Live from the APA: To Know Thy Neurons is to Know Thyself

John McManamy Health Guide
  • It’s 9:30 in the morning at the APA annual meeting and I’m slowly easing into the day. Yesterday was a 13-hour marathon – into my first session at nine in the AM, and out of my last session at ten in the evening. And that included two heavy duty brain science lectures, which is extremely taxing on the neurons.


    “Easy for you to understand this stuff,” I joked to a European psychiatrist next to me. “You’ve been to medical school. Me, I got a C in high school biology.”


    I don’t know if there’s anything such thing as shiatsu for the frontal lobes, but by three in the afternoon I was in dire need of some kind of cranial massage. Stick my head in a popcorn maker, anything.

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    But brain science is starting to crack open our understanding about our illness, and by extension ourselves. A little perspective:


    We know that there’s a lot more going on with mood disorders than just mood. At one session I was at yesterday, the entire panel of speakers wanted to set a match to the DSM and start again. Think of all those other disorders you probably have to go with your bipolar, full-blown or maybe the once-over-lightly version – perhaps anxiety, perhaps panic, perhaps OCD, perhaps ADD, perhaps substance use, perhaps something to do with personality. We can go on and on.


    According to the speakers, this indicates there is something seriously wrong regarding how we define and classify mental illness. Are we all walking around with three or four co-occurring disorders, or is the real problem below the surface, out of sight. In other words, is something going on in the substrata of the brain that manifests in different ways, as different symptoms and illnesses?


    At this particular symposium, Hagop Akiskal MD of UCSD, the foremost proponent of a mood spectrum to explain what he sees in the patients he treats (and the tens of thousands he has studied), referred to a landmark brain science study from several years back. The study fingered a hyperactive limbic system that implicated a whole range of mental ills, from anxiety to stress-induced depression to alcoholism.


    Now you see why I am so interested in the brain science. To know thy neurons is to know thyself.


    One of the sessions I attended involved John Krystal MD of Yale talking about the fine points of glutamate. Dr Krystal has been researching the brain from a schizophrenia perspective. So why am I interested in hearing about schizophrenia? For one, seven times more research funding goes into schizophrenia than bipolar. If something interesting about the brain turns up, odds are it will come from a pure brain scientist or a schizophrenia researcher.


    Also, is bipolar a mood disorder with some thought problems or a thought disorder with some mood problems? Yes, we may be different than the schizophrenia population, but might we share a few of the same brain circuit glitches? Believe me, if it’s relevant to schizophrenia, its relevant to us. You will hear a lot more about this in future blogs.

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    On a slightly different but related topic, I turned up at a dinner symposium that freely acknowledged the limitations of antipsychotics. Finally, psychiatrists are waking up to the fact that they may be killing their patients. The warnings have been on the drug labeling for years – heart, metabolic syndrome, diabetes, prolactinemia, and so on - not to mention a whole host of authoritative studies, not to mention patients who have been pointing out the obvious from the beginning of time, but the wake-up call came from a recent NIMH-underwritten series of trials called CATIE 2.


    The same symposium also contained an echo of the Krystal lecture, namely that cognition is the main problem with schizophrenia, not psychosis. Antipsychotics do a good job knocking out hallucinations and delusions, but they may make simple thought processing tasks even worse.


    Clearly, a lot of us do need antipsychotics, but we will do a lot better with smart antipsychotics med strategies rather than dumb ones. If your psychiatrist turns a deaf ear to smart strategies, it’s time to shop around for a doc who listens.



    In a few minutes I’m off to hear Nancy Andreasen MD of the University of Iowa talk on “The Creating Brain: The Neuroscience of Genius.”


    There may be an awful lot we don’t like about our brains, but some of what we have is the envy of the rest of the human race. Take heart. Sometimes our illness is a real blessing.


    This is John McManamy, “live” from the APA.


Published On: May 23, 2007