Tag Archives: depression

Introducing GLEO: SandyG’s Positive Tetrad

Most of you would be familiar with Aaron Beck’s Cognitive Triad also known as the Negative Triad. To recap, a depressed person is characterized by negative views about the self, negative views about the world and negative views about the future.

Guilt, shame, worthlessness, not accepting the self are all aspects of negative views about the self, which I conveniently relabel as self-loathing. It can even be conceived that these self concepts are closer to a neurotic belief system.

Similarly, being pessimistic and having a sense of hopelessness, is what can be thought of as having negative views about the future. Learned helplessness, an explanatory model of depression, is more aligned with this aspect.

That leaves us with negative views about the world. Items that measure it include “No one values me” or “People ignore me all the time”; items that talk more about negative views about other people rather than world at large. Also we know that depression is characterized by rumination or repetitive negative brooding over the past. So my humble submission is that its better to break this negative views about the world into two components: one about negative views about other people and the other about negative views about the past/ present.

So, Cynicism or cynical hostility, which is characterized by cynicism, distrust, resentment, and suspicion, would be what is dysfunctional in depression as far as negative views about others is concerned. There is some evidence that high scores on cynical hostility raises the odds of being depressed 5 times the general population.

And that leaves us with the last of factors that affect depression: bitterness or negative views about the past/ present. There is an automatic negative tendency to see past as full of regrets and losses and missed opportunities and this leads to rumination and sustaining of sad mood and depression.

This however means that Beck’s triad is no longer a triad but has become a tetrad. This needs to be empirically verified but I’m sure it will be a useful construct.

Most important, from the perspective of this post is how we can flip these unconscious, negative automatic thoughts and replace them with positive automatic thoughts/ habits so as to immunize and buffer us against depression (and other disorders) . So with some fanfare I introduce SandyG’s Positive Tetard.

Self-esteem, self-efficacy, self worth, self acceptance etc are all positive processes and indicators that one has a positive view of self. Like the other three components of GLEO/Positive tetrad, these all can be developed and are state like/ trait like and not fixed in nature. Bandura for eg. has elaborated extensively on how self efficacy can be developed. Rosenberg similarly has focused on self-esteem. The E of GLEO comes from this component (self Esteem/Self Efficacy). Developing this buffers against self-loathing and is thus a protective factor.

Optimism (generalized expectancy as well as learned optimism) and hope (wills and ways) are positive processes and indicators that one has a positive view of future. Optimism interventions like Best possible future selves exercise leads to increase in optimism and again helps buffer against depression/ other disorders. The O in GLEO come from Optimism. This protective resource can again be built.

Love, compassion, kindness and altruism all come form a place where others are trusted and one has positive views about others. Interventions like loving-kindness mediation or random acts of kindness can increase the social support one feels and thus buffer against depression/ other disorders. The L in GLEO comes from Love. Other people matter and to build social support you have to start by trusting/ loving others.

That leaves us with the G in GLEO. It stands for Gratitude. Thankfulness, feeling blessed and grateful all lead to a positive view or interpretation of what has happened in the past or is continuing to happen in present. Gratitude interventions like counting your blessings or a gratitude visit leads to noticing and appreciating the good that has happened and continues to happen. This acts as a strong antidote to feelings of bitterness and buffers against depression.

Taking a bird’s eye view, sadness driven by ruminating on past events leads to depressive disorders and can be prevented by gratitude interventions. Fear driven by apprehension of future events leads to anxiety disorders and can be buffered against by optimism/ hope interventions. Anger driven by cynical hostility towards others leads to aggression(intermittent explosive disorder)/ conduct disorders and can be protected against by cultivating kindness/ compassion etc. Finally, disgust (with self ) that may be driven by self-loathing may lead to neuroses / impulsive and compulsive disorders (OCD, personality disorders etc) and can be prevented by developing self esteem, self compassion etc. I know this is slightly conjectural, but I have good reasons to extend this tetrad beyond depression.

Finally, how this new concept of GLEO/SandyG’s Tetrad compare to existing constructs like HERO/PsyCap and the ‘light triad‘ ?

HERO/PsyCap I believe is limited by its focus on work domain. It gets the Hope/Optimism and Self-Efficacy part right but stops short. Self-concept should include more things like self esteem and adding gratitude and love to the model makes it many fold strong and in a sense equivalent to my model as Luthans is explicit that PsyCap is state like and can be developed. However, I see of GLEO as more processes than as either trait like or state like.

‘Light Triad’ on the other hand is posited as opposed to the ‘dark triad’ and is more or less a personality trait construct. Perhaps, Cynicism is a milder and passive form of the dark triad and Love/compassion/altruism is the milder form of the light triad. I think of it in these terms, but I may be mistaken.

I am excited to unveil this model; does this resonate with you? Should we all cultivate GLEO as a path to glee and happiness?

Depression : Symptoms and Subtypes

Depression is one of the most common mental illness; as a matter of fact it has been said to be the common cold of mental disorders- almost everyone gets it one time or the other. ~57 million people, in India itself, are estimated to suffer from depression. However, depression thought currently diagnosed and classified as one entity,  is not a homogeneous illness in practice. There are different sub-types of depression.

But first lets recall the symptoms of depression. These I have drafted in ABCD terms for easy recall. Its also useful to think of symptoms as tings that are added to normal experience (the positive symptoms if you may) and things that are missing (the negative symptoms) – although this distinction is usually made in case of schizophrenia. Also important to remember is that at least 5 of the following symptoms need to be present for at least 2 weeks for a clinical diagnosis.

  1. Affective:  Presence of affect : Low mood or prolonged sadness is an affect that is present, and required for diagnosis of depression. The sad emotion is something that has been added.
  2. Affective : absence of affect: Typically one feels pleasure while doing small everyday activities like having a cup of coffee in the morning. A depressed person doe snot feel pleasure form such activities and suffers from Anhedonia – on the inability to experience pleasure. Here something has been taken away from the normal experience.
  3. Behavioral:  presence of behavior: Depression results in abnormalities in sleep, appetite and body weight. When excess sleep (hypersomnia) or excessive appetite or psychomotor agitation or weight gain appears that can be a symptom of depression.
  4. Behavioral:  absence of behavior: Depression results in abnormalities in sleep, appetite and body weight. When loss of sleep (insomnia ) or less appetite or psychomotor retardation or weight loss appears that can be a symptom of depression.
  5.  Cognitive: presence of thoughts/ beliefs: dysfunctional beliefs are present in depressed people including worthlessness and guilt. These thoughts do not make or dominate the normal thought repertoire of most people.
  6. Cognitive: absence of cognitive capacity: Depressed people are not able o think or concentrate; they are also indecisive. All these are cognitive capacities that are lacking or compromised as compared to normal folks.
  7. Drive: presence of motivation : Here I am tempted to put suicidal ideation and attempts: a drive to escape from life and end it. Something again not normally found in normal people, but a motivational force for the depressed person.
  8. Drive: absence of motivation: Anergia (loss of energy) and fatigue go here: one feels drained and unwilling and unable to do anything. Again normal people have decent amount of energy or drive  and this is somewhat deficient in the depressed person.

Now that we know what depression looks like, and how its diagnosed (above is as per DSM-5 criteria), what can we conjecture about the heterogeneous nature of depression?  One useful way to think about depression sub-types is to think of whether it is predominantly Affective in nature, or is it Behavioral or Cognitive or Motivational. Could this differentiate among meaningful sub-types?

For this it may make sense to refer to this paper [pdf] about which I blogged some time back. Please do read my blog or the original paper. The authors identified two dimensions of Anhedonia and Anxiety and identified four neural subtypes of depression. They replicated the four subtypes in Generalized Anxiety Disorder (GAD) too which is closely related to depression.

It is instructive to note that in that paper, that Anhedonia axis is affect related while Anxiety axis is more cognitive.  To me the four subtypes appear as equivalent to whether the predominant symptoms are affective (subtype 3), or whether they are behavioral (subtype 1?) or cognitive (subtype 4?) or motivational (subtype 2).

Irrespective of what the underlying subtypes may refer to, its clear that depression is heterogeneous and the better we identify and start treating the subtypes differently the better it will be for those suffering from depression.

Anxiety, Depression and the Internalizing Spectrum

Pathological mental health problems in children and young adults have been classified into externalizing (substance abuse, conduct disorder etc) and internalizing disorders (depression , anxiety etc). Today’s post will try to  work out the structure of this internalizing spectrum.

English: An anxious person

English: An anxious person (Photo credit: Wikipedia)

The first major difference, that is made in say DSM, is between Mood disorders (disturbance in mood) and Anxiety disorders (characterized by anxiety and avoidance behaviors) . However, Watson in this article (pdf) emphasizes that this classification is not proper and in many cases these disorder say depression (say MDD) and Anxiety (say Panic disorder) are co-morbid with each other.

To explain this as well as other genotypical and phenotypical findings, Watson has developed a structure of these ‘distress disorders’ – however the road was long, an intermediate stop was tripartite model of depression/anxiety.

According to this tripartite model (developed by Watson and Clark), both depression (MDD, dysthymia etc)  and anxiety disorders (phobia, panic etc) share a common non-specific factor called Negative Affect (NA) which is characterized by things like preponderance of negative emotions like sadness, fear, guilt, anger etc as well as irritability, difficulty concentrating etc.

Depressive disorders meanwhile are specifically characterized by lack of Positive Affect (PA), which means less emotions like happiness, interest etc, but also Anhedonia or inability to derive pleasure from earlier pleasurable experiences.  Anxiety disorders, on the other hand, are characterized by physiological hyper arousal (PH) (shortness of breath, dizzyness etc) .

This model however was also found wanting and replaced with an hierarchical integrative model, which posited that there was a generic non-specific factor of NA common to both anxiety and depressive disorders, and a lower order low PA factor characterizing depression and more specific multiple low order factors (instead of one PH hyperarousal factor) associated with the different types of anxiety disorders like panic/ agoraphobia, Phobia-specif stimuli, phobia social etc .

However , Watson further modified the structure and came up with this model shown below:   One broad factor of distress/NA; two specific factors of anxious-misery and fear and then further unique factor specific to individual diagnosis.

To summarize and also extending it a a bit,

  1. At top there is an internalizing spectrum and associated with it a non-specific NA factor.
  2. In middle there are four spectrum:-  a depressive spectrum , a Fear spectrum and a bipolar spectrum and an Obsessive compulsive spectrum.
  3. each of these can be further divided into discrete diagnosis along two factors/dimensions (I will not eb focusing too much on bipolar or OCD for the purposes of this post) :
    1. Depressive spectrum :
      1. group 1: MDD and dysthemia
      2. group 2: GAD and PTSD
    2. Fear Sepctrum
      1. group 1: Panic and agarophobia
      2. group 2: Phobia (specific stimuli) and Social Phobia
    3. Bipolar spectrum (bipolar I, II and cyclothymia)
    4. OCD

Lets focus more closely on Depressive and Fear Spectrum and try to see alignment with ABCD model. MDD/Dysthemia imho are mainly about mood or Affect;  GAD/PTSD are more Cognitive (reaming stuck in a thought loop) ; Panic/agorophobia more Physiological or Dynamic in nature and Phobia (both specific and Social) more Behavioral in nature (avoiding people, places and animals).

Each of these in turn splits into four factors; for ex PTSD splits into four factors- Dysphoria (A), Intrusions (C), Hyperarousal(D) and Avoidance (B). Similarly, recent research has shown that MDD is itself heterogeneous made up of four neural subtypes- one way to list those would be – marked primarily by Anhedonia (A), Anxiety (C) , Psychomotor retardation (D) and Fatigue (B) . Similar analysis should be possible for other discrete diagnosis.

For now, we will turn to the structure of Bipolar and OCD spectrum by analogy to dep/anxiety spectrum.

  1. Biploar spectrum:
    1. Euphoria (Affective)
    2. Flight of ideas (Cognitive)
  2. OCD spectrum
    1. Obsessions (Dynamic)
    2. Compulsions (Behavioural)

Within this OCD can be seen to be comprising  of four factors: Hoarding (A?) , Order and symmetry (C), Obsessions and Checking (D) and Washing and cleaning (B).

Another way to think about the depressive and anxiety spectrum is to say that Depression rgoup 1 is characterized by Low PA, depression group 2 by high PH; Fear group 1 by High PH and Fear group 2 by low PA. What distinguished Fear spectrum from Depression spectrum is the fact that much more variance is explained by High NA for depressive syndromes and only moderate variance explained by NA for Fear syndromes.

What do you think is missing from the above model? Where might it be wrong? where might it be correct? If correct what are the implications?

Goals and Depression

Striving towards meaningful goals is good for your well-being; even just having goals by themselves are indicative of well-being. This is an established dogma of positive psychology, so how can one argue that goals may be at the root of the experience called depression.

A framework that aims to throw some light on this is the dual-process Tenacious Goal Pursuit (TGP) and Flexible Goal Adjustment (FGA) theory as proposed by Brandstatdter and colleagues.

As per this framework, we all strive towards goals, but only goals that are meaningful (say goals which align with our self-identity) and attainable (we have self-efficacy beliefs and can figure out strategies to achieve the goals) lead to well-being. A goal that we find meaningful and are highly committed to, but which becomes unattainable due to either external circumstances or our internal capacities, may lead to depression.The depression, and the helplessness and rumination that accompany it, may paradoxically have the function of decreasing our commitment to the goal and releasing ourselves from that unattainable goal.

And here is where the TGP and FGA theory comes to the rescue. In view of internal or external obstacles, that is when you are not able to make progress towards meaningful goals, you may either try to change the situations or your actions to ensure that they are congruent to the goals and would thus be demonstrating an adaptive process of assimilation (not to be confused with Piaget’s use of assimilation) also known as Tenacious Goal Pursuit (TGP), or you may adjust your goals and ambitions to reflect the situations / your capacities using the process of accommodation also known as Flexible Goal Adjustment (FGA).

Now, lets backtrack a little and reflect on the many routes to happiness: some say its all in your head- that you just need to change your mindset/ perception of events and you can be happier;  others say that happiness is dependent on your situations and the actions that you take- you can and should cultivate happiness by activities and by changing your circumstances. Like all debates, like Nature-Nurture, the answer probably lies in the interaction and in-between. Haidt has famously claimed that happiness lies in-between, and I concur.

Similarly, sadness or depression may lie in your flexibility and tenacity of goal pursuits – while showing rigidity to a goal and not giving up may lead to sadness and depression, giving up too early or not being tenacious when circumstances could have been changed, may also lead to regret and sadness.

Bring Back My Happiness

Bring Back My Happiness (Photo credit: Wikipedia)

Its important to note that changing circumstances/ TGP etc are active processes; meanwhile changing mindset/ FGA are relatively passive processes, in that they happen in the background and not so much consciously.

That brings me to my major thesis: Depression is a disorder characterized by inability to use the adaptive process of FGA optimally. To me, Depression is a disorder of Behavior related to the Passive polarity of the ABCD Behavioral dimension. When one has a goal, to which one is committed, but is no longer attainable (and this may include an irreparable loss like bereavement ) then most people will use Flexible Goal Adjustment to come out of that state. However, the people with depression may be less able to use FGA and may remain committed to unattainable goals.

One of the evidence that comes to mind is, and for this you have to refer to my previous post about personality disorders and emotions,  that the passive pole of Behavior dimension in ABCD model is also associated with Dysthemic and borderline personalities and hypothesized to be associated with the Conscentiousness trait. Now, It does seem that there is some evidence that highly conscientious people who have high commitment to goals, also are more likely to get depressed following setbacks or adverse life events. This makes immense theoretical sense too.

One can also examine the Active pole of the Behavior dimension in ABCD model to gain equivalent insights. As I had mentioned in my last post, that is associated with personality disorders of Histroinic and Hypomanic personality disorders and likely associated with the trait Impulsive Sensation Seeking. Extending this joy/ happiness related dimension, all these are also likely to be associated with the active process of Tenacious Goal Pursuit; here it is instructive to note that a high score on Impulsive Sensation Seeking may prevent TGP from happening as the person may keep moving from one activity to the other; and extremes of this may lead to manic behavior. The high scores on Impulsive Sensation seeking leading to less TGP leading to full-blown mania, is similar in nature to high scores on Conscientiousness leading to less FGA leading to full-blown depression.

To me, this seems a novel and fruitful approach to think about and conceptualize depression- as an inability to give up goals that are no loner feasible. If we focus more on this aspect, perhaps we need to augment our talking therapies of CBT etc that focus on negative self-talk and also introduce safe spaces and experiences whereby people can indulge in Flexible Goal Adjustment and give up on goals that are no longer feasible and replace them with other more meaningful and attainable goals.

Growing From Depression

“Growing from depression” is a short, easy read on the subject of the depressive experience and how to make best use of and grow from that experience. The book is written by Dr. Neel Burton, who is a psychiatrist as well as a philosopher, and an exceptionally good writer.

“If I had more time, I would have written a  shorter letter” so wrote Pascal/ Twain and in case of Neel he seems to have spent enough time on this book, making it succinct yet easy to understand and follow by a layman.

The book is organized in four sections; one dealing with defining and delineating depression – an experience that is bound to affect us or our close family/friends once in the lifetime. Some estimates have put lifetime incidence of depression as high as 30 percent , which means we are either a sufferer or a caregiver at some point, thus the importance of the topic.

The second section deals with current treatments for depression, including CBT, ECT and antidepressants. Maybe in future editions newer treatments like Metacognitive therapy or rTMS/ DBS can be explored and elaborated at in depth.

The third section makes the meat of the book- its a self help section with bite sized chapters making one think aloud and get help growing from the depressive experience. Given that Neel is a philosopher, some chapters do digress a bit and become more philosophical/ at tangent with the main premise of the book, but overall the suggestions and elaboration is grounded in what we do indeed know about depression- including things like depressive realism.

The last section is related to mental health services and mental health law and has limited appeal to international audience as its focused and based around the UK health care system and the UK laws.

Overall, its a pretty good read and makes you realize that there is much that you can gain from the depressive experience- including wisdom as to how prevent a relapse by controlling daily stress, maintaining good daily habits like exercise etc.

I wish many more experts and scientists  were able to break up from the jargon, and write a self help book for people at large. I am sure we all will be richer for that!

Buy the book here.

Manic Depressive Leaders in a Time of Crisis

S. Nassir Ghaemi, in his book, A First Rate Madness: Uncovering the links between  Leadership and Mental Illness, makes a case for the fact that while ‘normal’ leaders are good in times of stability and peace; in times of crisis, mentally ill or mentally abnormal people make for better leaders.

He does this via historical analysis of leaders like Gandhi, Martin Luther King jr, Franklin D. Roosevelt, Winston Churchill, Abraham Lincoln etc. Some of these leaders he classifies as being predominantly depressive, others as manic while the rest as being of bipolar proclivity. In the book he writes:

The depressed person is mired in the past; the manic person is obsessed with the future. Both destroy the present in the process.

He lists four traits that distinguish a manic/depressive leader from other normal leaders: Empathy, Resilience,  Creativity and Realism! I can easily map these to the ABCD dimensions: empathy is an Affective trait (the ability to feel emotions), resilience is more about Behaviors (bouncing back from failures), creativity is related to Cognition (ability to think in a divergent manner) while realism can be linked to Desire/Dynamism (do we do realistic assessments).

He claims, and I find that claim very attractive and true, that depressive people typically are better at empathy and realism, that is, they have heightened empathy and realism as compared to the normal population; in a similar vein, manic people are typically better at creativity and resilience than the normal population.

If one views depression and mania  as somewhat opposed to each other. at least on on some dimensions, it goes without saying that depressive people may be less creative (they are typically stuck in ruts)/resilient (they often cant cope and sometime stake the extreme step of suicide); similarly, in a manic phase, people may be less realistic (may even become psychotic losing touch with reality)/ empathetic (may not be able to get inside the head of others).

While a depressive or manic phase may be debilitating, the relatively ‘normal’/symptom free period may confer advantages on depressives, manics or bipolars by making them leverage their resilience, creativity, realism and empathy, especially to tide over crisis.

Why should it be the case that in normal periods a ‘normal’ leader may help, but in a crisis only an ‘abnormal’ leader may be able to rise to the occasion? The answer lies in evolution and genetic diversity. Consider moths that are generally gray in color, but some are darker (closer to black) while some others lighter (white in color) . The majority gray moths are the ‘normal’ moths, while the minority black and white are abnormal ones. Now these moths are exquisitely adapted to their environments, and typically gray moths will flourish. However if the area has suddenly become polluted such that darker color moths are now less easier to detect than the gray moths by the predators, then dark moths will thrive at the cost of  light moths.

A similar analogy can be applied to humans. Normal leaders are adapted to stable conditions; while in times of crisis, more atypical brains may suffer greater advantage.

So next time you select a leader, be mindful of whether its a change/crisis situation or a stable situation; if a crisis/ change situation, you may do well to do some reverse discrimination and select a mentally ill/ abnormal person as a leader!!

Why is the world vivid in mania, but bleak in depression?

Down in a hole
Image by ParanoidMonk via Flickr

ResearchBlogging.org
No, I am not speaking metaphorically. Quite literally,there has been accumulating evidence that sense are sharpened and have great acuity in mania while they are dulled in depression and the effects can be seen within the same individual over time as he/she suffers from manic/depressive episodes.

The latest study to add to this literature is by Bubl et al that found that depressive people’s brain registered lesser contrast than that registered by normal control brains when presented with same black and white images. They used pattern electroretinogram (PERG) to find whether the contrast gains registered by depressive retinas (those suffering from MDD) were different from those of controls and they found a strong and significant association with the severity of the depression.

I have covered earlier studies that found that sense of taste was compromised in depression (and enhanced in mania) and similarly that the sense of smell showed similar effects. Some snippets from the earlier posts:

What this means is that if you increase the amount of serotonin in the brain, then the capacity to detect sweet and bitter tastes is increased; if you increase noradrenaline levels those of detecting salty and bitter tastes is augmented; while a general increase in anxiety leads to better bitter taste detection. This also means that an anxiety state produces more bitter taste perception whereas a depressive state (characterized by low serotonin) is marked by bland sense of taste with marked inability to detect sweet and bitter tastes. A stressed state , marked by abundance of noradrenaline, would however lead to more salty and bitter taste perception.

and…

In one of my earlier post on depression, I had commented on the fact that those suffering from depression have less sensitivity to sweet and bitter tastes and as such may compensate by eating more sugar thus leading to the well documented diabetes – depression linkage.

In a new study it has just been discovered that not only depressives have bland sense of taste, their sense of smell is also diminished and they may make compensations by using greater amounts of perfume. Overall it seems that those suffering from depression will have bland subjective experience of flavor(which is a combination of both smell and taste) and thus may even not really find what they eat to be tasty.

Further on, I speculate prophetically that blander vision will also be found:

To me, this is an important finding. To my knowledge no research has been done in other sense modalities (like vision), but there is every reason to think that we may discover a bland sense of vision in depression. Why do I surmise so? this is because there is extensive literature available regarding the manic state and how things seem ‘vivid’ during that state including visual vividness. If depression is the converse of Mania, it follows that a corresponding blandness of vision should also be observed in those who are clinically depressed.

We also know that in extreme or psychotic forms of Mania, auditory hallucinations may arise. I am not suggesting that hallucinations are equal to vividness, but I would definitely love to see studies determining whether the auditory sense is heightened in Mania (maybe more absolute pitch perception in Mania) and a corresponding loss of auditory absolute pitch perception in depression. If so found, it may happen that music literally becomes subdued for people with depression and they sort of do not hear the music present in everyday life!

Whether other sense like touch, vestibular/ kinesthetic , proprioception (a heightened sense of which may give rise to eerie out-pf-body experiences in Mania) are also diminished in depression is another area where research may be fruitful.

Of course I have also speculated about the others senses and would love to hear studies supporting/contradicting this thesis. But given that senses are attenuated in depression and exaggerated in mania the question remains why? Which brings me to the topic of this post- why is the world bleak /bland to a depressive and vivid for a manic?

This was also the question asked by Mark Changizi (@Mark_Changizi) on twitter with respect to this new study uncovered today and I replied that this may be due to broaden-and-build theory being applied to sensory domain or sensory gating phenomenon differentially acting in manic/ depressive states, while Mark was of the opinion that it might be the result of physiological arousal with arousal being the variable of interest controlling whether the sense remain acute or dull?

I do not see the two views necessarily contradictory and it may be that chronic affect per se activates arousal and that is the mediating variable involved in its effect on senses; and we can design experiments to resolve this by measuring the effect of state sadness/ happiness/arousal on visual acuity (if the effects of state manipulations are big enough); howsoever, I woudl like to elaborate on my broaden and build theory.

In the cognitive, psychological and psychosocial domains the broaden and build theory of positive affect is more or less clearly elaborated and delineated. I wish to extend this to the sensory domain. I propose that chronic positive affect signals to our bodies/brains that we can afford to make our attention more diffuse, let senses be perceived more vividly as we have more resources available to process incoming data; conversely in a chronic low affect state we might like to conserve resources by narrowing focus/ literally narrowing the range of sensory inputs/reducing the sensitivity of sense organs and pool those resources elsewhere.

I know this is just a hypothesis , but I am pretty convinced and would love to hear the results of experiments anyone conducts around this theory.
Bubl, E., Kern, E., Ebert, D., Bach, M., & Tebartz van Elst, L. (2010). Seeing Gray When Feeling Blue? Depression Can Be Measured in the Eye of the Diseased Biological Psychiatry, 68 (2), 205-208 DOI: 10.1016/j.biopsych.2010.02.009

Enhanced by Zemanta

stress and neurogenesis: the orchid -dandelion effect

ResearchBlogging.org

Orchid
Image by santoshnc via Flickr

Chronic stress in mice leads to the ‘learned helplessness‘ model of depression in mice. Also, from studies in humans as well as other animals we know that chronic stress is a risk factor and cause for depression and this is mediated by the interactive effects of two stress related systems: “the neural substrate for the organism’s stress response comprises two anatomically distinct but functionally integrated circuits, the corticotropin-releasing hormone CRH system and the locus coeruleus–norepinephrine LC-NE system.”

The relation between cortisol level/ activity in the CRH/LE-NE system and stress related maladaptation is not simple , but the relationship is complex.

There are many theories of depression. A finding that has gained ground in recent years is the enhanced neurogenesis due to administration of anti-depressants and how the action of anti-depressants may be due to their enhancing neurogenesis effects.

However this new study in PNAS, conducted on mice,  casts doubt that the relation between stress/depression and neurogenesis is simple. It seems the relation is as complex as that between stress/depression and the cortisol levels.

I would first like to briefly summarize the findings of the study:

  • chronic stress paradigm used was that of social defeat (cohabitation with a socially dominant conspecific). 10 days of this social defeat were administered. this typically leads to social avoidance behaviors and these behaviors are correlated with other depressive phenotypes.
  • after 10 days when social avoidance (time interacting with a potential friendly con-specific) was measured it was found that about half the mice exhibited social avoidance and were sensitive to the stress; the rest of the half were ‘resilient’ and did not differ from control mice (not exposed to chronic social defeat) in their social avoidance.
  • all mice, both resilient and sensitive , showed decreased proliferation in subgranular zone (SGZ) for new cells immediately after stress exposure. This effect disappeared / normalised after 24 hrs.
  • Cell survival for cells created before stress exposure was not affected by stress exposure.
  • cell survival for neurons created 1 day after stress exposure was enhanced selectively for those mice that were susceptible or sensitive to stress, but was not enhanced for the resilient mice or the mice taken as a whole.
  • when the mice were irradiated, before stress exposure,  to prevent neurogenesis, then the social avoidance behavior, even in susceptible mice disappeared. It is thus evident that social avoidance is mediated by increased neurogenesis post-stress exposure in the susceptibel mice.

Overall, the results I believe are clearly in favor of conceptualizing the susceptible mice as ‘orchid’ mice – having enhanced tendency for neurogenisis following positive/negative events of interests. they are biologically sensitive to context and exhibit neurogenesis reactivity similar to stress reactivity shown by orchid children. Given a positive life experience the increased neurogenesis post-event helps in having happy memories and cognition s and better functioning; preponderance of negative life vents in contrast lead to more negative and longlasting cognitions and memories leading to reduced functioning. Of course the dandelion mice are resilient and not that much affected by chronic stress. However, they would also not be able to make best use of environment in good conditions.

The only hiccup I see in the whole scheme of things is the effect of anti-depressants on neurogenesis and my earlier theorizing that cells may die under repetitive stress and reduced or absent neurogenisis would be a prime factor in depression. However, the relation between neurogenesis and stress will be , I am sure, complex and needs to be settled empirically, rather than theoretically.  However one thing is clear, neurogenesis has a rpime role to play in depression , mediated perhaps by, chronic stress exposure and genetic diatheisis (orchid-dandelion effect).

I am excited and would love to hear of more papers that are addressing this new trend in depression – neurogenesis research keeping in mind the biological sensitivity to context thing too.

Reblog this post [with Zemanta]

Lagace, D., Donovan, M., DeCarolis, N., Farnbauch, L., Malhotra, S., Berton, O., Nestler, E., Krishnan, V., & Eisch, A. (2010). Adult hippocampal neurogenesis is functionally important for stress-induced social avoidance Proceedings of the National Academy of Sciences, 107 (9), 4436-4441 DOI: 10.1073/pnas.0910072107

Am Manic, will focus; Am sad, will drift

ResearchBlogging.org

Lucky Guy Happy Gal... :-)
Image by wazari via Flickr

Attention can be focused or it can be diffused. Attentional focus has been shown to be affected by mood or affect; with positive affect leading to a broadening of attentional focus;  and negative affect, in general been shown to be associated with a narrowing of focus.

However, Gable and Harmon-Jones argue that emotion or affect is not a uni-dimensional construct, but has at least two dimensions: affective valence- i.e. whether it is felt as pleasurable or dis-pleasurable; and motivational  direction- i.e. the action tendency to approach or avoid in pursuit of a preventive/promotional goal.

Much work on emotions has emphasized that they have a number of underlying dimensions. Two dimensions that have received considerable attention are affective valence, the felt pleasure or displeasure, and motivational direction, the action tendency associated with a particular emotional state—approach or withdrawal. Approach motivation refers to an urge or action tendency to go toward an object, whereas withdrawal motivation refers to an urge or action tendency to move away from an object.

They also argue that much of the extant literature on emotion-attention linkage has focused on emotional valence alone, with just one type of motivational direction, and thus has not clarified the (in)dependent role of valence and motivational direction as regards to attention.

Thus, for e.g., the finding that positive emotions lead to  broadening of attention is focused on such research as emotions of joy, contentment etc that are low in approach motivation and are emotions felt after the goal has been reached.

Similarly, the research that has found that negative emotions lead to narrowing of focus have relied on emotions such as fear, anger etc that are high in withdrawal motivation and are pre-goal.

I believe, it is important to step back a little here and go back to our conception of happiness-ennui (mental well-being) continuum and sadness-mania (mental illness) continuum. Another way to conceptualize them is to see sadness having negative valence and low withdrawal motivation – it is passive; mania as having positive valence and high approach motivation- mania is characterized by immense desire for a goal and is pre -goal. Happiness is post goal emotion and is characterized by positive valence and low approach motivation- you have already reached the goal and do not need to exert much efforts in goal directed activity; ennui/boredom/listlessness is negative in valence and has high withdrawal motivation- it is pre-goal- a search for a worthwhile goal.

Another way to make the difference stark is employ the terminology of Berridge et al: happiness is related to liking and the opioid system; while mania is related to wanting and the dopamine system.  Depression/sadness  is related to disliking /feeling pain while ennui/boredom is related to dreading the outcome/feeling anxious (nothing to do and hence life is useless/meaningless!..anxiety but existential anxiety). Berridghe et al have shown that wanting/liking and dreading/disliking differ and have different neural and neurochemichal correlates.

To become a little philosophical, the wanting/disliking  mental illness continuum leading to mania or depression in extremes is to be avoided (thus the dictum of all religions to shun desire/ be stoic) while the happiness-ennui/boredom/existential anxiety system is more preferable where you focus on liking positive outcomes and dreading negative/neutral ones. While the former, to paraphrase Freud,  is the hysterical misery at worst, the latter is common unhappiness at worst.

But anyway that was long detour. Lets get back to the studies by Gable et al.

In the first study, the authors showed that motivational direction was relevant and was the reason behind the positivity-broadening of attentional focus effect. they showed that positive emotions lead to broadening of attention only in low approach motivation condition; but when the positive emotion had high approach motivation (emotions like desire. engagement etc), the positive affect lead to narrowing of focus.

Now a brief detour into methodology: the attentional focus is usually measured using local-global tasks whereby it is determined whether one is paying attention to global features or local features of an ambiguous/mixed stimuli. For eg, the most popular of these consists of a global big H made up of smaller (say 5 in number) F’s and then determining whether the subject notices the global H or the local F. Details can be seen in the Gable papers which are open access.

Now the authors found robust support for their hypothesis that it is the motivational direction and not affective valence that determines the attentional focus. They also relate it to adaptivity.

Positive affects, particularly those low in approach motivation, suggest a comfortable, stable environment and allow for a broadening of attention and cognition, which may serve adaptive functions (Carver, 2003; Fredrickson, 2001). However, broadening does not occur when positive affects are high in approach motivation. Such positive affects often encourage specific action tendencies, such as tenacious goal pursuit, and an associated reduction in attentional breadth. This reduced attentional breadth may prove adaptive, as it assists in obtaining goals.

They also extend these finding to negative affects and depression etc and I can easily relate them to earlier work I have covered regarding the danger or safety of environment and promotional/ preventive focus:

Together with past research, the present research supports the idea that low- and high-approach-motivated positive affect produce opposite effects on attentional breadth. It is possible that the intensity of withdrawal motivation exerts similar attentional effects; that is, low-withdrawal-motivated negative affect may cause broadening, whereas high-withdrawal-motivated negative affect may cause reduction in breadth. Indeed, such an interpretation would fit with past research. For example, individuals with depression, a low-intensity motivation, are more creative than nondepressed individuals (Andreasen, 1987) and show broadening of attention and memory (von Hecker & Meiser, 2005). In the case of low-motivated negative affects such as sadness and depression, “a more open, unfocused, unselective, low-effort mode of attention would prove not deficient but, on the contrary, beneficial” (von Hecker & Meiser, 2005, p. 456), as one disengages from a terminally blocked goal and becomes open to new possibilities (Klinger, 1975). The past research that found negative affect caused decreased attentional breadth may have evoked negative affective states that were high in withdrawal motivation (e.g., fear; Gasper & Clore, 2002).

This brings me to their current paper , aptly titled , The Blues Broaden, but the Nasty Narrows, that found exactly the effect hypothesized above that sadness/depressive mood was related to broadening of attention, while disgust, a negative emotion with high withdrawal motivation was related to narrowing of focus. they also found that the effect of negative emotion was mediated by arousal which could stand as a proxy for motivational direction.

These two experiments revealed that the relationship between negative affect and attentional precedence is more complex than commonly thought. In line with past theory and evidence, Experiment 2 demonstrated that negative affect caused a narrowing of attention. However, this narrowing occurred only when negative affect was high in motivational intensity. When negative affect was low in motivational intensity, in Experiment 1, it caused a broadening of attention. These results are consistent with the idea that the effect of emotion on local/global precedence is not due to negative versus positive affect, but is instead due to motivational intensity. Positive and negative affects of low motivational intensity broaden attention, whereas positive and negative affects of high motivational intensity narrow attention.

To me this is sufficient, clinching and converging proof of the theories I have been trying to develop with regards to emotions (specifically mania, depression, happiness and despair) and make clear that there are at least two dimensions to happiness/sadness and mental well being/illness constructs. Perhaps if we start liking what we have and stop coveting or wanting more, we have a philosophical, religious, as well as now a psychological, blueprint for how to lead the good life and how to avoid a living hell.

Gable, P., & Harmon-Jones, E. (2010). The Blues Broaden, but the Nasty Narrows: Attentional Consequences of Negative Affects Low and High in Motivational Intensity Psychological Science, 21 (2), 211-215 DOI: 10.1177/0956797609359622
Gable, P., & Harmon-Jones, E. (2008). Approach-Motivated Positive Affect Reduces Breadth of Attention Psychological Science, 19 (5), 476-482 DOI: 10.1111/j.1467-9280.2008.02112.x

Reblog this post [with Zemanta]

Chronic stress, neurogenesis and depression

ResearchBlogging.org

Diagram of hippocampal regions in a rat brain....
Image via Wikipedia

Chronically stressful life events have been shown to lead to depression. Chronic stress leads to hyperactivity of HPA axis leading to more glucocorticoids (cortisol) in the human body. This excess cortisol in term is proposed to underlie the affective symptoms of depression. Also, depressive people have been found to have up to 20% smaller hippocampal volume, and a recent theory is gaining ground that depression is due to reduced neurogenesis. Even if the entire spectrum of depressive symptoms is not due to reduced neurogenesis and atrophied or smaller hippocampus, at least the cognitive symptoms of depression are largely due to this.

I stumbled upon a commentary by Robert Sapolsky that although is 10 years old, but I still found interesting and worth bringing to notice of my dear readers. In it Sapolsky looks at a study by Czeh et al that found evidence linking reduced proliferation in dentate gyrus and a shrunken hippocampus to depressive stress as modeled by psycho-social stress paradigm in tree shrew. Also, they found that an antidepressant, tianeptine, reversed the effects of stress by restoring proliferation and hippocampus size and thus reversing symptoms of depression. However the level of glucorticiods were still higher, after anti-depressant treatment, and thus it is apparent that anti-depressants work downstream of stress induced increase in glucorticoids.

Sapolsky believes that the data support either of models presented in figure 1A or figure 1B i.e. the increased glucocrticoids can lead to shrinkage of hippocampus directly or through their effect on affective symptoms. I believe figure 1C is also possible and its not necessarily incompatible with 1A or 1B and that increased stress may lead to increased cortisol- may lead to reduced neurogenesis may lead to shrinkage of hippocampus and which may in turn lead to affective and cognitive symptoms.

An alternative to reduced neurogenesis/ proliferation theory is the dendritic atrophy/ neurotoxicity theory that posits that shrinkage of hippocampus is due to cell death/ white matter loss. This again is a possibility but the evidence in favor of reduced neurogenesis is growing and becoming strong by the day.

Overall the new paradigms in depression research that look beyond serotonin or mono amine imbalance is a welcome trend and hopefully would lead to better interventions and prevention strategies and not just better pharmaceutical innovations. Its time one realized the rile chronic stress play sin depression and how that can be easily prevented to reduce the mental health burden.

Sapolsky, R. (2001). Depression, antidepressants, and the shrinking hippocampus Proceedings of the National Academy of Sciences, 98 (22), 12320-12322 DOI: 10.1073/pnas.231475998
Czeh, B. (2001). Stress-induced changes in cerebral metabolites, hippocampal volume, and cell proliferation are prevented by antidepressant treatment with tianeptine Proceedings of the National Academy of Sciences, 98 (22), 12796-12801 DOI: 10.1073/pnas.211427898

Reblog this post [with Zemanta]