tag:theconversation.com,2011:/nz/topics/mood-disorders-11713/articlesMood disorders – The Conversation2022-12-08T13:32:46Ztag:theconversation.com,2011:article/1925702022-12-08T13:32:46Z2022-12-08T13:32:46ZPeople can have food sensitivities without noticeable symptoms – long-term consumption of food allergens may lead to behavior and mood changes<figure><img src="https://images.theconversation.com/files/499637/original/file-20221207-18-b6a7kw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Asymptomatic sensitization may lead people to continue consuming food allergens, causing hidden neurological issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-in-striped-shirt-from-back-choosing-royalty-free-image/1357286617">Garetsworkshop/iStock via Getty Images Plus</a></span></figcaption></figure><p>The prevalence of food allergies is increasing worldwide, <a href="https://doi.org/10.1111/j.1399-3038.2011.01145.x">approaching an epidemic level</a> in some regions. In the U.S. alone, <a href="https://www.foodallergy.org/resources/facts-and-statistics">approximately 10% of children and adults</a> suffer from food allergies, with allergies to cow’s milk, eggs, peanuts and tree nuts being the most common. Some patients have mild symptoms that might not need medical attention, leaving these cases unreported. </p>
<p>Food allergies, or food hypersensitivities, result from the overreaction of the immune system to typically harmless proteins in food. They can manifest as a <a href="https://acaai.org/allergies/allergic-conditions/food/">spectrum of symptoms</a>, ranging from itching, redness and swelling for milder reactions, to vomiting, diarrhea, difficulty breathing and other potentially life-threatening symptoms for severe reactions.</p>
<p>Besides self-reporting, food allergies can be <a href="https://acaai.org/allergies/testing-diagnosis/">diagnosed by exposing patients</a> to trace amounts of offending proteins, or allergens, via their mouth or skin and observing their immediate reactions. More commonly, doctors use blood tests to measure the levels of <a href="https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/immunoglobulin-e-(ige)-defined">immunoglobulin E, or IgE</a>, a specialized antibody that the immune system uses to identify allergens and trigger a response. Although healthy individuals may have low levels of IgE in the blood, patients with food allergies have much higher levels that increase their risk of having severe allergic reactions.</p>
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<a href="https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient undergoing skin-prick allergy test on arm" src="https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499636/original/file-20221207-16-gmhxjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Skin-prick allergy tests involve exposing patients to trace amounts of an allergen and observing their reactions.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/immunologist-doing-skin-prick-allergy-test-on-a-royalty-free-image/1288998568">ronstik/iStock via Getty Images</a></span>
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<p>But <a href="https://doi.org/10.1159%2F000517824">some people</a> who test positive on skin-prick allergy tests with moderate increases in IgE don’t notice any allergy-related symptoms when they eat the allergen. This condition is sometimes referred to as <a href="https://www.verywellhealth.com/what-is-sensitization-82988">asymptomatic sensitization</a>. In many cases, people with this condition may not even be aware that they have a food hypersensitivity. </p>
<p>Are they truly asymptomatic, though? Or are there effects within their body that they aren’t aware of?</p>
<p>I am a <a href="https://scholar.google.com/citations?user=kXRRwk4AAAAJ&hl=en">neuroscientist</a> studying how the brain is affected by food allergies. I became interested in this topic when I found that some of my family members had a hypersensitivity to cow’s milk. Some totally avoid dairy products because they have experienced severe, life-threatening symptoms. Those who don’t have typical allergic reactions occasionally eat dairy, but appear to develop seemingly unrelated illnesses a day or two later.</p>
<p>What I and other researchers have found is that food allergens can affect your brain and behavior if you’re hypersensitized, even if you don’t have typical food allergy symptoms.</p>
<h2>Food allergies linked to behavioral disorders</h2>
<p>Researchers have suspected food hypersensitivities to be a potential cause for behavioral disorders for decades.</p>
<p>A <a href="https://doi.org/10.1097/00007611-194908000-00017">1949 case report</a> described behavioral and mood disturbances in patients after they ate certain foods, such as milk and eggs. Their symptoms improved after removing the suspected foods from their diet, suggesting that a food hypersensitivity was the likely culprit. However, I was intrigued that the patients had been able to eat the offending foods up until they chose to avoid them. In other words, they were asymptomatically sensitized, or tolerant, to the allergens.</p>
<p>Several recent studies in people have supported the association between food allergies and various neuropsychiatric disorders, including <a href="https://doi.org/10.1111/all.12829">depression, anxiety</a>, <a href="https://doi.org/10.1016/j.aller.2016.03.001">attention-deficit/hyperactivity disorder</a> and <a href="https://doi.org/10.1002/aur.2106">autism</a>. They strengthen the possibility that some reactions to food allergens could involve the nervous system and manifest as behavioral disorders.</p>
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<figcaption><span class="caption">The food you eat can affect your brain in many ways.</span></figcaption>
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<p>However, the idea of food hypersensitivity causing neuropsychiatric disorders is still controversial because of inconsistencies across studies. Differences in the types of allergies, ethnic backgrounds, dietary habits and other factors among the study participants can produce conflicting results. More importantly, some studies included those with self-reported food allergies, while others included only those with lab-confirmed food allergies. This limited investigations to only symptomatic individuals.</p>
<h2>Food hypersensitivity, brain and behavior</h2>
<p><a href="https://doi.org/10.1016/j.bbi.2021.03.002">My laboratory tested</a> whether food allergens could manifest as behavioral symptoms, particularly in asymptomatically sensitized individuals. We wanted to find out whether eating offending foods could lead to brain inflammation and behavioral changes after sensitization, even in the absence of other obvious severe reactions.</p>
<p>To minimize the individual differences found in human studies, we decided to work with mice. We sensitized mice of the same age and genetic background to the common milk allergen β-lactoglobulin, or BLG, and fed them the same diet in the same room. We found that while <a href="https://doi.org/10.1016/j.bbi.2021.03.002">BLG-sensitized mice</a> produced moderately but significantly elevated levels of IgE, they did not show immediate allergic reactions. They could even eat food containing the milk allergen for two weeks without showing any obvious symptoms, despite maintaining elevated levels of IgE. This indicated that they were asymptomatically sensitized.</p>
<p>We then observed whether they showed any changes in emotionally driven behavior. Because we could not ask mice how they felt, we deduced their “feelings” by noting changes from their normal, survival-oriented behavior. Mice instinctively explore their environment to search for food and shelter while avoiding potential danger. However, “anxious” mice tend to spend more time hiding to play it safe. We identified “depressed” mice by briefly holding them by the tail. Most mice will keep fighting to get out of the uncomfortable predicament, while depressed mice quickly give up.</p>
<p>Our experiments were designed to simulate situations where asymptomatically sensitized individuals would eat either a large amount of an offending food in one day or small amounts every day for a few weeks. We mimicked these situations by placing a large amount of the milk allergen directly into the stomach of sensitized mice with a feeding tube, or giving them an allergen-containing mouse chow to eat the allergen a little at a time.</p>
<p>Interestingly, BLG-sensitized mice showed <a href="https://doi.org/10.1016/j.bbi.2021.03.002">anxiety-like behavior</a> one day after receiving a large amount of the allergen. Another group of sensitized mice developed <a href="https://doi.org/10.3390/cells11040738">depression-like behavior</a> after eating small amounts of allergen for two weeks. In addition, BLG-sensitized mice showed signs of brain inflammation and neuronal damage, suggesting that changes in the brain may be responsible for their behavioral symptoms.</p>
<p>We also investigated the <a href="https://doi.org/10.3389/falgy.2022.870628">long-term effect</a> of allergen consumption by keeping BLG-sensitized mice on the allergen-containing diet for one month. We found that IgE levels declined in sensitized mice by the end of the month, indicating that continually eating small amounts of the allergen led to decreased immune responses, or “desensitization.” In contrast, signs of brain inflammation remained, suggesting that the harmful effect of allergens persisted in the brain.</p>
<h2>Chronic brain inflammation</h2>
<p>Researchers have yet to study prolonged brain inflammation, or neuroinflammation, in people who are asymptomatically sensitized. In general, though, <a href="https://doi.org/10.1172/JCI90609">chronic neuroinflammation</a> is a known contributor to neurodegenerative diseases, such as multiple sclerosis and Alzheimer’s disease, although the exact causes of these diseases are unknown. A better understanding of the role allergens play in neuroinflammation can help researchers clarify whether food allergens trigger chronic inflammation that can lead to these diseases.</p>
<p>This knowledge could be especially important for patients undergoing <a href="https://www.aaaai.org/Tools-for-the-Public/Allergy,-Asthma-Immunology-Glossary/Oral-Immunotherapy-Defined">oral immunotherapy</a>, an approach to allergy treatment that involves incrementally ingesting small amounts of allergens over time. The goal is to desensitize the immune system and reduce the incidence of anaphylaxis, or life-threatening allergic reactions. In 2020, the U.S. Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treatment-peanut-allergy-children">approved a standardized form of peanut allergens</a> to prevent anaphylaxis in eligible pediatric patients. However, its possible long-term effect on the nervous system is unknown.</p>
<p>Food allergens can affect the brain and behavior of seemingly asymptomatic people, making them not so asymptomatic neurologically. Considering how your brain responds to the food you eat puts a whole new meaning to the phrase “you are what you eat.”</p><img src="https://counter.theconversation.com/content/192570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kumi Nagamoto-Combs receives funding from the National Institute of Allergy and Infectious Disease and the National Institute on Aging. </span></em></p>Food allergies have been linked to behavioral and mood disorders, including depression, anxiety and ADHD.Kumi Nagamoto-Combs, Assistant Professor of Biomedical Sciences, University of North DakotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944172022-12-05T13:28:18Z2022-12-05T13:28:18ZShorter days affect the mood of millions of Americans – a nutritional neuroscientist offers tips on how to avoid the winter blues<figure><img src="https://images.theconversation.com/files/496594/original/file-20221121-18490-5tf8u2.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5742%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For those prone to seasonal affective disorder, a shift in the sleep cycle can impact energy levels.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-alone-royalty-free-image/1129211268?phrase=seasonal%20affective%20disorder&adppopup=true">Ben Akiba/E+ via Getty Images</a></span></figcaption></figure><p>The annual pattern of winter depression and melancholy – better known as <a href="https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651">seasonal affective disorder, or SAD</a> – suggests a strong link between your mood and the amount of light you get during the day. </p>
<p>To put it simply: The less light exposure one has, the more one’s mood may decline.</p>
<p>Wintertime blues are common, but about 10 million Americans are affected every year by a longer lasting depression called <a href="https://www.bu.edu/articles/2019/seasonal-affective-disorder/">seasonal affective disorder</a>. Along with low mood, symptoms include anxious feelings, low self-esteem, longer sleep duration, constant craving for carbohydrates and low physical activity levels.</p>
<p><a href="https://www.binghamton.edu/decker/health-wellness-studies/profile.html?id=lina">I am a nutritional neuroscientist</a>, and my research focuses on the effects of diet and lifestyle factors on <a href="https://scholar.google.com/citations?user=sOMbzQ0AAAAJ&hl=en">mood and brain functions</a> such as mental distress, resilience and motivation. </p>
<p>Through my research, I have learned that seasonal affective disorder can strike anyone. However, people with a <a href="https://doi.org/10.1034/j.1600-0447.2000.101003176.x">history of mood disorders are at a higher risk</a>. In particular, young adults and women of all ages <a href="https://doi.org/10.1016/j.jadr.2021.100157">have an increased susceptibility</a>. </p>
<h2>Why seasonal depression happens</h2>
<p>When daylight saving time ends each fall, the one-hour shift backward reduces the amount of light exposure most people receive in a 24-hour cycle. As the days get shorter, people can experience general moodiness or a longer-term depression that is tied to a shorter exposure to daylight.</p>
<p>This happens due to a misalignment between the sleep-wake cycle, eating schedules and other daily tasks. Research shows that this mismatch may be associated <a href="https://doi.org/10.1038/s41398-020-0694-0">with poor mental health outcomes</a>, such as anxiety and depression. </p>
<p>Our sleep-wake cycle is controlled by the <a href="https://nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx">circadian rhythm</a>, an internal clock regulated by light and darkness. Like a regular clock, it <a href="https://theconversation.com/why-does-night-shift-increase-the-risk-of-cancer-diabetes-and-heart-disease-heres-what-we-know-so-far-190652">resets nearly every 24 hours </a> and controls metabolism, growth and hormone release. </p>
<p>When our brain receives signals of limited daylight, it <a href="https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know">releases the hormone melatonin to support sleep</a> – even though we still have hours left before the typical bedtime. This can then affect how much energy we have, and when and how much we eat. It can also alter the brain’s ability to adapt to changes in environment. This process, called <a href="https://www.sciencedirect.com/topics/neuroscience/neuronal-plasticity">neuronal plasticity</a>, involves the growth and organization of neural networks. This is crucial for brain repair, maintenance and overall function.</p>
<p>It is possible to <a href="https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/diagnosis-treatment/drc-20364722">readjust the circadian rhythm</a> to better align with the new light and dark schedule. This means getting daylight exposure as soon as possible upon waking up, as well as maintaining sleep, exercise and eating routines that are more in sync with your routine prior to the time change. Eventually, people can gradually transition into the new schedule. </p>
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<figcaption><span class="caption">Sleeping too much or too little, bingeing on junk food and withdrawing from others are three symptoms of seasonal affective disorder.</span></figcaption>
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<h2>The intimate connection between serotonin and melatonin</h2>
<p>Serotonin is a chemical messenger in the brain that is a key player in regulating several functions such as <a href="https://my.clevelandclinic.org/health/articles/22572-serotonin#">mood, appetite and the circadian rhythm</a>. Serotonin also converts to melatonin with lower light intensity. As mentioned above, melatonin is a hormone that regulates the sleep-wake cycle and signals the brain that it’s time to sleep.</p>
<p>Less daylight exposure during winter months leads to the conversion of serotonin into melatonin <a href="https://doi.org/10.1126/science.7434030">earlier in the evening</a>, since it gets dark earlier. As a result, this untimely melatonin release causes a disruption in the sleep-wake cycle. For some people this can cause moodiness, daytime sleepiness and loss of appetite regulation, typically leading to unhealthy snacking. People with seasonal affective disorder often <a href="https://doi.org/10.1016/S0149-7634(02)00004-0">crave foods rich in simple sugars, such as sweets</a>, because there is an intimate connection between <a href="https://doi.org/10.1093/cdn/nzab049_009">carbohydrate consumption, appetite regulation and sleep</a>. </p>
<h2>Strategies to combat the winter blues</h2>
<p>In winter, most people leave work when it’s turning dark. For this reason, <a href="https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298">light therapy is typically recommended</a> for those who experience seasonal affective disorder, or even shorter periods of seasonal funk. </p>
<p>This can be as simple as getting some light shortly after awakening. Try to get at least one hour of natural light during the early morning hours, preferably about <a href="https://www.cdc.gov/niosh/emres/longhourstraining/light.html#:%7E:">one hour after your usual morning wake-up time</a> when the circadian clock is most sensitive to light. This is true no matter what your wake-up time is, as long as it’s morning. For people living at northern latitudes where there’s very little sun in winter, light therapy boxes – <a href="https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298">which replicate outdoor light</a> – can be effective. </p>
<p>You can also improve your sleep quality by avoiding stimulants like coffee, tea or heavy meals close to bedtime. <a href="https://doi.org/10.1113/JP276943">Exercising during the day is also good</a> – it increases serotonin production and supports circadian regulation. A balanced diet of complex carbs and healthy proteins <a href="https://doi.org/10.1016/j.jand.2022.01.007">supports steady serotonin and melatonin production</a>, and practicing downtime before bed can reduce stress. </p>
<p>Taking these small steps may help the circadian rhythm adjust faster. For the millions with mood disorders, that could mean happier times during what are literally the darkest days.</p><img src="https://counter.theconversation.com/content/194417/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lina Begdache does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that young adults and women are particularly susceptible to seasonal affective disorder.Lina Begdache, Associate Professor of Health and Wellness Studies, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772442022-03-13T12:28:41Z2022-03-13T12:28:41ZWhen you eat matters: How your eating rhythms impact your mental health<figure><img src="https://images.theconversation.com/files/450784/original/file-20220308-3342-10y3ywk.jpg?ixlib=rb-1.1.0&rect=1146%2C204%2C5333%2C3390&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When the main circadian clock in the brain is out of sync with eating rhythms, it impacts the brain's ability to function fully.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Eating is an essential part of human life and it turns out that not only what we eat but when we eat can impact our brains. Irregular eating times have been shown to contribute to poor mental health, including depression and anxiety, as well as to <a href="https://dx.doi.org/10.3390%2Fnu13082775">cardio-metabolic diseases and weight gain</a>. </p>
<p>Fortunately, it is possible to <a href="https://dx.doi.org/10.1038%2Fs41398-020-0694-0">leverage our eating rhythms</a> to limit negative mood and increase mental health. As a doctoral student in the field of neuropsychiatry and a psychiatrist studying nutrition and mood disorders, our research focuses on investigating how eating rhythms impact the brain. </p>
<p>Here’s how it all works: The circadian clock system is responsible for aligning our internal processes at optimal times of day based on cues from the environment such as light or food. Humans have evolved this wiring to meet energy needs that change a lot throughout the day and night, creating a rhythmic pattern to our eating habits that follows the schedule of the sun. </p>
<p>Although the main clock manages metabolic function over the day-night cycle, our eating rhythms also impact the main clock. Digestive tissues have their own clocks and show regular oscillations in functioning over the 24-hour cycle. For example, the small intestine and liver <a href="https://dx.doi.org/10.3389%2Ffnut.2020.00018">vary throughout the day and night in terms of digestive, absorptive and metabolic capacity</a>.</p>
<p>When the main circadian clock in the brain is out of sync with eating rhythms, it impacts the brain’s ability to function fully. Even though the brain is only two per cent of our total body mass, it consumes up to 25 per cent of our energy and is particularly <a href="https://dx.doi.org/10.1016%2Fj.tins.2013.07.001">affected by changes in calorie intake</a>. This means that abnormal meal times are bound to have negative health outcomes. </p>
<h2>Food and mood</h2>
<p>Although the underlying mechanisms are still unknown, there is overlap between neural circuits governing eating and mood. Also, digestive hormones exert effects on dopamine, a neurotransmitter that plays a large role in mood, energy and pleasure. Individuals with <a href="https://dx.doi.org/10.1073%2Fpnas.1500877112">depression and bipolar disorder have abnormal dopamine levels</a>. Altered eating rhythms are thought to contribute to the poor maintenance of mood. </p>
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<img alt="A chalk drawing of a brain on a blackboard, with the right half of the brain filled in with healthy foods" src="https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=278&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=278&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=278&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=349&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=349&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450786/original/file-20220308-23-10zpba4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=349&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There is overlap between the neural circuits governing eating and mood.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Irregular eating may even play a role in the complex underlying causes of mood disorders. For example, individuals with depression or bipolar disorder <a href="https://doi.org/10.1016/j.jpsychires.2009.08.003">exhibit disturbed internal rhythms and irregular meal times</a>, which significantly worsen mood symptoms. In addition, shift workers — who tend to have irregular eating schedules — <a href="https://dx.doi.org/10.2105%2FAJPH.2019.305278">demonstrate increased rates of depression and anxiety</a> when compared to the general population. Despite this evidence, assessing eating rhythms is not currently part of standard clinical care in most psychiatric settings. </p>
<h2>Optimizing eating rhythms</h2>
<p>So, what can be done to optimize our eating rhythms? One promising method we have encountered in our research is time-restricted eating (TRE), also known as intermittent fasting. </p>
<p>TRE involves restricting the eating window to a certain amount of time during the day, <a href="https://doi.org/10.1016/j.cmet.2016.06.001">typically four to 12 hours</a>. For example, choosing to eat all meals and snacks in a 10-hour window from 9:00 a.m. to 7:00 p.m. reflects an overnight fasting period. Evidence suggests that this method optimizes brain function, energy metabolism and the healthy signalling of metabolic hormones. </p>
<p>TRE has already been shown to <a href="https://doi.org/10.1002/jnr.24741">prevent depressive and anxiety symptoms in animal studies designed to model shift work</a>. The antidepressant effects of TRE <a href="https://dx.doi.org/10.2174%2F1570159X13666150326003852">have also been shown in humans</a>. Eating on a regular schedule is also beneficial to reduce the <a href="https://dx.doi.org/10.1038%2Fnm.3010">risk of health issues such as obesity, diabetes and cardiovascular disease</a>.</p>
<h2>Circadian rhythms in a 24-hour world</h2>
<p>We live in a 24-hour world filled with artificial light and round-the-clock access to food. That makes the effects of disturbed eating rhythms on mental health an important topic for modern life. As more research provides data assessing eating rhythms in individuals with mood disorders, incorporating eating rhythm treatment into clinical care could significantly improve patient quality of life. </p>
<p>For the general population, it is important to increase public knowledge on accessible and affordable ways to maintain healthy eating. This includes paying attention not only to the content of meals but also to eating rhythms. Aligning eating rhythms with the schedule of the sun will have lasting benefits for general well-being and may have a protective effect against mental illness.</p><img src="https://counter.theconversation.com/content/177244/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elisa Brietzke receives funding from Faculty of Health Sciences, Department of Psychiatry and Centre for Neuroscience Studies (CNS), Queen's University.</span></em></p><p class="fine-print"><em><span>Elena Koning does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Healthy eating is not just what you eat, but when you eat. Eating rhythms that are in sync with the circadian clock can benefit general well-being and may have a protective effect against mental illness.Elena Koning, PhD Student, Centre for Neuroscience Studies, Queen's University, OntarioElisa Brietzke, Professor, Department of Psychiatry, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1644482021-07-27T14:25:45Z2021-07-27T14:25:45Z“Instagram therapy” and how women use social media for mental health support, solidarity<figure><img src="https://images.theconversation.com/files/413065/original/file-20210726-17-wxwm8s.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5982%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The popularity of Instagram makes it a valuable resource for mental health support, especially for women.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Women make up <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">the majority of people living with mood disorders in Canada</a>. However, treatments and resources that are adapted to their needs are still lacking. Looking for ways to feel better, many women are turning to social media platforms like Instagram. </p>
<p>To make sense of the phenomenon called “<a href="https://greatist.com/connect/instagram-therapists-and-second-hand-therapy">Instagram therapy</a>,” I interviewed more than 20 women in 2020 who use Instagram for mental health care. I found that women turn to the image-sharing platform to counter the lack of available resources. Instagram allows them to tackle issues related to their gender identity, connect to others with similar experiences and, ultimately, feel less alone. </p>
<p>Even though awareness about mental health has increased, especially during the pandemic, gender-based stigmas, biases and expectations <a href="https://www.who.int/teams/mental-health-and-substance-use/gender-and-women-s-mental-health">continue to affect women’s well-being at a growing rate</a>. </p>
<h2>Hysterical histories</h2>
<p>These issues date back to <a href="https://time.com/6074783/psychiatry-history-women-mental-health/">19th-century psychiatry</a>. Women were portrayed as hysterical or “crazy,” and over-represented among the mentally ill, entertaining the idea that insanity is inherent to women’s nature. </p>
<p>Consequently, women are not only more susceptible to being labelled as mad, but traditional psychology also tends to generalize their experiences, not taking into consideration that gender is lived differently depending on race, sexual identity and other social determinants. Today, even though years of research have challenged the association between women and madness, gender norms continue to affect women’s well-being and accessibility to adequate care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An etching of a man holding on to a woman who has fainted as he addresses a room full of male students" src="https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=471&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=471&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=471&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=591&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=591&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413063/original/file-20210726-25-l2xtbg.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=591&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An 1888 etching of Jean-Martin Charcot demonstrating hysteria in a hypnotized patient.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/qrkb3myu">(A. Lurat/Wellcome Collection)</a></span>
</figcaption>
</figure>
<h2>Validation and community</h2>
<p>For the women I interviewed, Instagram acts as a tool to tackle these norms as well as seek validation and community. While Instagram therapy has been <a href="https://www.refinery29.com/en-gb/2021/01/10237732/mental-health-therapy-instagram-accounts">called out as dangerous</a>, my research reveals that Instagram actually helps women progress in their recovery because they can access information and make connections that are not possible otherwise. </p>
<p>Cécile, a philosophy student, decided to seek help for her eating disorder right before the pandemic. When the lockdown started, she recalls her Instagram feed being full of memes about weight gain during quarantine, something that was particularly triggering. Instead of leaving Instagram, one of the few places where she could still connect with people, she decided to start following hashtags like #bodypositivemovement and share her recovery journey in her Instagram stories.</p>
<p>Cécile uses her stories to change the conversation around dieting and add links to existing resources. For her, doing this work really “helps women to feel less alone, it creates a feeling of solidarity.”</p>
<p>Émilie, a biracial woman living with generalized anxiety, doesn’t share her personal journey on Instagram, but actively uses the content of accounts such as <a href="https://www.instagram.com/browngirltherapy/">@browngirltherapy</a> and <a href="https://www.instagram.com/letterstoblackwomen/">@letterstoblackwomen</a> in her recovery process. Her mental health, she tells me during our interview, cannot be dissociated from the everyday racism she experiences as a Black woman — the content she follows on Instagram allows her to address this dimension.</p>
<p>“It provides validation for things that are not necessarily addressed in therapy or that I feel I can’t talk about with the people around me.” </p>
<p>For example, it is thanks to these accounts that Émilie became aware of many micro-aggressions she was experiencing but didn’t know had an effect on her well-being. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/B_iG7r0Fnju","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Challenging the gender gap</h2>
<p>But to think that Instagram could challenge the gender gap in mental health is not what automatically comes to mind when mental illness and social media are coupled together. Indeed, social media researchers have demonstrated that Instagram can be empowering, but also harmful in perpetuating <a href="https://doi.org/10.1080/13573322.2019.1613975">unrealistic gender expectations</a>.</p>
<p>Instagram’s algorithm structures our networked interactions in ways that push forward certain content and shadow others, encouraging standardized definitions of femininity and self care to endure. </p>
<p>For example, Instagram promotes esthetically pleasing models of recovery such as bubble baths and scented candles that continue to put the responsibility of well-being in the hands of women instead of social infrastructures. Women are therefore not only compelled to use Instagram to address the lack of mental health resources, but also for the self-realization, empowerment and transformation that it promises. </p>
<h2>Reframing the conversation</h2>
<p>But however diverse social media’s impact on mental health can be, my participants’ stories shed light on the necessity to reframe the discourse around social media and mental health. While there is a tendency to focus on how Instagram aggravates women’s mental health, there is a pressing need to acknowledge that women also turn to the platform to consult information related to their health and find recognition. </p>
<p>This is especially important because Instagram currently polices mental illness-related content in ways that are <a href="https://www.wired.com/story/opinion-the-perils-of-moderating-depression-on-social-media/">harmful to these communities</a>. We must recognize that Instagram is not always bad for mental health in order to hold the app accountable for further stigmatizing women. Actually, it should be the responsibility of Instagram to assure that women can continue to create and access vital information and communities without being censored.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CEUsBeCn0-Q","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Finally, content posted online represents an important body of knowledge that must be taken seriously if we ever want to create resources that are better tailored to women’s needs. Attending to the complexity of women’s Instagram use allows us to better understand the limits and possibilities of digital care when our health is increasingly tied to mobile apps. </p>
<p>The government of Canada is <a href="https://pm.gc.ca/en/news/news-releases/2020/05/03/prime-minister-announces-virtual-care-and-mental-health-tools">developing a virtual care platform</a> to help Canadians navigate mental health issues. The digital tools will be designed to help users connect to mental health providers and find reliable information while reducing the pressure on the health-care system. </p>
<p>Looking at how women are using available platforms and networks like Instagram can help adapt these technologies to their needs and potentially reduce the gender gap.</p><img src="https://counter.theconversation.com/content/164448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fanny Gravel-Patry receives funding from Fonds de recherche du Québec - Société et culture. </span></em></p>To combat the lack of resources for women’s mental health, women turn to the popular image-sharing network Instagram for access to information about mental health.Fanny Gravel-Patry, Ph.D. Candidate and Public Scholar, Communication Studies, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1605882021-05-18T21:06:38Z2021-05-18T21:06:38Z3 lessons the COVID-19 pandemic can teach us about preventing chronic diseases<figure><img src="https://images.theconversation.com/files/401417/original/file-20210518-23-1d2i3e0.jpg?ixlib=rb-1.1.0&rect=202%2C0%2C4291%2C2991&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unequal access to preventive resources such as healthy foods, a family doctor, health screening and health promotion programs put some groups at increased risk for chronic illness.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Forty-four per cent of <a href="https://www.canada.ca/en/public-health/services/chronic-diseases/prevalence-canadian-adults-infographic-2019.html">Canadian adults live with at least one chronic health condition</a> such as heart disease, diabetes or a mood disorder. <a href="https://www.who.int/chp/chronic_disease_report/media/Factsheet2.pdf">Up to 80 per cent of these conditions can be prevented</a>. </p>
<p>However, chronic disease prevention and health promotion are not taken seriously enough. Instead, Canadian health care is focused on treating acute and chronic conditions. As a result, the treatment of chronic diseases <a href="https://www.csih.org/sites/default/files/resources/2016/10/elmslie.pdf">costs our health-care system $68 billion per year</a> and overburdens health-care providers.</p>
<p>While the pandemic has focused the world’s attention on how to prevent infectious disease, many of the lessons learned from COVID-19 prevention can also be applied to chronic disease prevention. </p>
<p>We — a scientist who develops health behaviour-change interventions, and a family doctor who is passionate about preventive medicine — have noted several pandemic lessons that could be used to improve chronic disease prevention. Here are three:</p>
<h2>1. Address the inequities</h2>
<p>COVID-19 infections are not evenly distributed among Canadians. Infection rates are <a href="https://doi.org/10.1111/cars.12336">higher in regions with greater proportions of low-income and Black residents</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An urban streetscape" src="https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401420/original/file-20210518-19-gt41p8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People cross the street in a Toronto neighbourhood that Ontario designated a COVID-19 infection hotspot. Infection rates are [higher in regions with greater proportions of low-income and Black residents.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>Likewise, health iniquities mean that racialized and Indigenous people, immigrants, people with disabilities and those affected by poverty <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research/key-health-inequalities-canada-national-portrait-executive-summary/hir-full-report-eng.pdf">are at increased risk for developing chronic diseases</a>. These groups may not have equitable access to preventive resources such as healthy foods, a family doctor, health screening and health promotion programs. In addition, the stress caused by poverty, trauma and discrimination can affect the body, <a href="https://doi.org/10.24095/hpcdp.35.6.01">increasing the likelihood of developing a chronic disease</a>. </p>
<p>COVID-19 has exposed long-standing health inequities. In response, we’ve seen community groups, public health agencies and governments work together to <a href="https://doi.org/10.1016/j.eclinm.2021.100812">provide free masks, community testing sites, vaccines, and other services in low-income and racialized communities</a>. Health inequities that increase the risk for chronic disease could be eliminated by continuing to provide these types of services to the people most in need.</p>
<h2>2. A one-size-fits-all approach doesn’t work</h2>
<p>Physical distancing can work to reduce the risk of COVID-19, but is impossible if you live in a multi-generational household, use public transportation or have a disability and rely on caregivers. From masks to physical distancing to physical barriers, different types of protection are needed to reduce the risk of COVID-19 spread for people in different circumstances. Even better is when <a href="https://www.cbc.ca/news/canada/british-columbia/south-asian-community-covid-bc-1.5903837">communities are engaged and empowered</a> to develop their own culturally appropriate advice and messages. </p>
<figure class="align-right ">
<img alt="A finger-prick blood sugar monitor" src="https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401422/original/file-20210518-17-19vzjje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Forty-four per cent of Canadians live with at least one chronic conditions such as diabetes, heart disease or a mood disorder.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Likewise, chronic disease prevention programs must be tailored to take into account a community’s needs and priorities. This is best accomplished by designing programs and policies in partnership with the communities who will use them. Community involvement helps ensure programs are tailored to community members’ needs and that users will benefit. </p>
<p>For instance, researchers from the University of British Columbia <a href="https://ccdpm.med.ubc.ca">Centre for Chronic Disease Prevention and Management</a> worked with nearly 300 community members to design a physical activity program specifically for people with disabilities. Over six months, <a href="https://doi.org/10.1007/s40279-019-01118-5">program participants increased their weekly physical activity by 363 per cent and significantly improved their heart and lung health</a>. The program would not have been so successful had community members not <a href="https://news.ok.ubc.ca/2019/07/09/partnership-key-to-fitness-success-for-people-with-spinal-cord-injury/">helped to tailor the program to the unique challenges and needs of people with disabilities</a>.</p>
<h2>3. We can (and must) get research into practice faster</h2>
<p>The pandemic has shown that science can be drastically accelerated to move innovations quickly from the lab to the community to individual citizens. The pandemic prompted many researchers to pause their own projects and <a href="https://www.the-scientist.com/news-opinion/researchers-from-all-over-the-world-pitch-in-to-fight-covid-19-67698">collaborate worldwide</a> to detect and identify the virus, study its transmission and create and test vaccines. <a href="https://www.canada.ca/en/institutes-health-research/news/2020/03/government-of-canada-funds-49-additional-covid-19-research-projects-details-of-the-funded-projects.html">Funding was allocated to facilitate research collaborations</a>. </p>
<figure class="align-right ">
<img alt="Hands holding a syringe and a vial of vaccine" src="https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=758&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=758&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=758&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=953&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=953&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401421/original/file-20210518-13-ywpk7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=953&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Funding and co-operation expedited the development, testing and distribution COVID-19 vaccines.</span>
<span class="attribution"><span class="source">HE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>These actions sped up the research process. The findings were then quickly translated into public health advice, guidelines for medical care and vaccines that have been shared and used around the world. </p>
<p>Research can guide which evidence-based chronic disease prevention programs are put into practice. However, the translation of health research evidence into practice is notoriously slow.</p>
<p>A frequently cited study estimated that <a href="https://doi.org/10.1258%2Fjrsm.2011.110180">it takes 17 years to put just a fraction of health research into practice</a>. One reason for this delay is that the scientists who develop and test chronic disease prevention programs, and the community, health-care and government organizations who deliver programs, typically do not work together.</p>
<p>The pandemic has <a href="https://cen.acs.org/biological-chemistry/infectious-disease/How-COVID-19-has-changed-the-culture-of-science/99/i3">changed the culture of science</a>. We have seen the benefits when scientists collaborate across disciplines, and industry and government partners are at the ready to quickly move new discoveries into practice.</p>
<p>If we approached chronic disease prevention with the same urgency, promising evidence-based interventions could be quickly scaled up and delivered in communities across the country. </p>
<p>Applying the lessons of COVID-19 to chronic disease prevention has the potential to benefit millions of Canadians and save billions in health-care costs. The response to the COVID-19 pandemic has proven that focused attention and collaborative efforts can yield effective results in disease prevention and treatment.</p><img src="https://counter.theconversation.com/content/160588/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen A. Martin Ginis receives funding from Canadian Institutes of Health Research, Social Sciences and Humanities Research Council of Canada, PRAXIS Spinal Cord Institute, Canadian Tire Jumpstart Charities, and Canada's Digital Supercluster.</span></em></p><p class="fine-print"><em><span>Sarah Brears does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While the pandemic has focused the world’s attention on how to prevent infectious disease, many of the lessons learned from COVID-19 prevention can also be applied to chronic disease prevention.Kathleen A. Martin Ginis, Professor and Director of Centre for Chronic Disease Prevention and Management, University of British ColumbiaSarah Brears, Regional Associate Dean, Interior, Faculty of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1492132020-11-04T14:04:28Z2020-11-04T14:04:28ZDepression, anxiety and heart disease risk all linked to single brain region<figure><img src="https://images.theconversation.com/files/367479/original/file-20201104-19-1poelhg.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5982%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Over-activity in the brain's subgenual anterior cingulate cortex is likely to be one cause of depression and anxiety.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/puzzle-head-brain-concept-human-face-269726339">ESB Professional/ Shutterstock</a></span></figcaption></figure><p>Although depression and <a href="https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf">anxiety</a> affect <a href="https://www.who.int/news-room/fact-sheets/detail/depression">millions of people</a> worldwide, there’s still much we don’t know about them. In fact, we still don’t fully understand which brain regions are involved in depression and anxiety, and how they differ between people with varying symptoms. Understanding how or why these differences occur is fundamental to developing better treatments. </p>
<p>So far, we know that part of the brain’s frontal lobe, the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/prefrontal-cortex">prefrontal cortex</a>, often shows <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2522333/">activity changes</a> in people with depression and anxiety. Parts involved in cognition and regulating emotions are underactive, whereas other parts involved in emotion generation and internal bodily functions are over-active.</p>
<p>One key region shown to be over-active in people with depression and anxiety is the subgenual anterior cingulate cortex (sgACC), thought to be involved in emotional responses. However, neuroimaging studies only show correlation and don’t tell us that the over-activity causes any of the symptoms. But <a href="https://www.nature.com/articles/s41467-020-19167-0">our new research</a> has found over-activating the sgACC induces symptoms of depression and anxiety, highlighting causality. </p>
<p>For our study, we used marmosets (a type of primate) because their brain closely resembles a human’s brain. We found over-activity in this region causes several key features of mood and anxiety disorders, particularly how reactive they are to threat. Their reaction to threat is important, as patients with depression and anxiety tend to perceive and react to situations more negatively.</p>
<p>To over-activate sgACC, we implanted tiny hollow tubes – called cannulae – into the marmosets’ brains. We then infused small amounts of a drug into sgACC to increase excitability without damaging or disrupting function in other brain regions. We also implanted a small wireless device into an artery to measure blood pressure and heart rate.</p>
<p>But before over-activating sgACC, we trained the marmosets to associate a specific tone with the presence of a rubber snake, which marmosets find threatening. After learning this association, the marmosets exhibited fear and had higher blood pressure when hearing the tone. We then presented the tone without the snake to break this association. This allowed us to measure how quickly the marmosets could dampen their fear response with and without sgACC over-activation. </p>
<p>Without over-activation, marmosets gradually regulated their threat response within minutes when hearing the tone without the snake. But after over-activating sgACC, marmosets exhibited fearful behaviour and higher blood pressure for much longer. They also remained anxious around other types of threat (in the form of an unfamiliar human). This reaction showed they could no longer dampen down their threat responses. Being unable to regulate emotions is also seen in many patients with anxiety and depression.</p>
<figure class="align-center ">
<img alt="A marmoset sits on a tree branch looking at the camera." src="https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/367477/original/file-20201104-13-1qx3ayb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The marmosets were more anxious around perceived threat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/marmoset-tree-woods-300583817">nattanan726/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These findings build on our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344231/">earlier work</a> that showed over-activity of sgACC reduces anticipation and motivation for rewards, mirroring the anhedonia (inability to feel pleasure) seen in depression. This suggests sgACC over-activity can cause two of the core symptoms seen in depression – negative emotions (including anxiety) and lack of pleasure. </p>
<h2>Heart disease and depression</h2>
<p>Another outstanding question is why people with depression also have <a href="https://academic.oup.com/eurheartj/article/41/17/1687/5303703">increased risk of heart disease</a>. While there’s undoubtedly lifestyle and socioeconomic factors linking heart disease and depression, we wanted to test whether sgACC over-activity itself could disrupt cardiovascular function. We thought this region might be important because it’s connected to the brainstem, which regulates our heart rate and blood pressure.</p>
<p>We found that sgACC over-activity not only exaggerated marmosets’ blood pressure response to threat, it also increased heart rate and reduce heart rate variability even at rest. Heart rate variability is an important measure of how rapidly the heart can adapt to changes in the environment, especially cues which predict reward or punishment. </p>
<p>These changes mirror some of the cardiac dysfunction seen in <a href="https://academic.oup.com/eurheartj/article/41/17/1687/5303703#203097326">depression and anxiety</a>. The elevated heart rate and reduced heart rate variability suggests that over-activity in sgACC promotes the body’s “fight-or-flight” response, which – if lasting over long periods of time – puts the heart under extra strain and might explain the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800172/">increased incidence of heart disease</a>.</p>
<h2>Treatment response</h2>
<p>We also used brain imaging to investigate the other regions affected by sgACC over-activity in threatening situations. We saw increased activity in two key parts of the brain’s stress network, the amygdala and hypothalamus. By contrast, reduced activity was seen in parts of the lateral prefrontal cortex, which regulates emotional responses and is underactive in depression. These changes were very different to those seen following over-activation during a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344231/">rewarding situation</a>. </p>
<p>Knowing these differences may be key to us understanding which treatments will be most effective depending on the symptoms exhibited by a patient. This then led us to investigate why some people respond to antidepressants while others don’t. The most common type of antidepressants are selective serotonin re-uptake inhibitors (SSRIs). But <a href="https://pubmed.ncbi.nlm.nih.gov/17074942/">up to one-third</a> of people who take antidepressants are treatment resistant – meaning they don’t respond to them. New treatments are urgently needed for these people. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968361/">Ketamine</a> has shown some promise in successfully treating people with treatment resistant depression – and acts within hours to relieve symptoms. Previously, we had shown ketamine effectively <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344231/">treated anhedonia</a> after sgACC had been over-activated.</p>
<p>But in our recent study, we found that ketamine could not improve the elevated anxiety-like responses the marmosets displayed towards the unfamiliar human. This shows us different depression and anxiety symptoms react differently to different types of antidepressants or treatments. On one hand, anhedonia was reversed by ketamine, while anxiety was not.</p>
<p>But over-activation of sgACC is likely to be just one underlying cause of depression and anxiety. Others may have altered activity in different regions of the prefrontal cortex, which are also <a href="https://pubmed.ncbi.nlm.nih.gov/32958652/">linked to anxiety</a>. There’s still a long way to go before we have identified the different causes of depression and anxiety and which treatments can improve them. But our research shows that for some, targeting sgACC over-activity may be key in treating their symptoms.</p><img src="https://counter.theconversation.com/content/149213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Charlotte Roberts receives funding from the Medical Research Council and the Wellcome Trust</span></em></p><p class="fine-print"><em><span>Christian Wood and Laith Alexander do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This brain region also shows how effective certain treatments will be.Laith Alexander, Academic Foundation Doctor, University of CambridgeAngela Charlotte Roberts, Professor of Behavioural Neuroscience, University of CambridgeChristian Wood, Postdoctoral Research Associate, Physiology and Pharmacology, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1431982020-07-29T09:09:31Z2020-07-29T09:09:31ZWhat is bipolar disorder, the condition Kanye West lives with?<p>American rapper Kanye West has been making headlines recently as he mounts a campaign to be elected president of the United States.</p>
<p>We’ve seen a series of chaotic and emotional public outbursts, including during his first <a href="https://www.aljazeera.com/news/2020/07/kanye-west-launches-presidential-campaign-emotional-rally-200720004838830.html">presidential campaign appearance</a>, as well as a string of <a href="https://www.wkrn.com/news/kanye-west-starts-twitter-rant-amid-presidential-campaign/">incoherent tweets</a> which he subsequently retracted.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349834/original/file-20200728-15-a07mk9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The cover of Kanye West’s 2018 album Ye reads ‘I hate being Bi-Polar its awesome’.</span>
<span class="attribution"><span class="source">Wikipedia</span></span>
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</figure>
<p>Although the journey from celebrity to high public office is no longer implausible, it is tempting simply to dismiss West’s outbursts as yet another display of 21st-century narcissism. </p>
<p>But he suffers from <a href="https://www.cbsnews.com/news/kanye-west-opens-up-to-david-letterman-about-his-struggle-with-bipolar-disorder/">bipolar disorder</a>, so it’s important we understand his behaviour in the context of his mental illness.</p>
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<strong>
Read more:
<a href="https://theconversation.com/mood-and-personality-disorders-are-often-misconceived-heres-what-you-need-to-know-94971">Mood and personality disorders are often misconceived: here's what you need to know</a>
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<h2>What is bipolar disorder?</h2>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00241-X/fulltext">Bipolar disorder</a>, previously known as manic-depressive illness, involves <a href="https://www.scribd.com/document/468501592/2020-Bipolar-disorder">alternating periods</a> of intense mania (high energy and activity) and severe depression (low energy and mood).</p>
<p>Manic periods, which can last days to weeks, are associated with: </p>
<ul>
<li><p>an intense internal drive to be active and inability to sit still</p></li>
<li><p>grandiose ideas and motivation to achieve big things</p></li>
<li><p>fast speech that’s difficult to interrupt</p></li>
<li><p>poor sleep</p></li>
<li><p>a strong sense of oneness with the world</p></li>
<li><p>irritable or elated moods. </p></li>
</ul>
<p>When these periods are less severe or shorter, it’s typically referred to as hypomania. </p>
<p>West’s recent public behaviour indicates he may have been experiencing a <a href="https://www.scribd.com/document/468501592/2020-Bipolar-disorder">hypomanic period</a>.</p>
<p>Depressed periods, which often last weeks to months, are associated with: </p>
<ul>
<li><p>overwhelming fatigue</p></li>
<li><p>low moods </p></li>
<li><p>suicidal thoughts and behaviours.</p></li>
</ul>
<p>We also see mixed states, where the person is very active or agitated but simultaneously very distressed. </p>
<p>And as the illness is characteristically episodic rather than persistent, many people with bipolar disorder have long periods of being well and productively engaged with their families, work and wider society.</p>
<figure class="align-center ">
<img alt="A young woman sits against the wall at home looking outside into the night." src="https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349835/original/file-20200728-25-4ydy2h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bipolar disorder affects men and women equally.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Who does bipolar disorder affect, and what causes it?</h2>
<p>The illness typically has its onset <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2749076">during adolescence</a>, and goes on to affect about <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00241-X/fulltext">1% of the adult population</a>. It runs <a href="https://www.nature.com/articles/mp2013173">strongly in families</a> and occurs equally <a href="https://www.tandfonline.com/doi/abs/10.3109/09540261.2010.514601?journalCode=iirp20">in men and women</a>.</p>
<p>Less severe forms of the illness, often termed bipolar II or bipolar spectrum disorders, have less intense manic periods (hypomania) as well as unstable or depressed mood, and may affect <a href="https://www.scribd.com/document/468501592/2020-Bipolar-disorder">a further 2-3%</a> of adults. </p>
<p>While classified descriptively as “mood disorders”, it’s more likely these disorders represent a failure of the internal body (circadian) clock to stay in close synchronisation with our normal 24-hour light/dark and activity/sleep cycles. </p>
<p>Some researchers have proposed this failure of the <a href="https://www.tandfonline.com/doi/abs/10.1517/14728222.2015.1018822">internal circadian system</a> to maintain strong rhythms is the true cause of bipolar disorder. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gene-based-tests-may-improve-treatment-for-people-with-bipolar-disorder-87680">Gene-based tests may improve treatment for people with bipolar disorder</a>
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<hr>
<p>Indeed, switches from normal daily rhythms to manic periods <a href="https://www.sciencedirect.com/science/article/abs/pii/S0924977X16000754?via%3Dihub">commonly occur</a> with seasonal changes in autumn and spring, when the day length (and period of light exposure) varies most rapidly.</p>
<p>This sits well with <a href="https://www.tandfonline.com/doi/abs/10.1517/14728222.2015.1018822">recent evidence</a> showing regular exposure to daylight has profound effects on the motor behaviour and moods of diurnal (active during daylight) mammals.</p>
<p>Similarly, other factors that disrupt the <a href="https://pubmed.ncbi.nlm.nih.gov/27418862/">normal sleep-wake cycle</a> can precipitate episodes, such as international travel, rotating shift-work, stimulant drugs and childbirth.</p>
<p>But we still have a lot more to learn about what causes bipolar disorder and what sparks the manic episodes that come with it.</p>
<h2>Can bipolar disorder be treated?</h2>
<p>Untreated bipolar disorder can have adverse effects on a person’s life, including on their relationships and capacity to participate in society. But the condition can be treated.</p>
<p>In the late 1940s, Australian psychiatrist John Cade made one of the most remarkable therapeutic discoveries in modern medicine: <a href="https://www.nature.com/articles/d41586-019-02480-0">lithium carbonate</a>. Lithium continues to be used today as a “mood stabiliser” for people with bipolar disorder.</p>
<p>Lithium has been shown to induce a unique state of calming without sedation in hypomania or mania, prevent recurrence of further manic episodes and <a href="https://www.nature.com/articles/d41586-019-02480-0">reduce suicidal behaviour</a>.</p>
<p>But not everyone responds to lithium, and it does have <a href="https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-016-0068-y">side effects</a>. In high doses, it’s toxic to the brain, while in therapeutic doses it may cause tremor, thirst, urination, diarrhoea, nausea, acne and reduced thyroid function.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-people-with-bipolar-struggle-to-communicate-and-heres-why-40895">Some people with bipolar struggle to communicate – and here's why</a>
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</em>
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<p>One of lithium’s primary effects is <a href="https://www.tandfonline.com/doi/abs/10.1517/14728222.2015.1018822">stabilisation of the circadian (body) clock</a>, probably via its direct biochemical impact on the molecular machinery in the brain. This has created interest in what other medical, psychological and behavioural therapies may achieve the same result — ideally with less risk. </p>
<p>Today, a range of other agents that stabilise brain function (most notably <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181564/">anti-epileptic compounds</a> such as carbamazepine, sodium valproate and lamotrigine) or target the brain’s circadian clock (by mimicking the normal night-time release of the sleep hormone melatonin) are also used.</p>
<figure class="align-center ">
<img alt="Young teenage boy sits on couch talking with counsellor." src="https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349841/original/file-20200728-35-1n9sg2b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Symptoms of bipolar disorder generally begin during adolescence.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Often, providing effective treatment for the depressive phase is the most challenging. Many <a href="https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-018-0133-9">common antidepressant drugs</a> are less effective for bipolar disorder, or may lead to further mood instability.</p>
<p>Importantly, all medicines should be combined with key behavioural features like regular work and social rhythms, daily exercise, morning light exposure and regular sleep patterns to have the greatest effects. Psychological therapies may also play a role.</p>
<h2>Creative, perceptive, driven</h2>
<p>People with bipolar disorder, often between episodes of illness or when receiving effective treatments, have been frequently observed to be <a href="https://pubmed.ncbi.nlm.nih.gov/22088366/">highly creative</a>, socially sensitive, exquisitely perceptive, remarkably lucid, and having strong drive to pursue collective social goals.</p>
<p>When we encounter public displays like West’s, before rushing to judgement, we need to take a little more time to consider the experience of the person at the centre of the media storm, and the effects on their family. His wife <a href="https://www.abc.net.au/news/2020-07-23/kanye-west-struggle-bipolar-wife-kim-kardashian-says/12482944">Kim Kardashian West</a> has implored compassion.</p>
<p>We still have a long way to go before we can really appreciate the challenges of living with bipolar or any other major mental disorder.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-your-mental-health-deteriorating-during-the-coronavirus-pandemic-heres-what-to-look-out-for-134827">Is your mental health deteriorating during the coronavirus pandemic? Here's what to look out for</a>
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</em>
</p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/143198/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hickie is a Senior Principal Research Fellow of the National Health and Medical Research Council. He has previously led public and professional education programs focusing on depressive disorders supported by various pharmaceutical companies. He has conducted investigator-initiated medication treatment trials for depressive disorders, focusing on the role of melatonin and a synthetic analogue compound, agomelatine (produced by Servier Pharmaceuticals). He has a 5% equity shareholding in Innowell Pty Ltd, a joint venture company of University of Sydney and PwC, established to develop digital mental health care. </span></em></p>Kanye West’s recent outbursts have shone a spotlight on his struggles with bipolar disorder. The condition involves alternating periods of intense mania and severe depression.Ian Hickie, Professor of Psychiatry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1280392020-01-03T09:36:56Z2020-01-03T09:36:56ZWhy bipolar disorder is becoming more ‘desirable’ than other mental illnesses<p>Bipolar disorder is a severe mental health condition. But in recent years it has become the one mental health diagnosis that patients are willing to accept. <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/CD7DCB2BFE1C2BA5118A1084F7307304/S1758320900004649a.pdf/i_want_to_be_bipolara_new_phenomenon.pdf">Research shows</a> that to some people it has actually become “desirable” when compared with other mood disorders.</p>
<p>This could be because of bipolar disorder’s association with creativity. For example, <a href="https://www.theatlantic.com/health/archive/2012/09/historical-geniuses-and-their-psychiatric-conditions/262249/">Charles Dickens and Beethoven</a> are thought to have had bipolar disorder. The de-stigmatising effect of considerable media coverage could also be factor. As could its association with successful celebrities such as Stephen Fry, Kanye West and Carrie Fisher.</p>
<p>Figures like Fry – who made the revealing BBC television documentary, <a href="https://www.theguardian.com/society/2006/jul/21/mentalhealth.broadcasting">The Secret Life of the Manic Depressive</a> – have used their positions to bring home the disturbing realities of the condition. </p>
<p>But it could be said that celebrities like West are skewing the perception of it in the public. For example, in <a href="https://www.youtube.com/watch?v=QdDYjNImN4w">a high profile interview</a> with David Letterman, West said he “felt a heightened connection with the universe” when he was “ramping up”. Also, on his album Ye (which carried the banner I Hate Being Bipolar It’s Awesome) he refers to it as a “<a href="https://www.buzzfeednews.com/article/laurenstrapagiel/kanye-west-talks-about-bipolar-disorder-on-his-new-album">superpower</a>”.</p>
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<p>This is not to say that people are hoping to be diagnosed with a mental health condition. But it would seem from the most recent evidence that people who do have mental health issues, especially mood disorders, say they would rather be diagnosed with bipolar disorder than other conditions.</p>
<p>The fact is most people with bipolar disorder do not enjoy “a heightened connection with the universe”. Bipolar disorder is in fact a very destructive condition with a lifetime prevalence of suicide attempts of up to 30%, which is <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2005.463003.x">higher than for any other psychiatric disorder</a>. During a depressive phase with low energy levels, poor concentration and negative thoughts, people struggle to maintain a normal level of functioning, nevermind display any behaviour likely to have them thought of as a creative genius.</p>
<p>Also, people in a state of elevated mood (a hypo-manic state) can engage in seriously socially embarrassing behaviour, such as being sexually dis-inhibited or while experiencing grandiose delusions may engage in excessive spending leaving them <a href="https://doi.org/10.1080/09638237.2018.1521920">in financial difficulties</a>. So the reality is that bipolar disorder can have negative as well as positive effects on people’s lives and can leave people in need of extended hospital treatment. </p>
<p>The often cited positive association with creativity is, at best, only part of the picture. Though people may have increased energy and believe themselves to be more creative, the reality of bipolar disorder is somewhat different for most people. When people’s mood becomes elevated they often find it difficult to concentrate on one task or train of thought. Such a state of mind may be conducive to creativity for some but cause chaos for others. </p>
<p><a href="https://books.google.co.uk/books/about/Manic_Depression_and_Creativity.html?id=NEU282Oo46cC&redir_esc=y">Researchers have argued</a> that for some people it is the grandiosity associated with manic states that sustains them in their endeavours, no matter the opinion of others, helping some creative people through long periods of hardship where their works go unrecognised. </p>
<p>But <a href="https://www.amazon.co.uk/Dynamics-Creation-Anthony-Storr/dp/0345376730">other studies</a> point out that many creative people are encouraged from childhood to concentrate their energies in areas where they are seen to have a particular talent, rather than being driven by some form of psychopathology.
So the relationship between their mental health issues and artistic creativity is by no means clear. Even in artists who openly discuss their depression, like the writer <a href="https://www.nytimes.com/1991/04/14/books/the-man-who-detested-the-sea.html">Joseph Conrad</a>, who referred to the “madness” in one of his most famous characters in <a href="https://theconversation.com/how-conrads-imperial-horror-story-heart-of-darkness-resonates-with-our-globalised-times-94723">Heart of Darkness</a>.</p>
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<h2>Side-effects</h2>
<p>One of the biggest dangers of an increase in desirability for bipolar disorder is that it could be leading to <a href="https://www.sciencedirect.com/science/article/pii/S0022395609002118?via%3Dihub">increased rates of misdiagnosis</a>. This could mean people being treated for a condition they don’t actually have or not receiving treatment for one that they do. This is important because the mood stabilising drugs used to treat bipolar disorder carry the risks of significant side-effects. Some of the mood stabilisers are very harmful to foetuses, for example, and so should not be given to women of child-bearing age unless they are prepared to use contraception. </p>
<p>Some are also very toxic in overdose and so require careful monitoring. These drugs should not be given to people where it is not clear they actually have bipolar disorder. The <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/CD7DCB2BFE1C2BA5118A1084F7307304/S1758320900004649a.pdf/i_want_to_be_bipolara_new_phenomenon.pdf">pressure to diagnose bipolar</a> in those that don’t have it can also lead to conflict when doctors refuse to do so. Anecdotally, I have both seen and heard of this occurring in the teams across the city where I work. </p>
<p>It is no doubt true that the increased awareness of mental health issues brought about by anti-stigmatising campaigns and famous people talking about their mental health has had a positive impact on perception. But society must ensure that this does not lead to certain conditions becoming the one to have. It gives a false impression about the seriousness of those disorders and could have serious consequences if people are misdiagnosed.</p><img src="https://counter.theconversation.com/content/128039/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Fallon received funding from the Department of Health Research for his research fellowship 2002-2009</span></em></p>Are high profile celebrities trivialising bipolar disorder by linking it to creativity?Paul Fallon, Senior Practitioner for Nursing and Lecturer in Mental Health, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1223812019-09-24T20:13:15Z2019-09-24T20:13:15ZDepression: it’s a word we use a lot, but what exactly is it?<figure><img src="https://images.theconversation.com/files/293702/original/file-20190924-54775-1a5nssg.jpg?ixlib=rb-1.1.0&rect=44%2C0%2C3225%2C1838&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with depression experience symptoms that affect their mood, cognitive function and physical health.
</span> <span class="attribution"><span class="source">from www.shutterstock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Depression is a serious disorder marked by disturbances in mood, cognition, physiology and social functioning. </p>
<p>People can experience deep sadness and feelings of hopelessness, sorrow, emptiness and despair. These core features of depression have expanded to include an inability to experience pleasure, sluggish movements, changes in sleep and eating behaviour, difficulty concentrating and suicidal thoughts.</p>
<p>The first <a href="https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/">diagnostic criteria</a> were introduced in the 1980s. Now we have an expanded set of concepts for describing depression, from mild to severe, major depressive disorder, chronic depression and seasonal affective disorder.</p>
<p>Over the past 50 years, our understanding of depression has advanced significantly. But despite the wealth of research, there is <a href="https://www.health.harvard.edu/mind-and-mood/what-causes-depression">no clear consensus on how this mental disorder should be explained</a>. We propose a <a href="https://www.researchgate.net/publication/331356640_The_Classification_and_Explanation_of_Depression">new route through the thicket</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-depression-what-we-know-dont-know-and-suspect-81483">What causes depression? What we know, don’t know and suspect</a>
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<h2>Classifying mental disorders</h2>
<p>How we <a href="https://www.mentalhealthtoday.co.uk/innovations/an-introduction-to-the-classification-of-mental-disorders-the-dsm-and-the-icd">describe and classify</a> mental disorders is a fundamental step towards explaining and treating them. When carrying out research on people with depression, diagnostic categories such as major depressive disorder (<a href="https://www.healthline.com/health/clinical-depression">MDD</a>) shape our explanations. But if the descriptions are wrong, our explanations will suffer as a consequence. </p>
<p>The problem is that classification and explanation are not completely independent tasks. How we classify disorders directly impacts how we explain them, and these explanations in turn impact our classifications. In this way, psychiatry is stuck in a circular trap.</p>
<p>The danger – for depression and for other mental disorders – is that we tailor our explanations to fit the classifications available and that the classifications are inadequate. </p>
<p>Traditionally, research has focused on understanding mental disorders as classified in manuals such as the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions">Diagnostic and Statistical Manual of Mental Disorders</a>. Most of these disorders are what we call “psychiatric syndromes” – clusters of symptoms that hang together in some meaningful way and are assumed to share a common cause. </p>
<p>But many of these syndromes are poorly defined because disorders can manifest in different ways in different people. This is known as “disorder heterogeneity”. For example, there are 227 different symptom combinations that meet the criteria for major depressive disorder. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weve-all-heard-about-postnatal-depression-but-what-about-antenatal-depression-69051">We've all heard about postnatal depression, but what about antenatal depression?</a>
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</em>
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<h2>Improving how we classify disorders</h2>
<p>The other problem is that diagnostic criteria often overlap across multiple disorders. Symptoms of restlessness, fatigue, difficulty concentrating, irritability and sleep disturbance can be common for people experiencing generalised anxiety disorder or major depressive disorder. </p>
<p>This makes studying disorders like depression difficult. While we may think we are all explaining the same thing, we are actually trying to explain completely different variations of the disorder, or in some cases a completely different disorder.</p>
<p>A significant challenge is how to advance classification systems without abandoning their descriptive value and the decades of research they have produced. So what are our options? </p>
<p>A <a href="https://www.psychologytoday.com/us/blog/dsm5-in-distress/201004/dsm5-and-dimensional-diagnosis-biting-much-more-it-can-chew">categorical</a> approach, which sees disorders as discrete categories, has been the most prominent model of classification. But many researchers argue disorders such as depression are better seen as <a href="https://www.psychologytoday.com/us/blog/dsm5-in-distress/201004/dsm5-and-dimensional-diagnosis-biting-much-more-it-can-chew">dimensional</a>. For example, people who suffer from severe depression are just further along a spectrum of “depressed mood”, rather than being qualitatively different from the normal population.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/for-womens-sake-lets-screen-for-depression-as-part-of-the-new-heart-health-checks-118910">For women's sake, let's screen for depression as part of the new heart health checks</a>
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<p>Novel classification approaches such as the <a href="https://medicalxpress.com/news/2017-04-diagnostic-psychiatric-disorders.html">hierarchical taxonomy of psychopathology</a> and <a href="https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/index.shtml">research domain criteria</a> have been put forward. While these better accommodate the dimensional nature of disorders and are less complex to use, they are conceptually limited. </p>
<p>The former relies on current diagnostic categories and all the problems that come with that. The latter relies on neuro-centrism, which means mental disorders are viewed as disorders of the brain and biological explanations are used in preference to social and cultural explanations. </p>
<p>A new approach called the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269502/">symptom network model</a> offers a departure from the emphasis on psychiatric syndromes. It sees mental disorders not as diseases but as the result of interactions between symptoms. </p>
<p>In depression, an adverse life event such as loss of a partner may activate a depressed mood. This in turn may cause neighbouring symptoms, such as insomnia and fatigue. But this model is only descriptive and offers no explanation of the processes that cause the symptoms themselves. </p>
<h2>A simple way forward</h2>
<p>We suggest that one way of advancing understanding of mental disorders is to move our focus from psychiatric syndromes to clinical phenomena.</p>
<p>Phenomena are stable and general features. Examples in clinical psychology include low self-esteem, aggression, low mood and ruminative thoughts. The difference between symptom and phenomena is that the latter are inferred from multiple information sources such as behavioural observation, self-report and psychological test scores.</p>
<p>For example, understanding the central processes that underpin the clinical phenomenon of the inability to experience pleasure (<a href="https://www.psychologytoday.com/us/blog/brain-sense/200912/depression-and-anhedonia">anhedonia</a>) will provide greater insight for cases that are dominated by this symptom. </p>
<p>In this way we can begin to tailor our explanations for individual cases rather than using general explanations of the broad syndrome “major depressive disorder”.</p>
<p>The other advantage is that the central processes that make up these phenomena are also more likely to form reliable clusters or categories. Of course, achieving this understanding will require greater specification of clinical phenomena we want to explain. It is not enough to conclude that a research finding (such as low levels of dopamine) is associated with the syndrome depression, as the features of depression may vary significantly between individuals. </p>
<p>We need to be more specific about exactly what people with depression in our research are experiencing.</p>
<p>Building descriptions of clinical phenomena will help us to better understand links between signs, symptoms and causes of mental disorder. It will put us in a better position to identify and treat depression.</p><img src="https://counter.theconversation.com/content/122381/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Understanding of depression has advanced significantly since the first diagnostic criteria were introduced in the 1980s, but we still lack clear consensus on how this mental disorder should be explained.Samuel Clack, PhD Candidate, Te Herenga Waka — Victoria University of WellingtonTony Ward, Professor of Clinical Psychology, Te Herenga Waka — Victoria University of WellingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1156972019-05-14T22:50:22Z2019-05-14T22:50:22ZKetamine: The illicit party psychedelic that promises to heal depression<figure><img src="https://images.theconversation.com/files/273668/original/file-20190509-183077-1whnt10.jpg?ixlib=rb-1.1.0&rect=83%2C330%2C2483%2C1521&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ketamine is effective for those who do not respond to traditional anti-depressants. It also shows promise for the treatment of PTSD and bipolar disorder. </span> <span class="attribution"><span class="source">(Unsplash/Kal Visuals)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>It’s been 50 years in the making, but the anaesthetic and illicit party drug ketamine is now having a clinical comeback. New studies show that this commonly used anaesthetic can provide quick relief of core symptoms associated with severe depression, including <a href="https://www.cbc.ca/radio/april-13-2019-black-hole-imaged-a-new-tiny-human-rebuilding-coral-reefs-and-more-1.5093713/ketamine-works-its-magic-on-depression-by-stabilizing-the-brain-in-a-well-state-1.5093729">suicidal ideation</a>. </p>
<p>Amazingly, ketamine works within hours and its <a href="https://doi.org/10.1001/archpsyc.63.8.856">effects are maintained for at least one week</a>. Most strikingly, ketamine is effective in those patients who are <a href="https://doi.org/10.1176/appi.ajp.2013.13030392">resistant to ordinary antidepressants</a>, and they make up around <a href="https://doi.org/10.3310/hta18310">30 to 50 per cent of the depressed population</a>.</p>
<p>Now, efforts in <a href="https://doi.org/10.1111/pcn.12675">Mexico</a>, <a href="https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12616001096448">Australia</a>, <a href="https://doi.org/10.1016/j.psychres.2015.10.032">France</a>, <a href="https://doi.org/10.1016/j.biopsych.2018.02.1052">Canada</a> and the <a href="https://doi.org/10.1016/j.biopsych.2009.04.029">United States</a>, among others, are focusing on understanding exactly how ketamine does this, and to what extent it is safe and effective in a clinical setting. Together, these studies will increase our understanding of depression around the world and perhaps expand ketamine’s potential to treat other forms of mental illness as well.</p>
<p>The focus of <a href="https://www.uoguelph.ca/psychology/users/francesco-leri">our lab at the University of Guelph</a> is to understand how specific drugs, such as ketamine, work in the brain and influence behaviour. </p>
<p>My doctoral research, specifically, looks at <a href="https://www.researchgate.net/profile/Brett_Melanson2">the link between stress, inflammation and behaviour</a>. I am studying how ketamine influences behaviour and can reduce the effects of stress, and what this means for mood disorders, such as major depression.</p>
<h2>The first dissociative anaesthetic</h2>
<p>Initially, ketamine was developed as an alternative to the well-known, illegal party drug, phencyclidine (PCP). In the late 1950s, PCP was the focus of Parke-Davis pharmaceuticals for its use as an anesthetic. However, the drug came with <a href="https://doi.org/10.1097/ALN.0b013e3181ed09a2">uncomfortable side effects</a> such as delirium and a loss of feeling in the limbs, which lasted for several hours after the drug was taken.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273394/original/file-20190508-183083-i63nor.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Ketamine is known as the party drug Special K.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>To fix this issue, Cal Bratton of Parke-Davis encouraged scientists to look into possible ways to modify PCP, with a primary goal of reducing side effects. In 1962, the organic chemist, Calvin Stevens, made a PCP-like compound which he said had similar anaesthetic properties, with shorter acting psychoactive effects than PCP. </p>
<p>This compound, <a href="https://doi.org/10.1097/ALN.0b013e3181ed09a2">originally known as CI-581</a>, was eventually named <a href="https://doi.org/10.1097/EJA.0000000000000638">ketamine</a> based on the ketone and amine group that formed its chemical structure.</p>
<p>Followings its discovery, ketamine was then used in the first human trials in the mid-1960s which included testing on <a href="https://doi.org/10.1111/j.1365-2044.1990.tb14287.x">volunteer inmates of Jackson Prison</a> in Michigan, United States. </p>
<p>After consistent reports of feeling “disconnected” from the environment when given ketamine, it was classified as the first <a href="https://doi.org/10.1097/ALN.0b013e3181ed09a2">dissociative anesthetic</a>. </p>
<p>In the years after its initial testing, the effects of ketamine rapidly gained popularity around the globe, and the approval as a human anaesthetic was passed by the U.S. Food and Drug Administration (FDA) in 1970 — <a href="https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm">to be sold as Ketalar</a>.</p>
<h2>Unique antidepressant effect</h2>
<p>Recent studies describing ketamine’s antidepressant properties have led to a dramatic shift in how we view the drug and treat mental illness.</p>
<p>Typical antidepressants work by controlling levels of neurotransmitters in the brain known as monoamines, such as serotonin and norepinephrine. Ketamine’s antidepressant effect is unique, as it <a href="https://doi.org/10.1016/j.psychres.2014.10.028">modifies the activity of glutamate</a>, which is the main excitatory neurotransmitter in the brain and is not a monoamine.</p>
<p>One of the fascinating findings about ketamine is that it can rapidly reduce depressive symptoms in <a href="https://www.ncbi.nlm.nih.gov/books/NBK487457/pdf/Bookshelf_NBK487457.pdf">patients who do not respond to typical monoamine antidepressants</a>. This suggests the role of glutamate in depression.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273667/original/file-20190509-183112-e1i9bo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The study of ketamine is opening new doors for treating mental illness.</span>
<span class="attribution"><span class="source">(Unsplash/Candice Picard)</span></span>
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<p>In fact, studies have related ketamine’s antidepressant effect with its ability to maintain connections between neurons (or nerve cells) in the brain. These connections are known to continuously change in response to our environment, which is a process known as <em>plasticity</em>. Interestingly, the ability of these neurons to change connections highly relies on normal glutamate activity. </p>
<p>A combination of human and animal studies suggest that ketamine’s antidepressant effect may involve regulating glutamate levels to <a href="https://doi.org/10.4103/1673-5374.230288">strengthen these connections</a> and/or restore them <a href="https://www.bbrfoundation.org/event/brain-plasticity-effects-antidepressants-major-depression">back to a pre-stressed state</a>.</p>
<p>Further study of ketamine’s ability to restore these neural connections and how glutamate relates to mood disorders will surely open new doors for understanding mental illness.</p>
<h2>Nasal sprays and biomarkers</h2>
<p>Current research has shown positive effects of ketamine for other forms of mental illness as well, such as <a href="https://doi.org/10.4088/JCP.17m11634">post-traumatic stress disorder (PTSD)</a> and <a href="https://doi.org/10.9740/mhc.2017.01.016">bipolar disorder</a>. Though the results seem quite positive, more studies are required to validate their use beyond depression. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273395/original/file-20190508-183103-1t9fg1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A vial of ketamine.</span>
<span class="attribution"><span class="source">(AP Photo/Teresa Crawford)</span></span>
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</figure>
<p>Other studies using a <a href="https://doi.org/10.1176/appi.ajp.2018.18070834">repeated treatment method over several weeks</a> showed that ketamine can produce long-term reductions in symptoms of treatment-resistant depression, lending potential to its safety and effectiveness over longer periods of treatment.</p>
<p>Recently, the FDA has approved esketamine (ketamine’s “close cousin”) in the U.S., sold as <a href="https://www.cnn.com/2019/03/05/health/esketamine-depression-nasal-spray-fda-bn/index.html">Spravato</a> in the form of a nasal spray. Importantly, the spray is only prescribed to treatment-resistant patients who continue to take an oral antidepressant and can only be used under the supervision of a health-care provider.</p>
<p>Finally, studies are also looking into <a href="https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-research-focuses-on-mechanisms-of-action-and-biomarker-development/mac-20430311">biological markers that can predict response to treatment, also known as biomarkers</a>. If successful, this research would allow for more accurate and effective treatment delivery in the form of <a href="https://www.canbind.ca/research/why-and-how-we-study-depression/">personalised treatment plans</a>.</p>
<p>Increasing accessibility to ketamine treatment for depression will be the next major milestone for this drug. It is sure to provide effective relief for those who continue to experience treatment-resistant and severe depression.</p>
<p><br>
<br></p>
<p><em>The promise of ketamine for treating mood disorders only applies in a carefully monitored clinical setting. The street drug <a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/ketamine">Special K can be addictive, put users at high risk and cause long-term psychological harm</a>.</em></p><img src="https://counter.theconversation.com/content/115697/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brett Melanson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that ketamine can produce long-term reductions in symptoms of treatment-resistant depression.Brett Melanson, PhD Student in Neuroscience and Applied Cognitive Science, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/793982017-07-27T13:04:56Z2017-07-27T13:04:56ZDoes sugar make you sad? New science suggests so<figure><img src="https://images.theconversation.com/files/179845/original/file-20170726-30134-1drts0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/102952706?src=SL-HbRdA8BSGllj-odHAuw-4-65&size=huge_jpg">Ruth Black/Shutterstock</a></span></figcaption></figure><p>The thought of a cupcake, skillfully frosted with fluffy vanilla icing, may put a smile on your face, but research suggests that, in the long term, a sweet tooth may turn that smile into a frown – but not for the reasons you think. In a <a href="http://www.nature.com/articles/s41598-017-05649-7">new study</a>, published in Scientific Reports, my colleagues and I found a link between a diet high in sugar and common mental disorders.</p>
<p>The World Health Organisation <a href="http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/">recommends</a> that people reduce their daily intake of added sugars (that is, all sugar, excluding the sugar that is naturally found in fruit, vegetables and milk) to less than 5% of their total energy intake. However, people in the UK consume <a href="https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012">double</a> – in the US, <a href="http://ajcn.nutrition.org/content/94/3/726.long">triple</a> – that amount of sugar. Three-quarters of these added sugars come from sweet food and beverages, such as cakes and soft drinks. The rest come from other processed foods, such as ketchup.</p>
<p>At the same time, one in six people worldwide suffers from a <a href="https://academic.oup.com/ije/article-lookup/doi/10.1093/ije/dyu038">common mental disorder</a>, such as a mood or anxiety disorder. Could there be a link between high sugar consumption and common mental disorders?</p>
<p>Earlier <a href="http://onlinelibrary.wiley.com/doi/10.1002/da.10054/abstract">research</a>, published in 2002, examined the link between depression and sugar consumption in six countries. The researchers, from Baylor College in the US, found that higher rates of refined sugar consumption were associated with higher rates of depression. </p>
<p>Since then, a handful of studies have investigated the link between added sugar consumption and subsequent depression. In 2011, <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/fast-food-and-commercial-baked-goods-consumption-and-the-risk-of-depression/CF02E46F44CFC28D5F4D151FAD39EC77">researchers in Spain</a> found that when they grouped participants based on their commercial baked food consumption, those who ate the most baked food had a 38% increased chance of developing depression compared with those in the group with the lowest intake. The association remained even after accounting for health consciousness and employment status. </p>
<p>In 2014, researchers studied the association between sweetened beverages in <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094715">a large US group</a>. They found that sugar-sweetened and artificially sweetened drinks (diet drinks) could increase a person’s risk of developing depression. And, more recently, <a href="http://ajcn.nutrition.org/content/early/2015/06/24/ajcn.114.103846.abstract">a 2015 study</a>, including nearly 70,000 women, found higher chances of depression in those with a high added sugar intake, but not in those with a high intake of naturally occurring sugars, such as those found in fruit.</p>
<h2>Trying to explain the link</h2>
<p>We are still not sure what causes depression, but some researchers believe that biological changes are at the root of it. Some of these changes could be influenced by sugar and sweet taste. For example, a <a href="http://www.sciencedirect.com/science/article/pii/S0306452202001239">study</a> in rats found that diets high in sugar and fat can reduce a protein called BDNF that influences the growth and development of nerve cells in the brain. This protein is thought to be involved in the development of depression and anxiety.</p>
<p>Another possible biological cause is inflammation. High sugar diets can increase <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dietary-factors-and-lowgrade-inflammation-in-relation-to-overweight-and-obesity/D4F1B9B32B1DE434557332EB79972100">inflammation</a> – a protective reaction of the body, normally directed against microorganisms or foreign substances. While common signs of inflammation, such as redness, are far from a mood disorder, the symptoms that keep us in bed with a cold are much closer, such as low energy and being unable to concentrate. Ongoing <a href="http://www.mdedge.com/currentpsychiatry/article/76288/depression/depression-and-inflammation-examining-link">research suggests</a> that mood disorders could be linked with inflammation, at least in some cases. </p>
<p>Dopamine is another possible culprit. A <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000698">study</a> using rats earned headlines for suggesting sweet foods could be as addictive as cocaine. This might be due to affects on dopamine, a brain chemical involved in the <a href="https://theconversation.com/explainer-what-is-dopamine-and-is-it-to-blame-for-our-addictions-51268">reward system</a>. Dopamine is also thought to influence mood. And addiction is itself associated with a higher risk of developing a mood disorder.</p>
<p>Finally, sugar intake could be associated with other factors, such as obesity, which itself is related to mood. </p>
<p>But these associations could also reflect a reverse phenomenon: low mood could make people change their diet. Sweet foods could be used to soothe bad feelings by providing a <a href="http://www.sciencedirect.com/science/article/pii/S019566630700298X">short-term mood boost</a>. And low mood and anxiety could make simple tasks, such as grocery shopping or cooking, so difficult and exhausting for the sufferer that they might start to avoid them. Instead, they might opt for junk food, takeaways and ready meals – all of which have a high sugar content.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179819/original/file-20170726-30134-ysquc5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microwave meals have high levels of added sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/70820704?src=htq7M9dreWtq5P8Rb2RWYA-1-23&size=medium_jpg">Joe Gough/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What our study adds to the debate</h2>
<p>For our latest study, my colleagues and I put the reverse association idea to the test. We used sugar intake from sweet food and drinks to predict new and recurrent mood disorders in a group of British civil servants. We also investigated whether having a mood disorder would make people more inclined to choose sweet foods and drinks. </p>
<p>We found that men without a mood disorder who consumed over 67g of sugar a day had a 23% increased risk of suffering from a mood disorder five years later, compared with those who ate less than 40g. This effect was independent of the men’s socioeconomic status, physical activity, drinking, smoking, other eating habits, body fatness and physical health. </p>
<p>We also found that men and women with a mood disorder and a high intake of sugar from sweet food and drinks were at higher risk of becoming depressed again five years later, compared with those who consumed less sugar. But this association was partly explained by their overall diet. </p>
<p>We found no evidence for a potential reverse effect: participants did not change their sugar intake after suffering from mood disorders.</p>
<p>Despite our findings, a number of questions remain about whether sugar makes us sad, whether it affects men more than women, and whether it is sweetness, rather than sugar itself, that explains the observed associations. What is certain, though, is that sugar is associated with a number of health problems, including tooth decay, type 2 diabetes and obesity. So cutting down on sugar is probably a good idea, regardless of whether it causes mood disorders or not.</p><img src="https://counter.theconversation.com/content/79398/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anika Knüppel receives funding from the European Commission.</span></em></p>New research sheds more light on the link between sugar and mood disorders.Anika Knüppel, PhD Candidate in Epidemiology and Public Health, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/633242016-09-25T19:33:14Z2016-09-25T19:33:14ZThe emotion centre is the oldest part of the human brain: why is mood so important?<figure><img src="https://images.theconversation.com/files/137877/original/image-20160915-23120-g1xxy0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our mood is a transient frame of mind that influences how we think and view the world. </span> <span class="attribution"><a class="source" href="https://unsplash.com/?photo=W5TJpNKI9c4">David Schap/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>The brain is key to our existence, but there’s a long way to go before neuroscience can truly capture its staggering capacity. For now, though, our <a href="https://theconversation.com/au/topics/brain-control-series-31489">Brain Control series</a> explores what we do know about the brain’s command of six central functions: language, mood, memory, vision, personality and motor skills – and what happens when things go wrong.</em></p>
<hr>
<p>“<em>Somebody</em> woke up on the wrong side of bed this morning.” You know that comment; the one that rarely makes you feel any more gracious towards the world (or the person saying it). At other times you might feel particularly gracious and sunny, for no reason at all. </p>
<p>Our mood is a transient frame of mind that influences how we think and view the world. It is influenced by events in our lives, the amount of <a href="https://theconversation.com/chill-out-disturbed-sleep-plays-havoc-with-your-mood-and-mind-15994">sleep</a> we get, <a href="https://theconversation.com/chemical-messengers-how-hormones-affect-our-mood-42422">hormones</a>, even <a href="https://theconversation.com/here-comes-the-sun-how-the-weather-affects-our-mood-19183">the weather</a>. But what role does the brain play in shaping our mood?</p>
<h2>The limbic system</h2>
<p>Many regions fundamental to mood are buried deep in the most primordial parts of the brain; that is, they are thought to have been among the first to develop in the human species. This is probably because mood is evolutionarily important. </p>
<p>Being glum can be advantageous and has been shown to <a href="http://pss.sagepub.com/content/13/1/34.abstract">sharpen our eye for detail</a>, for instance. But, overall, the brain seems geared towards maintaining a <a href="http://www.ncbi.nlm.nih.gov/pubmed/25253069">mildly positive frame of mind</a>. Being in a good mood makes us more likely to seek new experiences, be creative, plan ahead, procreate and adapt to changing conditions.</p>
<p>The limbic system is the major primordial brain network underpinning mood. It’s a network of regions that work together to process and make sense of the world.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/138916/original/image-20160923-25468-13oswmr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you feel great, the hippocampus might guide you to walk down a path fringed with daffodils.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Neurotransmitters, such as serotonin and dopamine, are used as chemical messengers to send signals across the network. Brain regions receive these signals, which results in us recognising objects and situations, assigning them an emotional value to guide behaviour and making split-second risk/reward assessments.</p>
<p>The limbic system sits under the cerebrum (the largest and newest part of the brain) and is made up of structures such as the hypothalamus, hippocampus and the amygdala.</p>
<p>The almond-shaped <a href="http://www.sciencedirect.com/science/article/pii/S0896627305008238">amygdala</a> attaches emotional significance to events and memories. It came to the attention of emotion researchers in 1939 when monkeys whose amygdalae were removed <a href="http://www.nature.com/mp/journal/v6/n1/full/4000812a.html">showed bizarre patterns</a> of behaviour. They became fearless, hypersexual and either devoid of emotion or irrationally aggressive. </p>
<p>Dubbed Kluver-Bucy Syndrome, it is rare in humans, but has been observed in people with amygdala damage incurred, for instance, after a bout of brain inflammation.</p>
<p>The <a href="http://www.nature.com/neuro/journal/v7/n3/full/nn1190.html">hippocampus</a>, meanwhile, reminds us which courses of action are congruent with our mood. For instance, if you feel great you might like to walk down a path fringed with daffodils. If you feel crap, you may instead be drawn to that bar that spins melancholy albums by The Smiths. </p>
<p>The hippocampus has been <a href="https://theconversation.com/depression-damages-parts-of-the-brain-research-concludes-43915">shown to be shrunken</a> in people with chronic depression. This may account for common features of the condition, such as <a href="http://psycnet.apa.org/index.cfm?fa=search.displayRecord&uid=2006-23058-006">vague or non-specific recall</a> of personal memories.</p>
<p>The limbic system also regulates <a href="http://my.slc.edu/ICSFileServer/9fd1fc33-4c44-4830-af85-b9efc72b4a6f/bede258f-5443-47a2-96b3-b6ad68a46116/8bade204-0b95-444e-9a59-46320b312f17/ekman-levenson-friesen-83.pdf">biological functions</a> in line with our mood, such as accelerated heart rate and sweating triggered by feeling flustered. Being so old, however, the limbic system is rather primitive. In day-to-day life it’s controlled by some newer networks that co-ordinate how we think and act, so our behaviour is <a href="https://theconversation.com/why-you-shouldnt-want-to-always-be-happy-62086">conducive to achieving longer-term goals</a>, rather than always going wherever the mood takes us.</p>
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<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1172&fit=crop&dpr=1 600w, https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1172&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1172&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/138754/original/image-20160922-22540-3x9dov.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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</figure>
<hr>
<h2>Rival networks</h2>
<p>Researchers are increasingly looking towards newer networks to understand how the brain controls mood. Two particular networks that stand out across numerous studies are the autobiographic memory network and cognitive control network.</p>
<p>The autobiographic memory network processes information related to ourselves, including recalling personal memories and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24502540">self-reflection</a>. Key <a href="http://psych.colorado.edu/%7Ehannaje/Publications_&_CV_files/Andrews-Hanna_Smallwood_Spreng_YCN_2014.pdf">hubs in this network</a> comprise brain areas inside the prefrontal cortex, which sits in the front of the brain; the hippocampus; the posterior cingulate cortex, which is the upper part of the limbic lobe; and parietal regions, which sit behind the frontal lobe and are important for mental imagery.</p>
<p>The cognitive control network links up regions that co-ordinate our attention and concentration so that we can <a href="http://www.sciencedirect.com/science/article/pii/S1364661313002222">complete tasks</a>. It recruits a circuit of <a href="http://link.springer.com/article/10.3758/s13415-011-0083-5">the front part of the cingulate cortex</a> and dorsolateral prefrontal cortex, which are specialised for cold, unemotional, rational thought.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137166/original/image-20160909-13348-1eqn450.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The autobiographic memory network switches on when someone is preoccupied by thoughts concerning themselves.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/james_sickmind/5448338716/in/photolist-9isahq-6Cbkrn-6ma21Z-51VtbF-6YUfab-9Bi5Nf-7LbZex-eoMgkT-dYye4K-noHe6D-cPCujs-7qYHVK-iiH6Rf-98Gx8P-5JrHG4-qhNVUY-8fwvFX-9xDSKk-2fPPTM-98KEQq-o692cA-8V1xZJ-dhqS4L-9V8r1T-fPfxTY-h9uur2-836bC9-btEDnt-aaXGYR-i2odhL-faYVrT-c2HwyN-5XcTmq-hsdayN-6enoYv-9Fq3PL-jcRtZ-4mG4eo-cmGtF5-aEiva9-7bM8aC-hLsNvB-HC2WHf-byGds7-4W6cGb-hLtAGJ-8SjP45-dSypEh-bWmQNf-ivTJJF">Mitya Ku/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>These two networks are thought to have a strained relationship. The autobiographic memory network switches on when someone is preoccupied by thoughts concerning themselves. This causes <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850105/">the task-oriented cognitive control network to switch off</a>, thereby reducing our ability to complete whatever task we’re supposed to be doing. This is why daydreaming is frowned on at work. </p>
<p>Conversely, the autobiographic memory network is suppressed when the cognitive control network <a href="http://www.ncbi.nlm.nih.gov/pubmed/19913622">is required to gather the attention needed for a task at hand</a>. This is in line with the notion that we “lose ourselves” when we are absorbed doing something. </p>
<p>When the two networks don’t work properly, they can result in what psychiatrists refer to as <a href="https://theconversation.com/feeling-down-when-does-a-mood-become-a-disorder-14566">mood disorders</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/138384/original/image-20160920-11095-6rb666.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>Mood disorders</h2>
<p>The <a href="https://theconversation.com/feeling-down-when-does-a-mood-become-a-disorder-14566">two major types</a> of mood disorders are depressive disorders, characterised by a persistent down mood, and bipolar disorders, expressed as extreme high or manic moods that alternate with periods of feeling down. </p>
<p>In depressive disorders, the autobiographic memory network gets <a href="http://www.ncbi.nlm.nih.gov/pubmed/26562681">stuck being on</a>. This leads to thinking-too-much-about-ourselves symptoms, such as brooding, rumination and self-loathing. The concurrent suppression of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/26562681">cognitive control network</a> gives rise to symptoms such as poor concentration, indecisiveness and sluggish thinking.</p>
<p>Treatment for depressive disorders, such as <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/neurobiological-mechanisms-of-repetitive-transcranial-magnetic-stimulation-of-the-dorsolateral-prefrontal-cortex-in-depression-a-systematic-review/859706D1B9CF90C267BE1D8348B832D9">transcranial magnetic stimulation</a>, involves stimulating the cognitive control network to work better. And medications aim to restore normal levels of <a href="https://www.youtube.com/watch?v=G4r3qCkLUDQ">neurochemicals</a> that communicate between the two networks and the limbic systems.</p>
<p>Many psychological therapies empower the sufferer to wrest control over their own mood. They often train the person to activate the cognitive control network, by challenging negative thoughts for instance, to strengthen it over time. They also seem to disrupt the domination of the autobiographic memory network through techniques such as mindfulness.</p>
<p>While trying to understand the neuroscience behind disordered mood is necessary, there is a push in psychology for mood investigations to focus more on the positives in everyone’s psychology; involving the fostering of <a href="http://www.blackdoginstitute.org.au/docs/Positivepsychology.pdf">resilience and our individual strengths</a>, for instance. </p>
<p>Much like the zeitgeist itself, however, investigations into the brain’s role in these functions are in their infancy.</p>
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<p><em>Want to know how the brain controls your language? Read today’s accompanying piece <a href="http://theconversation.com/what-brain-regions-control-our-language-and-how-do-we-know-all-of-this-63318">here</a>.</em></p><img src="https://counter.theconversation.com/content/63324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Genevieve Rayner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many regions fundamental to mood are buried deep in the most primordial parts of the brain; that is, they are thought to have been among the first brain regions to develop in the human species.Genevieve Rayner, Postdoctoral Research Fellow, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/508472016-02-23T19:05:48Z2016-02-23T19:05:48ZStomach and mood disorders: how your gut may be playing with your mind<figure><img src="https://images.theconversation.com/files/109118/original/image-20160125-437-awjn7n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For years, we've known that brain activity can affect our gut.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/demandaj/4936432056/in/photolist-8wdvgw-4z9Nv5-5ei3uq-5XZ8Qx-8TvhiJ-7fCa9f-8n44BR-cE16cU-2jjKLc-59129F-8Ax5xZ-6CsLvz-a7ctzf-PQwfZ-8onbvx-5UxchZ-7HNwWw-w5L29L-eYVWeE-6G6nxh-dNLUk-4yYPUZ-9xJwrQ-byHepJ-9fpV5q-jWzMbR-9jzH6h-d5m7iL-5sjRDy-dKVnW-bwtj2y-5zhjCN-4AgJ7b-CJjAk-253x-4DCQYd-Cmkcyq-4nHQf-oFKWdK-agKHGC-aiEkc4-qgVNo6-uhoPXj-xoftUn-pK97Pa-aHGocM-5p59fH-6QNqp9-Cgiua-pKaXoA">amanda tipton/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>If you’ve eaten a fabulous meal recently, the experience was pleasant, comfortable and pain-free because your stomach and intestinal system worked seamlessly to move the food along and eventually absorb it. </p>
<p>Our gastrointestinal tract, or gut, is sometimes described as our “second brain”. This is because it is controlled by its own complex nervous system comprising hundreds of millions of neurons – more than all the nerves in your spinal cord.</p>
<p>The gut and brain talk to each other through nerve signals, the release of gut or stress hormones, and other pathways. We have long known that emotions can directly alter gut function. </p>
<p>But lately we’ve been discovering that it works the other way too: our gut actually has an effect on our brain. And because it’s easier (and generally safer) to manipulate the gut than the brain, this knowledge provides the possibility that doing so could treat some chronic psychological and brain diseases.</p>
<h2>How your brain affects you gut</h2>
<p>Think of a time you had to do an exam and had “the runs” (diarrhoea) or felt anxious and developed butterflies in your stomach. This is your brain driving your gut. If you are stressed or anxious, you even change the production of stomach acid through nerve connections. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1357&fit=crop&dpr=1 600w, https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1357&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1357&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1705&fit=crop&dpr=1 754w, https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1705&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/112468/original/image-20160223-16459-vlyvrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1705&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Think of a time you had to do an exam and had the runs.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Traditionally it was thought gut symptoms came about from an underlying psychological disorder, such as anxiety. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25644097">Anxiety changes gut function</a>. Over time, this can lead to unpleasant symptoms such as pain, diarrhoea, bloating or excessive fullness.</p>
<p>Many people who suffer from irritable bowel syndrome (IBS) <a href="http://www.nejm.org/doi/full/10.1056/NEJMra1501505">or severe indigestion</a> are anxious, for instance. And <a href="http://gut.bmj.com/content/early/2015/11/13/gutjnl-2015-310721.abstract">doctors have investigated antidepressants</a> and psychological treatments in these disorders with variable success.</p>
<p>But actually many signals go <a href="http://www.ncbi.nlm.nih.gov/pubmed/9616311">up to the brain from the gut</a> as well as in the downward direction. So could it be that in some cases, changes in the gut are actually driving anxiety experiences rather than the other way around? Accumulating evidence suggests this is likely to be the case. </p>
<h2>How the gut changes your brain</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/22234979">We followed 1,002 people </a> over a 12-year period in Sydney and found about 50% of the participants with chronic gut issues had been anxious first and then developed their gut problems. </p>
<p>But the other 50% developed the gut disorder before the psychological problems arose. In other words, their gut appeared to get sick first and this led to brain dysfunction manifesting as anxiety, not the other way around. </p>
<p>We later <a href="http://www.ncbi.nlm.nih.gov/pubmed/25710826">observed similar findings</a> – that psychological distress can predict later onset of gut disorders and vice versa – in a large study in the United Kingdom.</p>
<p>We know that some people with IBS have mild gut inflammation. We have also identified that some people with IBS have <a href="http://www.ncbi.nlm.nih.gov/pubmed/26444549">elevated levels of cytokines</a> in their blood. These are byproducts of inflammation; part of the immune response. </p>
<p>One study showed a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17383420">clear increase of certain cytokines</a> in people with both anxiety and IBS. Higher anxiety levels strongly correlated with higher cytokine levels. Based on this new information, we concluded that gut inflammation releases cytokines that may cause anxiety in IBS.</p>
<h2>How the bugs in your gut alter your brain</h2>
<p>Everyone’s gut is chock a block full of bugs (trillions of them) that can be good, bad or indifferent. They hang out all the way from the mouth through to the end of the bowel. </p>
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<img alt="" src="https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=566&fit=crop&dpr=1 600w, https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=566&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=566&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=711&fit=crop&dpr=1 754w, https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=711&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/112469/original/image-20160223-16425-xdgcfi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=711&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Everyone’s gut is chock a block full of bugs.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>The bugs talk to the nervous system through pathways, including the immune system, that keeps them in check. Experimental work suggests an <a href="http://www.jneurosci.org/content/34/46/15490.abstract">imbalance in these bugs can affect the brain</a> and, in some cases, may lead to anxiety or depression. </p>
<p>Altering gut bacteria is a new way to treat many diseases of the gut and possibly the brain, including through diets (<a href="http://www.nature.com/nature/journal/v505/n7484/full/nature12820.html">changing your diet rapidly changes your gut bugs</a>), or by providing <a href="http://www.ncbi.nlm.nih.gov/pubmed/23474283">“good” bacteria and suppressing “bad” bacteria</a>, that can be done with probiotics. Other methods include <a href="http://www.nejm.org/doi/full/10.1056/NEJMe1214816">transplanting stool</a> from healthy people to those in need.</p>
<p>Intriguing observations could also unlock new ways to manage currently incurable degenerative nervous diseases. For instance, altered gut function manifesting as constipation is often the <a href="http://www.ncbi.nlm.nih.gov/pubmed/12809835">first symptom of Parkinson’s disease</a>. </p>
<p>And studies are currently exploring the <a href="http://www.ncbi.nlm.nih.gov/pubmed/24370461">role of the gut in neurological diseases</a> such as multiple sclerosis.</p>
<p>But for the moment, new evidence suggests when the gut is inflamed, it may affect the brain and lead to psychological dysfunction.</p><img src="https://counter.theconversation.com/content/50847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Talley receives funding from University of Newcastle and NHMRC Grants.</span></em></p>Could it be that in some cases, changes in the gut are actually driving mood disorders rather than the other way around? Mounting evidence suggests this is likely to be the case.Nicholas Talley, Deputy Vice-Chancellor Research (Acting) and Pro Vice-Chancellor, Faculty of Health and Medicine, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/504102015-11-26T04:32:44Z2015-11-26T04:32:44ZSouth Africa isn’t managing mental illness, particularly for the poor<figure><img src="https://images.theconversation.com/files/103174/original/image-20151125-23833-afwxoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A child from a special care centre in Cape Town celebrating international kite day. In South Africa mental health services are not a priority. </span> <span class="attribution"><span class="source">Epa/Nic Bothma </span></span></figcaption></figure><p>Mental health conditions, disorders and diseases are rarely on the frontline of health regulations and international health agendas. But global institutions such as the World Health <a href="http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf">Organisation</a> have been engaging with governments to improve mental health systems.</p>
<p><a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001178">Research</a> shows there are several barriers blocking improving mental health care. These include diminished civil society support, a lack of global consensus on mental illness and its treatment, missed policy opportunities and limited evidence on the delivery of mental health interventions.</p>
<p>But in the last two decades increased attention has been given to mental health as a global priority. Civil society has become more active. In addition, high impact journals such as <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000160">PLoS Medicine</a> and <a href="http://www.thelancet.com/series/global-mental-health-2011">The Lancet</a> have raised the profile of mental health. </p>
<p>The new sustainable development goals have also put mental health and wellbeing firmly on the agenda, although there has been <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001846">criticism</a> that the goals fall short of their true potential. </p>
<p>It is estimated that globally between 12% and 48% of people suffer from mental <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001178">disorders</a>. Over 70% of this burden lies in low and middle income countries. </p>
<p>In South Africa, as in many developing countries, mental health doesn’t feature as a public health <a href="http://www.dailymaverick.co.za/article/2015-07-15-psychiatry-in-distress-how-far-has-south-africa-progressed-in-supporting-mental-health/#.VlWQR3YrLIU">priority</a>. In <a href="http://www.who.int/mental_health/evidence/south_africa_who_aims_report.pdf">rural</a> communities mental health is not supported at all. </p>
<p>One of the consequences is that trauma is common in South African society. This is evident from unusually high interpersonal <a href="https://africacheck.org/2014/09/17/comment-why-is-crime-and-violence-so-high-in-south-africa-2/">violence</a>, including homicide, rape and domestic violence.</p>
<h2>Low levels of care</h2>
<p>At least 15% of those interviewed for the South African Stress and Health <a href="http://www.ncbi.nlm.nih.gov/pubmed/18245026">Study</a> - the first nationally representative survey of psychiatric disorders in an African country - said they suffered from anxiety disorders. These could include obsessive compulsive disorder, post traumatic stress disorders and panic disorders. Nearly 10% suffered from mood disorders such as depression or bipolar disorders. Another 9% suffer from substance abuse disorders. Nearly a third of the respondents reported a lifetime history of at least one psychiatric disorder. </p>
<p>But only about a quarter of those who needed treatment were getting access. This is partly because expenditure on mental health is <a href="http://www.who.int/mental_health/evidence/south_africa_who_aims_report.pdf">pitiful</a>. On average, provinces spend less than 3% of their health budgets on mental health, mostly on psychiatric hospitals which, in any case, should be the last resort in the chain of treatment. </p>
<p>There are several other reasons for this dismal provision. These include:</p>
<ul>
<li><p><a href="http://www.who.int/mental_health/policy/services/integratingmhintoprimarycare/en/">vast distances</a> to access specialized services,</p></li>
<li><p>the chronic <a href="http://www.ncbi.nlm.nih.gov/pubmed/2499642">stigma</a> barrier in public health facilities, </p></li>
<li><p>inequality and poverty. People suffering from mental illness are caught in a “cycle of <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960754-X/abstract">poverty</a>”, which leaves little prospect of escape.</p></li>
</ul>
<h2>Where are the carers</h2>
<p>South Africa’s mental health <a href="http://www.ncbi.nlm.nih.gov/pubmed/19506789">workforce</a> is woefully inadequate. There are only 0.3 psychiatrists, 0.3 psychologists and 0.4 social workers for every 100 000 residents. <a href="http://www.who.int/mental_health/evidence/atlas/profiles/bra_mh_profile.pdf">Brazil</a> has 3.07 psychiatrists, 9.60 psychologists and 1.02 social workers for every 100 000 residents.</p>
<p>South Africa has 800 registered psychiatrists and nearly 8 000 psychologists, mostly working in private <a href="http://www.health-e.org.za/2015/10/12/mental-health-the-poor-neglected-stepchild/">health</a>.</p>
<p>Although the government has made significant strides creating <a href="http://www.health-e.org.za/wp-content/uploads/2014/10/National-Mental-Health-Policy-Framework-and-Strategic-Plan-2013-2020.pdf">policy</a> and passing <a href="http://www.gov.za/sites/www.gov.za/files/38182_rg10309_gon874_0.pdf">legislation</a> to provide mental health services, implementation has been a problem. This is because:</p>
<ul>
<li><p>Most of the groups supporting people with mental disorders are non-profit organisations that survive on shoestring budgets. </p></li>
<li><p>A shortage of state resources for the specialised and complex needs of psychiatric disorders.</p></li>
</ul>
<p>There should be strong collaboration between the service providers, particularly non-profit organisations, and the private sector. This does not happen. </p>
<p>Recent developments are not promising. The Gauteng Department of Health <a href="http://www.gov.za/speeches/gauteng-health-terminates-life-healthcare-esidimeni-contract-21-oct-2015-0000">announced</a> it will end its contractual relationship with Life Healthcare – South Africa’s largest and longest running public-private partnership. This will result in more than 2000 patients with chronic mental illness being discharged from Life Esidimeni, which means “place of dignity”. </p>
<p>In the absence of proper community care, people who need care often end up homeless or in jail as has been shown in the <a href="http://www.ncbi.nlm.nih.gov/pubmed/6479924">US</a>. In addition, pressure increases on under-funded non-profit organisations.</p>
<h2>Glimmers of hope</h2>
<p>There are some promising initiatives in the pipeline to strengthen mental healthcare in the country and in parts of the continent. </p>
<p>This includes groups that empower practitioners and policy makers enabling them to <a href="http://www.cpmh.org.za/">lobby</a> for mental health services. There are also consortia that investigate cost effective <a href="http://www.affirm.uct.ac.za/">interventions</a> for mental health disorders, how to <a href="http://www.prime.uct.ac.za/">scale up</a> mental health services and enhance the health systems to deliver mental health services adequately. </p>
<p>The state has a responsibility to provide mental illness treatment and to promote mental health. But the reality is that it will need to tap into human resources from non-profit organisations as well as private sector funding. This collaboration can only happen if the state renews its focus on how it can deliver mental health services.</p><img src="https://counter.theconversation.com/content/50410/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>André Janse van Rensburg is affiliated with the University of Stellenbosch (Department of Political science) and Ghent University (Department of Sociology) as a doctoral candidate, and with the Centre for Health Systems Research & Development, University of the Free State, as a researcher.</span></em></p>While the global health community has made mental healthcare a priority, South Africa is not following suite. The impact is felt most acutely by poor people suffering from mental health disorders.André Janse van Rensburg, Researcher at the Centre for Health Systems Research & Development, University of the Free StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/274332014-08-13T20:24:17Z2014-08-13T20:24:17ZTalking therapies can harm too – here’s what to look out for<figure><img src="https://images.theconversation.com/files/55161/original/wx76dzsd-1406617497.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You may find yourself talking to a therapist who is completely inappropriate to your needs.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/james_nash/2533278341">James Nash/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>People seeking therapy should always talk to a practitioner who provides good quality treatment that’s appropriate to their needs. Because <a href="https://www.shef.ac.uk/scharr/sections/hsr/mh/mhresearch/adeptproject">research shows</a> that even the innocuous-sounding “talking therapies” (essentially counselling and psychotherapy) can be harmful for some when they’re unsuitable. </p>
<p>Reflecting my day job, I’m going to focus here on mood disorders. Some of these (melancholic depression, for instance, and bipolar disorder) are essentially “diseases” because their causes are largely genetic, and reflect primary biological brain changes.</p>
<h2>The wrong model</h2>
<p>People with these mood disorders tend to respond to medication but not usually to talking therapies. Therapists with a narrow treatment approach will generally fail to be of any assistance to people who suffer from such conditions. </p>
<p>But sadly, as per the aphorism “if all you have is a hammer, then everything looks like a nail”, some therapists reject any possibility they might be providing totally inappropriate treatment. </p>
<p>I cringe when recipients of such treatment – many substantially impaired for years – tell me their practitioner has reassured them that their continuing depression (which might have responded within weeks to an antidepressant drug) needs to be “experienced before it can be worked through,” or some other defensive pseudo-profound explanation. </p>
<p>In such cases, talking therapies are indirectly harmful by being inappropriate and ineffective.</p>
<p>Conversely, there are many depressive disorders that lack primary biological changes. But, despite the most appropriate treatment here being a talking therapy, the individual receives a procession of inappropriate and ineffective antidepressant drugs that may also have distressing side effects. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/55165/original/ffjq2sxx-1406618014.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sadly, as per the aphorism ‘if all you have is a hammer, then everything looks like a nail’, some therapists reject any possibility they might be providing totally inappropriate treatment.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jerthebear/5850272087">Jerry Swiatek/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Here again, harm – and a lack of therapeutic response – may arise from the wrong therapeutic model. But harm may also accrue from the ingredients of therapy and how they’re applied by individual therapists.</p>
<h2>Components and risks</h2>
<p>Psychotherapies, such as cognitive behaviour therapy or dynamic psychotherapy, are all developed with an underlying logic and possess powerful specific ingredients. </p>
<p>Cognitive behaviour therapy, for instance, challenges faulty thinking patterns that cause people to view themselves, their future, and the world negatively. While dynamic psychotherapy, which is derived from psychoanalysis, is designed to identify the early formative events that led the individual to develop psychological problems.</p>
<p>But all psychotherapies also contain non-specific therapeutic ingredients that may – when present in some circumstances, or absent in others – benefit or harm the patient. These include the therapist being empathic, and providing a clear therapeutic rationale in a healing and restorative setting. </p>
<p>An analysis of several studies shows <a href="http://www.ncbi.nlm.nih.gov/pubmed/12063144">only 8% of patient improvement</a> during psychotherapy is due to any specific therapy component. </p>
<p>Other research <a href="http://books.google.com.au/books/about/Handbook_of_Psychotherapy_Integration.html?id=FXc_eNJCjcYC">puts the figure at an estimated 15%</a>, with the remainder emerging from non-specific components – a third from the therapeutic relationship, and some from patients “expecting” to improve, but most improvement from patient and extra-therapy factors such as the therapist being empathic, offering a logical model, hope and expectancy of improvement.</p>
<p>But just as the ideal therapist can contribute significantly to improvement, if he or she lacks such ingredients – or is actively “toxic” – then harm occurs. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/55164/original/5cct325n-1406617595.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cognitive behaviour therapy challenges faulty thinking patterns that cause people to view themselves, their future and the world negatively.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/87781710@N02/8343819455">Fox valley Institute/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/18187527">Psychotherapists argue</a> that because their work is “only talking… no possible harm could ensue”. But all effective medication is accompanied by risk and the same holds for talking therapies.</p>
<h2>The harm of talking therapies</h2>
<p>In 2009, a colleague and I published an <a href="http://anp.sagepub.com/content/43/9/787.full">overview of reported harmful effects</a> from talking therapies, examining scenarios such as the insensitive, critical, voyeuristic or sexually exploitative therapist, and their prevalence. </p>
<p>In a <a href="http://www.ncbi.nlm.nih.gov/pubmed/23337740">subsequent research report</a>, we developed a measure of adverse therapeutic styles experienced by people who had received a psychological therapy and left or (perhaps more concerning), remained in therapy and had their condition worsen. </p>
<p>The most common “negative therapist” style identified was a lack of empathy or respect, and not having the patient’s interests at heart. </p>
<p>Next, was the “preoccupied therapist” who made the patient feel alienated and powerless; the controlling therapist who encouraged dependency; and, finally, the passive therapist who was inactive, inexperienced or lacked credibility.</p>
<p>While side effects from medicines are generally physical, the adverse effects of psychotherapy and counselling naturally tilt to the psychological. They tend to leave the harmed person inclined to feel self-blame, helpless, and demoralised (or to become more self-centred and self-absorbed), while commonly remaining dependent on the therapist.</p>
<h2>Better ways</h2>
<p>To avoid this, all health practitioners should be evaluated by their clients in terms of both style and substance. Most patients seek practitioners who meets both requirements; who are perceived as caring and technically proficient. But, if invited to choose which to prioritise, most will generally go for “style” (preferring the kindly practitioner). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/55169/original/3294ctpy-1406619153.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While side effects from medicines are generally physical, the adverse effects of psychotherapy and counselling naturally tilt to the psychological.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/doug88888/2800841720">Doug Wheller/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>This is also a matter of concern; kindly practitioners may meander without a therapeutic game plan so that, while the patient is appreciating their warmth, there is no actual progress.</p>
<p>Unfortunately, there are no formal processes in place for evaluating professional psychotherapists and counsellors. While a therapist would not (and could not) allow an independent observer to judge the therapy on a session by session basis, there’s no reason why a patient cannot seek a second opinion from another therapist to determine if the therapy being received is cogent and provided at a professionally logical level.</p>
<p>Informal ratings provided on platforms, such as websites, should not necessarily be trusted because ratings may be weighted to the aggrieved (satisfied customers are less likely to rate), and professional rivals may “load” negative reports.</p>
<p>If someone is exploited or abused by a therapist, they should make a report to the appropriate professional disciplinary board. If the therapist is less overtly concerning (whether simply passive, on the wrong wavelength or causing you to feel troubled or even worse), best to cut and run. </p>
<p>You may have psychological problems but rely on your instincts; therapy that matches your needs is an incomparable balm and will advance your recovery. Therapy that fails this is not worth your while.</p><img src="https://counter.theconversation.com/content/27433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gordon Parker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People seeking therapy should always talk to a practitioner who provides good quality treatment that’s appropriate to their needs. Because research shows that even the innocuous-sounding “talking therapies…Gordon Parker, Scientia Professor , UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.