Friday, March 30, 2007

TO WRITE: Could a "Laughter Club" Beat Out Prozac?
Is it hard to laugh when you're depressed? Well, consider doing it in a group. That old saw about laughter being the best medicine is being enthusiastically applied in Shanghai. China Daily reported that this month faculty members at Fudan University began inviting students to "laugh away their cares and concerns" by joining the Heartfelt Laughing Club.

Members, inspired by observations that laughter is powerful - and contagious - typically meet in parks early in the morning. They raise their arms high and begin laughing loudly, then silently with mouth closed, then open, in an effort to ease everyday stresses. Sometimes the laughter is combined with yoga and meditation. Chinese psychologists leading the Fudan group discovered that others follow the humor-filled practice too: There are more than 80 laughter clubs in India, and several thousand around the world!

Do you think they could be on to something?

Play with this ...
Even if it's been a while since you've giggled much, recall some times you have. Did you laugh yourself silly at Bugs Bunny as a kid? Or was it that time you and friends played a prank on a teacher? For me, watching Monty Python or Saturday Night Live with my gang of pals in high school comes to mind.

Write the story of a funny - no, hilarious - thing you once laughed at. How did it start, how did you react, did you feel different afterward? Are similar events still amusing to you now, or have your tastes changed? And what might make you laugh today - could you rent a video, play with the dog, rehash a family mishap with your sister? As usual, give yourself 20 minutes to write continuously about the laughter in your life. And leave a comment to let us know what works for you!

Thursday, March 29, 2007

TO READ: Approaching a Genetic Understanding of Depression
Scientists continue to chip away - and sometimes blast away - at the mystery of depression. And they're making progress. In a major step forward, a consortium of psychiatric researchers announced last month the identification of a region on chromosome 15 that has "a very good chance" of ultimately explaining why some people develop depression.

You probably know that both genetic and environmental factors are believed to be responsible for depression. A better understanding of specifically which genes (there are thought to be several) in our DNA place us at risk for depression would constitute a major research breakthrough: If scientists can locate the key genes, they can determine how they affect the brain and, as a result, can develop more effective therapies for the illness.

Two studies reported in the February American Journal of Psychiatry were conducted by groups at six universities, led by Stanford professor Douglas Levinson, M.D. First these researchers studied 650 families in which two or more members had experienced multiple bouts of severe depression that began in childhood or early adult life. They scanned the entire genome and found areas of "linkage" between depression and DNA markers in several areas. Then they homed in on the most suspicious region, which lies on chromosome 15.

What they found, after studying more than 88 DNA markers in that area, was what Levinson called "one of the strongest genetic linkage findings for depression so far."

The consortium is now studying more than 2,000 people to identify specific genes in the regions, including on chromosome 15, that look most likely to carry variations that increase depression risk.

Tuesday, March 20, 2007

TO WRITE: What We See and What We Don't
Many writers claim that observation is what their work is really all about. Author and writing teacher Natalie Goldberg says, "Writing is 90% listening."

But it's not just the writer surreptitiously monitoring the lovers at the next restaurant table for plot ideas and dialog. In fact, every human needs to observe his life and the world around him and try to fit the two together. Observing and reflecting are key, whether it's deciding when it's safe to step off a curb, or determining when to change careers. For people living with depression, observing the situations that make us feel worse or better, and the reactions we have to those stimuli, can be a powerful tool. We can use this technique both in the present and in retrospect.

Play with this...
Write continuously for 20 minutes, starting with the following prompt, and see what you discover.
Looking back, it was obvious...

Monday, March 19, 2007

TO READ: Changing the Structure of Your Brain
Wow, am I reading a great book right now! Train Your Mind, Change Your Brain by the wonderful science writer Sharon Begley, is billed on the cover as, "How a new science reveals our extraordinary potential to transform ourselves," and, "A groundbreaking collaboration between neuroscience and Buddhism."

Sound confusing? Well, I suppose anytime you get the Dalai Lama to write a foreword for a book on nerve cells in the brain, it's unusual, that's true. And neuroscience is typically thought of as a daunting field. Despite those things -- or maybe because of them -- I'm telling everyone I know to read this book! It's absolutely fascinating and it's very accessible.

Here are some of the things I've learned so far, boiled down and boiled down again. When I was a college student, and even when I was a graduate student in biology, it was taken as a given that whatever brain cells you were born with were what you got for good -- no exceptions. This was simply a basic rule of neuroscience. But... Begley describes a whole host of recent experiments that show how that belief is hooey. Instead, the incredible changes our brains can make -- the "neuroplasticity" of the brain -- will amaze you. For instance, in people blind from birth, you might imagine that the enormous visual cortex part of the brain would sit silent, since no visual input can get in through the eyes. No! In fact, instead of lying dormant, the visual cortex actually switches jobs to help the person hear certain tones and rhythms more acutely than sighted people can. In other words, it helps them compensate. Similarly, the brain region believed to only be able to process auditory stimuli can, in deaf people, be recruited to help the visual cortex to gain even more information from peripheral vision than usual, thus helping a deaf person to notice and react to changes in the environment more quickly.

What these kinds of experiments mean is that we can change our brains. By attending to particular things in our environment, we can cause regions of nerve cells in the brain to grow, to shrink, to adjust their function, even to change jobs completely. So, if you take up the violin, even as an older adult, your brain's motor cortex in the region controlling your left (fingering) hand, will grow. It takes attention and practice, but our minds really can change the structure and the electrical and chemical activity in our brains! That's consciousness changing matter.

I'm only half-way through the book, but I'm hooked. So stay tuned for an upcoming discussion of what happens when neuroscientists study the brains of Buddhist monks who have meditated for years, and learn what these discoveries mean for the treatment of OCD and depression.

Monday, March 12, 2007

TO WRITE: How Do You Care for Yourself?
Last time I circulated a notepad asking for writing topic suggestions in our class meeting at Stanford, I got an amazing mix of responses. We've already written using several of them as our jumping-off point -- from "joy" to "patriarchy" to "I'm afraid of" to imagining being "rich beyond dreams."

But one topic that comes up very regularly on such lists is how to manage your moods. And on this page, the topic of "self-care" came up specifically. Everyone who has coped with a mood disorder, even for a short time, has probably gravitated toward some activities that feel self-soothing or calming or activating or encouraging, depending on what you need at that time. When I'm depressed, reading a novel or writing about the situation over a big cup of coffee at Starbucks helps considerably. It doesn't remove the depression, but it reminds me that there are still things I can enjoy - even if only a little bit - and that I have the ability to seek out those things. And, in my case, the jolt of caffeine doesn't hurt either.

Play with this...
What self-care techniques can you recommend to others? Does walking the dog help you bond with her and get some exercise? Does herbal tea help you get a much-needed good night's sleep? And what about writing -- you may not feel up to crafting a poem, but does a good freewrite in your journal ease your burden a bit? Write continuously for 20 minutes on self-care and see what you discover -- then share your findings with a friend who could use them, and perhaps pick up a few tips from her too.
TO READ: Gamma knife surgery - could it help depression someday?
A former writing student recently made me aware of a "knife-less" brain surgery technique which is becoming widely used around the world. Called gamma knife surgery, it destroys tiny bits of brain tissue by focusing beams of cobalt radiation on, for example, a brain tumor. The gamma knife can be used even for deep brain sites and, unlike conventional radiation treatments or surgery, can be focused with one-tenth of a millimeter precision, so healthy tissue is largely unaffected.

Sounds very impressive to me. Now vascular malformations, both cancerous and benign brain tumors, epilepsy and other conditions are being treated with the gamma knife on over 60,000 patients each year, according to one web site.

But what about depression? I surfed and web-surfed some more, but haven't come across any studies on using gamma knife surgery in this realm. Yet. One site discusses using it for obsessive-compulsive disorder and even vaguely suggests using it for depression in the future....

But where in the brain would it be used? As this blog has described several times, more and more evidence is stacking up that says brain structures - not just the flow of neurotransmitters - are changed in depression. Perhaps one of these sites could be treated. Often the confusing point in these cases is that we don't know whether those structural changes cause, or are caused by, depression. The other approach would be to simply focus on brain regions now understood to regulate emotions and mood. But identifying the precise areas to target is still too difficult. Still, it sounds as though researchers are starting to consider the possibilities of gamma knife surgery for psychiatric illnesses. One more potential future treatment to keep an eye on.

For more info:,

Monday, March 05, 2007

TO WRITE: Are You Friendly with Your Little Pink Tablets?
If you take antidepressants - or mood stabilizers, antipsychotics, anti-anxiety drugs, sedatives, stimulants or any other of the panoply of psych meds - how do you feel about them? For many people with depression, that handful of tablets and capsules that it sometimes seems we gobble like candies can be hard to get down. That is, while we know intellectually that these drugs are helping us, or at least could help us, many of us still have mixed emotions about taking them.

Have you ever wondered what exactly those pink or white or turquoise or yellow pills are doing once you swallow them? Scientists still can't fully explain how they operate to change our thoughts and our entire mood. How does that mystery leave you feeling? At different times I've felt dumbfounded, nervous, grateful, embarrassed, angry, resentful and relieved to reach for my regular doses from those amber bottles.

Play with this...
Write continuously for 20 minutes describing your feelings about taking medicines for psychiatric reasons. What emotions did you feel initially? Have they changed at all? How do you feel when you take your prescribed dose today? And would you feel any differently if these were drugs you were taking for some non-psychiatric ailment? Untangling such thoughts and feelings may provide some insight into our attitudes toward our depression and our life situations as well as our treatments.
TO READ: Drug Combo for Resistant Depression
Has your depression - or you - been dubbed "hard to treat"? Been through drug after drug without success? A new study looking at treatment with the combination of antidepressants Effexor (venlafaxine) and Remeron (mirtazapine) looks encouraging.

Irish psychiatrists just reported a study of 32 patients (44% men) who had been through an average of 2.5 drug trials without depression relief. Impressively, after 4 weeks on this combination of meds, 44% had responded; after 8 weeks, 50% responded; and at a 6-month follow-up, 75% of those still taking the meds had significantly responded.

The down-side? No "serious" side-effects were reported, but 19% of patients felt sedated and 19% experienced weight gain. Five of the 32 quit the trial because of these effects. Remember to keep trying if your depressive symptoms haven't been helped by meds yet - just because one drug or combination doesn't work for you doesn't mean others won't!

For more info: Journal of Psychopharmacology, Vol. 21, No. 2, 161-164 (2007).

Friday, March 02, 2007

TO WRITE: Are You "Religious"?
Many, many people, I've found, bristle at this question. OK, those who practice the rituals of a particular religion, who attend temple or church or mosque regularly -- or even just once a year on a holiday -- have little problem with it. But what about the others? I've often heard the response, "Well, I was raised (insert religion here), but I never really practice it...."

Either of these responses can be fruitful to explore. Our relationship -- or lack thereof -- with a religious life sheds light on many aspects of our world view, our moral and ethical beliefs, our sense of spirituality outside a formal religion, and what we draw on in times of crisis, such as depression.

Play with this...
What religious beliefs did you grow up with -- Were Mom and Dad strict atheists? Did Grandma take you to mass every week? Did you learn to bow and pray several times a day? Meditate? Did you develop your own ideas about the mysteries of life?

How do those childhood beliefs and experiences affect you as an adult -- Do you practice any formal religion now? Where did you get married? What are you teaching your children? And how do your past and current beliefs affect you as you cope with depression?

Write for 10 minutes on each of these two main questions and see what you discover.

Thursday, March 01, 2007

TO READ: Men and Depression
Conventional psychiatric wisdom has it that depression is twice as common in women as in men. But that rule of thumb may not be correct.

Newsweek's cover story last week (Feb. 26, 2007 issue) was on men and depression, and it reports that more and more medical providers are discovering that men just don't admit or even face up to their depressive symptoms at the rate women do. Six million men will be diagnosed with depression this year, and more and more men are seeking treatment as stigma gradually lessens. Still, many men feel they must maintain a certain image -- for themselves as well as for others -- of being "in control." As a result, the article claims, men's moods may manifest as irritability, anger, alcoholism and other substance abuse, even violence.

In addition to the untold suffering of these men and their families due to such effects, depression leads men to commit suicide at rates at least four times greater than women. At a societal level, depression's effects are enormous as well: studies estimate that adult depression leads to $83 billion (with a "b") worth of lost productivity.

I certainly know many men who have had the "manliness" to step up, realize they have a problem, and seek treatment for their depression. They, like women in our society, still face tremendous stigma. But they do it. "Coming out" with depression is often the wisest, and healthiest, thing they can do -- for themselves, their families and their careers.