Archive for August, 2007

Some researchers are arguing that often when someone’s antidepressant stops working, it’s because they were only getting a placebo effect off of it. They quote one of the researchers, Dr. Mark Zimmerman, as saying:

a message can be conveyed to patients who have repeatedly improved on medication and then lost its benefit that perhaps they are more capable than they think in bringing their own resources to bear to improve their depression

That edges awfully close to victim-blaming.  (I hope they were misquoting him.) If you’ve been on several medications that pooped out on you, it was your own ability all along!  So if you decide to stay depressed now, then it’s your fault for not getting it together. It’s a slightly sciencified version of “pull yourself up for your bootstraps”.
We don’t know a lot about the placebo effect, but it’s unlikely to be the same as bringing your resources to bear.   For example, the placebo effect in pain reduction is associated with greater expectation of a reward, but this has only been shown to be an individual-difference thing, that is, we don’t know whether trying to get people to expect a reward will lead to greater pain relief.  And it seems unlikely that trying to get people to expect a reward when they have no external reason to (i.e., medication or something similar) is going to make a difference.

(Imagine that you’re about to get your wisdom teeth pulled and your dentist says: “We’re not going to give you medication to reduce pain.  Instead, we want you to expect that you’ll get a reward.  Now, open your mouth.”)

If it’s accurate that most people who have antidepressants poop out are actually having a placebo effect poop out, that raises some interesting questions.  The most important might be “how can we replicate the placebo effect’s effects without having a placebo for peoples’ psyches to use?” and the second most important might be “why does the placebo effect keep pooping out and how can we make it last?”

Brains and also little synapses.  I like the brain earrings, but I wish I could get post earrings without the brain stem.  I know it’s important and helps you breathe and stuff, but it’s not very aesthetic.

A DNA pendant (see p.2, they won’t let me link directly) sure would be pretty, though.  Nice aesthetic design on the part of all those genes.

I also like the rainbow squooshy brain (in bestsellers).

I’m not sure what to make of this.

I do know that similarity in symptoms doesn’t necessarily mean similarity in etiology (in what causes a disorder).   For example, you can have a thyroid problem that looks like a mood disorder, but we know they’re not the same disorders because many people with mood disorders don’t have thyroid problems.  And brain damage can mimic psychiatric disorders.  Kind of like if you have a bucket chain to put out a fire – the house might burn down because there wasn’t any water, or it might burn down because the people started getting smoke inhalation problems and stopped.  Totally different causes, same end result.

I’ve wondered about that with ADD when it occurs in bipolar disorder versus when it does not.  Since ADD is so very common in bipolar disorder, maybe it’s a set of symptoms caused by something in the mood/energy brokenness, but caused by something else when there isn’t bipolar disorder.  Who knows?  I poked through PubMed a little but couldn’t find any speculations on the reason for the comorbidity (in bipolar or in anything else).

This is a huge problem for me and has been so for about eight years.  It’s not that I sleep through alarms, it’s that always, absolutely no matter what, unless I am responsible to other people to be somewhere on time, going back to bed is incredibly attractive and the world outside seems miserable and desolate.  (It’s worse when I’m actually depressed.)

When I think about it at any other time, I think, “My god, how could I possibly be so stupid as to keep going back to bed?” but, unfortunately, knowing down to the core of my bones that I am a stupid horrible lazy person I am does not enable to me to magically get out of bed.  It actually tends to make things worse, because the worse I feel the less I want to get out of bed.

There are two possible problems a person can have here.  One is not sleeping through the alarm; the other is staying out of bed.  You can usually fix the first with a superloud alarm or a vibrating alarm or a light alarm or all three.   The second is harder.  I need to be out of bed for long enough that I’m fully mentally awake.  When I was in sophomore year in college, I got up and stayed up on time every day because I was sleeping in a top bunk without a ladder, and by the time I was awake enough to clamber back up the furniture I was using to get into the bunk, I no longer wanted to.   I can’t practically build a loft in my current apartment, but I think doing something cognitively engaging would work, for me and possibly for other people.

So I had this awesome idea for a computer program alarm clock that would stay off only if you answered a number of flash cards correctly, or touch-typed for a certain amount of time with a certain amount of speed and accuracy.  Several other people have had a similar idea about a math-problem alarm clock, including a friend’s roommate who wrote one in Python.  I don’t actually know Python well enough to convert it, and may not be able to take the time to, but that’s still pretty damn cool.  I’ve thought about writing one in Javascript, which I do know, but probably not well enough to write it before classes start.
Unfortunately, no one seems to implemented something similar yet for computers (although there is Sleeper Killer for the Nintendo DS).  There are some similar physical alarm clocks, but they’re not that cognitively engaging and are kind of expensive.  And some dude in Japan will come vacuum your face to wake you up, but that’s not practical if you don’t live in Japan or don’t want your face vacuumed.

So for lack of sufficient programming skill, I’m looking into this instead, which I found while searching for alarm clocks today.  The basic idea is that you want to train yourself to get out of bed and stay out of bed when the alarm goes off.  So, train yourself to do it automatically by doing it when you’re awake enough to actually stay out of bed – and keep training yourself until it starts transferring over to when you wake up in the morning.

I’m also working on some CBT trying to address the thing where I’m convinced that if I get up in the morning in response to my alarm I’ll feel desolate and lonely, since that’s not actually true for more than a brief period of time.

As an adjunct to all that, I would like to get somebody to build me a working bacon alarm clock.  Mmmm….

I enjoyed reading this post and the comments, which are noteworthy for having some actually interesting content (sleep disorders, suggestion that the distinction between ADD-inattentive and other forms of ADD is that the former primarily have attention problems, and the latter primarily have executive function deficits surrounding poor behavioral inhibition).

They do inevitably get hijacked by a troll of the “there’s no physical proof therefore it’s not real” variety, with guest appearances by the “they’re just bored gifted kids” and the “sit down and shut up” variety. There’s also a little bit of the “ADD people save the tribe from predators! Yay ADD people!” self-valorization thing, but it’s pretty minimal.

That phrase keeps showing up in media reports, including the recent ones on Risperdal getting approved for pediatric use. Where are all the non-powerful sweet gentle antipsychotics, huh?

Anyway, John McManamy has a good post on the subject, with both healthy skepticism about anti-antipsychotics movements and healthy skepticism about the reasons that Risperdal is getting approved at this point in time.

It just occurred to me that, on average, anti-psychotics might very well be gentler on bipolar people than antidepressants. But “powerful antidepressants” sounds like a good thing, doesn’t it?

More Dichotomy Week stuff: A call to end the notion of a mind-brain split, in an article in Psychiatric News from earlier in August.

I just discovered retrospectacle, a blog by a neuroscience graduate student. She has a variety of good posts like in her “Science Vault” series (Multi-nippled sheep of Alexander Graham Bell, Coffee as treatment for the Plague) as well as in general, but the post I wanted to point you toward has a bit on ancient Egyptian medical understandings of neurological disorders at the bottom.

Reading about things like that makes me appreciate cultural ratchets like databases a whole lot. Sometimes gaining knowledge is surprisingly cheap and can be done without the aid of modern technology (although not necessarily easily). But it’s pretty easy to lose, and then people keep spending time rediscovering it.

A more problematic aspect of the same issue, of course, is that without a cultural ratchet, we can’t keep track of all the knowledge we keep discovering that is inaccurate. So we invent and disprove and invent and disprove the same mistaken but attractive notions again and again throughout history. And again and again within an individual culture, if we don’t have a way of spreading that knowledge.

Here’s where I’m coming from, out of a graduate program that emphasized the effects of culture on thought, with attention to evolution…Culture does not exist without biology. In the simplest sense, you have to have brains and bodies to create and perceive stimuli. That’s kind of a no-brainer, but it’s easy to underestimate how complex brains and bodies are. It’s usually not obvious how concretely and specifically our brains shape aspects of culture like Google, South Park, internet messenging, and so forth. (Some quick, incomplete, and not necessarily accurate suggestions: Google is a response to a universal human demand that provided information be relevant; South Park involves dominance hierarchies, irreverence, and shock value; and internet messenging is about human communication taking over any available medium.)

Biology can’t exist on its own either, unless you call everything biology. All genes in existence are here because they gave an edge to reproduction and survival over millenia, including in situations involving cultural phenomena like changing in-groups and out-groups, gossip, status, etc. If those environments had been different, we would have different genes. Looking just at the present day, cultural phenomena like knowledge of nutrition, parenting classes, social norms, and many other things, affect how children’s bodies and brains are built as they grow up. As an example, norms about acceptable emotions and how to display them will affect, for example, whether a child displays anger or fear in response to an interpersonal conflict – but they are very unlikely to make that child show joy or relief; cultural norms encourage some available biological states over others, but they don’t determine them so strongly that biology is irrelevant.

At any given moment, a person’s brain and body is the result of everything that has previously happened and everything that is currently happening between and among their genes and their body/brain and their environment. It’s not nature versus nurture, it’s not even nature plus nurture.

But it’s also not just a big tangled un-studyable mess. For example, we can look at some phenomena (like when people display what emotions) and conclude that cultural upbringing teaches children which specific emotion, out of several potential emotions, they should display in an interpersonal conflict with an equal. Or we could look at another phenomenon – like the ability to understand others’ beliefs and desires – and find out that there are very minimal innate tendencies that are heavily enriched by lots and lots and lots of interactions with others.

And this is where it starts to be possible to talk about all the different, specific kinds of ways culture/biology works, and to talk about things like cultural variation in mental illness and evolutionary explanations for mental illness. Which I will do, after some other interludes.

This is post 3 of Dichotomy Week.

A brief interlude in Dichotomy Week:

Preventive migraine therapy raises quality of life

Was there anyone saying it did not? When you take two medications known to be effective in treating migraines, and you give them to people so that they will have fewer migraines, and then they have fewer migraines, is it noteworthy to report that their quality of life improves? It would be interesting and unexpected if peoples’ quality of life stayed the same despite fewer migraines, or that it dropped, but the people who might argue that (the happiness-stays-the-same-after-you-adjust-to-life-changes emotions researchers) weren’t in the article. (Although, interestingly, peoples’ mild anxiety and mild depression didn’t change in the study…but they don’t go into that.)

The study was probably run with the expectation that the two drugs they looked at would perform differently, but since they didn’t apart from one finding the article doesn’t explain, they tried to make the best of the quality-of-life finding. It’s not a bad finding, their study just isn’t well-presented so as to capture interest and attention, like it would have been if they’d presented something more surprising.