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Your Mental Health

Depression - what is it good for?

Many times I have talked about the prevalence of depression. Of all the psychiatric conditions, depression and anxiety are by far the most common and major depression is thought to affect roughly eight percent of the population at some point in life.

Compare that with the less than one percent of people who experience schizophrenia or bipolar disorder and it seems a very large number. So what is it about depression that allows it to continue existing in our species at such a high prevalence?

We often think of depression as similar to an illness in any other major organ – simply a malfunction that needs to be treated. Of course, treatment is important and helps many people in their ability to function on a daily basis, but we still don’t know why the illness continues to occur in such abundance. Researchers have been studying this question for some time.

One theory involves the purpose or value of rumination – the process of pondering and thinking things over and over and over – that is one of the hallmarks of depression.

Individuals who self profess to be ruminators do seem to be more prone to depression as well as to being unnerved by stressful events. Therapy often encourages people to get out of the habit of excessive rumination as it can lead to fixating on flaws or problems and thus extend negative thoughts.

According to proponents of this theory of depression, this kind of thinking is not necessarily bad but may be a useful skill for us to learn from our mistakes or sort through complex problems. Some go so far as to say depression is a way of forcing the mind to focus on its problems.

A couple of studies have found some benefits to this kind of analytical thinking. One found that individuals with depression seem better able to make complex decisions because they are more willing to spend the time to thoroughly analyze the options and information put before them.

Certainly, there have been and are today many great thinkers, artists and poets whose melancholy has undoubtedly informed and inspired their craft. I have talked about this in past columns.

At the same time, research has also shown individuals with major depression experience cognitive impairments in other areas and imaging studies have shown cumulative damage to some areas of the brain with each episode of depression experienced.

Perhaps an argument can be made that depression has some helpful element to it when it is mild – however anyone who has experienced a severe depression can tell you the benefits are far outweighed in these circumstances. A severely depressed person who cannot be motivated to get out of bed or who is experiencing a psychotic episode is not going to be a more effective problem solver.

I don’t believe treating depression will eliminate a person’s ability for complex or analytical thought – but it will help in getting back to enjoying life.





Autism genes complex

 
Yet again, genetic research is teaching us so much more about the way things work in the human body and taking us down unexpected paths.
 
For the past couple of decades we have suspected genetic involvement in the cause of autism spectrum disorders (ASD). Over the past couple of years, research is confirming this but its genetic complexity has also surprised scientists.
 
In the 1990s it was thought there may be as many as about 15 different genes involved in the development of ASD and its associated symptoms. Newer research is showing us there are likely hundreds of unique gene mutations involved in these disorders that may arise spontaneously and occur in a different combination in almost every person with ASD.
 
Several studies published in the journal Neuron examined the genetics of autism in more than 1,000 families with only one affected child. Analysis suggests the genes may be part of a large network involved in controlling the development of the synapses between nerve cells, which allow them to communicate.
 
One team of researchers discovered a particular cluster of pathways involved in the development of synapses in young brains was being interrupted as a result of some gene mutations. In these cases, there was an overabundance of connections between nerve cells in autistic children. These same genetic mutations causing too many connections in autistic children seemed to produce an opposite effect among children with Williams syndrome – a rare developmental disorder in which people tend to be highly social, sensitive and empathetic.
 
Researchers have also long been interested in the reasons why four times as many boys are affected by ASD as girls. After analyzing data from these studies, it did appear the mutations were much likely to cause autism in boys than girls. Girls seem able to better resist the development of symptoms and need larger gene disruptions to actually cause the disorder – more research is needed but scientists involved in these studies believe girls might have some unique protection against genetic anomalies.
 
Although many clues have been uncovered in recent years, the research has also revealed just how complex ASD truly is. With no universal gene responsible for the disorder and literally hundreds of different variations, it will be a long time before we get concrete answers about many aspects of these disorders. Even the most common mutations were seen in only about one percent of affected children – and experts say we still cannot understand most cases of ASD.
 
There is still much to learn about the rare mutations involved with autism and why the condition seems to be on the rise in our population. I look forward to seeing more data as it comes forward.


ADHD - not just for kids

It’s a disorder almost everyone associates with hyper kids who can’t sit still in a classroom, but for 90 percent of kids with ADHD, symptoms continue to cause problems throughout adulthood.

Although the name, attention deficit disorder, implies the condition is primarily a problem with paying attention, new research now suggests this is actually an executive function disorder with an unfortunate name.

Characterized by problems with distractibility, self regulation, impulse control, time management, concentration and inhibition, ADHD causes many difficulties for the roughly one in 25 adults who live with it.

Adults with ADHD have difficulty meeting their full potential in school or work settings, often have failed relationships, can be unreliable and have difficulty holding a job. In addition, adults with ADHD are at much higher risk for substance abuse and smoking than the general population and are twice as likely to die as a result of accidental causes.

Co-existing depression and anxiety are also quite common among those with ADHD and low self esteem can also be a problem due to lifelong negative feedback related to the condition.

Of course, common myths that the disorder doesn’t exist or is the result of poor parenting, too much sugar, or somehow the person’s fault don’t help.

As with most conditions affecting the brain, there is still much to learn about ADHD, what causes it and exactly what is happening within the brain. However research has advanced considerably in recent years. Neuro-imaging studies have proven the condition does exist and affects certain areas of the brain associated with executive function. Among those with ADHD, these areas are generally three to 10 percent smaller than those without the condition and they are also 10 to 25 percent less active than they should be.

Several specific genes have also been linked with the condition and some experts believe genetic testing as part of diagnosis is not too far in the future.

Along with the many difficulties associated with ADHD, those with the condition are often creative, energetic risk takers and can be quite successful if they find a career in an area suited to them. Several famous artists and athletes have recently come forward with ADHD including Michael Phelps and Canadian comedian Rick Green.

Even for those who manage success in their careers, the condition still tends to create chaos in other areas of life.

Some experts including Russell Barkley, author of Taking Charge of Adult ADHD, have come up with several indicators and adult symptoms they’d like to see included in the diagnostic manual for this condition. Some of these include: poor performance at work, frequent job changes, risky sexual behaviour, unsafe driving, difficulty managing money, problems in relationships, anti-social activities and a less healthy lifestyle.

Their hope is that if these indicators are included in the definition of ADHD, it would help adults experiencing the condition to get help when needed. As it stands, only seven percent of the adults living with ADHD are being treated and there is no official adult ADHD service in Canada.

If you are adult and you believe you might be experiencing ADHD, speak with your doctor about it and request referral to a specialist for an assessment. Treatment options are available and generally very effective.





Optimism - a helpful human bias

Pretty much everyone can tell you if they are a “glass is half full” or “glass is half empty” person. Do you tend to look on the bright side of things? Or pick out the negative aspects of most situations?

If you are an optimist, you’re not alone. Research has shown that optimism is a human trait we are pre-disposed to as a species.

Research in the past few years has taught us a lot about how optimism works in the human brain.

One brain imaging study completed in 2009 asked volunteers to imagine going on vacation to a variety of different locations and to rate them by how happy they thought they would be in each place. After the destinations were rated, volunteers were asked to pick between two spots they had given equal ratings and then to rate them again.

Interestingly, once a decision was made, people rated their selected vacation spot higher than they had before choosing it and they rated the discarded one lower.

On the brain images it showed that an area of the brain related to processing rewards and expectations changed during this decision making process. This reinforcement of our decisions likely helps us feel confident in the myriad choices we have to make every day. When our brain changes to affirm a choice, we do not go through life with unending buyers remorse – second guessing every choice.

Other studies have shown our brains tend to encode positive information that will enhance optimism but will not do the same for unexpectedly negative information – thus creating an optimism bias as the ‘good news’ sticks with us more permanently than the bad.

We don’t know why humans seem to be generally hard-wired for optimism, but optimists are known to be generally healthier and live longer than pessimists and some new research indicates this trait may be linked to some specific genes. For this reason, some believe there could be an evolutionary advantage to the trait.

Obviously, there are some positives to looking on the bright side – but there are also some dangerous risks associated with putting on the blinders to potentially negative ramifications of some decisions.

In an article on the topic by author Barbara Ehrenreich, she points out how the optimistic mantra of modern capitalism has led many to financial ruin with sub-prime mortgages and belief that the soaring stock market and housing boom would never end. And of course the recent recession is another example of how unflinching optimism could backfire. She posited that we need to balance our optimism with sober reality to protect ourselves.

Simply understanding that we are biased toward optimism – that our brains will automatically affirm our choices and have us expect hopeful things -- can help us to keep a watchful eye out for hidden potential pitfalls.

As helpful as it can be, positive thinking alone cannot solve all our problems, heal all that ails us or protect us from every negative consequence in this life. Still, it can certainly help keep us smiling and hopeful through adversity.



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About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.

 

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.


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