Any person suffering from depression will tell you that they are in pain. Every day in my work as a psychiatrist I see patients in such agony. For some it is physical: An elderly Russian immigrant complains of a stabbing in his chest. A young Latina feels mysterious burning in her back. A dentist complains of constant roiling in his belly. For others, like a mother of two I recently saw, depression’s pain is a feeling of disconnection from others, a haunting alienation from all life’s pleasures.
As William Styron put in his classic book Darkness Visible: A Memoir of Madness, “The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” As a psychiatrist, this connection has long baffled me: Is it metaphorical or real? Practitioners can theorize endlessly about such possibilities. Researchers, if fortunate, can collect data. Such was the case for our group at Columbia University’s Department of Psychiatry. Over the past several years, we completed two clinical trials of antidepressant medications combined with repeated MRI brain imaging for people with chronic depression. These studies compared antidepressants (the serotonin-norepinephrine reuptake inhibitors duloxetine in one study and desvenlafaxine in the other study) with placebo treatment over several months and obtained brain scans before and after treatment. Over the course of these two studies, we obtained more than 200 scans, and for the past several years we have been busy analyzing abnormalities related to the state of depression, and changes caused by treatment. Our team began looking at measures of resting-state activity in the scans—that is, spontaneous activity of the brain when the patient lies in the MRI scanner, with her eyes shut, and lets her mind wander. The brain’s resting state is a fascinating one, because when the brain is 'at rest' there are characteristic patterns of activity. Analyzing the brain at rest reveals patterns of coordinated nerve cell activity—and these show how various brain centers are connected to one another. Resting-state MRI scans, therefore, can show ‘functional networks’ in the brain. Suffice it to say, we were all surprised by the findings. The brain network that showed changes with antidepressant medicine—but not with placebo—involved the pain network. The pain network has been identified when studying people's responses to physical pain, and consists of a series of connections from the cortex to lower-brain centers, the ‘thalamo-cortico-periaqueductal network.’ This network is central to processing pain, but it has never been previously connected to depression. Antidepressant treatment with both medications (whether desvenlafaxine or duloxetine) decreased the activity of this network, suggesting that the alleviation of mental pain follows similar paths to what is seen with physical pain. In comparison, treatment with placebo had no effect on pain network activity. Not only that, but the more the symptoms of depression improved, the more the network’s activity decreased--suggesting that activity of those pathways is finely tuned to the severity of depression.
0 Comments
Leave a Reply. |
Author & Personal InterestJohn Anderson Smith joined us on 3 June 2019. He comes to us from an News agency company & He also has the skills of Computing, Communication with other and another thing. He also look forward to see what is happening around our worlds. John Anderson Smith are proud to help our customer with anything he also happy for other Issues such as Education and etc. Archives
October 2019
Categories
All
|