“If you have the capacity to respond to reward, then you have the placebo effect,” says neuroscientist and radiologist Jon-Kar Zubieta, senior author of the new study published this week in Neuron.
In this study they used brain imaging techniques. The 14 volunteers were told they would receive painful injections of saltwater in their jaw muscles. This shot would be followed by a painkiller. Half of the volunteers would receive the painkiller and the other half would be injected a fake painkiller, so they were told. However all volunteers were injected with the fake painkiller (placebo). During this procedure they were monitored with brain imaging techniques (positron emission tomography (PET) scans).
The scans showed that half of the participants who believed they were receiving painkillers reported feeling significantly less pain than did other volunteers. Their dopamine levels were noticeably higher (than that of the others) from the moment they were told they were receiving authentic painkillers.
On another day these fourteen with 16 new volunteers were brain scanned with functional magnetic resonance imaging (fMRI) during a card gambling game. They were told they could win or lose a certain amount of money each round; they would then push a button to determine the real take.Several of the participants showed a flurry of activity involving dopamine release in the nucleus accumbens while awaiting the outcome, indicating that they were expecting a reward. These participants were also the people reporting pain relief from the fake painkiller. So there is a strong link between the reward system (dopamine, nucleus accumbens) and the placebo effect. With this result you can predict the placebo response or even develop techniques targeting the dopamine system to increase the placebo effect.
A commentary in the JAMA by Prof Max Fink. In this commentayr he sumarizes the most important recent topics in ECT.
1. Remission for depressive illness with ECT: 55%-86%, these results compare favorably to the response rates in the STAR*D trial.
2. Relapse prevention after ECT, nortriptyline with lithium is first choice, continuation ECT for patients who relapse despite this treatment and for those who may not tolerate medication.
3. ECT is a primary treatment for psychotic depression.
4. ECT reduces the acute risk for suicide.
5. Medication resistance does not bare relation to treatment efficacy with ECT.
6. He still favours bilateral electrode placement.
7. Important side effects are anterograde-, retrograde amnesia.
8. Vagus Nerve Stimulation and Deep Brain Stimulation are not comparable in efficacy to ECT.
This is in short his few about the recent achievements in ECT treatment and it’s research. His preference for bilateral ECT is a topic for debate. Unilateral electrode placement is technically more complex but comparable in efficacy when done the right way. That is with supratreshold stimulus dosage after stimulus titration during the first session. Research with side effects should be done for the long term and focussed on individual differences
These are the words of a wise old man. George W. Comstock, an epidemiologist renowned for proving both what worked and what didn’t in the prevention and treatment of tuberculosis. He died last sunday of prostate cancer on the age of 92 and he had never retired.
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The secret modality is ‘Tantric Kundalini movement’ on the table. The orgasmic way of exercising motion in the body, like a protoplasm swimming in a liquid wonderland. A full body systemic response is healthy and enjoyable. Guess what, life comes from water (Jing) and when human tissue becomes’ stagnate, it dies.
Tantra without breath training is not Tantra! I teach you the way of the cobra; relaxing the belly (ego), toning and strengthening the sacred pleasure at the tip of your spine. Give yourself permission, let your spirit rise and unfold before you. Oscillate like a snake on the table, feel your animal nature unwinding.
Prostate cancer is the most common cancer in American men. It is the second leading cause of cancer deaths in men. Cancer is caused by a lack of oxygenation in cell development, causing erratic cell division. This can be prevented with good local circulation from cellular stimulation, fascial release, and lymphatic drainage. It can also be detected by doing a prostate cancer screening.
Comstock said of his career: “I never really thought too much of it in terms of achievement. While there are people in science, of course, who are shooting for the Nobel Prize, who are shooting to be the top dog in this field, but I think most of us are just interested in learning something that will push the knowledge a little bit further ahead. And, you know, that’s gratifying.”
For his achievements you can read an article at WSJ.com Health Blog by Jacob Goldstein.
For me these words are an example of wisdom that struck me.
The way adolescents act and react such as poor decision making, recklessness, and emotional outbursts makes many parents hopeless. At least that’s what I remember from my parents although I was a very agreeable adolescents. The title of this post is by Dr. Huxtable, Bill Cosby in The Cosby Show who has the same opinion as many parents.
As a psychiatrist I am also a consultant for a adolescent unit in our hospital. The consults are very few but mostly about depressed adolescents. I find it very hard to diagnose depression in this category of patients, they do have symptoms comparable to adults but they can also differ in their symptoms.
Can adolescents be depressed, is it the same as with adults? I wonder. So I have chosen to explore this topic from a more scientific, biological view point. Are the brains of adolescents different than those from adults, can these brains become depressed or are their differences explaining a different symptom pattern and treatment needs?
Brain maturation continues into the teen years and continues even into the 20’s. During the teen you get an overproduction of gray-matter. Gray matter is distributed at the surface of the cerebral hemispheres (cerebral cortex) and of the cerebellum (cerebellar cortex) mostly, but also in the deeper centres of the brain.
After the overproduction of gray matter the brain undergoes a proces called “pruning”. Pruning is a neurological regulatory process, which facilitates a productive change in neural structure by reducing the overall number of overproduced or “weak” neurons into more efficient synaptic configurations. It is often a synonym used to describe the maturation of behavior and cognitive intelligence in children by “weeding out” the weaker synapses. Connections among neurons in the brain that are not used wither away. This is also called: the use it or lose it principle.
This pruning proces makes the brain more efficient by strengthening the connections that are used most often, and eliminating the clutter of those that are not used at all.
Functional magnetic resonance imaging (fMRI) research found that compared to adults teens’ frontal lobes are less active during the showing of pictures of people with fearful expressions and their amygdala is more active. The frontal lobe is the seat of goal oriented rational thinking and the amygdala is involved in discriminating fear and other emotions.
Teens often misread facial expressions, the judgement insight and reasoning power of the frontal cortex is not up up to the task yet as it is in adults. Adolescents process information differently from adults.
What does this mean?
1 Adolescents are “hard wiring” their brains during this period in life, that’s probably why this is the period for education
2 This explains why adolescents fail to to heed adults’ warnings, they may simply not be able to understand and accept logical arguments
3 It is also possible that adolescents misperceive or misunderstand the emotions of adults, leading to miscommunication
4 Adolescence seems not to be the right time to experiment with alcohol and drugs
The question about depression and adolescence in view of brain development remains for a next article, to be continued
Cyberonics Inc. on Monday said the United States Food and Drug Administration has approved its Demipulse and Demipulse Duo generators for commercial release. The products are used for vagus nerve stimulation, which is used in the treatment of epilepsy and certain types of depression.
In August 2006 Cyberonics saw the FDA reject the company’s application to use its implantable generator to treat depression in patients who do not respond to medications. Mainly due to disappointing results of clinical trials. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on. For summary of safety and effectiveness data see this FDA rapport.
The pacemaker-like device, which is surgically implanted into a patient, has been available in the U.S. since 1997 as a treatment for epilepsy.
VNS uses a stimulator that sends electric impulses to the left vagus nerve in the neck via a lead implanted under the skin. The left vagus nerve is stimulated rather than the right because the right plays a role in cardiac function such that stimulating it could have negative cardiac effects. The exact method of therapeutic action is unknown, but VNS has been shown to affect blood flow to different parts of the brain, and affect neurotransmitters including Serotonin and Norepinephrine which are implicated in depression. Some patients experience an alteration of voice quality and loudness during the time that the pulse is being delivered to the vagus nerve. Other common side effects include hoarseness, throat pain, cough, shortness of breath.
For further eading on VNS please see Wikipedia.
For more explanations about the differences between VNS, Magnetic Brain Stimulation and Deep Brain Stimulation, please see this website from Biotele.
For more information about VNS see this page from the Mayo Clinic. And this one for Deep Brain Stimulation.
My opinion is that efficacy is not proven for these treatments for depression although there are patients that can benefit. Before you try one of these methods be sure they have been treated with all regular options including ECT or electroshock.
The New York Times reveals that among specialists the psychiatrists are the one’s that get payed the most by pharmaceutical industries in the USA. In the USA drug companies are required to disclose their payments to doctors for lectures and other services. Endocrinologists received the second largest amount.
Efforts to require disclosure of payments to doctors began almost by happenstance in 1993. Compliance with the law seems to be “spotty”. In The Netherlands such laws do not exist. To my opinion it would be time to make them. Even with disclosures in abstracts, articles and lectures it is still hard to evaluate the objectiveness of some psychiatrists.
Well that’s to posts on money and health today.
In the biggest attempt yet to change the public perception of conditions such as depression and schizophrenia, three major charities are to run a TV campaign showing that many conditions thought of as incurable are treatable.
The amount of money involved in this campaign is about 16 million pounds, according to the Guardian.
Side effects of ECT, the possible memory loss is a topic for debate. Not only between psychiatrists but also between patients. Here is another story of how these side effects ruined the life of a patient. Made a comment to this post but it was not published on the blog as a comment. Here is another more positive opinion about ECT from a patient.
Side effects will be a topic for discussion for a long time. On this blog two other views are described in 2 posts. First a view from Prof Max Fink and here a post about an ongoing discussion with Prof Sackeim.
I will post your comment anyway.
An unfortunate 46 years old man had a strange side effect with a selective serotonin re uptake inhibitor (SSRI). SSRIs are antidepressants. In continuation of yesterdays post about chocolate here is another strange story. After approximately two weeks of treatment with the SSRI he noted an intense itching sensation in his scalp after eating a piece of chocolate cake.
The itch spread to the arms, abdomen and legs and the patient treated himself with clemastine and the itch disappeared. He now realised that he had eaten a chocolate cake before this episode and remembered that before the first episode he had had a chocolate mousse dessert. He had never had any reaction from eating chocolate before and therefore reported this observation to his doctor.
The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause itching when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have itching and other dermal side effects.
This case report suggests that there may be individuals that are very sensitive to increases in serotonin concentrations.
“Life is a box of chocolates, you’ll never know what you’ll get” (Forrest Gump)