The rise and fall of antidepressants

Newsweek has an excellent article that charts the rise and fall of antidepressants from their status as a wonder drug that made people ‘better than well’ to the recent evidence that suggests for many people, they’re not much better than placebo.

The piece particularly follows the work of psychologist Irving Kirsch who was the first to conduct a meta-analysis of the effects of anti-depressants back in 1998.

Titled “Listening to Prozac but hearing placebo” it suggested that the drugs were hardly more effective than placebo and, for many, marked Kirsch out as a biased and dangerous ‘anti-psychiatrist’.

However, later studies in a similar vein by both Kirsch and others have supported his original findings and many countries have now changed their treatment recommendations as a result.

The Newsweek article tracks this story but also picks up on many important subtitles in the story, notably that the research doesn’t suggest that antidepressants are useless – quite the opposite – just that their effect is only in part due to their direct chemical effect; and that many patients in trials work out that they’re not taking placebo because of the side-effects and this realisation can trigger a stronger placebo effect.

It also integrates evidence from the recent STAR*D study, one of the most complete on the best methods to treat depression.

If you want a good overview of the debate on the effectiveness of these iconic drugs, this is a good place to start.

Additionally, if you’re interested in a good analysis of the most recent study in this area, just published in the Journal of the American Medical Association, the Neuroskeptic blog has a great write-up and analysis of what this means for the concept of depression itself.

Link to Newsweek piece on antidepressants (via @DrDavidBallard).
Link to write-up of JAMA study at Neuroskeptic.

World changing images

BBC Radio 4 has just concluded a wonderful series on medical imaging that overs everything from the microscope, to ultrasound, to the brain scanner.

The series is five 15 minute programmes that tackles the technology and its controversies. The brain scanning programme is particularly good and shows both ends of the spectrum of enthusiasm for the use of functional brain scans to understand human nature.

Because of the BBC’s black hole of death archive, the programmes will start being sucked into the void in three days time, so do catch them before then.

The programmes also cover DNA imaging and X-rays and the website apparently has a gallery of images on but I have given up trying to find them on the dreadful Radio 4 website.

Link to ‘Images That Changed The World’ audio links.

Can you actually be frightened to death?

Photo by Flickr user Kman999. Click for sourceScience isn’t sure whether fear can kill but several courts have been convinced and have convicted people for murder on the basis that they caused death through fright. An article just published in the American Journal of Cardiology summarises the eight murder trials.

The cases are not, as I first suspected, where someone had deliberately tried to kill someone else using fright as a ‘weapon’ (like in the infamous scene in Belgian serial killer mockumentary Man Bites Dog – clip here – warning: not pleasant).

Instead, they typically describe where someone has died of a heart attack in the midst of an armed robbery or assault, despite not being mortally wounded.

In a similar case, State v. Edwards,10 the defendant and his accomplices entered a bar in Tucson, Arizona and committed a robbery at gunpoint. Shortly after the robbers had fled, the proprietor experienced a heart attack and died. The defendant argued that the victim’s death was accidental and unintended and could not constitute murder. Moreover, the defendant maintained that the evidence was insufficient to prove that the robbery actually caused the victim’s death.

The court disagreed on both counts, finding first that accidental, unintended consequences could form the basis of a murder conviction. Second, the court pointed to the testimony of a pathologist that the death was caused by anxiety resulting from the robbery at gunpoint. The court held that this provided adequate evidence to support causation.

However, this is not the only area where supposedly being ‘frightened to death’ has caught the interest of psychologists. There is a small psychological literature on ‘psychogenic death’ that attempts to explore reports of death after curses, spells or violation of cultural taboos.

This is from an excellent brief article from 2003, published in the journal Mental Health, Religion & Culture:

Landy (1977, p. 327) describes the phenomenon as follows: ‘a process is set in motion, usually by a supposed religious or social transgression that results in the transgressor being marked out for death by a sorcerer acting on behalf of society through a ritual of accusation and condemnation; then death occurs within a brief span, usually 24 to 48 hours’. Ellenberger (1965) distinguishes acute from slow psychogenic death. In some cases, the death can be rapid, in other cases the process occurs over several weeks where the patient sickens and dies. There has been some doubt expressed as to whether voodoo death is part of ‘colonial folklore’ only based on anecdotal reports (Williams, 1928).

Lewis (1977, p. 11) asks, ‘Is it really the case that healthy people have died in a day or three days because they know they were victims of sorcery? Who has seen this happen with his own eyes? Is there no explanation for it but sorcery?’ Yap (1977) calls for concrete findings from anthropologists and medical field workers that can be appraised critically. Questions have arisen as to whether or not these victims had pre-existent pathological conditions predisposing them to death. There is however some direct evidence for its occurrence.

The evidence is not people just dropping dead, but from several documented cases where perfectly healthy people rapidly give up eating and drinking after being ‘cursed’ and dehydration leads to death.

Link to PubMed entry for ‘Homicide by fright’ article.
Link to DOI entry and summary for ‘psychogenic death’ article.

2010-01-29 Spike activity

Quick links from the past week in mind and brain news:

io9 has a great brief summary of a citation analysis that describe how neuroscience became a major scientific discipline in just one decade. Interestingly, it didn’t happen in the Decade of the Brain.

The ability to resist temptation is contagious, according a new study covered by The Frontal Cortex. I suspect this means I am patient zero of giving in to temptation.

Salon has an interview with psychologist Susan Clancy about her new book ‘The Trauma Myth’ on child abuse, which is likely to be both important and controversial. The comments are a mix of the insightful, angry and loopy.

This chap might have found a photo of Phineas Gage from before his injury.

Radio 4 has a good documentary on ‘Super Recognisers’ that will disappear off the face of the earth in only a few days if you miss your chance to listen to it.

The Prison Photography blog is excellent.

NPR has a brief segment on new evidence suggesting that heavy drinking in teenage years may have a lasting impact on the brain.

Special therapy bears work through mirror neurons (what else) according to a bizarre claim unearthed by The Neurocritic.

NeuroPod has just released a new edition covering optogenetics, AI cockroaches, stem and grid cells.

Does time dilate during a threatening situation? asks Neurophilosophy.

Science Daily reports that thinking of the past or future causes us to sway backward or forward on the basis of a new study.

C.G. Jung’s famous ‘Red Book‘ has finally been published and Brain Pickings has a fantastic review and preview.

The Journal of Neurology, Neurosurgery, and Psychiatry has launched a new podcast which is aimed at clinicians and is. a. bit. stilted. but sounds promising.

There’s a good piece about the new and not very effective female ‘sex drug‘ flibanserin in Inkling Magazine.

Horizon, the flagship BBC science programme, recently had an episode on the Big Pharma, medicalisation and disease mongering. Apart from some minor pharmacological dodginess (ADHD a ‘chemical imbalance’, Ritalin a ‘clever pill’) it’s excellent and features our very own Dr Petra. Torrent here.

A new study finding people’s personality is reflected in their internet use is covered by the BPS Research Digest. See also a new study finding social behaviour is similar both online and offline.

Quirks and Quarks, the excellent Canadian radio show, discusses kuru disease immunity in cannibals.

Why is there no anthropology journalism? asks Savage Minds.

The Economist covers a new study finding that the more widespread a language, the simpler it is, suggesting that that languages become streamlined as they spread.

Incoming! APA press release forewarns of imminent clinical psychology fight: psychodynamic therapy best says not yet published meta-analysis.

PsyBlog has an excellent round-up of 10 studies on why smart people do irrational things.

The secrets of looking good on the dance floor and research on the psychology of social dance is covered in Spiegel magazine.

Life magazine has a gallery of famous literary drunks and addicts.

The US is quietly abandoning the ‘war on drugs‘ according to an article in The Independent. Does this mean the expansion of military bases in Colombia is to be re-justified as part of a war on salsa music? Kids told to ‘just say no’ to fake tans and enthusiastic rhythm sections.

The BPS Research Digest reports the development of what could be the first anti-lie detector in neuroscience.

Bootleg Botox, a potent neurotoxin, could be a weapon of mass destruction according to a piece in the Washington Post.

Wired reports on the Jan 25th anniversary of the first recorded human death by robot which occurred in Flint, Michigan, 1979.

The marriage market and the social economics of high-end prostitutes are tackled in a new study discussed in Marginal Revolution.

Better Thinking Through Chemistry

This chapter was due for inclusion in The Rough Guide Book of Brain Training, but was cut – probably because the advice it gives is so unsexy!

rgbt_cover_small.jpgThe idea of cognitive enhancers is an appealing one, and its attraction is obvious. Who wouldn’t want to take a pill to make them smarter? It’s the sort of vision of the future we were promised on kids TV, alongside jetpacks and talking computers.

Sadly, this glorious future isn’t here yet. The original and best cognitive enhancer is caffeine (“creative lighter fluid” as one author called it), and experts agree that there isn’t anything else available to beat it. Lately, sleep researchers have been staying up and getting exciting about a stimulant called modafinil, which seems to temporarily eliminate the need for sleep without the jitters or comedown of caffeine. Modafinil isn’t a cognitive enhancer so much as something that might help with jetlag, or let you stay awake when you really should be getting some kip.

Creative types have had a long romance with alcohol and other more illicit narcotics. The big problem with this sort of drug (aside from the oft-documented propensity for turning people into terrible bores), is that your brain adapts to, and tries to counteract, the effects of foreign substances that affect its function. This produces the tolerance that is a feature of most prolonged drug use – whereby the user needs more and more to get the same effect – and also the withdrawal that characterises drug addiction. You might think this is a problem only for junkies but, if you are a coffee or tea drinker just pause for moment and reflect on any morning when you’ve felt stupid and unable to function until your morning cuppa. It might be for this reason that the pharmaceutical industry is not currently focusing on developing drugs for creativity. Plans for future cognitive enhancers focus on more mundane, workplace-useful skills such as memory and concentration. Memory-boosters would likely be most useful to older adults, especially those with worries about failing memories, rather than younger adults.

Although there is no reason in principle why cognitive enhancers couldn’t be found which fine-tune our concentration or hone our memories, the likelihood is that, as with recreational drugs, tolerance and addiction would develop. These enhancing drugs would need to be taken in moderate doses and have mild effects – just as many people successfully use caffeine and nicotine for their cognitive effects on concentration today. Even if this allowed us to manage the consequences of the brain trying to achieve its natural level, there’s still the very real possibility that use of the enhancing drugs would need to be fairly continuous – just as it is with smokers and drinkers of tea and coffee. And even then our brains would learn to associate the drug with the purpose for which they are taken, which means it would get harder and harder to perform that purpose without the drugs, as with the coffee drinker who can’t start work until he’s had his coffee. Furthermore, some reports suggest that those with high IQ who take cognitive enhancers are mostly likely to mistake the pleasurable effect of the substance in question for a performance benefit, while actually getting worse at the thing they’re taking the drug for.

The best cognitive enhancer may well be simply making best use of the brain’s natural ability to adapt. Over time we improve anything we practice, and we can practice almost anything. There’s a hundred better ways to think and learn – some of them are in this book. By practicing different mental activities we can enhance our cognitive skills without drugs. The effects can be long lasting, the side effects are positive, and we won’t have to put money in the pockets of a pharmaceutical company.

Link to more about The Rough Guide book of Brain Training
Three excellent magazine articles on cognitive enhancers, from: The New Yorker, Wired and Discover

We go with the flow

The Psychologist has a completely fascinating article on how we perceive things to be more appealing, easier to handle and more efficient based on how simple they are to understand – even when this is based on irrelevant or superficial properties – like its name or the font it is described in.

The core idea is that we partly judge things on ‘processing fluency’, that is, how easy it is to immediately grasp something. This seems intuitive, as we tend to prefer things that make sense to us, but it turns out that this preference is also heavily influenced by surface features.

For example, the article discusses the surprising amount of work on how simply changing the font can change our opinion of what the text is describing.

When they were presented [with physical exercise instructions] in an easy-to-read print font (Arial), readers assumed that the exercise would take 8.2 minutes to complete; but when they were presented in a difficult-to-read print font, readers assumed it would take nearly twice as long, a full 15.1 minutes (Song & Schwarz, 2008b). They also thought that the exercise would flow quite naturally when the font was easy to read, but feared that it would drag on when it was difficult to read. Given these impressions, they were more willing to incorporate the exercise into their daily routine when it was presented in an easy-to-read font. Quite clearly, people misread the difficulty of reading the exercise instructions as indicative of the difficulty involved in doing the exercise…

Novemsky and colleagues (2007) presented the same information about two cordless phones in easy- or difficult-to-read fonts. They observed that 17 per cent of their participants postponed choice when the font was easy to read, whereas 41 per cent did so when the font was difficult to read. Apparently, participants misread the difficulty arising from the print font as reflecting the difficulty of making a choice.

The article contains numerous examples of how changing surface features, such as giving something an easy or difficult to pronounce name, alters what we think about it.

However, the piece also mentions that giving something difficult-to-process or unfamiliar features also means we scrutinise it more closely, which means we often pick up errors more easily.

This is is a wonderfully elegant example:

As an example, consider the question ‚ÄòHow many animals of each kind did Moses take on the Ark?‚Äô Most people answer ‚Äòtwo‚Äô despite knowing that the biblical actor was Noah, not Moses. Even when warned that some of the statements may be distorted, most people fail to notice the error because both actors are similar in the context of biblical stories. However, a change in print fonts is sufficient to attenuate this Moses illusion. When the question was presented in an easy-to-read font, only 7 per cent of the readers noticed the error, whereas 40 per cent did so when it was presented in a difficult-to-read font…

Link to Psychologist article on processing fluency.

Full disclosure: I am an unpaid associate editor and columnist for The Psychologist and I have an unfamiliar first name – draw your own conclusions.

John Cleese on neuroanatomy

British comedian John Cleese tackles the brain and gives a tour of the organ’s major anatomical landmarks in this short video from 2008.

It’s a tour de force of descriptive neuroanatomy and even the most experienced neuroscientist is likely to encounter much that is new and interesting.

It also finished on a short but important piece of advice that is worth bearing in mind in all lab situations.

Link to John Cleese on the brain (via @brainshow).