“[I] guess there are times when we all need to share a little pain, and ironin’ out the rough spots is the hardest part when memories remain. And its times like these when we all need to hear the radio, ‘cause from the lips of some old singer we can share the troubles we already know… When all hope is gone, sad songs say so much.” -Elton John

Arguably one of the most successful artists in recent decades, Elton John evidently believes—among countless others—that music can reach us when no one else can. Perhaps not a surprising logic for most of us, but why is this the case?

Why does music speak to us?

Almost all of the species on our planet can communicate through vibrations. Whether it be arthropods, snakes, dolphins, elephants, humans, and perhaps even plants, communication through vibrations is among the oldest evolutionary mechanisms for sharing information.

Grouped in with this is sound. Among animals, the ability to create sounds with the voice caused by the larynx—a structure in our neck that allows us to breath and make sounds—is highly conserved, evolving from a relatively primitive larynx like that of the lungfish, to the incredibly complex and specialized larynx of humans. So, what drove the continued evolution of the larynx into a structure capable of manipulating sound with such precision?

“These phenomena are really rooted in social communication”, says Dr. Daniel Bowling (PhD), a translational neuroscientist and instructor of psychiatry and behavioural neuroscience at Stanford University, whose research focusses on music-based treatments for mental health disorders. Dr. Bowling goes on to explain that the physiology of the larynx and its ability to constrain sound is also tied to emotional state, which is often expressed in the quality of tone (i.e., pitch, loudness, timbre, etc.).

This is a highly advantageous adaptation. The ability to convey an internal emotional state simply with tone, without spoken words, allowed animals to reach a new level of mutual understanding and connectedness. Knowing this, it is perhaps not surprising that many researchers believe that composing coordinated sounds and tones with the voice—otherwise known as music—is how spoken language began. Right from the beginning music was inescapably intertwined with emotion, social connection and communication, and has continued to be so across all ages and cultures for millennia.

This begs the question, with such tight evolutionary roots to emotion and social connection, what is the evidence for music’s contribution to mental health?

“People do use music to modulate their mental health all the time, … 70 to 80% of people [in global surveys] will say music is very important to their mental health. That’s a big deal”, says Dr. Bowling. He continues in saying that “our best therapies [for mental health] don’t help people that much, … they help on average a third of people… Music is a powerful alternative”.

This is also supported in clinical studies showing that music and/or music therapy can help reduce symptoms associated with mental illness, including depression, anxiety, stress and pain, with many patients believing that music should be a part of the healthcare experience.

What about on a biological level? How can music be modulating our emotions and possibly helping overall mental health and well-being?

Good vibrations in the brain

Pinpointing the brain regions responsible for the beneficial effects of music is challenging because music engages the entire brain rather than being localized to just one or two areas. That being said, we will look at few key areas in the brain that contribute to our emotional and physiological responses to music.

The amygdala and hippocampus, which play roles in emotion and social interaction, are involved in generating feelings such as joy, peacefulness, and sadness when we listen to music. The nucleus accumbens, often called the brain’s reward center, is linked to the pleasure or chills we may experience while listening to music. Additionally, the nucleus accumbens can change the way the hypothalamus (a critical regulator of the stress response) works, possibly altering stress levels. Finally, it is known that music can modulate neurotransmitters (signalling molecules in our brain) that control systems in the brain responsible for reward, movement, social bonding and pain, and all of these systems also contribute to emotional state.

Dr. Bowling highlights the fact that many of the fundamental dimensions of mental health, including emotional regulation, anxiety and social isolation/loneliness, and the brain networks associated with these, are also some of the exact aspects of the brain that music impacts. This means that music may influence many different systems in the brain that alters our emotional state, but the overall influence it has on our mental health depends on how we choose to engage with music.

“Music is a powerful emotional modulator, and that has two sides to it”, says Dr. Bowling. On the one side, music can help distract, comfort or alter your emotional state in a positive direction, but on the other side, music can also exacerbate negative emotions that can further worsen mental health, and this very much depends on the individual. This is common in people suffering from depression, for example, where they will tend to listen to sad music, which may intensify that emotion. But this same principle can also be used to help.

Music therapy

There are helpful and basic principles in music therapy that most people don’t know about, explains Dr. Bowling. One such is called Iso principle, which uses music to help guide an individual from an undesirable emotional state to a more constructive one. How does this work?

Music that initially matches your emotional state can lend a certain aspect of understanding that builds an unconscious trust between you and the music. Now that you're connected to the music, changes in rhythm and tone that are more associated with positive emotional states may be able to pull you out of your current state towards that positive emotional state. Dr. Bowling explains it as “mapping a trajectory through emotion space”.

Music therapy, whether in a group session, one-on-one or as an individual, is currently not a mainstream treatment option for different forms of mental health disorders. One reason outlined by Dr. Bowling is the extreme lack of music therapists available to perform this sort of work. Other reasons are perhaps a skepticism that’s present in the medical field in terms of the efficacy of music in mental health. “We think of music as entertainment, … but we should all take [music] seriously as a therapeutic option”, says Dr. Bowling.

Music—a complex symphony of vibrations—has deep roots in the evolution of language, emotion, expression of emotion and social communication, and is ubiquitous in every culture and community on Earth. Because of this, it’s perhaps not surprising that the word ‘vibes’ (i.e., vibrations) is used to describe social situations. Vibrations have been an absolutely essential aspect of social connection and emotion since well-before we could put these emotions into words. As it turns out, sad songs really do say so much.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

1. Animal communication and vibration.

2. A randomised controlled trial for individual music therapy for depression.

3. A systematic review and meta-analysis for the effectiveness of music therapy and stress reduction.

4. How and why does music move us? (Hodges et al., 2015).

5. The Paul Lepsoe music initiative: The integration of live music into healthcare.

6. A global scoping review of the use of music and treatment/managment of mental illness.

7. Engaging with Music. A global survey sponsored by the International Federation of the Phonographic Industry.

When prompted with the question What is mental health? Hazel Meredith, CEO of Mental Health Recovery Partners South Island (MHRP), countered, “What is the opposite of mental illness?” For someone who thinks so much about this topic, I was surprised by my own lack of clarity in replying. Hazel continued, “The opposite of mental illness is no mental illness”.

What is mental health?

If mental health is not the opposite of mental illness, then what is it? In Hazel’s words, “[mental health] is about doing the kinds of things to maintain a sense of optimism, purpose, meaning, contentment, and engagement in your life”. Along similar lines, the World Health Organization (WHO) establishes that “mental health is a state of wellbeing in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.” This is perhaps why substance abuse counselor Christopher Rossey reasons mental health is “a way to become more integrated, and being more integrated makes you an active rather than a passive agent in your own health.”

Who has mental health?

If you’re like me, you might be wondering, “does this mean that mental health is only afforded to the lucky amongst us who can check all these boxes and haven’t experienced any mental illness?” The answer is a refreshing no. Hazel describes “[...] people struggle with thinking that if you have a mental illness, you can’t possibly have mental health. But we all have mental health.” Much like everything else in life, mental health “is a continuum of situations, of how you are feeling, how your brain is responding to environmental factors,” shares David Butler, Clinical Nurse Educator of Early Intervention in Psychosis at Island Health Vancouver Island Health Authority (IHVIHA).

Similarly, Olivia Howard, Core Services Manager at MHRP and host of a podcast about this topic summarizes,

Mental health is something that every single person experiences fluctuations in [...], we all have a body […] a mind, therefore, we all have mental health.

What influences mental health?

Fluctuations in mental health help us adapt to our ever-changing contexts. According to Dr. Daniel Boston, a psychiatrist at IHVIHA, all biological, psychological, and social domains of life can influence mental health and vice-versa. As I watch all the public health and safety issues the world is currently facing, I am reminded of Hazel’s interview “And any of us, whether we have a mental illness or not, would struggle if we’re not having our social determinant needs met”. Throw our biological and psychological needs in the mix and it’s easy to appreciate why it can be so hard to reach the ambitious WHO standards of mental health right now.

It's important to emphasize we can seek support along the way. “Being overwhelmed is normal, but people aren’t aware there are mental health resources to treat mental health symptoms such as these. They assume you need a diagnosis before seeking help,” says mental health advocate and Brown University Surgical Neurophysiologist Helen Karimi.

What about mental illness?

Changes in mental health can go haywire and not lead to adaptation at all. This is where mental illness comes in. The path forward, just like in any other health issue, is treatment and, hopefully, recovery. But, as the saying goes, prevention is better than cure. For Dr. Boston, systemically, this means changing healthcare systems to comply with our advanced understanding of mental health, for example, removing, where possible, the focus from medical doctors and placing it in counseling services. For all our interviewees, in turn, this also means increasing awareness about mental health. To put it another way, “we might know of mental health, but do we understand it?”, asks Olivia Howard.

What is Mentally Minded?

Mentally Minded is here to tackle this issue. It’s a place where you can ask questions about mental health and get answers. It’s where you will find scientific, accurate and accessible information about mental health. We hope the information we share can help you find solace in your own mental health journey.

Summary

Just like physical health, mental health is a consequence of being human, a dimension of life built by a complex symphony of biological, psychological, and social factors. Mental health gives room to adaptation and is not a diagnosis. In the candid words of Hazel, “mental health impacts everyone and we all have a stake, a role, a responsibility. It’s a gift that we can share, give, and receive from one another.”

I recently went to my first beach campfire. The idea came from a friend who wanted to do a sort of pre-summer cleanse. We would write things we wanted to let go off on a piece of paper and use them as fuel. 

Not long after we started hearing the crackling sound of fire, the group began sharing the intentions behind each burned piece of paper. Many of us spoke of fear, gut feelings, and power imbalance. 

In listening to this, I am reminded of a difficult, but incredibly important question submitted to Mentally Minded. The question was: 

How can I respond to aggressive behavior from a partner? 

Before diving into our answer, I would like to stop and acknowledge that this is an extremely difficult topic, in particular for survivors of domestic violence. My heart goes out to everyone who reads these words and feels any resemblance to their personal stories. Please take care of yourself during this read (and at all other times for that matter). 

How to act when people cross our boundaries

Much like a country that secures its frontiers in relation to neighboring countries, people have personal frontiers. These are boundaries, or limits, rules and values one lives by in their relationships with others. They set what one is or is not comfortable with.

There are multiple kinds of boundaries: physical, emotional, material or spiritual; and each person has the right to set their own rules. For one person, raising voices during an argument can be normal, while for another it can be where they draw the line to stop a conversation. These are two different emotional boundaries. 

Personal boundaries are a basic need and crucial for one’s well-being in any relationship, be it at work, with family and friends, or in romantic contexts. If boundaries are crossed in any of these situations, that’s aggression. In fact, any behavior that harms an individual, regardless of the scale, is a form of aggression 1. 

Violence, on the other hand, occurs when the harmful behavior is intentional and aims to hurt, physically or psychologically.

Both aggression and violence in romantic relationships are common. Aggression that does not lead to physical injury has been estimated to occur at around 50-60% of couples in the United States 2,3. Meanwhile, 40-50% of both women and men report having previously suffered intimate partner violence 4. 

The types of violence or aggression in relationships are varied. Though we often think only of physical aggression like slapping, or verbal aggression like name-calling, other aggressive behaviors might be less obvious. For example, controlling the finances of a partner or restricting contact with family and friends. Psychologically aggressive behaviors can cause as much or more harm as physically aggressive behaviors, says Dr. Erica Woodin, psychology professor at the University of Victoria, who primarily researches conflict and aggression in close relationships.

In responding to aggression or violence within a relationship, we must circle back to what each individual holds as their personal boundaries. What can you accept from yourself and other people? What will you not? How do these rules align with those of your loved ones?

Another crucial piece of the puzzle is the context in which the aggression occurs. In fact, that may well be what draws the line if the answer is to stay or leave.

Where relationship researchers draw the line

Researchers broadly classify two types of intimate partner violence: coercive control violence and situational couple violence. According to Dr. Woodin, coercive control violence usually involves one partner being the primary aggressor and the other feeling a lot of fear. They may often use physical aggression, and this kind of relationship carries a lot of risk for escalating violence. 

Situational couple violence, instead, happens in the context of an argument. Couples that have a hard time managing conflict in their relationship might experience increasing escalation of a bad argument, potentially resulting in physical injury to one or both parties involved. The key differences here are that in this type of violence both people are engaging in the escalation cycle, and are not afraid of each other. 

While the danger of coercive control violence is clear, Dr. Woodin alerts that situational couples violence may be particularly damaging to the relationship. Escalating arguments rarely solve the problem that caused the argument in the first place. Thus, situational couple violence is associated with higher rates of divorce. 

The response depends on the context

Separating intimate partner violence into two categories is helpful because they require largely different responses. Coercive control violence scenarios carry great risk, so the victim has to act carefully. Here, researchers do not recommend couples therapy. “Both people have to be willing to work on de-escalating their relationship, and the controlling partner often is using violence as a weapon, as opposed to just emerging out of a dysregulation,” said Dr. Woodin. As such, the victim is encouraged to reach out to domestic violence resources and develop a safety plan, which includes, for example, separating documents and ensuring a personal bank account. “Things that are going to give you an ability to take care of yourself, and to also leave the relationship in a safe way,” Dr. Woodin said. 

For situational violence, leaving may seem extreme. Partners in this scenario may want to stay in the relationship and learn how to deal with conflict more effectively. In this case, Dr. Woodin recommends a “timeout procedure”. How exactly this timeout works will depend on each couple. The length or location of the time out can vary, but she explains further, “You basically say, step one, I need a timeout, step two, here's when we can come back and talk about this,” she said. This timeout approach takes practice, particularly for individuals who were brought up in contexts where conflicts always escalated to some sort of violence. Contrary to coercive control violence, in this process, Dr. Woodin says couples therapy can help. 

Is this research applicable to all types of relationships? 

I was curious if the same patterns of aggressive behavior were true for relationships that differ from heterosexual, cis-gender, or monogamous norms. “We do not have much research on non-monogamous couples, and that’s where the field needs to go right now,” Dr. Woodin explained. To my surprise, a lot of research has been carried out on LGBTQIA2S+ couples. In general, the dynamics in these relationships seemed to be similar. “There are similar challenges that can come up around violence, and it tends to occur at roughly the same rates as it does in heterosexual relationships.” 

Different relationships may experience different stressors, however. In heterosexual couples, research shows that there is an increased pressure to fulfill stereotypical gender expectations, where men bring in the money and women take care of the household. Couples who show a more egalitarian split of the household tend to have healthier relationships.  

In LGBTQIA2S+ couples, there is an added layer of minority stress. Can we hold hands without fearing retaliation? Can we share with our families that we are in a relationship? According to Dr. Woodin, research on minority stress shows it is associated with a greater chance of depression and anxiety. “And that's been shown to be associated with more violence”. 

TL;DR: you deserve to feel safe

Human beings are social creatures. Despite being our backbone, relationships are no trivial task. Understanding our boundaries and the dynamics in our relationships can guide us along the way. But we must remind ourselves: we all deserve to feel safe. If you are experiencing any challenges with aggression and violence in your relationships, reach out for help through: https://findahelpline.com/

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram or Twitter!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

1. https://books.google.ca/books?hl=en&lr=&id=MOljg8xXI1oC&oi=fnd&pg=PA1&ots=obi2aOlwQi&sig=CCHUFWXdzjH0G8Q6JSGxu6RVgSI&redir_esc=y#v=onepage&q&f=false

2. Confidence and accuracy in person perception: Do we know what we think we know about our relationship partners?: Swann, W. B., Jr., & Gill, M. J. (1997). Confidence and accuracy in person perception: Do we know what we think we know about our relationship partners?Journal of Personality and Social Psychology, 73(4), 747–757. https://doi-org.proxy3.library.mcgill.ca/10.1037/0022-3514.73.4.747

3. http://www.scielo.org.co/scielo.php?pid=S0121-54692019000200091&script=sci_arttext

4. Exploring “common couple violence” in heterosexual romantic relationships

5. Exploring the Link Between Relationship Cycling and Aggression in Challenging Romantic Relationships

6. A dyadic approach to the study of romantic attachment, dyadic empathy, and psychological partner aggression

During the American Civil War in the 1860s, thousands of soldiers were held in prison camps under the most distressing conditions. Morality was low and mortality was high. Oftentimes, these prisons had an invisible but very real perimeter that prisoners could not cross, named the ‘deadline’.

After the civil war, the word ‘deadline’ gradually took on another meaning. What was once a very literal border began denoting a time limit for projects, job applications, contracts and just about anything involved in our often-bureaucratic lives.

Unfortunately, a large percentage of us knowingly put off projects and walk closer and closer to the deadline, knowing fully well what waits on the other side. It isn’t enemy aggression, but the consequences are also hard hitting. This seemingly illogical behaviour is called procrastination.

Procrastination, or the “voluntarily delay in an intended course of action despite expecting to be worse off for the delay”, has been prevalent in society for millennia. Numerous philosophers have ruminated over what the cause, potential benefits and pitfalls of this behaviour could be. Perhaps the most striking writings about procrastination from antiquity come from the Roman Emperor Marcus Aurelius, the stoic philosopher. Marcus Aurelius wrote in Meditations that one must “stop letting your emotions override what your mind tells you”. Although neuroscience and neurobiology in his life were far from what they are today, this statement is far more accurate than the stoic Roman Emperor probably realized. But I’ll get to that later.

Procrastination and Mental Health

Roughly 20% of adults are chronic procrastinators (i.e., putting off tasks several times a week and/or day), although this number is higher (50%) in students. Although people who practice procrastination are mislabeled as lazy, procrastination has its roots in genetics and the actual wiring of the brain, often rendering individuals seemingly little choice but to procrastinate.

So, what leads to procrastination? Researchers have identified a few important hints, including motivation, impulsivity and lack of task value. Each of these characteristics, which are not mutually exclusive, constantly interact with one another.

Self-control and Impulsivity

Self-control and impulsivity are perhaps the biggest contributors to procrastination. In fact, researchers have shown that these behaviours can be linked to procrastination through genetics, and are actually heritable. Self-control and impulsivity are essentially opposites of each other—although they are distinct and not necessarily two sides of the same coin. Self-control involves resisting temptation and holding oneself back. Impulsivity, on the other hand, is action without adequate forethought, giving into temptation more easily, and focusing on short-term satisfaction and goals. When someone procrastinates, their self-control—their ability to keep focussed on a single goal even if they do not enjoy the task—is reduced, whereas their impulsivity—their desire to abandon the task to perform another non-essential one—is increased.

Motivation

Motivation can work for or against procrastination. We can be motivated to complete a task, but also motivated to avoid it. Many factors contribute to which direction motivation will drive us. Researchers have identified task aversiveness, which typically promotes motivation to not perform a task, as a main component. This is a straightforward idea; if you dread doing something, you are less likely to do it until you absolutely must. This idea is supported by something known as the temporal motivation theory, which states that people become more motivated to complete a task as the deadline gets closer. This could be due to the reward or punishment of the deadline increasing motivation to complete the task to levels that outweigh our motivation to not complete the task.

Lack of Task Value

Lack of task value is simply how important someone perceives a task to be, and it is tightly tied to motivation. For example, if some task is highly engaging and associated with a substantial reward, one is more likely to place a high value on it, making them less likely to procrastinate. The reverse is also true, where laborious tasks that someone does not enjoy are more likely to be avoided. Some researchers theorize that procrastination is more common in students because many of them typically do not want to be in school, but instead are there due to social pressures. The same has also been hypothesized for people who have jobs that they do not particularly enjoy.

Procrastination is a combination of many interacting behaviours and biological factors, making it a very complex topic to research and for people to overcome. Created with Biorender.com.

All these behaviours are involved in procrastination, but are also commonly observed in various mental health conditions. It’s not surprising that although procrastination is not itself a mental health condition, it is often seen in various degrees in depression and anxiety. Which causes which is difficult to pinpoint, as procrastination can lead to stressful scenarios that may worsen mental health, or mental health issues may cause individuals to procrastinate, perpetuating the cycle.

This chicken and/or egg situation is the case with many topics, including how nutrition influences mental health, the connection between loneliness and mental health, drug use and mental health, and more. However, one clue that neuroscientists can use to understand these complex interactions is to pinpoint what brain regions are involved in these behaviours, and see if there is any overlap between them.

Procrastination Station

Research looking into procrastination—although widely debated—has generally settled on one main idea when talking about the brain. Neuroscientists think that procrastination comes about due to a mismatch in communication between our ‘cognitive control system’ and the ‘affective processing system’. 

The cognitive control system mainly refers to the area of the brain called the prefrontal cortex, which essentially coordinates priorities and controls many tasks related to problem solving, attention and goal-directed behaviour.

On the other hand, the affective processing system involves the limbic system, a network of brain regions involved in emotional responses and regulation, reward, and more. When we procrastinate, our cognitive control systems seem to be less active, which prevents important signals from keeping the now more active affective processing system in check.

The prefrontal cortex and limbic system are constantly communicating and deciding what action to take next. Some think procrastination occurs when the limbic system wins. Created with Biorender.com.

With this knowledge scientists can begin to try to modulate these circuits to overcome procrastination. For example, researchers recently found that electrical stimulating the prefrontal cortex increases the likelihood that a task will be completed in a timely manner. In short, the increased brain activity within the cognitive processing system caused by this stimulation, quieted the urges to procrastinate put forth by the emotional centres of the brain.

This is where our old friend Marcus Aurelius was surprisingly accurate. By invoking that we “stop letting our emotions override what our mind tells us”, Aurelius broadly described what is happening in the brain during procrastination. The emotional centres of the brain are providing a strong urge to opt out of a certain task in favour of a ‘more attainable’ task, and the cognitive processing system is failing to suppress that emotional urge, which would allow you to perform the more difficult task. The result is a focus on achieving short-term satisfaction, reduced self-control, and ultimately, a loss of goal-driven behaviour directed by the cognitive processing system.

Procrastination also becomes easier when there are numerous activities that can provide short-term satisfaction and a sense of accomplishment, as is common in modern life. For example, when I began writing this article, I also had a pile of dishes sitting in my kitchen sink. Although the more difficult task of writing was more important in that moment than autonomously cleaning dishes, I opted for the easier task, and my brain rewarded me when I completed it. This reward then triggered the need/want to complete another mundane, easily accomplished chore, for which I was rewarded again. In people that suffer from chronic procrastination, this cycle can continue almost indefinitely, and can be achieved with much simpler and unproductive tasks, like scrolling through social media. In short, our brain can reward us for avoiding what we need to do, by providing easier alternatives that do not necessarily help our larger long-term goals.

Overcoming procrastination?

Procrastination is a behaviour present in people of all ages, cultures, backgrounds and locations, and will likely not be ‘cured’ or phased out any time soon. However, many scientists, speakers and coaches have developed different techniques that may help people overcome procrastination, and prevent the deadline from seeming so literal.

Some of these include direct interventions such as active transcranial direct current stimulation, while others—like cognitive training programs—are less invasive and easy to do at home. Nonetheless, perhaps one of the best ways to start to overcome procrastination is to break up a seemingly monumental task or goal into smaller, digestible chunks, so that each step seems easier than, say, washing dishes. As former Roman Emperor Hadrian allegedly said, “brick by brick, my fellow citizens, brick by brick.”

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram or Twitter!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

1. A review about the nature of procrastination and self-regulation.

2. Impulsivity, motivation and emotion regulation in procrastination.

3. Genetic relations among procrastination.

4. Neural substrates of procrastination using functional magnetic resonance imaging (fMRI).

5. Mechanisms underlying procrastination.

6. Procrastination and health outcomes in students.

7. Electrical stimulation and task completion.

If you’ve ever gone too long between meals, you’ve likely experienced the bitter cloud of “hanger” rolling in – your energy drops, your mood sours, and you become unreasonably irritable. But soon after a snack, the clouds part, the sun emerges and you’re back to your regular self. Clearly, food is deeply intertwined with our psychology. 

What can science tell us about the effect of nutrition on our mental health?

Credit: Pexels, Fauxels

Food for thought

Let’s start with the basics. Your brain is a complex processing machine that needs energy to keep it running. In fact, the brain uses about 20% of our body energy, coming in the form of calories. Beyond just calories, nutrients like tryptophan, vitamin B6 and B12, and magnesium are needed for the brain to create neurotransmitters like dopamine and serotonin, the molecules that allow our brain to function . That’s (one of the reasons) why it’s important to consume the recommended intake of fruit, vegetables, and whole grains that contain high amounts of these important nutrients. For example, spinach contains vitamin B6, magnesium, tryptophan, and nearly half the recommended daily amount of vitamin C in 100 grams. Omega-3 polyunsaturated fatty acids , found in fish, nuts, and some plant oils, also influence these neurotransmission systems. 

Mental health disorders can make meeting even these basic nutritional requirements difficult. . Depression, for example, is characterized by loss of interest or pleasure, disturbed appetite, poor concentration, and tiredness. These symptoms can make it feel impossible to summon the energy to get up and cook any meal, let alone a healthy one, which leads to a vicious cycle of even lower energy. While mental health can influence our relationship with food, the opposite is also true.

Can an improved diet actually help with mental health?

Several large-scale studies have looked at the effect of diet on mental health and the occurrence of mental disorders. There is, however, a lot of variety in the populations studied, the diets followed, and the rating scales used across different studies, sometimes making consistent conclusions hard to come by. 

The Mediterranean diet is often touted as the gold standard of healthy eating. This diet includes high intake of fruits, vegetables, whole grains, nuts, beans, and olive oil, with limited meat consumption. One study showed that patients diagnosed with clinical depression who followed this diet over 12-weeks had a greater reduction in depressive symptoms compared to patients without diet changes. On the other hand, the so-called “Western” style diet, with high intake of sugars, highly processed foods, and refined carbohydrates (which have been stripped of fibers, vitamins and nutrients) is associated with a higher risk of depression. 

The research suggests that diet can impact mental health, and lead to reduction in symptoms for some disorders. But how does food affect mental function and health?

What do specific nutrients actually do in the body and to the brain?

Our brain relies on chemicals called neurotransmitters to send signals. The production of important neurotransmitters like serotonin, dopamine, and norepinephrine requires vitamin B12 and folate. Deficiencies in these vital B vitamins are associated with depressed mood. However, instead of vitamin supplements, people should instead focus on a healthy diet to supply the amount of vitamins you need (although vegetarians and vegans may need an extra boost). 

Vitamin D deficiency is also famously associated with low mood, and some mental health disorders, including depression, seasonal affective disorder, and schizophrenia. The “sunshine” vitamin is normally made on the outer layer of our skin when UV light converts a byproduct of cholesterol into Vitamin D3. Without enough Vitamin D, our bodies can’t use calcium properly, leading to many health issues, including fatigue and depressed moods. Severe deficiencies in magnesium and zinc have also been found to  lead to mood changes and cognitive impairment. Both of these vitamins are found in seeds, nuts, and whole grains. 

Credit: Pexels, Wendy Wei

The Microbiota-Gut-Brain Axis

We aren’t the only ones affected by the food we consume. The human gut is densely populated by different species of bacteria – collectively called the gut microbiota. The gut microbiota helps increase our energy intake from food, modulates the immune system, and protects us from harmful bacteria. Diet heavily influences the diversity and function of these bacteria, which in turn influence the brain through a system called the microbiota-gut-brain axis.

A healthy gut microbiota is generally characterized by its diversity and resilience to change. Western-style diets have been found to decrease microbial diversity in as little as four days. The Mediterranean diet, on the other hand, increases diversity. The average person has about 160 different species of bacteria in their gut, though thousands of species have been identified in different individuals.

Probiotics, like greek yogurt or kefir, promote the presence of beneficial bacteria, such as lactobacillus and bifidobacterial. These microbes help digest, break down, and absorb nutrients that their human host can’t digest themselves. For example, a chemical group called polyphenols is commonly found in fruits, veggies, cocoa, nuts, red wine, and coffee. But 95% of polyphenols cannot be digested by humans, and are instead broken down primarily by gut microbiota. Once broken down, these chemicals can have beneficial effects by reducing inflammation and oxidation in the brain.  

Highlighting how drastically the gut microbiome can affect mental health, researchers performed a microbiota transplant from patients experiencing clinical depression to rats who had a sterile gut, containing no bacteria of its own. Shortly after the transplant, the rats began experiencing depression-like symptoms. Similarly, direct supplementation of harmful bacterial species into sterile-gut mice quickly provoked anxiety-like symptoms. 

Eating well allows us to take care not only of our own health, but also that of our microscopic friends (who, in turn, help take care of us). 

Image adapted from this source. 

Conclusion

Food is a vital part of our daily and social lives, and there is no harm in occasionally indulging in some comforting junk food as a form of self-care. However, proper nutrition is an important means of empowering mental well-being and one part of building a tool kit to maintain positive mental health. 

So remember, an apple a day helps keep the psychiatrist away. 

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

1. Nutrition and behavioral health disorders: depression and anxiety

2. Diet, Stress and Mental Health

3. Diet and the Microbiota-Gut-Brain Axis: Sowing the Seeds of Good Mental Health

4. Epigenetics, nutrition and mental health. Is there a relationship?

5. Vitamin D and Depression: Where is all the Sunshine?

6. How your brain makes and uses energy 

7. The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication

8. The Healthy Eating Source

Whether it be a shoulder to cry on, someone to run towards to share exciting news with, or simply a person to quietly sit with after a long day, companionship and social bonds are a big part of how we meaningfully experience our lives. This drive to connect — so strong in humans — is not new, but has been slowly developing for millennia. Group living and reliance on social bonds in primates goes as far back as an estimated 52 million years, meaning that social contact has been contributing to and shaping the evolution of humans since well before anything resembling the modern-day human evolved.

For this reason, it is shocking that one quarter of Canadians aged 14–24 years old and 10% of all Canadians reported that they always or often feel lonely, or that over half of American adults reported feeling lonely. These stats have resulted in what is now considered the epidemic of loneliness and isolation. The seriousness of this epidemic becomes even more apparent when we consider the physical and mental toll loneliness is having on people.

Of the people who reported always or often feeling lonely in Canada, almost 50% of them also report poor mental health, compared to just 7% who reported never or rarely feeling lonely.

So, are loneliness and mental health connected? Yes.

But what is actually causing this? What exactly is loneliness?

What is loneliness?

Everyone has experienced loneliness at one point in their lives. The emotion can be felt almost anywhere, whether it be traveling alone in a foreign country, a recent move to another city, or even at a party surrounded by others. Researchers think that loneliness could have developed in our ancestors as an alarm signal. It is as if your brain is saying, “WARNING! Social connections and community are lacking! You are now at risk to predation or a lack of food!”

“Loneliness is an evolutionary mechanism, a bit like thirst, pain, hunger, fear; it actually serves us… If we are lonely, we have an impulse to connect”, says Dr. Kimberley Brownlee, a professor at the University of British Columbia and Canada research chair in ethics and political and social philosophy. Brownlee’s research primarily focuses on loneliness and social human rights.

Loneliness may have evolved to keep us safe, but for most modern adults, a social network is not necessarily needed for protection or food. The importance of social connection — what was once a requirement to achieve these basic aspects of life — may now be more fundamental to our health than it was in our evolutionary past.

Dr. Mathew Lieberman’s book, “Social: Why our brains are wired to connect”, further explains this idea. Lieberman argues that Maslow’s hierarchy of needs, which places physiological needs as the most fundamental human need, was wrong. Instead, he suggests that social connection is the most fundamental of human needs. Without these social bonds, our ancestors would not have been able to organize themselves into self-sustaining communities, and newborns would quickly perish without the essential bond created between mother and infant. This social need remains ingrained in our biology throughout our lives.

Strikingly, one does not have to be alone to feel lonely. In fact, social isolation is only weakly associated with the feeling. So, if social contact is not necessarily the cause or ‘cure’ to loneliness, what could be driving this profound experience?

It ultimately comes down to a person’s perception that they are socially isolated, which can be inaccurate, says Brownlee. She continues to explain that chronic loneliness stems from a persistent and deep perception of isolation, which can result in a vicious cycle that impacts the way people respond to social situations. For example, someone will invest more time into a relationship that they perceive as satisfying, whereas the reverse is true for relationships that are unfulfilling — further harming their perception of the relationship and isolating them.

Loneliness is a complex and painful subjective emotional state that cannot always be within our control and can be increasingly difficult to break out of. This is partly because chronic loneliness can begin to change how we perceive social situations and our very nature towards others.

Loneliness and Health

“When [loneliness] starts to settle and becomes chronic, that evolutionary mechanism [tied to social connection] starts to overreact… our loneliness mechanism can start to be triggered in ways that make social connection seem threatening,” says Brownlee. Someone who is chronically lonely may begin to read social cues inaccurately. They may anticipate that relationships will be unfulfilling, defensively place more emphasis on independence and self-reliance, and find social situations increasingly stressful, both mentally and physically.

Research supports this notion. Scientists have observed that loneliness can result in increased bodily stress, as seen through an increase in circulating stress hormones, markers of inflammation, and changes to immune cells. Increases in inflammation and stress hormones have been known to affect health for decades. Therefore, it makes sense that loneliness is correlated with a higher risk of mortality across medical conditions, including alcoholism, suicidal ideation, depression, and anxiety.

To help put the risk of loneliness into context, researchers state that the lack of meaningful social connection is worse for someone’s overall health than smoking 15 cigarettes a day. Additionally, studies have shown that people reporting low social cohesion and social disruption have poorer antibody response to vaccinations and, as a consequence, have reduced immunity to viral infection, as studied in the context of the COVID-19 pandemic.

This ultimately results in a 50% decrease in survival rates for people experiencing loneliness.

Biological pathways involving stress hormones and inflammation are not the sole ways in which loneliness can affect health. Psychological and behavioral factors play a role alongside stress, and all three of these pathways influence the function and architecture of the brain.

Loneliness and the Brain

For the first time, a recent study aimed to come to a consensus on the neurobiology of loneliness by compiling all known research about the impact loneliness has on the brain. Researchers found that loneliness was associated with structural and functional differences in many areas of the brain, including the prefrontal cortex, insula, hippocampus, amygdala and posterior superior temporal cortex.

These different regions have many overlapping functions, but together they are important for regulating our ability to perceive and interpret social situations appropriately.

The behavioral and psychological shifts seen in people experiencing chronic loneliness, including mental illness or the inaccurate perception of social cues, may be a result of the changes in these brain regions.

There is strong evidence suggesting that loneliness can contribute to real changes in our body and brain that can lead to severe physical and mental health issues no matter the individual. Fortunately, governments are taking these findings seriously and are beginning to address them.

Health Authorities are Taking Notice 

In 2018, the UK government appointed a Minister of Loneliness. Just this year, the United States Surgeon General published a public health advisory that highlights the importance of social connection and community, and the serious health implications of loneliness. However, Brownlee points out that Canada is far behind the UK and USA in terms of identifying loneliness as a public health issue and addressing it accordingly.

Loneliness is complex, and addressing it can be difficult. “Just giving someone a pill to take away their feelings of loneliness would be to do a disservice to them”, says Brownlee. This kind of treatment would not actually get to the heart of the problem, just address the symptoms.

Being or searching for a shoulder to cry on, sharing and listening to exciting news, or just being present with people is likely the best way to start tackling the epidemic of loneliness. We know our bodies need water, food, and warmth to live a comfortable life. It’s time we also acknowledge they need social bonds and connection.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

1. Group living and social connection in primates goes back ~52 million years.

2. Loneliness in Canada. Stats Canada Survey.

3. U.S Surgeon General's Advisory on loneliness.

4. Evolutionary theory on loneliness.

5. Importance of neededness in loneliness.

6. Social isolation weakly associated with loneliness.

7. Social isolation, loneliness and cognitive decline in aging.

8. Stress and loneliness.

9. Loneliness, well-being and health.

10. Neurobiology of loneliness.

11. Loneliness and response to vaccinations.

12. Loneliness and immune response.

Trigger warning: this post discusses scientific information about suicide. If you or someone you know is in crisis, call a physician, a local hospital or a suicide prevention hotline/text line. Confidential help is available 24/7 for free. Find local help here: https://findahelpline.com/i/iasp

From the moment I opened my eyes today, I have had to make many decisions. Should I indulge and stay in bed for a few more minutes? Should I have juice or coffee for breakfast? On a typical day, the number of decisions we must make are almost endless. Ideally, our choices are guided by what is best for us, both now and in the future. But what happens when the line between the best and the worst gets blurred? What happens when we knowingly make decisions that are emotionally and physically harmful? What happens when suicide appears like an option? 

At Mentally Minded, we believe information is empowering. However, we recognize that talking about suicide can be challenging. So we want to start by saying that:  

 What is suicide ideation? 

Suicide ideation, the process in which someone considers or plans suicide, is a reality for many. In 2021, around 12.3 million adults seriously thought about suicide in the United States of America. To put this in perspective, this number is equivalent to the population of Pennsylvania. Globally, 9.2% of people experience suicide ideation at least once in their lifetime, a number almost as large as half of the population of China. 

Suicide is a complex public health issue that has no single cause. People who die by suicide often have a mental health disorder. However, the reverse is also true: the majority of people with mental health disorders do not experience suicidal behaviors. Researchers suggest suicide ideation arises from a combination of psychological pain and hopelessness that can be a result of multiple causes, such as physical suffering, social isolation, and negative self-perceptions. Adding to these social and psychological components, suicide ideation is associated with changes in brain function that can affect behavior, for example, by reducing someone’s ability to make safe decisions after comparing the pros and cons. 

Suicide ideation happens when your brain is not your friend

To measure an individual’s ability to make the best decisions, researchers developed a gambling task consisting of four decks of cards, called the Iowa Gambling Task. Each participant starts with a specific amount of money. The idea is to lose as little of it as possible over the course of the task. Participants must pick a card from either deck 100 times, adding or subtracting money from their original amount depending on the type of card. Decks C and D contain cards that give less rewards and less penalties, whereas decks A and B give larger rewards and larger penalties. Most participants usually notice this pattern between the 20th and 40th draw, proceeding to pick cards from only decks C and D because of their lower risk. If an individual, however, continues drawing from decks A and B, regardless of the higher risk, then it is assumed their decision-making capabilities are impaired.

Through this type of assessment, researchers have identified that adults and elderly  people with a history of suicide attempts make less advantageous decisions than those without a history of attempts or major depressive disorder. Such deficit in decision-making could be caused by changes in specific areas of the brain, like the orbitofrontal cortex, which sits just above the eyes. The orbitofrontal cortex is largely responsible for learning to connect specific sensations, such as the smell of bread, with a reward or punishment. Impairments to decision-making can occur when this region is injured, for example by rupture of brain blood circulation. Similarly, individuals who have previously attempted suicide show reduced orbitofrontal cortex activation when comparing risky versus safe choices in the gambling task. 

Suicide ideation is not the only context in which decision-making is impaired

Disrupted decision-making is not restricted to suicide ideation. Cognitive impairment is a reduction in brain function important for learning, memory, attention, and problem-solving that negatively impacts a person’s decision-making. Cognitive impairment affects roughly 12–18% of seniors (≥60 years of age) and is thought to be caused by changes in two parts of the brain: a region located at the very front of the brain, which contains the orbitofrontal cortex, called the prefrontal cortex, and seahorse-shaped structures that lie deep in the brain, the hippocampi.

If decision-making is disrupted in cognitive impairment and suicide ideation, do these conditions ever overlap? Yes. Researchers conducted a study with over 4500 people, all aged between 18 and 80, and found that impaired cognitive function, but not depression, was associated with the presence and frequency of suicide ideation. At the same time, people who attempt suicide are more likely to develop congitive impairment later in their life. 

We don’t know what causes suicide ideation or cognitive impairment

Whether cognitive impairment predisposes suicide ideation or vice-versa is unclear. Researchers are still grappling to find the biological causes of both conditions. Many results point to an association between mental health disorders and stroke, which disrupt the functioning of cells in the brain. Moreover, since cognitive impairment and suicide ideation are both passed down through family generations, researchers think that the increased risk is shared through changes in the guidebook that cells use to function, or DNA. 

In addition, early-life stress, for example, in the form of childhood abuse or parental neglect, has also been linked to increased suicide ideation and cognitive impairment. Researchers find that the body’s stress-response system can be overactivated in individuals who experience early-life stress. This overactivity disrupts the body’s ability to self-regulate and can impact how someone copes with stressful events later in life, potentially disrupting cognitive processes like decision-making and problem-solving. 

There is overwhelming evidence that recovery is possible

 For individuals with cognitive impairment or suicide ideation, weighing the pros and cons when making decisions may not be as easy as it might have used to be. However, there are things we can do to avoid or cope in times of crisis. To support others, an extended hand or an attentive ear can make all the difference, be it from a medical professional, therapist, friend or family. Quality health and mental care are essential to prevent suicide, as is reduced access to lethal means. On a personal level, researchers recommend activities that develop problem-solving skills, purpose, and engagement with the community. Lastly, in case your brain is not being your friend right now: 

Suicide is preventable. 

Help is available.

Treatment can be successful. 

Recovery is possible.

Resources:

1. A young person’s guide for communicating safely online about suicide

2. Definition of suicidal behaviors

3. Suicide statistics

4. China population

5. Suicide and the brain

6. Iowa Gambling Task

7. Decision-making and suicide in older populations

8. Decision-making and aneurysms

9. Orbifrontal cortex and suicide

10. Cognitive impairment definition

11. Conitive flexibility and suicide

12. Suicide ideation and cognition

13. Activity of orbifrontal cortex, decision-making and suicide

14. Decision-making in older age

15. Age and cognition

16. Cognitive impairment and suicide

17. Cognitive impairment, mental health and suicide in elderly

18. Risk of dementia after suicide attempt

19. Early-life adversity and cognition

20. Protective factors

What comes to mind when you think about light? For me, its light rays through the leaves on my favorite hiking trails. Or how the morning sun sneaks through the blinds in my room, waking me up just before my alarm does. Light feels peaceful in these thoughts, like a constant grounding force. As the northern hemisphere slips into winter, however, it’s a constant many of us are growing to miss. For some, the shortening days signal the approaching winter as sure as the cold and snow.Those who experience a severe decline in mood or develop depression-like symptoms with the changing seasons often have seasonal affective disorder, aptly coined SAD.

The Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) classifies SAD as a kind of depression. SAD shares many symptoms with depression, but are only felt during 4-5 months of the year. These symptoms can include low energy, oversleeping, and increased cravings for carbs, like bread and pasta. A small number of people may develop symptoms during the warmer months, where they experience increased irritability, insomnia, and weight loss. It is estimated that around 22 million people in the United States and Europe develop SAD symptoms.

Women are 3 to 5 times more likely to experience SAD. PC: Pexel.com RNDE Stock

What causes SAD?

While scientists are still trying to narrow down why people experience SAD, there are several ideas as to how changing seasons impact the brain. Some scientists think that changes in mood are the result of alterations to the body's sleep-wake cycle, known as their circadian rhythm. Most living things, including plants, have circadian rhythms to help the organism track the day and anticipate changes in the environment.. In mammals, this works like an internal clock, letting our brains know when we should be awake and active (during the daylight hours) as opposed to tired and asleep (during dark hours). Without any information from our environment, this cycle will continue every 24-25 hours. Our brains have some control over the timing of the cycle, using specialized neurons to tell when it's light or dark and adjust our rhythms to match the time of day.

In people experiencing SAD, shortened days may cause a “mis-match” between when their circadian rhythm expects light and when they actually receive it. Due to this shift, essential cardian rhythm hormones are produced at different times and levels in SAD. Melatonin, the hormone that makes us sleepy, may be made too often and too much in people with SAD. On the other hand, the hormone that works to promote alertness, called cortisol, is made later in the day for some people diagnosed with SAD.

Other scientists think that SAD is caused by the neurotransmitter serotonin, one of the many chemical signals in your brain that allow neurons to talk to each other. In human brain samples serotonin levels have been shown to change with the seasons, particularly in a region of the brain responsible for feelings of hunger. While researchers believe that most people experience this fluctuation in serotonin, it’s possible that people diagnosed with SAD are more susceptible to this.

How would levels of serotonin vary? Researchers think this is due to more efficient breakdown of serotonin. Supporting this idea, a study found that some people with SAD have better-working serotonin transporters, which aid in the degradation of serotonin, leaving less for their brains to use. Less serotonin in certain brain regions has been linked to low mood, sleep changes, and changes in appetite- all symptoms experienced in SAD.

Why would someone develop SAD?

Most of us experience the changing seasons, so what makes some people more likely to develop SAD than others? Scientists believe it may be due to genetics. Women are 3-5 times more likely to be diagnosed with SAD than men. Some studies have found that twins were more likely to experience similar changes in mood with the seasons. Since twins share a most of their DNA SAD may be partly due to their genes. Further support for this hypothesis comes from several studies in the late 80s and early 90s that have also linked a family history of mood disorders with the development of SAD.

Your genes aren’t the only risk factor. How far away you are from the equator has also been shown to contribute to SAD symptoms. Beginning as early as 1986, dozens of studies have tracked rates of SAD and mood changes across several states in the US. Consistently, these studies suggest a higher risk of developing SAD in states further from the equator, such as Alaska, when compared to those closer states, such as Florida. This is often explained by the amount of daylight, as southern states get more daylight hours than northern locations. This is also true for the southern hemisphere. A recent study demonstrated that rates of SAD are higher in southern Australia, which receives less light than the northern half in winter.

Are there any treatments?

Despite my personal desire to make fall last until spring, the earth keeps orbiting the sun and winter comes anyway. For those experiencing SAD this does not mean a decline in mood is inevitable, as different treatments have been shown to greatly reduce symptoms. Light therapy has recently emerged as a promising treatment for SAD and other types of depression. Individuals are instructed to sit in front of a specialized light source called a light box that delivers the same type of light as the sun, except for harmful UV rays. This is done in the morning, after waking, for 20-60 minutes starting in fall and lasting until spring. Another common treatment is a class of antidepressants called selective serotonin-reuptake inhibitors. These drugs work in your brain to increase important chemical signals, particularly serotonin. Both light therapy and drug treatments show similar ability to improve SAD symptoms and can often be used interchangeably. There is ongoing research that recommends other treatments, such as increased movement and time outdoors, vitamin D supplements, and talk therapy to help prevent and treat SAD.

Light is an important part of the way our brains work. Winter months have less light, and can often cause low moods. PC: Pexel.com Rodolfo Clix

As all of us in the northern hemisphere prepare for the winter months, it is impossible not to notice how much shorter the days are becoming. Later sunrises and colder temperatures are leaving us longing for those early morning rays to wake us more naturally than some annoying alarm. While we cannot defy physics and create longer day-time hours (yet, at least) we can work to lessen and prevent the effects of the changing seasons. If you or a loved one is experiencing mood changes, make sure to consult a physician to see if there are tools that can help make this winter feel a little lighter.

Resources:

1. NIH Fact Sheet SAD.

2. Symptoms of SAD

3. Tips for treating the Winter Blues

4. Mayo Clinic SAD causes

5. Mice to study SAD

6. How is SAD diagnosed

7. Genetics and SAD

8. Bright Light Therapy

9. SAD and the Southern Hemisphere

10. Circadian Rhythms

11. Does light therapy work?

12. SAD Overview

13. Latitude and SAD

14. Serotonin and SAD

15. Cortisol and SAD

People with attention-deficit/hyperactive disorder (ADHD) can be incredibly dedicated. Despite this, they may face a significant obstacle: how their mind works.

Image by rawpixel.com

ADHD is a misleading name

ADHD is the most common mental health disorder in kids, with a 7% prevalence worldwide. The symptoms can linger throughout life. It’s estimated that 2.5% of adults live with ADHD. The name ADHD can be misleading as individuals do not experience reduced attention in tasks, but instead show a deficit in shifting their focus from one activity to the other. Moreover, individuals with ADHD can show either inattentiveness, relentless behavior, or both.

Neurodiversity and ADHD

Two people can learn, think, and behave differently. More and more, researchers see this phenomenon as the rule instead of the exception, a framework known as neurodiversity. Because every brain is different from the next, conditions like ADHD do not necessarily need to be fixed, but society does.

For example, someone with ADHD often has an easier time with creative thinking and activities that feed off imagination. On the flip side, they might have a harder time controlling impulses and ignoring distractions. Each one of these traits can become either advantageous or disadvantageous, depending on the situation.

If work or school only value brains that can focus for long stretches of time, then precious creative resources of brains with ADHD can be simply lost in translation. If, however, society becomes more receptive and inclusive to different ways of thinking and behaving, then someone with ADHD can use their unique traits for the collective advantage.

Yellow-Red-Blue abstract painting by Wassily Kandinsky. Original public domain image from Wikipedia. Digitally enhanced by rawpixel.

The brain and ADHD

The cause of ADHD is under intense investigation. Researchers think it’s likely a combination of genetic, psychological, and environmental factors. In the brain, ADHD seems to be associated with a reduction in the size of some of the regions related to memory and the inhibition of movement, such as the hippocampus and the basal ganglia. Delayed prefrontal cortex development, a brain area primarily responsible for “executive functions”, or goal-directed behaviors, is another significant contributor to ADHD.

Researchers suggest the delay in the development of the prefrontal cortex during adolescence could be a window of opportunity for ADHD treatment. While the prefrontal cortex develops, it can more easily adapt to make connections with other brain regions or function better by itself. Physical activity, for instance, can increase blood flow to the brain region, increasing its energy and facilitating executive functions in individuals with ADHD, particularly at younger ages.

ADHD is diverse and can require multiple strategies

Most current research on ADHD is based on male-identifying individuals with hyperactive behavior. The current lack of diversity in research subjects is important when we consider that strategies to manage disadvantageous traits of ADHD may not be applicable to, for example, other genders or individuals without relentless behavior. This brings up an important point: Heterogeneity in ADHD means there is no one-size-fits-all solution, with individuals often adopting many strategies throughout life.

To improve concentration and time management, researchers suggest keeping planners, writing study goals, setting up reminders or taking notes while studying. But remember, motivation may not come easy to a person with ADHD. To address this, the research suggests using external strategies. For example, focusing on a task for short periods and switching to a rewarding activity, such as watching a new episode of your favorite show, is a commonly-used strategy.

Setting goals that have external motivators or rewards can also be a significant push. For example, getting better grades can mean entry into a prestigious medical school. Researchers suggest that a crucial game plan for someone with ADHD is to eventually draw from internal motivators, or the desire to complete an activity because it is interesting, challenging or in line with our values. Internal motivators, more than external rewards, can increase motivation and facilitate tasks that demand more concentration, such as studying.

Image by rawpixel.com

Are behavioral changes enough?

The debate whether purely behavioral changes are enough is not yet settled. Generally, upon diagnosis, medications are the frontline of ADHD treatment. Prescriptions will include drugs that can balance the levels of dopamine and norepinephrine in the brain, which are either too high or too low in ADHD. Dopamine and norepinephrine stimulate the activity of neuronal cells, facilitating the communication between different brain regions.

However, roughly one-third of individuals do not respond to or tolerate psychostimulants well. Cognitive-behavioral therapy, a goal-oriented form of psychotherapy, can follow, although studies disagree on which is more effective than the other: medication, therapy or behavioral changes.

All of this goes to say that, as much as we would like to have a straightforward answer to this question: science is not there, yet. In the meantime, individuals with ADHD can think like a researcher and experiment with their own learning. Of all the strategies I mentioned, what could work best for you?

References:

1. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation

2. Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis - ScienceDirect

3. Treatment strategies for ADHD: an evidence-based guide to select optimal treatment | Molecular Psychiatry

4. The neurodiversity concept: is it helpful for clinicians and scientists? - The Lancet Psychiatry

5. Brain development in ADHD - ScienceDirect

6. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder

We all know what it is like to not be able to focus. It may be on a long drive, it may be in a boring lecture, it may be during a morning meditation. Random thoughts arise spontaneously – did I switch off the lights? I shouldn’t have had that last piece of cake. I wonder how Jim is doing.

At best, these thoughts inspire your next great idea. At worst, they can be a barrage of distractions that you just can’t get out of your head. Scientists are still working out exactly why these spontaneous thoughts occur, but some research suggests a bad night’s rest may just have something to do with it.

First, let’s figure out what a spontaneous actually is. The definition itself is something of a debate in the neuroscience community. For some, spontaneous thoughts are defined by what they are not – directed thought, like the one needed to read this article.

Others argue the definition is too vague, too broad. They define spontaneous thought using a framework of automatic vs deliberate constraints. Automatic constraints on thought could be worries outside our immediate attention, like worry over a coming deadline. Deliberate constraints, on the other hand, are consciously imposed, like the attention required to listen to a lecture.

Thoughts with low deliberate constraints but high automatic constraints are thought of as ruminations, or obsessive thoughts. Thoughts with deliberate constraints but low automatic constraints are thought of as goal-directed, or focused thought. Using this framework, spontaneous thoughts are those with low automatic and low deliberate constraints – things like creative thinking, dreaming, and mind wandering.

These spontaneous thoughts can be further placed into positive or negative categories. “We have positive-constructive daydreaming, which relates to pleasant thoughts about the future, or problem solving” said Dr. Ana Lucía Cárdenas-Egúsquiza, a postdoctoral scholar in the department of psychology and behavioral sciences at Aarhus University in Denmark. Those are the great ideas that come in the middle of the night, or happy thoughts about your plans for the weekend.

There’s also a category called disruptive mind wandering and daydreaming. “They are related to more negative emotions,” said Dr. Cárdenas-Egúsquiza. Those are the thoughts that distract you from whatever you’re trying to focus on, thoughts centered on fears and guilt.

So spontaneous thoughts are those which we have little deliberate or automatic control over, and they fall into either positive or negative categories. What does sleep have to do with it?

Research suggests that a bad night’s sleep is correlated to an increase in disruptive daydreaming and mind wandering – the negative forms of spontaneous thought. Bad nights stemming from poor sleep quality, sleep disturbances, and sleep deprivation were all related to disruptive spontaneous thoughts. Sleep duration, on the other hand, did not seem to affect the amount of spontaneous thoughts.

Interestingly, not all kinds of spontaneous thoughts were affected the same way. Positive-constructive spontaneous thoughts – the great ideas, the happy daydreams – did not seem to be correlated with a bad nights’ rest.

How sleep quality and spontaneous thoughts are linked is still unclear. There are a few hypotheses researchers are actively studying.

For example, spontaneous thoughts may come from our stream of consciousness, the continuous thread of thoughts that accompany our everyday lives. When we focus on a task, psychologists theorize we use executive control to inhibit this stream of thoughts.

Executive control – the mental process we use to concentrate, plan, and think things through – requires energy to use. Studies in laboratory settings have observed that reduced executive control was associated with increases in daydreaming and mind wandering.

A bad night’s rest, somewhat unsurprisingly, has been associated with reduced executive control. We may feel tired the next morning, low on energy, possibly impacting our ability to exert executive control over our thoughts. No matter how hard you try to focus, spontaneous thoughts continue to appear.

Our mental health, too, may play a role. Depression and anxiety have both been associated with reduced sleep quality and an increase in daydreaming and mind wandering. Insomnia and certain types of spontaneous thought, particularly disruptive mind-wandering and thoughts of failure, can be considered a defining characteristic of many of these disorders.

It’s important to note, however, that none of these studies state that a bad night’s rest is causing an increase in spontaneous thoughts. “The other way could be true as well,” said Dr. Cárdenas-Egúsquiza. A day full of disruptive mind wandering, filled with thoughts of failure and guilt, could also affect your sleep that night. “I think it’s bidirectional,” she said.

Our thoughts accompany us wherever we go, whatever we do. They can appear at unexpected times, potentially offering a source of brilliance, potentially distracting us from a critical task. How and why exactly these spontaneous thoughts occur remains something of an ongoing mystery. It may just be that last night’s rest may hold the answer.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram or Twitter!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

The neuroscience of spontaneous thought

Mindfulness meditation and executive thought

A review of studies linking sleep with spontaneous thought

The neural basis of spontaneous thoughts

A framework for defining spontaneous thoughts

The cognitive toll of executive control

The link between spontaneous thought and mood disorders

An interview with Dr. Ana Lucía Cárdenas-Egúsquiza

“Friendship has no survival value; rather it is one of those things which give value to survival”

C.S. Lewis

TL;DR

Societal norms and expectations surrounding the loss of a romantic partner are often more recognized and supported compared to the loss of a friend. There are established rituals and cultural frameworks for grieving the end of a romantic relationship, whereas the loss of a friend may not receive the same level of acknowledgment or support. In combination with lack of societal support, the dissolution of delicate friendship bonds affects our identity, reconfigures our social connections and triggers feelings of shame - all making a friendship breakup just as, if not harder, than losing a romantic partner.

Is there anything more beautiful than the unexpected gift of friendship? Someone who, for no other reason than simple delight of your company, selflessly provides moments of comfort, joy and understanding? It is no surprise then, that experiencing the chilly consequences of a friendship dissolution creates similar feelings of distress compared to losing a romantic partner. Similar, but not the same.

Researchers in the Netherlands studied the relationships of 604 people and found that over half of friendships expire after seven years. Even experiencing strain in friendships, such as doubting that a friend will be supportive when needed, is a high predictor of chronic illnesses later in life. Enduring friendships on the other hand, are associated with better long-term health, well-being and life satisfaction.

What then, makes friendships such unique relationships?

Unlike romantic relationships, friendships are not mutually exclusive, voluntary, and based on equality—not expectation. These aspects allow some friendships to simply fade away with minimal or no formal closure.

Since friendships are also not bound by rigid institutional norms, their dissolution is made more difficult when major problems arise. Irene Levine, friendship expert and author of Best Friends Forever: Surviving a Breakup with Your Best Friend says, “Outsiders to the friendship may not appreciate the significance of the loss or offer up much sympathy. When someone breaks up with a lover or divorces, everyone rallies around her with support. The same isn't true with friendship endings.”

Both romantic and friendship breakups lead to decreased feelings of acceptance and self-esteem. Both result in heightened aggression. Both activate brain regions associated with physical pain (such as the anterior cingulate cortex and insula), which suggests breakups may involve overlapping mechanisms with physical and emotional pain. Yet romantic and friendship breakups have slightly different psychological consequences on mental health.

Attachment

Attachment to another is carved out by brain regions that support the innate social need to bond (prefrontal cortex and the posterior cingulate cortex). This system undergoes a drastic change as individuals detach from their former friend and reconfigure their social connections.

The brain's social cognition processes, involved in perceiving and interpreting social cues, is deeply affected following a friendship breakup.

Unlike romantic attachment that involves a heightened level of emotional closeness and an intense bond characterized by romantic love, passion, and the desire for a lifelong partnership, friendships involve the type of emotional intimacy that often centers around sharing personal thoughts, feelings and experiences, providing a safe space for vulnerability and empathy.

However, like in romantic breakups, the brain's capacity for resilience can contribute to healing. Over time, brain circuits associated with the pain of a friendship breakup may weaken, while circuits related to forming new friendships and resilience may strengthen.

Identity

Close friendships play a significant role in shaping our identity. Friendships provide emotional support, acceptance, and validation. When friends understand and appreciate one's values, beliefs and personal experiences, it can reinforce and shape aspects of self-identity. Friends can also contribute to one's self-concept by offering affirmation, empathy and understanding. Importantly, friends often encourage each other to be authentic which helps with individual growth.

When a friendship ends, individuals may question their own self-worth, feel a loss of social support, and struggle with a sense of identity disruption. It may require time and introspection to reestablish a sense of self and redefine one's social identity, along with rebuilding self-esteem and prioritizing self care activities.

Grieving

Ending a close friendship can trigger a grieving process, similar to what is experienced after the loss of a loved one. Individuals may go through stages of denial, anger, bargaining, sadness and acceptance as they come to terms with the end of the friendship. This grieving process is a natural part of adjusting to the loss and reconfiguring one's social connections.

However, adults tend to feel deep shame since there’s an expectation to have “friendships figured out.” It’s common to hide feelings, unlike the emotional outpour that may occur with a romantic breakup. Shame and fear after a friend breakup can feel isolating. In these cases, it’s crucial to reach out and talk to loved ones or a professional healthcare provider.

As part of the grieving process, forgiveness is also important. If you blame yourself for what went wrong, you must learn to accept the experience because you can’t change what happened. You can use your mistakes as a learning opportunity to become a better friend in future situations.

More research is needed to better support individuals going through this unique experience and develop interventions to promote emotional well-being and eventually, the formation of new friendships.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram or Twitter!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

1. NWO (Netherlands Organization for Scientific Research). (2009, May 27). Half Of Your Friends Lost In Seven Years, Social Network Study Finds. ScienceDaily. Retrieved June 19, 2023 from www.sciencedaily.com/releases/2009/05/090527111907.htm

2. CHOPIK, W.J. (2017), Associations among relational values, support, health, and well-being across the adult lifespan. Pers Relationship, 24: 408-422. https://doi.org/10.1111/pere.12187

3. Amati, V., Meggiolaro, S., Rivellini, G., & Zaccarin, S. (2018). Social relations and life satisfaction: the role of friends. Genus, 74(1), 7. https://doi.org/10.1186/s41118-018-0032-z

4. Social exclusion: Psychological approaches to understanding and reducing its impact. Citation. Riva, P., & Eck, J. (Eds.). (2016)

5. de Boer, A., van Buel, E. M., & Ter Horst, G. J. (2012). Love is more than just a kiss: a neurobiological perspective on love and affection. Neuroscience, 201, 114–124. https://doi.org/10.1016/j.neuroscience.2011.11.017

6. Vieth, G., Rothman, A. J., & Simpson, J. A. (2022). Friendship loss and dissolution in adulthood: A conceptual model. Current opinion in psychology, 43, 171–175. https://doi.org/10.1016/j.copsyc.2021.07.007

Between the seemingly random start and stops of our Uber driver, I tried—with difficulty—to spot the top of the buildings encircling the vehicle. Toronto, with a population of nearly 3 million people, is Canada’s largest city. One could walk for miles amongst the concrete and blinding windows and not stumble upon a single plant, unless you find yourself in one of the many waiting rooms at the base of every tower. It’s no accident that waiting rooms, offices and apartments have plants. Subjectively, they can make a space feel welcoming, visually appealing, lively and perhaps fragrant. But what scientific evidence has tied indoor plants to mental health? What about the recent global initiative to retrofit our concrete jungles into… well, concrete jungles?

Indoor Plants

Scientists estimate that people spend up to 90% of their time indoors. Knowing this, it’s not a surprise that many of us go to great lengths to make our indoor environment as comfortable as possible. This has never been more true than in the context of the COVID-19 pandemic. Lockdowns and quarantines increased time spent indoors even further, creating a level of intimacy with our indoor environment not yet experienced by most. This drew not only ergonomic and aesthetic attention, but also scientific attention to our indoor environment, prompting studies about how indoor plants may affect mental health.

Although evidence is still scarce, almost all studies suggest that indoor greenery likely has a positive impact on mental health. In fact, even just viewing images of natural scenery can result in a more relaxing bodily state compared to viewing images of human-made landscapes, a reason why most software companies queue up a beautiful natural landscape image on your desktop. But what functions are performed by living plants?

Plants provide many different services that can reduce stress and promote mental health. They release oxygen, control temperature and humidity, increase the microbial diversity of our homes and perhaps most importantly, have the ability to purify our air.

For urban dwellers, air pollution is a regular part of day-to-day life. Many might see our homes as safe-havens, but indoor environments also have air quality issues that can directly influence our health from allergies to cancers. Indoor air pollutants include particulate matter (e.g. dust) and gasses like nitrogen dioxide or formaldehyde, which can be formed/released by building materials, furniture, cooking with gas stoves or even burning incense. These compounds have been found to cross from the blood into the brain, where they cause inflammation and toxic stress to the cells necessary for proper brain function. Partly due to this, long-term exposure to air pollutants—even in small concentrations—can increase the risk for depression, anxiety and psychological distress.

House plants can offer a decorative and cheap solution to help combat poor air quality in our homes. If you think back to your high school biology classes, you may remember that plants ‘breathe’ in carbon dioxide and ‘breathe’ out oxygen during the process of photosynthesis. During this ‘inhale’, carbon dioxide is accompanied by other gasses and particles in the air, and these often remain inside the leaf where it is converted into non-toxic compounds. The breakdown of pollutants by microorganisms in the soil or the ability for plant stems to hold on to these compounds are also ways house plants can remove damaging compounds from the air. For example, the golden pathos (Epipremnum aureum), a very common indoor plant, can remove all detectable levels of formaldehyde from the air in a space slightly larger than a double oven within 5 hours.

In this way, plants can effectively purify the air within our homes, preventing the inflammation and cellular stress that is tied to mental health issues. Additionally, cleaner air would also mitigate other health complications like respiratory illnesses that also contribute to mental health, since physical ailments are tightly linked to mental well-being. In line with this, improved mood and reduced psychological stress can help our body physically heal, another benefit offered by indoor plants.

Plants have the ability to improve mental well-being through various different mechanisms.

The best example showcasing this effect was a clinical trial that looked to see if indoor plants had an impact on the recovery of patients after a surgical procedure. Patients that received the same operation were either placed in a hospital room with or without indoor plants. Remarkably, the presence of plants had a positive effect on patient recovery, evidenced by lower systolic blood pressure, reduced pain and anxiety, and higher satisfaction with their hospital experience. Perhaps this comes from a feeling of connectedness to the natural world. A sort of living relationship that we aren’t really conscious of, ultimately improving our mood and health (a hypothesis currently more philosophical than scientific).

It is important to note though, that these studies are extremely difficult to control, meaning that there are multiple factors that can influence the outcome of the study that the researchers can’t always account for, making any conclusion difficult to tie directly to house plants. Because of this, scientists cannot definitively say how or why indoor plants may cause these beneficial effects. It is also unclear how many indoor plants are needed for us to actually reap the benefits of these leafy functions. Added on top of this, the stress of trying to keep a plethora of house plants alive may counteract these beneficial effects!

Although it is still uncertain how or why plants improve our physical and mental health, increasing evidence suggests that they have a real, tangible positive impact. So even though taking care of house plants can be frustrating, remember that the relationship is reciprocal and that the effort is rewarded. It is clear that indoor plants can have profound effects on our health, but what about our outdoor spaces? Can these benefits be harnessed on a larger scale?

Concrete Jungles

Green cities are more or less exactly what they sound like—a push to retrofit our largest cities to incorporate green spaces like parks, street trees, community gardens and rooftop gardens. Singapore is a great example of how modern architecture can be combined with plant life to form a thriving green landscape. Besides the proposed benefits to wildlife, biodiversity, temperature moderation of buildings and air quality, green cities also have an impact on our mental health.

Singapore has made impressive strides in including plant life within the city. Credit.

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Several studies have shown the positive association between time spent in green spaces and mental health outcomes. A recent 2021 study with data from 18 different countries concluded that frequent visits to green spaces was linked to positive well-being, reduced rates of mental distress and reduced the use of doctor-prescribed medication for depression.

These benefits may be directly related to interactions with green spaces for many of the same reasons as for indoor plants, or because of social interactions and/or exercise that often accompany these visits. Distinguishing between factors like these is difficult and no clear answer has yet been agreed upon for how green spaces positively influence our mental health. But this distinction, although important, is not absolutely necessary for policy makers, city planners and/or individuals on a day-to-day basis. Whether green spaces directly influence mental health in a positive way or whether they provide a means for increased exercise and social interactions—which also produces these beneficial outcomes—or whether it is a combination of the two is beside the point. What matters is that there is a clear link between access to these areas and improvements in mental health, which is reason enough for their incorporation into our cities.

Allan Gardens

As our Uber driver abruptly pulls over and stops, a cool breeze meets us as we clamber out of the vehicle. We have arrived at Allan Gardens. Toronto, as menacing and busy as it may be, has also made impressive strides in including some green amongst the grey. The breath-taking green houses at the centre of this park, free to the public, showcase flowering tropical plants, which are stoutly guarded by a number of pampered turtles. This park is evidence enough that green homes and cities have the ability to promote mental well-being. Whether it is something as simple as the addition of a house plant or as complex as retrofitting a bustling city centre, everyone should have easy access to green spaces to collectively improve our mental health.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram or Twitter!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

A review covering the basic roles of indoor plants and health

A review of epidemiological studies on indoor plants and mental health

Indoor plants and air purification

Golden Pathos Fact

Air pollutants in our homes

Air pollution and depression

Indoor plants and recovery in hospitals

Green spaces and mental health

Study on the association between green spaces and mental health

Air pollution and biomarkers of Alzheimer's disease

Plants have the ability to modify indoor microbial diversity

Mental health and the microbiome of buildings

Incense smoke and health

Living with depression may feel like you’re underwater. The depth and turbulence of the water can vary day by day, or person to person. No matter where they are in the turbulent seas, many search for a life vest only to find very little to grab on to. Sometimes, the life vest offers a respite. Other times, we may be thrown back underwater. What life vests are available to us depend on current treatments for depression, which are complicated and on-going, with stumbles and setbacks along the way. Most of us are familiar with the experience described, either our own or our loved ones with depression. Depression is a unique and personal experience. Symptoms vary, and how they affect people are as distinct as the people themselves. For some, the drug treatments helped. For others, they may have done more harm than good. But drugs are supposed to work, right? Then why do so many people suffering with depression disagree?

For years scientists have believed that depression, like other mental illnesses, is caused by an imbalance in certain chemicals important for your brain to work. These chemicals, called neurotransmitters, help your brain communicate with itself and your body. A few neurotransmitters have been linked to depression. One of these neurotransmitters, serotonin, has been shown to be decreased in the brains of people with depression. While there are many types of antidepressants out there, the most common ones affect serotonin levels. Emerging as the leading treatment for depression, selective-serotonin reuptake inhibitors (SSRIs) work by blocking the breakdown of serotonin in your brain. Less breakdown of serotonin results in an additive effect- non-broken down serotonin plus any newly released are now available for the brain to work with.

While research suggests these treatments are able to successfully boost serotonin, not everyone feels better taking them. But why? Recent studies have looked into how many people are helped with standard courses of antidepressants. One study estimates that 40-60% of people are helped by antidepressants. Of these 40-60%, only a 20% decrease in depression symptoms are observed on average. If the treatment worked, why didn’t the symptoms go away? SSRIs also come with a host of side effects. While research suggests SSRIs act on the brain to do their job, they also can have unwanted effects. People who take SSRIs describe feelings of anxiousness, weight gain, sleep disturbances, and sexual dysfunction. These effects could be the result of serotonin in other parts of the body. 95% of serotonin is found in the gut, and it's known to have effects on digestion. Nerves and muscles also respond to serotonin, and the heart uses it to coordinate beating.

Image Credit: Shutterstock 2022544571

Scientists don’t currently have concrete answers to why antidepressants have varied effects. Some believe that people don’t respond to antidepressants in the same way because each person is a little different. Some people are better at breaking down drugs when they enter the body, leaving less to work in the brain. Others have lower levels of neurotransmitters, and any boost can cause noticeable differences. Each of us is unique in how our brains and emotions work and it's possible drug treatments for depression just can't keep up.

Perhaps future drug therapies lie in the complexity of the brain. Our brains use many neurotransmitters, not just serotonin. Future treatments may look at other neurotransmitters linked to depression. For example, some scientists are looking at glutamate, another neurotransmitter recently linked to depression, as a new potential target. Similarly, some researchers acknowledge that every person’s depression may be caused by unique changes in brain chemistry, and are hunting down ways to identify the cause and tailor treatment. Identification of these “bio-markers”, or bodily clues, would allow for better selection of therapeutics earlier in depression. Other researchers are taking a different approach entirely, instead wondering how we can make our brains more adaptive. Their goals are to increase our brain's ability to change, and with that change help move away from depressive symptoms.

The only way to know if therapeutic treatments for depression will ever be the life vest we're looking for is through continued understanding of how the brain works. Scientists are invested in understanding the billions of connections in the brain and using that knowledge to create new treatments. This push to dive into the depths of the human brain is transforming the way we understand depression. Scientists continue to seek new therapeutics targeting different chemicals, different parts of the brain, and different parts of the body. These combined efforts just might help more people escape the turbulent seas of depression.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Twitter!

If you're interested in reading more check out these evidence-based sources I used in researching this answer!

How effective are antidepressants?

How many people are helped with antidepressants?

How does the brain differ in depression?

Stats about depression

Depression symptoms

SSRI side-effects

Patient experience taking antidepressants

Serotonin outside the brain

Antidepressant use stats

New perspective on depression treatments

Personalized medicine to treat depression

Example of new treatments

Even if you’ve never seriously meditated, you already know the basics of the practice. Sitting comfortably, slowly breathe in and breathe out. That counts as one. Breathe in, breathe out. Feel your chest slowly expanding, then deflating. Breathe in, breathe out. Focus on the breath as it moves in and out of your lungs, thinking of nothing else. Breathe in, breathe out. That’s all. How is it that such a simple practice can help manage the many mental illnesses that so many struggle with?

Woman meditating at home. Image Credit

The practice of focusing your attention on your breaths, letting distractions fade away, is a type of meditation. Stemming from Buddhist traditions, mindfulness meditation is one of the most popular forms of the practice today. The general concept centers on turning your attention toward experiences and sensations you feel in the moment, noting them without judgment. Some practices call for focused attention on specific things, like your breath, while others call for a stream of consciousness-style awareness of your surroundings. “There are many different kinds of meditation, and they aim to do different things,” said Dr. Jonathan Greenberg, an Assistant Professor of Psychology at Massachusetts General Hospital and Harvard Medical School. “The most widely used meditation in the West probably is mindfulness,” he told me.

The benefits touted by those practicing mindfulness meditation are plenty, ranging from increased focus to higher levels of life satisfaction. But what about its effects on disorders like anxiety and depression?

Researchers have been interested in what meditation does to the brain, and our mental health since the early 1970s. Several intervention programs have been developed to improve mental health through concepts found in meditation, such as mindfulness based stress reduction or mindfulness based cognitive therapy. Mindfulness based cognitive therapy, specifically, was developed in the 1990s to treat recurrent depression. “You combine mindfulness skills with cognitive therapy skills, and it has been shown to effectively prevent depressive relapse,” Dr. Greenberg said. Since then, aspects of mindfulness have been integrated as a core component of many mental health therapies, such as standard cognitive behavioral therapy or dialectical behavioral therapy.

Targeted intervention programs, like mindfulness based cognitive therapy, are meant to serve as a foundation for meditative habits individuals can retain over the course of their lives. Generally, these programs run over a course of 8 weeks and involve a series of supervised and unsupervised meditation sessions. “The more you seed these bits of practice throughout the week, the more available these skills are to you and the more effective meditation can be,” said Dr. Greenberg. One doesn’t have to be a master meditator to begin seeing the benefits – a small effort can go a long way to establishing helpful habits.

Various clinical trials have shown that repeated meditation has proven effective in reducing the symptoms of common disorders, like depression and anxiety. Generally, patients undergoing a mindfulness-based intervention reported lower levels of anxiety and mood symptoms after the program. Researchers found the effects of meditation to be just as good as, if not better, than those of standard antidepressants or anti-anxiety medications. Mindfulness in general, not just dedicated programs, appears to help manage the symptoms of mood disorders. The rise of popular meditation apps, like Headspace or Calm, have made guided meditations more accessible to people. While the effect of self-guided meditation programs on mental health has not been extensively looked at, pilot studies have begun to investigate their benefits. For example, researchers from the University of Otago, in New Zealand, studied the effects of mindfulness apps on university students’ mental health. What they found echoed the results of the standardized mindfulness-based interventions – students who regularly used mindfulness apps, in this case Headspace or Smiling Mind, reported lower levels of depressive symptoms and anxiety.

So, meditation seems to work. Why and how it works, however, remains an open question. Part of the problem is that meditation and mindfulness are not simple tasks, and can be influenced by factors impossible to control – how tired people are, when did they last eat, how stressed they are. Meditation alone appears to activate several major brain regions associated with complex emotions like fear, memory, and decision-making – such as the amygdala, hippocampus, and prefrontal cortex, respectively. Some attempts have been made to investigate how these brain regions change in response to meditation, but studies are few and far between. More research will need to be done to determine if and how these changes are a result of meditation.

That being said, a lot of research has been carried out on the functional effects of meditation – how meditation changes your mind, not just your brain. The effects seen can be highly varied, and depend on a lot of factors. What kind of meditation you do, how long you do it for, and how experienced a meditator you are all key factors in reaping the benefits of meditation. “One of the most widely studied effects is stress reduction,” said Dr. Greenberg. Stress is one of the biggest clues we have to how meditation helps reduce symptoms of depression and anxiety. “High levels of stress make one more susceptible to anxiety, depression, and a host of medical conditions… by lowering stress levels, meditation can potentially prevent these from occurring or increase our ability to manage them,” said Dr. Greenberg. In addition to stress reduction, meditation appears to enhance emotion regulation, focused attention and alertness, as well self-awareness and self-esteem. There’s some evidence it may even improve sleep quality.

Brain Networks and Associated Brain Regions during Consciousness. Credit: Bremer at al, 2022; Scientific Reports.

The functional changes observed following meditation – increased attention, reduced stress – may be related to changes in how regions of our brain interact with each other. Different areas of our brain communicate with each other at different times, forming functional “brain networks”. Meditation is most often associated with three different brain networks – the default mode network, the fronto-parietal network, and sensory-motor network – which are involved in processes such as emotional regulation, body awareness, and spontaneous thought. Researchers have observed changes in the activation of these networks during meditation, such as a suppressed default mode network, or an activated fronto-parietal network. Some studies suggest that the regions that make up these networks change as individuals enter a meditative state, forming meditation-specific brain networks.

Meditation is an ancient practice, stemming from core Buddhist traditions. Yet, its effects can prove to be useful in managing our mental health today. You already know the basics – breathe in, and breathe out. Why not give it a try?

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Instagram or Twitter!

If you’re interested, check out some of the sources I used in researching this answer! All sources used for this answer are strictly evidence-based.

A review on the neuroscience of mindfulness meditation

A review on meditation as a self-help treatment for anxiety and depression

A report on a control trial on the effect of meditation apps on mental health

A review on mindfulness-based interventions in psychiatry

A three-year follow up on the effects of mindfulness-based stress reduction interventions in anxiety disorders

A case study on the effect of the “Calm” meditation app in reducing stress among college students

An analysis of the (lack of) changes in brain structure following mindfulness-based stress reduction

A case study analyzing the effects of mindfulness meditation on sleep quality

A review on the benefits of mindfulness meditation in mental health

A case study observing changes in brain structure following 8 weeks of mindfulness meditation training

An article examining changes in resting-state brain networks after a meditation program

Another article looking at changes in brain functional connectivity before and after meditation practice

An article looking at changes in brain network configurations during meditation

An article analyzing neuroplasticity in brain networks in meditation-based training

An article looking at changes in brain network activity during mindfulness meditation

Interview with Dr. Jonathan Greenberg

Image Credit

When one country attacks another, the ambushed country may defend itself by sending in land, air or water protection. In the same way, your immune system is ready to strike any foreign invaders to keep your body in good health. But what happens when your own defenders launch a coup? This is the definition of an auto-immune disorder, which occurs when the body’s own immune system attacks and destroys healthy body tissue by mistake. Lupus is one example of an auto-immune disorder that attacks not only the body, but also the mind.

Lupus: A Mysterious Disease

The most common type of lupus is also called systemic lupus erythematosus or SLE. Lupus is a long-term inflammatory disease that affects multiple organs in the body and can cause joint pain, fever, organ damage and skin rashes (including the distinct butterfly rash on the face). In individuals with lupus, zealous heads of state (B &T immune cells) decide to launch a full scale attack, resulting in the heavily trained reserve military (autoantibodies) destroying innocent individuals (healthy body tissue). There is currently no cure. Lupus is not contagious and for the majority of people living with the disease, it will not be fatal. Although the cause is unknown, it’s thought that the hormone estrogen may play a part in this condition since lupus is more prevalent in women than in men.

Lupus affects African-American, Hispanic, Asian and Native American women to a greater extent than Caucasian women, but the reason for this too, remains a mystery.

The majority of drugs used to treat lupus (for example steroids) suppress the overactive immune system, although not always successfully and with side effects.

Experts have a difficult time estimating how many people in the United States have lupus because it is difficult to diagnose. Some even call the disease “the great imitator”, as it is often confused for other illnesses. Compounding the problem is the manifestation of psychiatric symptoms associated with the disease, side effects of medications, and/or psychosocial stresses from chronic lupus. None of this is fully understood.

The latest neuroscience research suggests that lupus affects the protective layer which surrounds blood vessels in the brain, called the blood-brain barrier, allowing toxins to penetrate and damage brain tissue.

Specifically, the insulation (myelin) protecting neural tissue may be attacked, causing widespread problems throughout the brain.

Linking physical symptoms to mental health

Scientists have made some connections between disease symptoms, how they impact physical, social and occupational aspects, and how in turn, that may impair mental health. Compromised mental status also may impact lupus treatment such as adherence to medication and whether or not active coping strategies are used (Figure 1).

Figure 1: Symptoms of lupus and disease activity impact mental health, which in turn may impact lupus treatment. Image Credit.

Some of the most common mental health symptoms of lupus include, but are not limited to:

Difficulty concentrating, or “lupus brain fog”, is the most common mental health problem in lupus patients with a prevalence rate ranging from 20% to 80%.

Second is fatigue, with 53-80% of patients reporting it as one of their primary symptoms, and major depression affecting 25% of lupus patients, and major anxiety affecting 37% (Figure 2).

Figure 2: Frequency of mental health problems reported by patients with lupus

These same symptoms may result from the lupus treatment itself. For example, “steroid psychosis” has been used to describe the depression, mania and confused states of euphoria that may follow treatment with steroids. It should be noted that steroid treatment doesn’t commonly cause psychosis, but may cause other milder emotional changes.

In-flaming the lupus situation

As a result of the many factors impacting both their physical and mental health, lupus patients may feel grief for the losses around their personal independence and social connections, shame about the way they are looking, and frustration or anger at their diagnosis.

An added burden is that individuals with lupus commonly encounter stigma in their search for answers, as health care providers often believe they are “making it all up.”

Due to the complexity of the disease and the multi-directional nature of the symptoms, it’s important to pay attention to both the patient’s emotional and physical health. As we have written before, a physical disease is intertwined with the mind, and until we understand more about how this mysterious disease attacks our bodies, we would do well to not attack each other.

For those struggling with lupus, remember that you’re not alone. Many people with lupus find it helpful to seek out support groups where you can connect with others who are also dealing with lupus symptoms.

This website does not provide medical advice. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Thank you to our community member who asked this question! If you have any questions about mental health, send them over to our questions tab or reach out to us on Twitter!

This article has been written solely with evidence-based sources. Check them out below!

What is lupus?

Anxiety and Depression is common in people with lupus

Mental Health of among people with lupus during Covid-19

Lupus and brain fog

Anxiety symptoms in people with lupus

Fatigue symptoms in people with lupus

Effects of lupus medications on mood

Psychological and Psychiatric problems in people with lupus

Links between inflammation and the brain| Harvard Medical School

Neuropsychiatric Systemic Lupus Erythematosus | Bentham Science

On the table, there is a cake with pink and blue frosting. Inside the cake, a secret: the colour of the frosting indicates the sex of the new family member. Blue is for a boy, pink for a girl. Depending on the answer, much is at stake. The name of the baby, what they look like, but also a surprising factor: the baby’s brain and mental health.

In the late 90s, studies identified slight brain differences between boys and girls. Scientists found that the development of connections between specific brain areas starts at different points for boys and girls, though it ultimately synchronizes with time. Research looking at brain development, size and composition followed, but with conflicting results.

As it turns out, the differences between boys and girls were more fluid than we expected.

He was a boy, she was a girl. Can it get any more obvious?

As much as it pains me to say, Avril Lavigne was wrong. Studying the biological differences between boys and girls has been anything but obvious. Biology determines the sex one is born with. In more scientific terms, this is known as male, female or intersex, which is somewhere between the two. Every person is assigned one of the sexes when they are born. But for humans, on top of the biological sex, there are the influences of identity and society. This gets us to the concept of gender. According to the way someone sees and expresses themselves, their gender identity is constructed. Within the gender continuum, someone can have no gender, the gender corresponding to their biological sex, or a gender other than their biological sex.

Do biological sex or gender identity drive changes in the brain? The answer is: yes, but we don’t know exactly how. It is practically impossible to isolate gender and sex in humans. Thankfully, animal models can help.

Animal models don’t have gender reveal parties but they can tell us a lot about the female and male sexes

Similarly to us, animal models are assigned one of the three sexes at birth. With identity out of the picture, they have helped us see that, genetically and hormonally, female and male brains are different.

The genetic material, or genes, of males and females differ slightly. In the early 2000s, scientists began to wonder whether this would make any biological difference in the brain. The answer again is yes, although less dramatic than what Avril sings about. For example, the genes of males tend to make them more susceptible to aggressive behaviour when compared to females.

But genes are not everything. Genes provide instructions for cells to work. For instance, they can tell specific cells to produce messenger molecules known as hormones, which help relay information from one part of the body to the other. Different concentrations of hormones between females and males are tied to their different behaviours. Higher testosterone, a hormone driving male-related traits, causes changes in the brains of male but not female birds, making them sing during courtship. Hormones also modulate mood, coordination and even blood pressure. Higher concentrations of estradiol, a hormone driving female-related traits, protects females from the detrimental effects of blood flow interruption in the brain, commonly known as stroke.

Although different hormone concentrations and genetics can separate females and males into somewhat different categories, the distinctions between the two are unclear for other biological processes. Believe it or not, the majority of what we know in the health sciences has only been studied in males. Just recently rigorous funding agencies have started to demand that researchers include both females and males in their studies. And if they don’t, they must have really good reasons that go beyond “females’ menstruation complicates the study”.

Beyond this, animal models are just that: models. They offer only hints, but not exact answers for our very human problems.

Going back to humans: what a gender reveal party says about the baby’s mental health

Neuroscientists like to say that the brain is plastic – meaning it is constantly changing. Every experience sends new information to the brain that, in turn, modulates the connections between our brain cells. Among the numerous experiences that are part of life, the sense of identity is central. Although we are in the early stages of understanding how, it is safe to assume that gender both shapes the brain and is shaped by the brain. Some evidence points out that the concentration of testosterone during fetal development helps direct gender identity later in life. On the other hand, how a feminine identity changes brain connections, has yet to be explored. Moreover, how biologically fluid the transition between each identity is another complete mystery.

At the very least, sex and gender identity are predictors of mental health disorders. For example, autism spectrum disorders and early-onset schizophrenia are four times more prevalent in biological males than females. At the same time, anxiety and panic disorders are almost two times as common in biological females compared with males. Unfortunately, less is known about sex and gender identities outside the binary men-women bias. Research so far shows that youth who identify as transgender are more at risk of depressive and eating disorders than their peers, though the interaction between the societal and biological mechanisms of these risks are still unknown.

Many of our answered questions have their roots in societal problems.

When studying gender diversity in the realm of mental health, biological research often fails to catch up with the humanities. It is not uncommon to find research or medical papers that mistake sex and gender identity, or specific gender identities for a problem. This is evident in the history of the American Psychiatric Association’s Diagnostic and Statistical Manual, frequently used to understand mental health disorders. In the past, the distress that comes from identifying with a gender different from the sex assigned at birth was classified in this manual as a “gender identity disorder”. The manual implied that feeling an identity different from one’s biological sex was a disease or problem, which only contributed to stigma. In the future, understanding how sex and gender play with mental health will need approaches that are more inclusive and just to all.

Is mental health risk caused exclusively by genes, hormones and brain processes regulated by sex and gender? Likely not, but they are part of the answer. A better understanding of how exactly this happens will be fundamental to knowing what populations are more vulnerable and how we can best help them.

Who knew we could learn so much from a gender reveal party?

Sources:

1. The Mental Health of Transgender Youth: Advances in Understanding - ScienceDirect

2. Testosterone Suppression of CRH-Stimulated Cortisol in Men | Neuropsychopharmacology

3. Sex and the Suffering Brain | Science

4. The Trouble with Sex Differences - ScienceDirect

5. What does the “four core genotypes” mouse model tell us about sex differences in the brain and other tissues? - ScienceDirect

6. Sex Differences in the Brain: The Not So Inconvenient Truth - PMC

7. Full article: Non-binary or genderqueer genders

8. The Trouble with Sex Differences - ScienceDirect

9. Gender Differences in the Development of EEG Coherence in Normal Children

10. Language of Gender - Gender Spectrum

11. Sex in the brain: hormones and sex differences - PMC

12. Reversing song behavior phenotype: testosterone driven induction of singing and measures of song quality in adult male and female canaries (Serinus canaria) - PMC

13. Why estrogens matter for behavior and brain health - ScienceDirect

14. Sexual differentiation of the human brain: Relation to gender identity, sexual orientation and neuropsychiatric disorders - ScienceDirect

15. The Dynamic Development of Gender Variability

16. How early hormones shape gender development - ScienceDirect

17. Neurobiology of gender identity and sexual orientation - PMC

18. LGBTQs and the DSM-5: A Critical Queer Response

19. Psychiatry.org - What is Gender Dysphoria?

We all get overwhelmed sometimes. In a room with deafening noise, blinding lights, people constantly bumping into you – you’re probably scoping out the exit to get a breather. But if this overwhelming stimulus instead comes from within you, you can’t simply run away from the problem. Often, people suffering from mental health concerns turn to other routes of escape, like drugs and alcohol. Unfortunately, these self-medication routes provide only fleeting relief from their thoughts and emotions.

This method of escape can also lead to another complication: half of all people with severe mental illness have substance abuse problems. Substance use commonly occurs alongside anxiety, panic disorder, post-traumatic stress disorder, depression, bipolar disorder, attention deficit/hyperactivity disorder, and schizophrenia. But even if substances can seemingly help temporarily escape from a mental health crisis, how do they affect the onset and long-term course of mental illness?

The Chicken or the Egg – can drug use cause mental illness?

What came first: the substance use or the mental health issue? Establishing the cause vs. effect direction between drug use and mental illness is challenging. Take the example of a teenager going through life stressors – social pressure, family issues, problems at school. Perhaps they start smoking weed to calm their nerves and try to get themselves back into a good headspace. Gradually, this becomes a habit and they rely on it to help them feel ‘normal’. Later in life, they’re diagnosed with depression. Did drug use during a developmentally important period lead to changes in their brain structure, causing the mental illness? Did they already show sub-clinical symptoms of depression, or lack proper diagnosis, and turn to cannabis as relief? Or perhaps there are underlying vulnerabilities that made them more susceptible to both drug use and depression.

”If you put my hand into the fire and ask me to answer [which came first], I would say it's probably a chicken and egg question at this time,” quipped Dr. Jibran Khokar, a professor at Western University who studies substance use and schizophrenia. Schizophrenia is a serious mental disorder which is characterized by psychotic symptoms like hallucinations, delusions, and disordered thinking. Patients may also experience negative symptoms, like difficulty showing emotion and social withdrawal.

Substance use can worsen the course of schizophrenia – causing earlier onset, higher rates of hospitalization, treatment non-compliance, and (especially with alcohol) higher rates of violence and suicide. Of course drugs can also have physical health effects, which is especially problematic with an already vulnerable population, often leading to premature disability and death.

We know that genetics contribute to the development of schizophrenia from large datasets and family studies. One theory, sometimes called the “two-hit” model, suggests that this genetic vulnerability alongside an environmental stressor (like drug use or trauma) leads to schizophrenia. Under this model, genetics and drugs work together, so to speak, to cause the disorder. Indeed, high rates of cannabis use are associated with increased risk of psychosis and earlier onset, with heavy users having a 4-fold higher risk of developing it.

Up to a staggering 90% of patients with schizophrenia are chronic cigarette smokers. Nicotine activates a protein (called nAchR) in the brain that is important for the release of neurotransmitters; it plays a role in the reward/motivation system of the brain and general cognition. nAchR is present at lower levels in people with schizophrenia, which may partially explain some attention and memory deficits patients experience. The self-medication hypothesis suggests that individuals with schizophrenia may consume nicotine at such a high rate to compensate for their nAchR deficit, by causing more activation of the ones they do have. This would suggest that drug use is caused by the disorder, much like a fever is a symptom of an infection. Although nicotine may temporarily help to cope with some symptoms of schizophrenia, it can exacerbate other problems in the long run.

A unifying theory which could weave together these different ideas is the shared vulnerability hypothesis. Here, genetics is the primary cause. Genetic susceptibility makes a person more likely to use drugs and to develop a mental disorder. Drug use can trigger the disorder, and later the difficult symptoms of the disorder make the person more inclined to continue to use drugs. The chicken and the egg, as Dr. Khokar had phrased it earlier. People with mental illness can become trapped in a vicious cycle between substance use and disorder symptoms – a cycle they are dragged into by their genetics.

What if a person is able to escape that cycle? Dr. Khokar presents some optimistic news: “What we do know for sure is that if you can get somebody with schizophrenia to remain abstinent from a substance – studies have been done with both cannabis and cigarette smoking - you actually see improvements in all symptoms.”

What about other drug-disorder combinations?

This shared vulnerability idea holds true for other mental illnesses as well. Brain imaging studies suggest that ADHD is associated with changes in brain circuits that are also associated with drug cravings. In other disorders, brain circuits involved in reward, decision making, impulse control and emotions may be dysregulated. As for other drug-disorder combinations, Dr. Khokar explains “it does vary between the substance and the illness. And at the individual level, each person [will have different experiences]. We often look at this at a population level, but when you zoom in to each drug or each illness then different patterns can emerge.”

A constant between all combinations of drugs and disorders is that when treating a mental illness that occurs alongside excessive substance use, treating both at the same time is absolutely critical. It’s difficult to escape that vicious cycle when either triggering agent keeps pulling you back in.

Of course, casual & occasional drug use is different from chronic dependence. We should be mindful that excessive drug use may leave one more vulnerable to mental illness, just as mental illness may leave one more vulnerable to substance dependence. Ultimately, there shouldn’t be any shame or blame for substance use disorders or mental illness - it’s an overwhelming world out there and the genetic lottery isn’t kind to everyone.

Sources

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094954/

2. https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676785/

4. https://adai.uw.edu/pubs/pdf/2017mjanxiety.pdf

5. https://www.caddra.ca/wp-content/uploads/CANNABIS-AND-ADHD.pdf

6. https://academic.oup.com/schizbullopen/article/3/1/sgab052/6432326

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181760/

8. https://www.sciencedirect.com/science/article/pii/B9780128130353000174

For over 2000 years, doctors and philosophers alike have been struggling to understand the causes of mental illnesses. Opinions have swung back and forth, ranging from the possession of demons in the Middle Ages, to moral disturbances, to a physical illness no different than the common cold.

The idea that mental illnesses are different from physical ones only really began in the late 1700s, with the development of public “madhouses”. The separation between asylums and traditional hospitals emphasized a distinction in how we approached the two types of illness.

The establishment of the York Retreat in 1794, by the Quaker William Tuke in the United Kingdom, famously seeded the idea that mental illnesses were not a physical ailment, but a moral one. Shocked by the recommended treatments in hospitals at the time, which often included restraint and isolation, Tuke went on to establish a radically different method, one focused on compassionate moral treatment. The success of such treatments, both in the UK and other similarly-minded institutions, left an impression on the public. It was around this time that the term “mental illness” began being widely used, separating them from physical illnesses. This separation was only strengthened as autopsies of the time were unable to observe any obvious physical changes accompanying mental illnesses.

We now understand that the separation between physical and mental illnesses is not a biological one. The mind and body are highly interconnected. Many mental illnesses present physical symptoms which are clearly observed with current techniques, and many physical illnesses present general mental symptoms. Pain, for example, is the primary symptom of many physical injuries, like a broken bone or digestive issues. However, pain is a purely psychological phenomenon. Likewise, depression is often associated with a lack of energy, a physical symptom. While the biological causes of many mental illnesses remain an active area of study, it is now understood that they are firmly grounded in the body – the same as physical illnesses. As a result, modern medicine now treats mental illnesses as another type of disease (it’s currently listed as Category 6 in the International Classification of Diseases manual).

That being said, mental disorders do have identifying characteristics. Mental disorders are primarily characterized by significant changes in how someone thinks, feels, or behaves. While there are physical symptoms, such as tiredness or digestive issues, they are treated as secondary. Many mental illnesses, such as Parkinson’s Disease, show clear changes in the brain which can now be observed through modern techniques. The research into the biological causes and impacts of mental illnesses is still ongoing, and we don’t fully understand the mechanism by which our most common treatments help, nor why they help some but not others. For example, sertraline (also known as Zoloft) is a common antidepressant used to treat a range of disorders, including major depression and social anxiety. Sertraline belongs to a class of molecules known as SSRI’s, or selective serotonin reuptake inhibitors. In short, they cause an increased concentration of serotonin, a neural messaging molecule, in the brain. Setraline has been shown to significantly reduce social anxiety symptoms after 6 weeks, and modestly decrease major depressive symptoms after 12 weeks. However, recent evidence has put the role of serotonin in major depression into question. How does a medicine that affects serotonin levels in the brain reduce depression symptoms if serotonin isn’t a major player in depression? We don’t know the answers to these questions yet, and they’re not easy answers to find. They require rigorous (and confusing) research which can’t often be conducted in humans.

Additionally, the identification of mental illnesses, while much improved relative to 50 years ago, is still difficult. Misdiagnosis rates for several of the most common illnesses, such as depression and general anxiety, are over 60% — a number much higher than the average 10% misdiagnosis rate in general medicine. Similarly, stigma against mental illnesses remains a huge issue, and occurs much more commonly than stigma against general illnesses.

It’s tempting to separate mental illnesses into their own world. You wouldn’t be entirely wrong to, given how mental illnesses are and have been commonly treated in our society. But it’s important to understand that mental illnesses are just another kind of illness, and need to be treated no differently than more obvious physical ones.

If you’re interested in reading on some of the things mentioned in this article, feel free to check out the resources used while researching the answer!

• An overview on the history and philosophy behind separating physical and mental illnesses

• A history on the foundation of the York Retreat

• A study on physical symptoms in depression

• A recent study exploring the relationship between gut and mental health

• A report on diagnostic error in medicine

• An analysis of diagnosis rates of common mental illnesses

• An investigation on the role of serotonin in major depressive disorder

• A clinical trial investigating the effectiveness of sertraline in treating social anxiety disorder and major depressive disorder

• A fact sheet on sertraline

I would argue that, at least once in our lifetime, we all wonder whether our brains are working properly. Maybe you noticed that lately your mood has been strange for no particular reason, or the way your brain seems to work is quite different from everyone else’s. Persistent and significant changes in behavior, the way one thinks or feels, and one’s physical well-being, are all hints of a possible mental health disorder.

You might ask, how do I know what I have?

While it can be tempting to consult Dr. Google, only clinical assessments can arrive at a clear diagnosis. The reason why becomes clear once we realize that there are hundreds of mental health disorders out there.

Mental health professionals usually consult a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM) to arrive at a diagnosis. Currently, in its 5th edition, the DSM has been in use since 1844. It lists the majority of known mental disorders, including what symptoms are used to diagnose them, as well as their development and course.

But the DSM-5 isn’t the be-all and end-all of a diagnosis. For example, many argue that it turns normal behaviors and emotions like grief into mental health disorders. Moreover, the DSM-5 splits diagnoses into neat, separate boxes, often failing to account for how mental health disorders can co-exist in individuals.

The DSM-5 disorders are organized based on the time they usually begin, starting with early-life (neurodevelopmental, like autism spectrum disorder), followed by adolescence and young adulthood (such as bipolar, depressive, and anxiety disorders), as well as adulthood and later life (neurocognitive disorders, for instance, caused by Alzheimer's Disease).

Within disorders that happen at similar stages of life, the DSM-5 defines what is known as internalizing and externalizing disorders, based on the way the symptoms usually get expressed. Internalizing disorders (anxiety, depression) are marked by behaviors that affect oneself while in externalizing disorders (substance use, disruptive conduct) the negative behaviors are directed toward others and the environment.

Does this mean that everyone can read the DSM-5 and self-diagnose? Not at all.

Mental health professionals do much more than check off a symptom list. In order to weave the threads of a diagnosis, a careful clinical history and summary of social, psychological, and biological factors are needed. Another crucial factor is time. While fluctuations in emotions are expected in life, specific durations of symptoms are essential before a diagnosis. Additionally, because symptoms are often shared across different conditions, only mental health professionals have the expertise to dissect the pool of classes in the DSM-5.

But what are the classes? A summary of their characteristics can be found in the dropdown menu below:

• Neurodevelopmental Disorders

  Often manifest before the child enters school and are characterized by limitations in personal, social, academic, or occupational activities. Examples: autism spectrum disorder, intellectual developmental disorder and attention-deficit/hyperactivity disorder (ADHD).

• Schizophrenia Spectrum and Other Psychotic Disorders

  Marked by delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms, such as reduced emotional expression or lack of pleasure. Examples: delusional disorder, schizophrenia and substance/medication-induced psychotic disorder.

• Bipolar and Related Disorders

  Characterized by a fluctuation between abnormal and persistent periods of elevated, expansive, energetic, or irritable mood, and bouts of depressive episodes, for example, with severe changes in sleep and eating habits, feelings of worthlessness and fatigue. Examples: bipolar I disorder, bipolar II disorder and substance/medication-induced bipolar and related disorder.

• Depressive Disorders

  Distinguished by a presence of sad, empty, or irritable mood, affecting an individual’s capacity to feel pleasure, eat and sleep well, and perform in their day-to-day lives. Examples: major depressive disorder, premenstrual dysphoric disorder and substance/medication-induced depressive disorder.

• Anxiety Disorders

  Marked by excessive and persistent fear and anxiety due to specific or general triggers. These emotions are accompanied by bodily responses, for example, thoughts of immediate danger, increased heart rate, muscle tension, or avoidant behaviors. Examples: phobias, panic disorder and generalized anxiety disorder.

• Obsessive-Compulsive and Related Disorders

  Characterized by unwanted recurrent and persistent thoughts, urges, preoccupations, or images that drive an individual to perform repetitive and rigid behaviors, which can be body-related, for example, hair pulling. Examples: obsessive-compulsive disorder, body dysmorphic disorder and trichotillomania (Hair-Pulling Disorder).

• Trauma- and Stressor-Related Disorders

  Disorders in which persistent anxiety, fear, anger and aggressiveness happen in response to a clear traumatic and stressful event. Examples: reactive attachment disorder, posttraumatic stress disorder (PTSD) and prolonged grief disorder.

• Dissociative Disorders

  Distinguished by a break in an individual’s perception of who they are, their memories, emotions, body representation, and motor control. Examples: dissociative identity disorder, dissociative amnesia (memory loss) and depersonalization/derealization disorder.

• Somatic Symptom and Related Disorders

  Marked by pervasive distress and impairment due to bodily or somatic symptoms and/or illness anxiety, most commonly present in primary care. Examples: somatic symptom disorder, illness anxiety disorder and functional neurological symptom disorder (conversion disorder).

• Feeding and Eating Disorders

  Characterized by a persistent disturbance of eating or eating-related behavior, altering consumption or absorption of food, as well as impairing physical and psychological health. Examples: anorexia nervosa, bulimia nervosa and binge-eating disorder.

• Elimination Disorders

  Usually diagnosed in childhood or during adolescence. These disorders involve the inappropriate elimination of urine or feces. Examples: enuresis and encopresis, or repeated urination or defecation in inappropriate places, respectively.

• Sleep-Wake Disorders

  Typically involve persistent issues in the quality, timing, and amount of sleep that affect the day-to-day functioning of an individual. Examples: insomnia disorder, obstructive sleep apnea (pause in breathing) hypopnea (shallow breathing) and nightmare disorder.

• Sexual Dysfunctions

  Characterized by a severe disturbance in a person’s ability to respond sexually or to experience sexual pleasure. Examples: delayed or premature ejaculation, erectile disorder and female orgasmic disorder.

• Gender Dysphoria

  This class is dedicated to clinically-relevant distress that may accompany the difference between one’s experienced gender and one’s assigned gender at birth. Example: gender dysphoria.

• Disruptive, Impulse-Control, and Conduct Disorders

  Essentially includes conditions involving problems in self-control of emotions and behaviors, violating the rights of others and societal norms, for example, through aggression or destruction of property. Examples: conduct disorder, antisocial personality disorder, and kleptomania (habits of stealing).

• Substance-Related and Addictive Disorders

  Marked by intense activation of the brain reward system and deactivation of brain inhibitory mechanisms, severely disrupting an individual’s ability to function in other aspects of life. 10 separate classes of drugs are included, notably alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco; and other. Each substance is associated with use, intoxication, withdrawal, and associated mental disorders. Examples: alcohol use disorder, alcohol intoxication, alcohol withdrawal, and alcohol-induced mental disorders.

• Neurocognitive Disorders

  Characterized by a cognitive dysfunction that is acquired in adulthood. They can occur as a result, for instance, of Alzheimer’s disease, Parkinson’s disease, traumatic brain injury, HIV infection, or Huntington’s disease. Examples: delirium, and syndromes of major or minor neurocognitive disorder.

• Personality Disorders

  Distinguished by strong and lasting patterns of behavior that start in adolescence or early adulthood and deviate from the norms and expectations of the individual’s culture, leading to significant distress or impairment in life. Examples: general personality disorder, borderline personality disorder and narcissistic personality disorder.

• Paraphilic Disorders

  Marked by intense and persistent atypical sexual interest that can involve non-human objects, cause distress to the individual, risk harm to others, or is non-consensual. Examples: voyeuristic disorder, sexual masochism disorder and pedophilic disorder.

• Unclassified, medication-induced and conditions that affect mental health disorders

  Besides the well-known classes outlined above, the DSM-5 also includes mental disorders induced by medication, for instance, medication-induced parkinsonism; unclassified mental disorders; and conditions or environmental problems that can affect an individual’s mental disorder, for example, suicidal behavior and nonsuicidal self-injury. More research is needed to understand how the disorders in these three chapters come to be and their treatments.

Research shows that a diagnosis can be life-changing if it’s done at the right place and time. It can offer validation, relief, and hope for recovery, though for some it can also increase the stigma they feel. Different tools exist for the treatment and management of each mental health disorder. Knowing what goes on inside our own internal worlds is the first step. Seeking a clinical, outside perspective is the second.

Thank you to our curious readers for posing this important question! If you have your own mental health questions, please reach out on Twitter through our website.

Sources:

1.. Diagnostic and Statistical Manual of Mental Disorders. DSM Library https://dsm-psychiatryonline-org.ezproxy.library.uvic.ca/doi/book/10.1176/appi.books.9780890425787.

2. Perkins, A. et al. Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. The Lancet Psychiatry 5, 747–764 (2018).

3. Marshall, M. The hidden links between mental disorders. Nature 581, 19–21 (2020).

4. Pescosolido, B. A., Gardner, C. B. & Lubell, K. M. How people get into mental health services: Stories of choice, coercion and “muddling through” from “first-timers”. Social Science & Medicine 46, 275–286 (1998).

There is nothing more alarming than an ambulance. On a quiet road, its screeching sounds, blinding lights and outrageous speed all signal urgency. An ambulance signals a visible, audible and perceivable emergency that someone needs help. The sound of a person struggling with their mental health however, is often silence. The individual may be self-soothing by doing things without knowing why, like drinking an excessive amount of alcohol, hooking up with strangers or even washing their hands repetitively. In general, they are spending a lot of time thinking: “I don’t want to be thinking,” a coping mechanism known as avoidance. For many, avoidance is the first line of defense against intense emotions. I asked Dr. Mary Frances O’Connor, a clinical psychologist at the University of Arizona and the author of “The Grieving Brain”, why avoidance gets a bad rap:

“Avoidance is perfectly ok in small quantities. The problem is if you keep using avoidance as a primary tool. You eventually won’t be able to avoid because the things you are avoiding will keep growing.”

Dr. O’Connor is highlighting the difference between positive and negative avoidance tactics. If the behavior is used in the short-term to establish control over a situation that’s perceived as uncontrollable, it is positive and should be encouraged. If the behavior is used in the long-term, becomes a habit and doesn’t address the original problem, it is negative and likely requires professional help. To get a better sense of the difference between the two (and whether help is necessary), we must first answer: What am I avoiding, and why?

Let’s unpack this question, starting with the “why.” Emotions such as grief, anxiety and anger can be big. Love, traditionally thought of as positive, can also fall into this category depending on the individual's experience with it. So big in fact, that their size and unfamiliarity overwhelms us. We label them as bad and ignore them. We run to pleasure (or even nothingness) because it is familiar, comfortable and to some degree, in our control. O’Connor explains that “emotions can be painful and even counterintuitive to think about. People don’t know what will happen if they let themselves feel the emotion, and they have a hard time conceiving of their emotions in terms of an ebb and flow. They think emotions will last forever.” Avoiding strong emotions is normal then. And having strong emotions is human. The answer to why we avoid powerful emotions is simple: we’re scared.

And that’s human too.

The next part of the question delves into “what” people are avoiding. I talked to Mariam Hovhannisyan, a Clinical Psychology graduate student at University of Arizona, to best pinpoint what happens when someone begins using avoidance as a coping mechanism. Her answer was simple, “Look at your everyday life and ask yourself, are you doing things you want to be doing? Are you happy with those things? Don’t compare yourself to others, focus on your own progress. What’s changed and what caused it?”

It’s true. Identifying what event made ripples on the otherwise placid surface of our emotional waters is crucial in understanding the change that leads to using avoidance. Helpful questions such as, “Am I constantly thinking or worrying about what’s going on at school/work, even when I’m not there?,” or “Am I forgetting important events or tasks, do I feel like I’ve “lost time?” followed by “When did this start happening?” can be a powerful aid in singling out the cause for the mental anguish, and importantly, the first step in seeking professional help.

Towards the end of our interview, Dr. O’Connor kindly reminds me that professional help is not the only kind of help available, “You know, it doesn’t have to be me. It could be a pastor, a friend, or any respected authority figure. The idea is, you just tell someone. That’s the first step.”

So tell someone. Whether you’re the one in crisis or are witnessing a loved one struggling, turn on the resounding sound and flashing lights. Tell someone you need help. Because at the end of the scary ambulance ride, help will find you.

Helpful resources:

• If you feel overwhelmed, you can call the toll-free SAMHSA Disaster Distress Helpline, 24/7, at 1-800-985-5990.

• Canadian Mental Health Support

• Suicide Prevention Hotline

• Mental Health Factsheet

If you have any questions about mental health, send them over to our questions tab or reach out to us on Twitter!

Sources:

1. Buhk, Alex H., Mary J. Schadegg, Laura J. Dixon, and Matthew T. Tull. "Investigating the Role of Negative and Positive Emotional Avoidance in the Relation between Generalized Anxiety Disorder and Depression Symptom Severity." Journal of Contextual Behavioral Science 16 (2020): 103-08. Web.

2. Hofmann SG, Hay AC. Rethinking avoidance: Toward a balanced approach to avoidance in treating anxiety disorders. J Anxiety Disord. 2018 Apr;55:14-21. doi: 10.1016/j.janxdis.2018.03.004. Epub 2018 Mar 9. PMID: 29550689; PMCID: PMC5879019.

3. Kabigting, Edwin-Nikko R. "Conceptual Foreknowings: Integrative Review of Feeling Overwhelmed." Nursing Science Quarterly 32.1 (2019): 54-60. Web.

4. ​​Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

5. National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009.