HD 3700 1st Edition Lecture 14Outline of Last Lecture I. Polonius the psychiatristII. Defining depressionIII. Beck’s Cognitive TheoryIV. The brain and depressionV. Neurons and depressionVI. MAO inhibitors/tricyclics/SSRIs and how they work on serotonergic and noradrenergic pathwaysOutline of Current LectureI. Intro to mood disordersII. The players arriveIII. Stimulating the depressed brainIV. Approaching suicideV. Mania, hypomania, and bipolar variantsVI. Treating (and living with) bi-polarityCurrent LectureII. 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 senseo Depression is when there is a lack of response to experienceso 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 usII. 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 playo Hamlet pretending to be crazyo 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 prisonbecause your ambition is making you feel too crammed in because you’re a prince not a king”o Dreams are ambitiono Hamlet has gotten them to confess that they’ve been sent for- Hamlet’s speech—very importanto Describing depressiono The air, the majestic roof, etc. appears foul to meo The beauty of world is lost on meo Man is brilliant, intelligent creatures—but yet to Hamlet it’s like we’re just a piece of dirto Hamlet—man delights not me- “The players are coming” & Hamlet gets hypomanic upon hearing thiso When the players come, Hamlet associates to his speecho 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 playo Everything is getting doubled and tripled III. Stimulating the depressed brain- Antidepressants o Serotonin does not create moodo 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 worko 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 depressiono Beware of “magic” pills, antidepressants are not a cure- The newest approach: area 25 in the limbic systemo Deanna’s depression—slid into a deep depression, tried antidepressants, antipsychotics, and hundreds of sessions of ECT, nothing workedo Experimental surgery—deep brain stimulation (DBS) planting electrodes near the center of the brain called Area 25o 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 likea 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 systemo Mayberg, who speaks of a "paradigm shift," notes that she developed the trial toevaluate 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 generalizedapproach, 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 deconstructiono 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 characterizehigh-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 teenagerso 1.