cells or neurons are notoriously bad at dividing. Rather than divide, a neuron survives by making up to 10,000 connections to neighbouring neurons – and this is the key to how we learn and recall as memories are created and strengthened.  This compromise works well most of the time however in depression and anxiety a gradual loss in the strength of previous healthy connections in the emotional centres of the brain  – often triggered by a loss – starts to take it toll resulting in a noticeable reduction in mood as we find it harder to remain positive. As the illness progresses a vicious cycle develops whereby maladaptive thoughts and behaviours such as persistent negative thinking, phobias and apathy take hold  – driven by a new set of this time ‘faulty’ connections.

Brain wiring – making healthy connections – is the key to recovery  

Studies in animals show that medication (e.g. an antidepressant drug) not only makes the previously healthy connections in the brain work better but it also triggers the brain to grow new nerve cells. Psychotherapy on the other hand helps to rewire the faulty connections as well as wiring-up new healthy connections from the newly generated neurons. If depression and anxiety resembled a broken down car then medication is the petrol that revives the engine while psychotherapy is the tweaking of any faulty electronic wiring – allowing the car to hum along without a hitch.

Psychotherapy and medication – vive la différence

I predict that in the future – treatments for depression and anxiety will not only involve psychotherapy and medication but will also include a combination of other therapies such as social support, self-help techniques, nutrition, sleep hygiene and exercise. Furthermore, these therapies may be prescribed alone and in combination at key stages to promote the growth of new neurons, strengthen healthy connections and rewire the faulty ones. This combined approach will treat the person as a whole, and will mark the beginning of the journey back to wellness and a normal life.

Inside the storytelling brain

I was reading an article in the Guardian newspaper recently on how important stories are to our human and societal interactions   Most of our ways of understanding the world are narratives of one form or another, whether serious scientific stories  conceptual metaphors, or the kind of tales we use to justify our choices in life.

Watch as cognitive neuroscientist, Michael Gazzaniga ponders our need to hear and tell coherent stories about ourselves.

Weekly Round Up: Brain Research

Scientists now have a better understanding of the way that stress impacts the brain. New research, published by Cell Press in the January 26 issue of the journal Neuron, reveals pioneering evidence for a new mechanism of stress adaptation and may eventually lead to a better understanding of why prolonged and repeated exposure to stress can lead to anxiety disorders and depression.

Men may be at higher risk of experiencing mild cognitive impairment (MCI), or the stage of mild memory loss that occurs between normal aging and dementia, than women, according to a study published in the January 25, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Scientists have estimated for the first time the extent to which genes determine changes in intelligence across the human life course.

Researchers at the University of California, San Diego School of Medicine have created a new generation of fast-acting fluorescent dyes that optically highlight electrical activity in neuronal membranes. The work is published in this week’s online Early Edition of theProceedings of the National Academy of Science.

A new study led by researchers at the University of California, Berkeley, provides even more reason for people to read a book or do a puzzle, and to make such activities a lifetime habit. Brain scans revealed that people with no symptoms of Alzheimer’s who engaged in cognitively stimulating activities throughout their lives had fewer deposits of beta-amyloid, a destructive protein that is the hallmark of the disease.

Was it right to ban this boy’s assistance dog from school?

Luke Kelly-Melia with his assistance dog Aidan

I was reading over the weekend of the case of the parents of a young boy with cerebral palsy, who have opted to educate their child at home after they were told his assistance dog was not welcome at his primary school. Luke Kelly-Melia who is in sixth class at Knocktemple National School in Virginia, Co Cavan, has been told his golden retriever, Aidan, is not allowed on the school grounds until further notice.

I am not up-to-speed on the full details of this case, but I do know that research in neuroeducation -the brain science of learning – shows that the value of a trained child-friendly dog in the classroom  may far outweigh the concerns raised by the School Board of Management.

A 2002 study [“Behavioural effects of the presence of a dog in a classroom,” Anthrozoös 16 (2), 2003], conducted by Kurt Kotrschal and Brita Ortbauer, took place in Vienna.

The research found that having a dog in the classroom actually decreased behavioural extremes, making the diverse group more homogenous. Children were less engaged in loud, conspicuous, or troublesome behaviour. They paid more attention to their teacher, cooperated better, and communicated more intensely with one another. Improvements in social behaviour were more pronounced in boys than in girls, perhaps because girls showed less boisterous, “rough-and-tumble” activity to begin with. The researchers also speculate that the teacher’s authority increased, particularly with respect to certain male students, in the presence of her compliant, obedient dog.

A spokesperson for The Department of Education said it is a “matter for the board of management of each school to develop a policy on whether guide dogs or assistance dogs were allowed in the school, taking account of the needs of all the children in the school”. I do hope the School Board of Management will revisit their decision in respect of Luke and Aidan, as the newspaper article appears to indicate they may do.

Weekly Update: Brain Research

Using a sling or cast after injuring an arm may cause your brain to shift quickly to adjust, according to a study published in the January 17, 2012, print issue of Neurology®. The study found increases in the size of brain areas that were compensating for the injured side, and decreases in areas that were not being used due to the cast or sling.

A  new UC Davis study shows how the brain reconfigures its connections to minimize distractions and take best advantage of our knowledge of situations.

Neuroscientists at Kessler Foundation have documented increased cerebral activation in patients with multiple sclerosis (MS) following memory retraining using the modified Story Memory Technique (mSMT).  This is the first study to demonstrate that behavioral interventions can have a positive effect on brain function in people with cognitive disability caused by MS, an important step in validating the clinical utility of cognitive rehabilitation.

A program designed to boost cognition in older adults also increased their openness to new experiences, researchers report, demonstrating for the first time that a non-drug intervention in older adults can change a personality trait once thought to be fixed throughout the lifespan.

Researchers from the Institute of Psychiatry (IoP) at King’s College London have, for the first time, identified the facial expression of anxiety. The facial expression for the emotion of anxiety comprises an environmental scanning look that appears to aid risk assessment. The research was published this week in the Journal of Personality and Social Psychology.

New research from Uppsala University, Sweden, shows that a specific brain region that contributes to a person’s appetite sensation is more activated in response to food images after one night of sleep loss than after one night of normal sleep. Poor sleep habits can therefore affect people’s risk of becoming overweight in the long run. The findings are published in the Journal of Clinical Endocrinology & Metabolism.

Teenagers are more susceptible to developing disorders like addiction and depression, according to a paper published by Pitt researchers Jan. 16 in the Proceedings of the National Academy of Sciences.

Harvard scientists have developed the fullest picture yet of how neurons in the brain interact to reinforce behaviors ranging from learning to drug use, a finding that might open the door to possible breakthroughs in the treatment of addiction.

Virtual reality-enhanced exercise, or “exergames,” combining physical exercise with computer-simulated environments and interactive videogame features, can yield a greater cognitive benefit for older adults than traditional exercise alone, according to a new study published in the February issue of the American Journal of Preventive Medicine.

Sleeping after a traumatic event might lock in bad memories and emotions, a new study has found.

A team of researchers at the MedUni Vienna’s Department of Neurophysiology (Centre for Brain Research) has discovered a previously unknown effect of opioids – that opioids not only temporarily relieve pain, but at the right dose can also erase memory traces of pain in the spinal cord and therefore eliminate a key cause of chronic pain.

 

How to use your brain for business success

I was interviewed last week by  Conn Ó Muíneacháin of Edgcast Media for the  Small Business Show on the topic of using your brain to maximum effect in business.

Brain science is playing an increasing role in business and we talked about what the specific characteristics associated with entrepreneurship are and I outlined what makes the brain of an entrepreneur different.

You can catch up on our chat online and listen to a podcast of the show by clicking on the link below.

http://www.focusmeireland.com/business-and-the-brain-an-interview-with-professor-billy-oconnor

Related Post

What can neuroscience teach marketers? 

Your brain on cannabis

A recent article in the Irish Times exploring how a new, highly potent strain of cannabis now being grown in Ireland is more harmful than the drug’s benign image would suggest, prompted me to write about the topic this week.

Marijuana can hurt you

The marijuana problem is much bigger than previously recognized. It is the most widely used illicit drug in the world. Of the 5.6 million people suffering in the US, 62% are using marijuana and young people – some now as young as 12 years of age – represent 23% of the suffering population. The average age of initiation is decreasing while marijuana’s potency is increasing. With increasing potency and earlier use, marijuana poses a significant threat. It is no surprise then that of all teens in drug treatment, 62% have primary marijuana diagnosis. That number represents more young people in treatment than for alcohol and almost equal to the numbers from criminal justice and other sources

Route of administration

Marijuana (from the Mexican Spanish marihuana) also known as cannabis, is much more powerful today than it was 30 years ago. Marijuana is the herbal form of cannabis, and comprises the flowers, leaves and stalks of the mature female plant while hashish is the resinous, concentrated form of cannabis. Chemically, the major psychoactive compound in marijuana is Delta-9-tetrahydrocannabinol (Δ9-THC); it is one of 400 compounds in the plant The smoke also contains more than 150 other types of these cannabinoids such as cannabidiol (CBD), cannabinol (CBN), and tetrhydrocannabivarin (THCV), which can produce sensory effects unlike the psychoactive effects of THC. The pharmacology of marijuana is complex. The cannabinoids are vaporized (smoke) and then deeply inhaled. They are fatty compounds which rapidly cross from the lungs into the blood and tend to accumulate in specific regions of brain.

The psychological effects of marijuana – a Pandora’s Box

The immediate (acute) effects of marijuana include changes in time-sense, a loss of recent memory and impairment in attention. There is also a general difficulty expressing simple thoughts in words. Other effects include impaired motor skills, increase in hunger, nausea, dizziness, and  – depending on the personality of the person and the context in which it is taken – altered moods such as euphoria, a state of relaxation, panic, anxiety, tension, anger, confusion and – especially when eaten – an unpleasant sensation called depersonalization.

The effects on your body are not good either

Marijuana smoke contains more than 150 compounds many of which are cancer–causing so the respiratory system including the lungs suffer the most. Common symptoms include air obstruction, chronic cough, bronchitis, decreased tolerance to exercise and cancer. An increase in heart rate can aggravate existing cardiac conditions or high blood pressure (hypertension) – so don’t take this drug if you have a weak heart.

Definitely not good for your MOJO

Marijuana decreases blood testosterone levels, sperm count and motility. It also decreases sex-drive (libido) and impairs fertility as well as disrupting the female reproductive system which can impact pregnancy in adverse ways. The effect of the drug on the immune system is still unclear but recent studies in animals demonstrate that it impairs T helper cells – key cells in the immune system – which may increase the risk of cancer (by disrupting the cancer surveillance system).

In Part Two of Your Brain On Cannabis, we will take a closer look at the effects of marijuana on your brain, how the drug affects how you learn, how to counter the argument that it is a harmless drug, and if there is any scientific basis for using marijuana as medicine.

Weekly Brain Research Update

Even for healthy people, stressful moments can take a toll on the brain, a new study from Yale University suggests.

Neuroscientists at the Johns Hopkins University School of Medicine have discovered how the sense of touch is wired in the skin and nervous system.

A new study of how the brain processes unexpected events found that neurons in two important structures handle both positive and negative surprises.

New research finds that brain activity increases during delusional thinking, a finding that may allow new interventions and retraining for people with the disorder.

A new UC Davis study shows how the brain reconfigures its connections to minimize distractions and take best advantage of our knowledge of situations.

Researchers from the Medical Research Council (MRC) in the UK have found a protein made by blood vessels in the brain that could be a good candidate for regenerative therapies that stimulate the brain to repair itself after injury or disease.

Drinking alcohol leads to the release of endorphins in areas of the brain that produce feelings of pleasure and reward, according to a study led by researchers at the Ernest Gallo Clinic and Research Center at the University of California, San Francisco