Dana Grantee Aims to Offer a More Personalized Treatment for Depression

DrEtkin_Jan2013_8880_5x7eIn an effort to create a more personalized approach to treating depression and to better understand its underlying circuitry, Amit Etkin of Stanford University is studying the use
of repetitive transcranial magnetic stimulation (rTMS) in combination with whole-brain EEG and functional MRI. According to Etkin:

By stimulating brain activity and assessing circuit-level changes as they happen, we can garner important insight into what is wrong in depression and how to fix it in an optimized, personalized matter.

I’ll give you one concrete example: It matters whether stimulation is done to an area in the patient’s brain that is abnormal or normal. For any treatment in any psychiatric disorder, we don’t actually know whether the goal of treatment is to normalize abnormal brain activity or to engage compensatory circuitry. It’s a fundamental question that we cannot answer without a direct tool for manipulating brain systems and assessing the effects.

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Science in Storytelling


Wednesday night’s Story Collider x braiNY event provided audience members with five stories from five accomplished scientists of the Friedman Brain Institute at the Icahn School of Medicine at Mt. Sinai, all of whom had participated in a six week storytelling workshop.

The event took place in the charming lower level of El Bario’s Artspace in East Harlem, where brick walls, black curtains, and bright lights alluded to a crowded comedy night. And the storytellers did not disappoint–their recounts and anecdotes poked fun at either themselves or their situations in an endearing and hilarious way, garnering laughter from the audience throughout the night. But the event offered more than just humor; many of the stories took on a more serious tone as the night continued.

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From the Archives: Kay Redfield Jamison

At the end of her recent essay in the New York Times, “To Know Suicide: Depression can be treated, but it takes competence,” Dana Alliance member Kay Redfield Jamison mentions, almost in passing, her own suicide attempt. She wrote vividly about her experiences and those of others in her book, Night Falls Fast. Ellen Frank and David Kupfer reviewed the book for us in 2000; the review includes part of the book’s epilogue:

I was naive to underestimate how disturbing it would be to write this book. I knew, of course, that it would mean interviewing people about the most painful and private moments of their lives, and I also knew that I would inevitably be drawn into my own private dealings with suicide over the years. Neither prospect was an attractive one, but I wanted to do something about the untolled epidemic of suicide and the only thing I knew to do was to write a book about it. I am by temperament an optimist, and I thought from the beginning that there was much to be written about suicide that was strangely heartening.

As a clinician, I believed there were treatments that could save lives; as one surrounded by scientists whose explorations of the brain are elegant and profound, I believed our basic understanding of its biology was radically changing how we think about both mental illness and suicide; and as a teacher of young doctors and graduate students, I felt the future held out great promise for the intelligent and compassionate care of the suicidal mentally ill.

All of these things I still believe. Indeed, I believe them more strongly than I did when I first began doing the background research for this book two years ago. The science is of the first water; it is fast-paced, and it is laying down, pixel by pixel, gene by gene, the dendritic mosaic of the brain. Psychologists are deciphering the motivations for suicide and piecing together the final straws—the circumstances of life—that so dangerously ignite the brain’s vulnerabilities. And throughout the world, from Scandinavia to Australia, public health officials are mapping a clearly reasoned strategy to cut the death rate of suicide.

Still, the effort seems unhurried. Every seventeen minutes in America, someone commits suicide: Where is the public concern and outrage? I have become more impatient as a result of writing this book and am more acutely aware of the problems that stand in the way of denting the death count. I cannot rid my mind of the desolation, confusion, and guilt I have seen in the parents, children, friends, and colleagues of those who kill themselves. Nor can I shut out the images of the autopsy photographs of twelve-year-old children or the prom photographs of adolescents who within a year’s time will put a pistol in their mouths or jump from the top floor of a university dormitory. Looking at suicide—the sheer numbers, the pain leading up to it, and the suffering left behind—is harrowing. For every moment of exuberance in the science, or in the success of governments, there is a matching and terrible reality of the deaths themselves: the young deaths, the violent deaths, the unnecessary deaths.

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Mental Health Blog Party: Interview with Ellen Frank

Mental Health Blog Party

May is Mental Health Awareness Month and today is the Mental Health Month Blog Party, an idea conceived by the American Psychological Association to spread the importance of good mental health and reduce its stigma.

To participate, we interviewed Ellen Frank, Ph.D., a distinguished professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic. Dr. Frank is also a member of the Dana Alliance for Brain Initiatives.

What are you working on now?

Currently, my biggest project is with David Kupfer, my husband. We’re looking at whether integrating medical care with psychiatric care for individuals who have bipolar disorder can reduce the medical morbidity and mortality associated with the disorder and improve psychiatric outcomes. We think there is probably a pretty strong link between medical problems, particularly those associated with the metabolic syndrome and bipolar disorder. Certainly individuals with bipolar disorder are at markedly increased risks for almost all of the components of the metabolic syndrome—obesity, high blood pressure, high cholesterol, diabetes—and seem to begin to have those problems at a much earlier age. We’re thinking if we can create an environment where the right hand knows what the left hand is doing then we might be able to improve both medical and psychiatric outcomes.

How is that study coming along?

We’re about halfway through the recruitment process. It would be premature to say anything definitive at this point. The plan is to follow people for 18 months to two years. We already have 30 patients who have been followed for that long. What I can say is that study participants seem to be enthusiastic about taking better care of themselves. There are two reasons it is hard for them to take care of themselves physically. First, I think they always see their psychiatric illness as their primary illness, and if they only have the energy to take care of one thing, it’s going to be that. Secondly, as soon as they get to a general medical specialist who sees they are on one of these marker medications (such as lithium), they often find they are treated badly. The few who have the energy and the will to get themselves medical care often find the stigma associated with the mental illness leads them to being treated in not the kindest way. By integrating medical care with psychiatric care, they wouldn’t have to face either of those problems. They can get their medical care at the same time they are getting their psychiatric care and don’t have to worry about the stigma associated with their mental illness.

Can you gauge the public perception regarding stigma?

I’m an empiricist, a researcher. I was looking for some data on this topic recently and couldn’t find anything that specifically compared, let’s say, bipolar disorder with unipolar depression as far as stigma. I wish there were more specific research on the nature of stigma but to be honest I haven’t really seen much in the way of new studies. In general, I found that the public doesn’t necessarily distinguish among different psychotic illnesses. It is the psychotic disorders that are the most stigmatized.

Have you noticed a change in public perception over the last 5-10 years?

There has been a huge change with the stigma associated with unipolar depression. I think that is largely due to the public information provided by the pharmaceutical industry. In the process of advertising the newer antidepressant medications there has been a really remarkable education to the public about depression and a destigmatization of depression. I don’t know if that has transferred to bipolar disorder.

Do you think that could change in the near future?

I can remember as a child when you couldn’t say the word cancer out in public. We’ve certainly been successful in destigmatizing cancer in that way. I think over time, as more knowledge is accumulated, attitudes will change. We are most afraid of what we can’t understand and can’t treat, so as we’ve come to understand cancer better and have developed highly effective treatments for many forms of cancer, I think that’s been an important part of its destigmatization. As we come to understand the major mental disorders and have increasingly effective treatments, I’m hopeful the stigmatization associated with these illnesses will decrease.

What do you see as your role as far as educating and interacting with the public?

I do a fair number of community talks. I’m always enthusiastic about the opportunity to meet with the general community. I recently did a public talk at the University of Louisville. I also recently talked to students at Pittsburgh—undergraduate psychologists. It was a couple of hundred 18-19 year olds majoring in psychology, but they are certainly not fully-formed psychologists yet; they are in a sense going to be the general community of the future. It was very exciting to talk to them about new ideas we have about the causes of bipolar disorder.

Thank you for your time. Anything else you’d like to share?

One other thing I have been focusing on of late is the fact that we do have a series of highly effective psychosocial treatments for bipolar disorder. The challenge has been to get these treatments from the ivory tower to the general community where the average person with bipolar disorder is being treated. I’m really pleased that a colleague of mine just got a grant from the National Institute of Mental Health to study how best to implement these treatments in a general community mental health setting. We’re trying to understand what it’s going to take. That is something I think is very, very important.

–Andrew Kahn


PTSD in Haiti: Expert warns on post-quake mental health

With efforts in Haiti currently focusing on basic necessities and medical emergencies, the stage is set for a mental health epidemic. Lack of food, water, shelter and medical attention has left little time and effort for grieving or for psychological treatment. David Spiegel, a psychiatry professor at Stanford University, researches post-traumatic stress disorder and in a recent interview shed some light on what we should expect in the coming months in Haiti.

Half of the Haitian population will eventually show some signs of PTSD or depression, expects Spiegel, who has received brain and immuno-imaging grant funding from the Dana Foundation in the past. Witnessing deaths or severe injuries, as well as dealing with disease, hunger, dehydration and violence, are all stressors that lead to PTSD, he points out. The loss of a daily routine that included loved ones, friends, work and school, along with a lack of identification or proper burial for many quake casualties, can contribute to the onset of depression.

Symptoms of PTSD typically begin no less than a month after a trauma, Spiegel says. That means that there is still time for emotional support and organized mental health relief. The National Center for Posttraumatic Stress Disorder lists cognitive and exposure therapy, medication, eye movement desensitization and reprocessing, and counseling as some potential treatments for PTSD.  According to news reports, thousands of volunteers have shown up in Haiti on their own without clear direction or organization. Although these people have shown compassion to grieving children and adults and are doing their best to offer emotional support, they are not the mental health professionals that many Haitians currently need.

Spiegel points out that after the Sept. 11, 2001, attacks in New York and Virginia, trauma symptoms resolved pretty quickly because of an abundance of resources offering emotional and social support to onlookers and victims. The situation in Haiti, on the other hand, more closely resembles the aftermath of Hurricane Katrina, in which a delayed response by the government increased feelings of despondency and desperation. “I expect plenty of that in Haiti,” Spiegel says, “since the government has all but evaporated.”

-Angie Marin

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