Download - Natural Antidepressants Oct2015

““Therapeutic Lifestyle Changes”/Therapeutic Lifestyle Changes”/””Natural Antidepressants”Natural Antidepressants”

Evolutionary biology and neurophysiology psychoeducation for patients and their families

Dr Peter ParryConsultant Child & Adolescent Psychiatrist,

LCCH, CYMHS, Brisbane, Queensland Senior Lecturer, University of Queensland

Visiting Senior Lecturer, Flinders University

Gwinganna October 2015

Leon EisenbergLeon EisenbergChair APA Section of Child Psychiatry Chair APA Section of Child Psychiatry

(amongst innumerable posts and honours)(amongst innumerable posts and honours)

Brainless Psychiatry

v Mindless Psychiatry

Biopsychosocial Model George EngelBiopsychosocial Model George Engel

Australasian Psychiatry Mar 06 4

Chief-editorsChief-editors• Horton (The Lancet): How tainted has

medicine become? Lancet 2002 – “heavily and damagingly so”.

• Angell (NEJM): Drug Companies & Doctors: A story of Corruption New York Review of Books 2009

• Smith (BMJ): Medical journals have become an extension of the marketing arm of pharmaceutical companies. PLoS Med 2005

BackgroundBackground

• “Relief without Drugs” – 1970 best-seller.– Ainslie Meares, Australian psychiatrist

Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009

• “Yoga of the East and West: Integrating Breath Work and Meditation into Clinical Practice.”– Patricia Gerbarg, M.D., Richard Brown, M.D.– www.breath-body-mind.com

http://www.breath-body-mind.com/

Vagus – Vagus – the wanderer - the wanderer - NerveNerve

Pneumogastric NervePneumogastric Nerve• Charles Darwin (1872): • The Expression of

Emotions in Man and Animals– Heart, guts and brain

communicate intimately via the "pneumogastric" nerve, the critical nerve involved in the expression and management of emotions in both humans and animals.

Lifestyle treatment of depressionLifestyle treatment of depression• Evolutionary paradigm.

– Hunter-gatherer tribe.

Evolutionary PerspectiveEvolutionary Perspective

Evolutionary perspectiveEvolutionary perspectivePsychoeducation re nervous system


• Sympathetic (Stress/Survival) Nervous System

• Fight, Flight, Freeze, Faint/Feigned Death

• Amygdalae, Almonds, Alarms, ADRENALIN

• Frontal lobes offline


• Parasympathetic (Peaceful) Nervous System

• Rest & Digest, Recover & Grow

• Vagus Nerve

• Breath: Sigh, Yawn, Laugh, Sob

• GABA (Gamma-Aminobutyric Acid)

Evolutionary perspective on depressive reactionsEvolutionary perspective on depressive reactions

•Attachment Loss – Grief – moving on and reattaching – survival of tribe/group

•Status Loss – Survival

•Unmet expectations – demoralisation - Survival

Grief & TraumaGrief & Trauma

Status battles &Status battles &High expectationsHigh expectations

Lifestyle treatment of depressionLifestyle treatment of depression• Inflammatory theory of depression

– Acute stress is manageable. HPA system swings into gear with sympathetic nervous system response followed by parasympathetic relaxation and repair phase.

– Chronic stress is bad. Stress (current and unresolved), inactivity, poor sleep, poor diet, toxic load (tobacco, alcohol, obesity), sympathetic overdrive. → HPA axis dysfunction.

– HPA dysfunction leads to inflammation – body and nervous system.

– Pro-inflammatory cytokines.

Biological Psychiatry Biological Psychiatry 2009;65:732-7412009;65:732-741

Engaging young people in using a Engaging young people in using a breathing-relaxation techniquebreathing-relaxation technique

• “Has a teacher or counsellor ever taught you how to use slow breathing techniques to help…”

• “yeah, I’ve tried that – it doesn’t work for me!!”

• OK I believe you – it hasn’t worked for you when you’ve tried it – up to now. But actually it has worked for you when you haven’t tried it – I’ll tell you why… {come in with the sales spiel}

““The Spiel”The Spiel”• Draw brain and spinal cord plus eye and optic

nerve and schematic body with heart, lungs, guts, diaphragm muscle.

• within brain draw brainstem = autonomic N.S. “autopilot” = ‘reptilian brain’

• draw hemispheric limbic system with amygdalas (‘alarms’) = ‘mammalian brain’

• draw frontal lobes = ‘thinking/verbal brain’• Describe fight/flight/freeze

• Sympathetic N.S., adrenalin, amygdalas, frontal lobes switch off = ‘survival/stress N.S.’

• Need a circuit breaker to turn it off = parasympathetic “peaceful N.S.” = vagus nerve

Breath and the Vagus Breath and the Vagus NerveNerve

• Vagus nerve = feedback from diaphragm– amygdalas will listen– “I know for certain you already use this breathing-

relaxation technique!”– ??? (their expression)– yawning, sighing, laughing, sobbing…yawning, sighing, laughing, sobbing…– the ‘valsalva manoevre’ stimulates vagus.

• Enact a yawn, sigh etc– how this is same as a “yoga breath”– dogs, chimpanzees – use of yawning as

communication– humour helps!!

Breath and the Vagus NerveBreath and the Vagus Nerve• “victorious”

Breath and the Vagus NerveBreath and the Vagus Nerve• Elite athletes are trained to use it.

– AFL/NRL footballers lining up for goals– Olympic runners & swimmers– Johnny Wilkinson in Rugby, David Beckham in Soccer

• Singers and performers e.g. Australia’s Got Talent, X Factor etc

• Politicians making speeches– Julia Gillard speaking with slow diaphragmatic breathing and

exaggerated Australian drawl

Breath and the Vagus NerveBreath and the Vagus Nerve• Show how similar “breathing-relaxation” is to

yawning.– the sound “ocean breathing” on the lengthened out-

breath.

• Practice it in session (incl parents)

• Self-disclosure– for sleep, daily stress, exams etc– You shouldn’t preach this if don’t practice it!

Mindfulness is an Open SkyMindfulness is an Open SkyMindfulness is a MountainMindfulness is a Mountain

Mindfulness-Based Cognitive Mindfulness-Based Cognitive TherapyTherapy

Lifestyle treatment of depressionLifestyle treatment of depression• Sleep

– Draw graph sleep architecture – level 1 to 4– Explain value of deep sleep – cell repair, clear inflammatory debris

(cytokines)– EEG patterns – delta rhythm stage 4.– CSF flushing of neurons with resolvins - clean out debris– Teens need 9 ½ hrs average for full dose stage 4 ‘hardware’ clean up

and full dose REM stage 1 dreaming “software’ cleanup.

• Circadian Rhythm– Pineal gland, Supra-chiasmatic nucleus (SCN)– Melatonin = sleep chemical, SCN = clock– Need for sunshine in day and darkness at night– Computer/TV @ night (blue light/amber glasses)

• ISRT – Interpersonal Social Rhythm Therapy

Sleeping mouse flushing her brainSleeping mouse flushing her brain

Lifestyle treatment of depressionLifestyle treatment of depression• Exercise

– Superoxide Dismutase (SOD)– Brain derived neurotrophic factor (BDNF)– Tiredness to help sleep– Better insulin sensitivity, energy and weight control– Endorphins for mood

• Diet– Omega-3/omega-6 ratio of 1:1 in paleolithic hunter gatherers– Omega-3 building blocks for “resolvins” & neuroprotectin– Sugar, metabolic syndrome and inflammation– Nutrients, including antioxidants, and protein – lean meat, vegetables,

fruit, berries, nuts

Sparking Life (Dr John Ratey)Sparking Life (Dr John Ratey)

Brain FoodBrain Food

ObesityObesity– primarily a sugar/carb metabolism problem.

World Obesity Federation annual conference, Berlin 2015

Junk food shrinks brainJunk food shrinks brain

Lifestyle treatment of depressionLifestyle treatment of depression• Natural environments

– “Nature Deficit Disorder”– Mobile fractal patterns vs linear regularity– Korean CBT in forest study 5.21.61, hrv, salivary cortisol.

• Human touch– Evolved from apes who endlessly groomed eachother– Andaman islanders– Massage therapies

• Attachment and socialising– Friendships – face-to-face– Talking therapies

Nature Deficit DisorderNature Deficit DisorderEcotherapyEcotherapy

Our Primate Legacy…. •neurological immaturity at birth..

•slow development..

•in relationship to prolonged breast feeding and physical contact with adults Slide courtesy Prof J McKenna Orang-Utan

Consider the physical intimacy of the maternal-infant relationship

Slide courtesy Prof J McKenna

…socially and medically

obscured by western culture

Balinese

Mother and infant

Parent child holding Parent child holding

The Welsh ShawlThe Welsh Shawl

Tradition of long holding and carrying of infants was in West too.

The Tribe:The Tribe:Main Focus of Human EvolutionMain Focus of Human Evolution

Paradigm shiftParadigm shift

• “Integrative Psychiatry”• “Ancestral Health”• Truly holistic and developmental in

broader evolutionary perspective• Evolutionary perspective – niche &

nurture that is required by our nature• Biopsychosocioculturoevolutionary

model !!!

Download - Natural Antidepressants Oct2015

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