HD 3700 1st Edition Lecture 14 Outline of Last Lecture I Polonius the psychiatrist II Defining depression III Beck s Cognitive Theory IV The brain and depression V Neurons and depression VI MAO inhibitors tricyclics SSRIs and how they work on serotonergic and noradrenergic pathways Outline of Current Lecture I Intro to mood disorders II The players arrive III Stimulating the depressed brain IV Approaching suicide V Mania hypomania and bipolar variants VI Treating and living with bi polarity Current Lecture II Intro to mood disorders Hypomanic states are one way we respond to trauma Daffy Duck was bipolar Writers have been paying attention to hypomania for a long time Shakespeare Remember we respond deeply to experience hypomania makes sense o Depression is when there is a lack of response to experiences o Depression is flatness an inability to respond feeling deeply sad is not depression it is normal Our moods can change very quickly especially as teenagers it s very hard to diagnose bipolar disorder in teenagers We are responsive creatures this is why art music movies have such a strong influence on us II The players arrive Act II Scene II Polonius has just informed the King and Queen that Hamlet is crazy because Ophelia rejected him Rosencrantz and Guildenstern People are play acting with each other constantly and betraying other actors in this play o Hamlet pretending to be crazy o Rosencrantz and Guildenstern pretending to be friends Polonius is commiserating with Hamlet I ve had this problem too bad therapist Rosencrantz and Guildenstern tell Hamlet that he s crazy because the world is a prison because your ambition is making you feel too crammed in because you re a prince not a king o Dreams are ambition o Hamlet has gotten them to confess that they ve been sent for Hamlet s speech very important o Describing depression o The air the majestic roof etc appears foul to me o The beauty of world is lost on me o Man is brilliant intelligent creatures but yet to Hamlet it s like we re just a piece of dirt o Hamlet man delights not me The players are coming Hamlet gets hypomanic upon hearing this o When the players come Hamlet associates to his speech o There is an actor who is playing Hamlet he speaks to an actor playing an actor asks him to read a speech that he acted in a previous play o Everything is getting doubled and tripled III Stimulating the depressed brain Antidepressants o Serotonin does not create mood o Mood is created by perceived experienced by stimulus from outside internal thoughts from different parts of the brain that depend on serotonin levels for part of its work o In the majority of people it reduces some of the symptoms better than placebo they do not raise your mood they lower depressive symptoms o Antidepressants do not work with mild depression o Beware of magic pills antidepressants are not a cure The newest approach area 25 in the limbic system o Deanna s depression slid into a deep depression tried antidepressants antipsychotics and hundreds of sessions of ECT nothing worked o Experimental surgery deep brain stimulation DBS planting electrodes near the center of the brain called Area 25 o This procedure Deep Brain Stimulation has been very helpful for some patients suffering Parkinson s disease They have a current sent into their brain much like a pacemaker which is then adjusted by remote control The idea was to try this on treatment resistant depressed patients like Deanna o The D B S operation involves an intrusion that is delicate but brutal The patients are kept awake so they can describe any changes and the only drug administered is a local anesthetic o During the hour or so while the computer processed the scans Deanna chatted with Mayberg The day before she told Mayberg on video that what she most wanted was to hold her children and feel it o DBS worked for Deanna she came out of her depression Looking for a depression network in the limbic system o Mayberg who speaks of a paradigm shift notes that she developed the trial to evaluate not a treatment but a hypothesis In that sense the trial succeeded Mayberg s focus on Area 25 tests the emerging network model of mood disorders a new way of looking at psychiatric conditions that isn t restricted by the neurochemical model of mood that has dominated over the past quarter century or so Rather it incorporates neurochemistry into the concept of the brain as a circuit board or wiring diagram The network model carries profound implications for research and ultimately treatment o The Prozac revolution showed everyone that tweaking neurochemistry can dampen and sometimes extinguish depression but only through a generalized approach hitting the entire brain Carpet bombing one neuroscientist calls it And the 50 percent success rate of antidepressant drugs suggests that they aren t hitting depression s central mechanism The network approach on the other hand focuses on specific nodes pathways and gateways that might be approached with various treatments electrical surgical or pharmacological This small trial appears to confirm this model so emphatically that it s already changing the neuropsychiatric view of the brain and the direction of research o Dr Thomas Insel I really do believe this is the beginning of a new way of understanding depression IV When depression leads to suicidal thoughts What many people suffering from suicidal ideation say o It seems as though the pain will never end o My life will never change o I can t stand the guilt anymore o Suicide is something I keep in my back pocket The subjective experience of suicidal ideation Roy Baumeister s escape theory o The person tries to escape from negative affect by rejecting and avoiding meaningful thought i e by cognitive deconstruction o Main signs of deconstruction Time perspective constricted to narrow focus on present Concreteness reflected in focus on immediate movements and sensations rather than the broader ideas and emotions that characterize high level thinking Proximal goals action is guided by immediate proximal goals rather than distal goal Deconstruction might be seen in evidence of rejection of meaning or refusal to think creatively or openly in meaningful terms Suicide and non suicidal depressed teenagers o 1 Two groups of depressed adolescent girls matched by age family composition social class and level of depression One group was suicidal the other was not o 2 The parents filled out questionnaires about their mood life