Side effects

An unconventional treatment for depression: Sleep deprivation

I watched a good ‘psychological thriller’ the other night - Side Effects by Steven Soderbergh – that centers on a woman’s debilitating depression and critiques the pharmaceutical industry’s untoward influence over clinicians (it turns into a plot-twisty crime thriller, but that’s beside the point). The film got me thinking about our reliance on psychotropic medications to treat psychological distress, and how helpless we are when these pills don’t work.

I’ve written before on the over-medicalization of psychiatric disorders and the pharmaceutical industry’s role in this controversy, but this time the topic got me thinking about possible alternative treatments for depression, other than cognitive-behavioral therapy or mood-altering medications.

Pathologizing the norm: Follow-up

For those of you who are interested in this debate, there's a great new two-part article in the New York Review of Books by Marcia Angell questioning "The Epidemic of Mental Illness". The articles summarize three new books concerned about the prescription frenzy we are in the midst of and how this reliance on psychoactive medication came about. She addresses the problem of dealing with psychiatric disorders as chemical imbalances and the dubious efficacy of these drugs at actually improving symptoms at all. I highly recommend this read, as well as the second part in the series on "The Illusions of Psychiatry", for anyone concerned about our mental health system. One of the most resounding points she makes in this second piece is the perpetual expansion of the diagnoses listed in the American Psychological Association's Diagnostics and Statistical Manual (DSM). With every publication of the DSM there are more and more "disorders" that we have pathologized and created, and with the upcoming publication of the DSM-V it is certain that there will be a slew of new problems we can claim for ourselves and put a name to. Angell succinctly describes this problem stating, "Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology."

Finally, she brings to task the drug companies who are more involved in psychiatric treatment than in any other medical field. This applies not only to clinicians or psychiatrists with private practices, but also the research institutions, hospitals, universities, policy makers, patient advocacy groups, educational organizations and the APA itself.

Angell's writing takes a good hard look at the system of mental health, and while at time she makes some uncomfortable points, these are important questions that need to be addressed.

(Thanks to Emily Barnet for the Angell articles.)

The fascinating perils of plastic surgery

Cosmetic surgery and striving towards perfection of the body are nothing new. The first plastic surgery techniques date back to 800 BC in India, and there are records of ancient Egyptians and Romans carrying out reconstructive procedures. Karl Ferdinand Graefe first coined the phrase “rhinoplasty” in 1818 in attempt to de-stigmatize nasal reconstructive surgery, and there was a resurgence of plastic surgery research and development after the first and second world wars in the U.S. and Britain. In more recent history, silicone breast enhancements began emerging in the 1960s, and the economic boom in the 1980s, coupled with a flurry of modern developments in liposuction procedures, saw a rise in shrinking waists and thighs. Nowadays, surgical enhancements have been featured so often on reality TV and the cover of Playboy that we wouldn't dream of considering them shocking. Yet there is still debate surrounding these procedures, and two new studies have come out recently reporting on the side effects and efficacy of plastic surgery. One study explores the implications on the brain, while the other investigates the long-term impact on the body. A study on the cognitive-emotional effects of Botox from my own alma mater, USC, looks not at the physical consequences of undergoing the needle, but at Botox's effect on interpersonal relationships and empathy.

Body language and facial expressions are a large factor in communications, almost as important as language itself. Humans are typically very good at relating to one another by subtly and subconsciously mirroring posture and facial expressions during the course of a conversation. This helps both parties to better perceive what is being expressed and what the appropriate response is. By mimicking a partner’s appearance, you are able to internalize their emotion as your brain perceives your new expression and interprets the correct sentiment for it. When a friend is crying, you know they are upset and adopt their down-turned mouth and furrowed brow to better relate and express your empathy. Alternatively, when someone smiles at you on the street, it is difficult to not smile back and feel a little extra bounce in your step. This phenomenon is known as “embodied cognition” and involves the reciprocal relationship between the effects of the brain and the body.

However, in paralyzing your facial nerves Botox (or botulinum toxin) disrupts this process by preventing your face from creating those creases and crinkles that externally express and internally manifest as emotions. The rest of the world may not be able to tell your age or that summer you spent in Greece, but it also won’t be entirely sure you’re empathizing when they tell you that their dog died.

Researchers tested this theory by injecting participants with Botox or a placebo dermal filler and having them perform a common test of empathy. Individuals were shown a picture of a set of eyes and asked to guess the emotion that best matched the ocular expression. Participants who received the Botox injection performed significantly worse on this task than controls, though they were still able to perform with around 70% accuracy.

Study author Dr. David Neal eloquently summarized the results saying, "When you mimic you get a window into their inner world. When we can't mimic, as with Botox, that window is a little darker."

The second study involves the long-term physical effects of liposuction, questioning its enduring efficacy. Long heralded as a quick and relatively noninvasive fix for targeting fat areas, a recent study published in Obesity by researchers at the University of Colorado brings this notion into question. Drs. Teri Hernandez and Robert Eckel reported that in participants who had received liposuction as part of the study, within one year after the procedure total body fat percentage had returned to its baseline level, as determined by subcutaneous skinfold thickness and MRI scans. However, the suctioned fat did not return to the areas from where it was removed, instead the regenerated fat was redistributed to areas less typically associated with fat storage, such as the upper abdomen and arms.

It is thought that the gross number of fat cells in your body remains relatively stable throughout your life, determined in infancy and largely dependent on genetics and early diet. Instead, the difference in weight gain or loss is typically seen in the size or fullness of these cells. These fat cells are also in a relatively stable regional proportion throughout the body, relegating where an individual tends to gain or hold weight. However, after liposuction the remaining tissue from the targeted areas are too traumatized to generate new cells, yet the body still attempts to maintain the balance of its original number. Therefore, new fat cells return after you’ve deleted them, just not in the areas you would expect.

Despite this news,  more than half of the control subjects in the study, women who were initially interested in receiving liposuction but agreed to hold off for a year to serve as study controls, still wanted to undergo the procedure.

(Thanks to Ryan Essex for the article on Botox.)