Tuesday, January 24, 2012

Can't Hurt, May Help

     I just read a fascinating article called, "Your Brain on Psilocybin Might Be Less Depressed." The author, Nancy Shute, discussed the results of two recent brain-imaging studies which examined the effect of the hallucinogen, psilocybin (magic mushrooms) on areas within the brain thought to be involved in clinically significant depression. The researchers expected to find a hallucinogen-induced increase in activity within the thalamus and portions of the cingulate cortex. These areas coordinate and control different areas of the brain and are an integral part of the default network, an intricate neural superhighway which is thought to maintain our sense of self. What they found was the exact opposite: these areas became quiet during the volunteers' psychedelic experiences. Future research will investigate the utility of psilocybin in treating depression; it has already shown promise in treating existential anxiety and despair in terminally ill cancer patients. Psychedelics have long been utilized in religious ceremonies in other world cultures as a means of achieving spiritual awakening. They've gained popularity in our culture as experience-enhancing staples at raves and music festivals, but like any other mind-altering substance (which includes antidepressants!),  they can be dangerous in the wrong hands  Before you run out to that cow pasture for some shrooms (psilocybin mushrooms grow on cow patties), please note that psilocybin remains a Schedule I narcotic.
     In depressed patients, the posterior and medial cingulate cortices (PCC/MCC) are two of several brain regions that have been demonstrated to be hyperactive. The PCC and MCC are concerned with consciousness and ego, specifically autobiographical recall and speculation regarding the motives and intentions of others, and are postulated to serve as perceptive filters which are active while we're thinking, and suppressed when we perform cognitive tasks. Increased activity in the PCC as well as the amygdala, a structure responsible for fear conditioning, is positively correlated with rumination, an algorithmic, repetitive type of negative self-focused thought. Rumination is a known risk factor in the development and prolongation of clinical depression; it sustains, enhances and perpetuates a negative mood. People who ruminate are characteristically pessimistic or neurotic. They are unable to let things go because they devote a disproportionate amount attention to certain distressing or irrational thoughts, seemingly unaware of the fact that thoughts are just thoughts. This is what makes ruminators exceptionally vulnerable to depression.
     For most of us, thoughts come and go all the time. Some get our attention, while others are consciously or subconsciously filtered out; this cognitive equilibrium prevents our minds from becoming overwhelmed. Interestingly, those of us who daydream are more likely to become depressed. Daydreaming is associated with difficulty staying on task, and is mediated by a tendency toward rumination or poor concentration skills. When we daydream, we lose the ability to redirect our thoughts back to the present moment, and they effectively intrude on our ability to stay focused on what we're doing.
     Meditation is a form of non-judgmental awareness which is achieved by training the mind to attend to the present while simultaneously allowing background thoughts to pass. During meditation, breathing relaxation techniques or the use of a focal point, such as a mantra or a feeling, are employed to induce a state of voluntary control over one's thoughts, promoting a self-centered sense of heightened alertness and insight, as well as calm and concentration. People who meditate learn not only to control their own minds, but to regulate their vital processes, including their metabolisms, blood pressure, and heart rate. It has been found to have utility in treating chronic pain, depression, anxiety, and attention deficit disorder. Numerous studies have linked the practice of meditation with improved mental, physical, and spiritual health. My son, Nick, is a living example of this. He has cystic fibrosis, a genetic disease which affects the lungs and digestive tract. After he began practicing Kundalini meditation and yoga, his lung function increased and has remained stable. He hasn't been sick in a very long time.
     In the West, treatment of clinical depression is largely centered on the use of antidepressant therapy, with or without the use of concomitant psychotherapy. One in ten Americans is currently taking an antidepressant. The exact way in which these drugs work is poorly understood. Essentially, they alter the constitution of the brain's neurochemistry, affecting the synaptic concentration and activity of norepinephrine, serotonin, and dopamine. These drugs are associated with a host of side effects and adverse reactions, such as sexual dysfunction, nausea, impaired mental ability, sleep disturbances, and weight gain. The abrupt discontinuation of certain antidepressants can result in a severe withdrawal syndrome. The really bad news is that a recent review of literature published by the pharmaceutical companies and the FDA revealed that both parties selectively reported studies which yielded positive responses to antidepressant therapy, while omitting those which demonstrated little or no benefit. The results of the few negative studies which were published were skewed in a positive light. In an epic failure of scientific research, the pharmaceutical industry and the FDA concealed data from the American public. They hid the fact that antidepressants really don't work well at all! At best, patients taking antidepressants can expect only a partial response. Eighty-six percent of these folks will experience unpleasant side effects, and 50% will stop taking the drugs after four months. Even the positive studies demonstrated dismal success rates with antidepressants compared with placebo. Why are so many people taking these drugs and not getting better? It boils down to misinformation and complacence on the part of both the public and practitioners, and greed on behalf of the drug companies. Big pharma is cashing in on the American public, while the FDA permits this snake oil charade to continue. Insurance companies don't reimburse well for mental health, and everyone's either too poor or too busy to go see a shrink. We want a pill for everything that ails us, to suppress our symptoms instead of getting to the root of the problem. We don't want to be involved in treating, or much less, knowing ourselves. I am not criticizing those who take antidepressants, especially those who believe they are being helped by them; however, I think we as a society need to examine our dependence upon them, especially given the disappointing lack of evidence of their effectiveness.
     The brain imaging research which I addressed above raises some interesting questions in the context of treating the causes of depression, not just the symptoms. (One of Western medicine's biggest limitations is that it focuses on disease and symptom suppression, not on overall health). The brain structures which are suppressed by psilocybin have also been shown to be quieted by meditation. These areas of the brain have been elucidated as essential components in self-conceptualization, and it would follow that they are also intimately involved in the development of depression and anxiety. The beneficial effects of meditation in treating and preventing relapse in depressed patients have been studied fairly extensively, and the results are encouraging. Obviously, the drug companies would prefer that you didn't know about this; after all, your depression is important to them...cha-ching! Any initial cost incurred in learning to meditate would easily be offset by the fact that it is free of side effects and can be practiced anywhere, by anybody. (If you're lucky enough to have a Buddhist temple in your neighborhood, you can learn for free, like my son did. You don't have to become a Buddhist to participate, and they always provide great food!) Meditation requires discipline, a commitment to look deep within the self, to take 10 or 15 minutes each day to focus inwardly, permitting thoughts and apprehensions to come and go without allowing them to become intrusive. In doing this, you become well-acquainted with yourself, and you just may discover how much you honor and appreciate YOU! You may actually access the source of your depression, instead of numbing your mind with medication. There really isn't a downside to using meditation as an adjunct in treating depression. With or without antidepressants or psychotherapy, along with adequate sleep, good nutrition, and regular exercise, meditation certainly seems to be a "can't hurt, may help" modality. The pharmaceutical companies have profited from keeping us in an antidepressant-induced stupor long enough, don't you think?

Your Brain on Psilocybin Might Be Less Depressed
Turn Off, Tune In, Drop Out
Psylocibin found to ease end-of-life anxiety in a small study of patients with fatal cancer
Neural Correlates of Rumination in Depression
Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy
Why Antidepressants Don't Work for Treating Depression
This Is Your Mind on Meditation: Less Wandering, More Doing
Attending to the Present: Mindfulness Mediation Reveals Distinct Neural Modes of Self Reference


  1. Interesting to hear a physician's take on the anti-depressant conundrum. As a former therapist (short term), I'd say it depends on the severity of the depression. I'd recommend exercise, lifestyle changes, behavior changes, and meditation first. Popping pills should be a last resort.

  2. I've become increasingly intrigued with Eastern-based philosophy and alternative medicine, especially with regard to treating depression. Western medicine suffers under the weight of its damage-control mode of operating...we wait for disease to happen, instead of promoting physical/mental/spiritual health at all stages of life. We are good at controlling symptoms, but not at addressing the root cause of problems like depression and anxiety. I was stunned to discover that 1 in 10 Americans is taking an anti-depressant, and that these drugs are second in popularity to the cholesterol-lowering medications. A staggering amount of my patients are on antidepressants, and they seem to have no idea what for. I am willing to bet that the majority of those folks have never talked to a therapist. I am opposed to the continued and prolonged use of antidepressant drugs in the absence of counseling, especially in patients who've exhibited suicidal ideation, and I think it is careless on the part of practitioners who dispense these drugs like candy without ever exploring whey their patients are depressed in the first place. Our fast-paced society adds another dimension of difficulty in dealing with mental illness...we are too busy for introspection, and for some reason, we view looking inward as an undesirable, selfish activity. I am finishing Alan Watt's The Book: On the Taboo Against Knowing Who You Are, and I think he was really onto something. With proper guidance, self-centered awareness/reckoning with "I" seems very crucial in recovering from depression.