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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 48. This is the beginning of the thread.
Posted by Rosy Crucifiction on June 27, 2010, at 12:25:28
I hope everyone else benefits from this video as much as I have.
http://www.youtube.com/watch?v=6gFVQGD-aB8
Posted by rovers95 on June 27, 2010, at 17:44:25
In reply to The biology of depression: Wolkowitz brings hope, posted by Rosy Crucifiction on June 27, 2010, at 12:25:28
> I hope everyone else benefits from this video as much as I have.
> http://www.youtube.com/watch?v=6gFVQGD-aB8Thanks for the post, i found it very interesting, but, apart from giving hope for the future, how has it benefited your illness, have you tried dhea or fluconazole etc.?
thanks
rover
Posted by Rosy Crucifiction on June 27, 2010, at 22:56:09
In reply to Re: The biology of depression: Wolkowitz brings hope, posted by rovers95 on June 27, 2010, at 17:44:25
DHEA has helped. So have antidepressants. But the video helped me understand why I'm depressed. And how a cure can happen. FYI- curcumin boosts BDNF production as well.
Posted by linkadge on June 28, 2010, at 14:08:43
In reply to Re: The biology of depression: Wolkowitz brings hope, posted by Rosy Crucifiction on June 27, 2010, at 22:56:09
Well, the stress model of major depression is still only theoretical. It may not explain why some of us experience recurrent depression in the absence of significant life stress.
In the flinders animal model of depression, hippocampal neurogenesis is actually increased. In this model, theraputic nortriptyline or citalopram actually lowers hippocampal neurogenesis. Also, in animal models, escitalopram has no effect on hippocampal neurogensis.
Also, this does not explain why ECT or sleep deprivation can induce rapid improvement in depression. Theres not enough time here for new brain cells to mature and become funtioning.
Linkadge
Posted by SLS on June 28, 2010, at 14:23:08
In reply to Re: The biology of depression: Wolkowitz brings hope, posted by linkadge on June 28, 2010, at 14:08:43
> Well, the stress model of major depression is still only theoretical. It may not explain why some of us experience recurrent depression in the absence of significant life stress.
>
> In the flinders animal model of depression, hippocampal neurogenesis is actually increased. In this model, theraputic nortriptyline or citalopram actually lowers hippocampal neurogenesis. Also, in animal models, escitalopram has no effect on hippocampal neurogensis.
>
> Also, this does not explain why ECT or sleep deprivation can induce rapid improvement in depression. Theres not enough time here for new brain cells to mature and become funtioning.
>
> Linkadge
When you observe ultra-rapid cyclicity or ultra-dian cyclicity in person, you realize just how quickly and completely brain function can change. There might as well be a switch. There would seem to be no room for a neurogenesis explanation for this phenomenon. Do you think such a switch might lie in the cingulate cortex?
- Scott
Posted by Rosy Crucifiction on June 28, 2010, at 17:02:43
In reply to Re: The biology of depression: Wolkowitz brings hope » linkadge, posted by SLS on June 28, 2010, at 14:23:08
I would agree, as I think Wolkowitz would, that stress is only one model for depression. What is of greatest interest in his lecture for me is the emphasis on epigentic change. As someone who had an extremely stressful childhood, and is currently highly mood reactive, the notion of a genetic switch triggered in childhood makes sense for a phenomenon otherwise uncontrolled by meds or therapy. Neurogenesis doesn't explain how to unswitch the switch, but it may help explain my depression - particularly when you factor in the hippocampal shrinkage caused by chronic alcohol use.
Posted by Rosy Crucifiction on June 28, 2010, at 17:08:22
In reply to Re: The biology of depression: Wolkowitz brings hope » linkadge, posted by SLS on June 28, 2010, at 14:23:08
Scott,
I'm more inclined to view cycling through the lens of cognition. The same external state can be assimilated emotionally in dramatically different ways from moment to moment. The stress of this, and its effects, may lead to additive depression or dysthymia. From a therapeutic perspective, DBT seems as promising as mood stabilizers in clinical setting. The heavy BP1 folks I know have found DBT an essential part of finding fulfillment and, even, happiness.
Posted by SLS on June 28, 2010, at 17:28:34
In reply to Re: The biology of depression: SLS, posted by Rosy Crucifiction on June 28, 2010, at 17:08:22
Hi.
> I'm more inclined to view cycling through the lens of cognition.
I guess you gotta be it to fully appeciate it. I was an ultra-rapid cycler for an extended period of time. Phase changes are a biological switch. I found them to be independent of cognitive input, although cognitive output is certainly influenced by them. My cycle comprised 3 days up and 8 days down. It did not deviate by so much as a day over a two year period. Well, actually, it did skip one time. This isn't theory. It is reality.
- Scott
Posted by SLS on June 28, 2010, at 17:37:40
In reply to Re: The biology of depression: SLS » Rosy Crucifiction, posted by SLS on June 28, 2010, at 17:28:34
> Hi.
>
> > I'm more inclined to view cycling through the lens of cognition.
>
> I guess you gotta be it to fully appeciate it. I was an ultra-rapid cycler for an extended period of time. Phase changes are a biological switch. I found them to be independent of cognitive input, although cognitive output is certainly influenced by them. My cycle comprised 3 days up and 8 days down. It did not deviate by so much as a day over a two year period. Well, actually, it did skip one time. This isn't theory. It is reality.I haven't tried DBT. However, CBT doesn't influence my mood at all, and neither have other forms of psychotherapy. I do feel, however, that it is important to address extant psychological issues so that they don't prevent biological treatment success or lead to subsequent relapses.
- Scott
Posted by Rosy Crucifiction on June 28, 2010, at 17:37:46
In reply to Re: The biology of depression: SLS » Rosy Crucifiction, posted by SLS on June 28, 2010, at 17:28:34
I haven't been in it in the same way. But the point I was trying to make is that the genetic switch (the cause of the cycle) influences how you/I/we view a given situation. Drugs may effect the speed and direction of a switch. DBT may effect how the switch is experienced, and over time, even what is switched to. One guy I know has had a very bad time with switching and likens the distance gained from mindfulness practice to physical distance from the problem. The problem doesn't change, but the immersiveness of it can.
Posted by SLS on June 28, 2010, at 17:48:04
In reply to Re: The biology of depression: SLS, posted by Rosy Crucifiction on June 28, 2010, at 17:37:46
> The problem doesn't change, but the immersiveness of it can.
I found that the recognition of the independent nature of the mood illness was helpful so as not to become so immersed in it. It is what works for me. It really is getting old, though.
- Scott
Posted by Rosy Crucifiction on June 28, 2010, at 19:42:45
In reply to Re: The biology of depression: SLS » Rosy Crucifiction, posted by SLS on June 28, 2010, at 17:48:04
Amen to that brother.
Posted by jade k on June 28, 2010, at 19:57:53
In reply to The biology of depression: Wolkowitz brings hope, posted by Rosy Crucifiction on June 27, 2010, at 12:25:28
I'm waiting for the sequel :-)
Posted by linkadge on June 28, 2010, at 20:04:54
In reply to Re: The biology of depression: SLS » Rosy Crucifiction, posted by SLS on June 28, 2010, at 17:28:34
The epigenic theory doesn't explain it all too. As SLS mentioned, a rapid cycler can go through periods (brief) of normal on and off. Are the genes switcing this quickly?
The fact that some bipolars can go from the worst depression to euthemia or mania with a single nights sleep loss says that the capacity to feel normal is right there. There is just overactivation of certain brain circuity, or underactation of other circutry.
There is probably faulty wiring in the bipolar brain. Perhaps loss of density in certain brain regions that makes mood regulation difficult.
SSRI's work (IMHO) by temporarilty disrupting prefrontal cingulate circutry. They don't help fix the circuty, they just shut it off. This might work temporarily but eventually, the brain loses executive function and becomes depressed for differnt reasons altogether.
Perhaps the cure will be the injection of stem cells into areas with troubled circulty, or more sophisticated DBS which can more effectively reroute negative rumanative through processes.
Perhaps a DBS which actually monitors (in real time) the metabolic state of a certain circut only give a little jolt when a state of hypermetabolism is recieved.
This is as opposed to current DBS which give jolts at regular intervals.
Linkadge
Posted by linkadge on June 28, 2010, at 20:10:25
In reply to Re: The biology of depression: SLS, posted by Rosy Crucifiction on June 28, 2010, at 17:37:46
The problem is that there is no problem.
The anguish of chronic TR depression is not routed in reality. I believe epigenics might predispose a person to be over anxious (as this could be adaptive). But how would epigenics explain depression. In what what is it adaptive for any organism to remain depressed for years and years?
Besides we do have agents which can alter DNA hypermethylation. Valproate (and fluoxetine for that matter) can induce widespread DNA demethylation. Not that I know much about the subject, but I've heard the argument that such hypermethylation can be turned off.
Linkadge
Posted by violette on June 28, 2010, at 20:45:44
In reply to Re: The biology of depression: Wolkowitz brings hope, posted by rovers95 on June 27, 2010, at 17:44:25
Rosy-I loved it! I listened to it while painting so I didn't see the visual aids he was referring to--I did check the affiliated organizations at the end and watched the last 10 mins..I'll probably watch it to listen to it again since I didn't quite absorb all the genetic stuff due to the terminology.
..The whole model he suggests sounds as if he was explaining exactly what happened to me...(minus the genetic change stuff I don't understand entirely). I really like his suggested model!
How I benefited from the video:
1. Felt optimistic about the funding of research that is not the same comparison of SSRI drugs vs. thse drugs or SSRI drugs vs. ___ over and over..also was informative to understand why ADs are not as effective as they could be
2. Reminded me of the importance of how research funds are directed and from what source it came from...(funding sources are on a slide at the end)
3. Validated that the current treatment I have chosen--relational/attachment-based psychodynamic therapy--is the best choice for me given the other options (I plan to grow new neurons from psychotherapy instead of drugs..lol...and yes, it's been researched)
4. Made me feel less guilty of the time I spent researching mental health; the stuff I had pieced together about my situation-the stress exposure, childhood, relation with parents, and personality traits (ex. perceptual sensitivity--maybe this is from genes?) which explained how I got where I am today was verified by much of what he said
5. Validated my recent decision to not further pursue neurological testing, thinking lately my brain was damaged from the cognitive traits/neuro changes I developed as a result of the risk factors rather than from meds (saved lots of time/money
6. Confirmed my positive feelings about attachment theory-alot of what he said seemed to originate from attachment theorists-people who subsequently looked into the neuro, endo, and cognitive stuff a decade or so ago (like Schore)
7. Inspired me to exercise more, as it was pointed out that exercise had the same effect as ADs alone (not that I never heard of the benefits of exercise before-but it gave me motivation)
8. Enabled me to think of trying DHEA since I had never thought of that before
9. Validated I was not delusional when I showed up at endocronologist's offices, after ADs didn't work after years of heavy stress, asking about cortisol--although the endocronologists basically said they don't deal with 'mental health'
10. Confirmed some of my thoughts about psychosomatic illnesses (something psychoanalysts from the 1800s connected w/o the science to back it up)
11. Felt positive about future potential risk screening methods to intervene before people get ill
12. Gave me hope for future treatments for my grandchildren resulting from a new model which integrates endo/cog/psycho/bio/social
He seems like a sensible and humble guy, always pointing out much of what he thought was "highly speculative", only theory/not proven, or only tested in rats....that's how all higher theory starts I suppose..I wonder how clinicians generally feel about his model? Any out there who'd like to opine?
Some things I had wished he addressed in more detail: psychotherapy, anticonvulsants and off-label scripts..neuro in regard to defense mechanisms.
Tanks for posting this-I don't think I had ever seen one presentation that synthesizes everything so well. :)
Question: ??? I probably have to listen to it again because I missed something or another-did he say something about MAOIs enabling neurological growth, or was he referring to ADs in general?
Posted by violette on June 28, 2010, at 21:00:49
In reply to Re: The biology of depression: SLS, posted by linkadge on June 28, 2010, at 20:10:25
How to explain depression?
...Your brain gets exhausted from all the energy it has to expend to maintain your defense mechanisms to block out emotional pain/memories..it gets 'worn down' much like the effects of stress pointed out in the model
Also, your caregivers reinforce how you feel about yourself through mirroring and how they relate to you (can be overt or covert)..Just as I have an overactive nervous system-anxiety-scanning my environment, over observant/ perceptual sensitivity--as a result of how my brain formed maladaptive behavior from early childhood experiences (and sensitivity/ temperment)--how your only source of survival-your caretaker-relates to you changes how you feel about yourself--its internalized through facial expression, words, lack of touch, the attacment pattern of the caretaker, etc. Your defesse mechanisms play a role; it can be so painful your cognitiion finds ways to block the pain (dissociation, for example, which seems to be a biological process).
Maybe science can't measure some of these things, but when you are an infant-your caretakers are a source of life and death and survival is built into us.
Disclaimer: My research methodology is poor. :)
Posted by inanimate peanut on June 28, 2010, at 22:08:23
In reply to Re: The biology of depression: SLS, posted by violette on June 28, 2010, at 21:00:49
If that's the case, though, what explains bipolar switching? When I took Geodon, I went from deathly depressed to 100% well in less than 24 hours. Surely according to your theory my brain was still just as worn down from the stress as it was before I took the Geodon. There are obviously also people with bipolar disorder who switch from depression to normalcy or mania without any medication or other reason. How do you explain that?
Posted by topcatclr on June 28, 2010, at 23:19:11
In reply to Re: The biology of depression: SLS » violette, posted by inanimate peanut on June 28, 2010, at 22:08:23
Also, this does not explain why ECT or sleep deprivation can induce rapid improvement in depression. Theres not enough time here for new brain cells to mature and become funtioning.
Linkadge
One makes you to stupid and the other makes you to tired, to obsess!
Posted by violette on June 29, 2010, at 0:21:35
In reply to Re: The biology of depression: SLS, posted by topcatclr on June 28, 2010, at 23:19:11
Topcatlr-that makes sense. ECT has been said to cause memory loss - which could erase painful, but perhaps unconscious memories; while if your brain is too tired, you wouldn't have much mental energy for emotions to manifest since you are using all that energy to merely function.
I wish science could explain everything. I guess many things or concepts outside of mental health did not 'exist' before they could be scientifically validated.
Posted by violette on June 29, 2010, at 2:37:01
In reply to Re: The biology of depression: SLS » violette, posted by inanimate peanut on June 28, 2010, at 22:08:23
Hi Intimate Peanut (that is a really cute name),
"If that's the case, though, what explains bipolar switching?"
Maybe it's like one of those questions: Is there life on other planets? lol. Maybe the Psychobabble forum members will figure it out and make a huge discovery...Dr. Bob would become famous...(he better split the profits with us!)
But seriously, that is a really good question. I don't recall much said about bipolar (if at all) from the video, or maybe I wasn't paying attention and missed it.
From the mix of what I've read of different perspectives, keeping in mind I cannot truly read neuroscience or biochemistry (I can read some cognitive science though), I have some clues..no answers, unfortunately.
I do know that bipolar symptoms are similar to what some psychiatrist who have both psychology and medical backgrounds consider to be attachment issues (and maybe those w/o psychology backgrounds). Some consider bipolar to be more of a "mood dysregulation", which is a term used by some schools of thought for many disorders that are not considered to be in the 'bipolar spectrum'. Some of the journal articles or psychodynamic books I've read also say that procrastination/lack of motivation is a form of mood dysregulation rather than depression alone...
Bipolar symptoms can overlap with traits of what are considered personality disorders (PDs) (some anxiety-related traits are also included in PDs)...for which those "diagnoses" basically just outline a group of permanent characteristics in its most extreme form if an individual were to have all of the traits listed..Bipolar is sometimes confused with Borderline and people get misdiagnosed as Bipolar or the other way around; that's one thing I've frequently read in the literature. Narcisstic traits can be manic (grandious) alternated by depression (deflated gradiousity).If you read the emotional construct of bipolar traits (as opposed to the diagnostic lists), it becomes somewhat more clear how the emotional dysregulation can occur if the causes are more emotionally-related.
From an emotional perspective, a person can develop a pattern of relating from childhood experiences and defense mechanisms (DMs) that are developed and block painful emotions from surfacing; people seem to employ different ones for whatever reason...people tend to permanently adopt certain ones for whatever reasons.
Anyway, after reading and thinking about DMs, attachment theory and other perspectives, my emotional dysregulation became more clear. So the old theories about DMs (in addition to some traits/temperment) explain my symptoms and behavior; how my brain works. Right now I'm in psychotherapy learning about deep, unconscious feelings that have caused me to use those DMs; basically addressing the fears that contribute to my anxiety.
My anxiety "switches" off and on. So to me, it doesn't seem unusual that a person's depression could switch off and on from feeling low vs. high.
I used to have generalized anxiety disorder (GAD)--basically, I didn't react to specific situations-it was free floating anxiety. Since i have a childhood attachment issue, my anxiety changes when I'm in a relationship-this didn't happen until I was older, however. But-that doesn't explain why it was previously free floating (although I think its because of usage of certain DMs). In part, GAD could have been fear triggers for which at the time, I had no awareness or memory of, that are unconscious due to repression or other DMs. For example, my mother told me that as a baby, although very quiet much of the time, I would be startled and fearful by sensory stimulation-I would scream when this one woman came to visit; she wore really bright clothing, lots of makeup/jewelry, and very extroverted, lively with a high-pitched, loud voice. I have always been overly sensitive-so I can see how I developed severe anxiety (fear) while sis, who was not scared/clingy, did not. It could be that colors and sounds and other things outside of my direct awareness triggered the previous GAD. I don't know.
My sister has conventional (as diagnosed) Bipolar I. I can be almost certain that she has a childhood attachment problem like me, but that it might manifest differently in her, perhaps due to her temperment (maybe that is a key to the genetic component?). Her temperment was much different than mine; in fact, it was in many ways-the opposite of mine.
She tended to be: extroverted, exploratory, adventerous, hyper, agitated, risk-taker, etc. as a child; some traits when she was just a baby (fussy/demanding, getting into things). On the other hand, I was quiet, introverted, overly sensitive, clingy; described as 'delicate'...
So in our case, it makes more sense (to me) that I developed my primary emotional dysregulation-anxiety--which is basically fear based, while my sister may have developed her emotional dysregulation from parental interaction resulting from her traits-being punished for her adventurousness & lack of fear--behavior that made her file good--getting attention as a result of those traits that she was inclined to feel good-such as getting into things, running into the street, etc...as well as receiving attention fo her agitation/fussiness...However, despite gaining attention due to her tempermanent-she experienced the same nurturing neglect/lack of positive attachment parental behavior as I.
So since we both experienced extreme neglect-my sister perhaps got more needs met--was paid more attention to due to her temperment. Being fussy or adventurous actually brought her the only atention we may have received while young-which could have strenthened those traits...while my being quiet brought more neglect, which would lead to more fear, and thus strengthen my fear-based traits..
I wss told by my mother I slept through the night practically right from the hospital--maybe my cries were just too quiet to be heard? I will never know, but surely my survival instincts (perhaps as opposed to the full spectrum of emotions not yet developed) depended on being heard...if i was not heard, I would imagine being in a state of fear, though no one can really say how an infant 'thinks'. If, as an infant, caregivers react to you 'dangerously'--while at the same time--you have limited emotional capacity, such as fear-hunger-sensory pleasure-couldn't the survival based, but limited emotions become more ingrained as patterns in a developing brain?
Anyway, so if I was in a repeated state of fear while my brain was still developing-the ways I chose to cope, though unconscious at the time, became more permanantely ingrained after continous reinforcement; my DMs, included dissociation and repression, for example.
So in comparison to my sisters BP traits, perhaps while she felt good when she was acting on her adventerous, explortory impusles, she was continually put down for those same reasons. Maybe that in itself could be confusing to the developing mind that has not yet learned how to process complex emotions--confused by mixing up feeling good/manic with feeling bad/depressed. For a brain developing, maybe those emotional experiences were ingrained in her, much like my fear comes from patterns I had since a young age.
How could the things that make her feel good make her feel bad at the same time? Emotional dysregulation could be the result of experiencing confusion over and over like that...a baby/child doesn't have cognitive capacity, so it is not something that can be easily researched from the cognitive perspective like adults with mental disorders. That leaves a lot of unanswered questions..Another example, perhaps for those never neglected or outwardly abused-maybe just the father was abusive-and maybe you just saw him on weekends--could that cause a more time-oriented pattern of cycling such as 5 weekdays in a row of feeling good and 2 days of feeling bad for the baby exposed to certain distressing familial factors only on weekends? Sounds out there, but it crossed my mind. Either way, things which are reinforced over and over appear to me to affect development and emotional patterns.
We had both experienced abuse and neglect, but its interesting to think how I ended up with anxiety-related traits and she ended up with bipolar traits. But that's only 2 people though-my sis and I. :)
Abuse, though more neglect in the early years, affected how our brains developed; I think considering that things our brains possibly had to do--cognitively--in order to cope is largely unknown, and because infants and young children do not have fully developed brains to tell us what goes on their consciousness or awareness--it makes the whole mental illness concept more difficult to explain from all angles-specifically, the cognitive side, an aspect looked at in adults and used to explain some mental or neuro disorders-but can't be meaningfully compared directly with babies or young children who cannot yet speak or communicate maturely, who have different brain characteristics.
I do think that because some theories are older, that doesn't necessarily make them less valid unless disproven, and I also believe that defense mechanisms are important and should be looked at and included in mental health models.
That's just my personal theory of how a sibling and I may have turned out with different mental disorders; how her BP may have developed. I consider both anxiety & BP to be a form of emotional dysregulation and it was interesting to think about.
Does that help you find any answers, or does it relate to your situation at all?
I do hope that someone finds the answer.
Posted by Lou Pilder on June 29, 2010, at 7:07:33
In reply to The biology of depression: Wolkowitz brings hope, posted by Rosy Crucifiction on June 27, 2010, at 12:25:28
Friends,
If you are considering posting in this thread or parallel threads,I am requesting that you watch this short video.
Lou
Here is how you can see the video.
A. Bring up Google
B. Key in:
[youtube, prescribed drugs To Prescribers]
the caps are needed where you see them and if more than one video comes up, this is a short video with the date Feb 5, 2009
Posted by Lou Pilder on June 29, 2010, at 7:37:20
In reply to Re: The biology of depression: Wolkowitz brings hope, posted by linkadge on June 28, 2010, at 14:08:43
> Well, the stress model of major depression is still only theoretical. It may not explain why some of us experience recurrent depression in the absence of significant life stress.
>
> In the flinders animal model of depression, hippocampal neurogenesis is actually increased. In this model, theraputic nortriptyline or citalopram actually lowers hippocampal neurogenesis. Also, in animal models, escitalopram has no effect on hippocampal neurogensis.
>
> Also, this does not explain why ECT or sleep deprivation can induce rapid improvement in depression. Theres not enough time here for new brain cells to mature and become funtioning.
>
> LinkadgeLinkage,
Thank you for posting the above. I see that it shows judgment, critical thinking and more. I would like for you to look at some of the threads now on the admin and faith boards and if you could post your views there, I would appreciate it.
Lou
Posted by Lou Pilder on June 29, 2010, at 7:49:51
In reply to Re: The biology of depression: SLS » violette, posted by inanimate peanut on June 28, 2010, at 22:08:23
> If that's the case, though, what explains bipolar switching? When I took Geodon, I went from deathly depressed to 100% well in less than 24 hours. Surely according to your theory my brain was still just as worn down from the stress as it was before I took the Geodon. There are obviously also people with bipolar disorder who switch from depression to normalcy or mania without any medication or other reason. How do you explain that?
inanimate peanut,
Thank you for the post above.
Lou
PS...I also like your posting name and I hope that you never are a salted.
Lou
Posted by jade k on June 29, 2010, at 14:11:29
In reply to Re: The biology of depression, posted by violette on June 29, 2010, at 2:37:01
I liked the video, however I was diappointed at the end (why I am looking forward to the final episode: the cure)
This thread makes my brain hurt, however,
I have seen a Bi-polar 1 "switch".
I have seen an epileptic "switch".
I felt my brain "switch" from normal to a major depression in a very short time. I felt it "switch" back to full remission twice, (although short lived). Beyond frustration.
My feeling is that some of us are simply prewired and at risk for a mental health illness, and environmental stresses (physical and/or mental) usually cause the "switch" effect.
To explain major depression without a stressor, maybe that indivual's threshold is very low (more nature, less nurture involved.)
~Jade
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