Reith Lectures on Neuroscience and Beyond

The 2003 BBC Reith Lectures are still available to listen to or read. Vilayanur S Ramachandran, the lecturer, draws on a vast experience as Director of the Centre for Brain and Cognition and professor with the Psychology Department and the Neurosciences Programme at the University of California, San Diego, and he has lectured widely on art – as well as visual perception and the brain – and is a trustee of the San Diego Museum of Art.

Some seven years on and what is now a fairly routine report in today’s Guardian, neuroscience having become a prime source of news. This time it’s the amygdala again.

If your social life is a blur of friends and family, you might want to thank an almond-shaped clump of nerves at the base of your brain.

Researchers have found that part of the brain called the amygdala, a word derived from the Greek for almond, is larger in more sociable people than in those who lead less gregarious lives.

I have to confess I have become supersaturated in recent weeks with my study of popular accounts of neuroscience research. When I say “I”, I am probably referring to some complex interaction between thalamus, hippocampus and indeed amagdyla. The cingulate gyrus seems to have lost its place as a concept but I mention it for old time’s sake. I’ll be reading the Reith stuff but will be putting on hold reporting on my nascent interests in LSD research. I would however refer to this summary of relatively recent research since I shall be following up an interest in dream states and waking, and the effects of SSRIs: there’s some stuff via consideration of ‘filtering’ stimuli which interests me subjectively as the Duloxetine I’m on does some quite strange things when waking from vivid dreams (essentially, still being in some way still in a dreaming state).
I’m aware of a polarisation between science and humanities which I’m making, but will call this a ‘temporary autonomous zone’, just a convenient distinction. I can dimly see how to unite several discourses. At present I shall be returning more and more to the subjective, the literary and philosophical (pre-neurophilosophy), and older forms of ‘psychology’ including its existential slants (I have just re-read Rollo May’s The Meaning of Anxiety). I intend to be reading Iain McGilchrist’s The Master and His Emissary next week.

Duloxetine Five Weeks In: more Ups than Downs

I think that everybody prescribed a powerful medication has a duty to inform themselves about it as much as possible, and to raise any questions with their health professionals. Cymbalata (Duloxetine) has its fair share of user critics, some of whom have experiences very bad side effects, especially withdrawal side effects, and for others it has not been effective. The majority of people seem to have found it a positive medication. I think this will be true of all medications prescribed for depression, and it is common for patients to need to try different ones to discover one that works’. Probably the best places to look on the internet are those forums through which users can discuss their own responses and views.

So how is it for me? Having a while ago been first on Paroxetine and then Citalopram, and experiencing only very minor side effects and no ‘withdrawal’ problems, I’m not too worried about stopping the medication. However, the 60mg dosage I am on of what is an  SNRI(Serotonin–norepinephrine reuptake inhibitor acting on norepinephrine as well as serotonin whereas the other two act only upon serotonin) is much ‘stronger’. Side effects included initially some nausea which passed after a week or so. Ongoing side effects are annoying but not interfering with life too much: some difficulty getting to sleep, waking early, vivid dreams, some palpitations – which I have had for several years anyway – and frequent dizziness if I stand up too quickly – again, something I’ve had for many years on and off but it has been more pronounced over the past month).

Positively, Duloxetine began to work within four days. I felt a mood uplift (I had been sluggish, hopeless, careless of living or dying) and the world looked lighter, brighter – literally so. The most pronounced effect has been a calming of anxiety, an anxiety which has been the twin attribute of that something I would equally call depression. There’s been an uplift too in concentration ability, and although I have not been able to write at length, I have produced shorter pieces which I am content with.

Overall, with 2 grams daily of Depakote as a mood stabiliser, I am feeling much better than before. Of course, I am used to mood swings anyway so make no messianic claims for this drug. I still experience, for instance, on a daily basis rapidly fluctuating ups and downs but, as I say, these seem attenuated, dampened and it is possible to take the more ‘cognitive’ assistance of naming and accepting such a state of feeling, this naming being of benefit itself. I’m also still suffering from fluctuations in energy levels. As I am at home most of the time – perhaps thereby lacking stimulation of work or society – I usually feel I need a longish nap (up to an hour) mid or late afternoon.

Duloxetine and some thoughts on medication

Looking around websites and blogs on depression and other conditions, I see it’s customary to insert a disclaimer about the content: certainly I’m no expert on medication but I’d add that the pairing of ‘expert’ and ‘medication’ may itself be somewhat a convenient fiction at the general level of therapy. I’ve commented recently on the beneficial effects of Duloxetine for lifting my mood but I’d want to add that there is more to me or anybody than just a mood state. I have a category here called ‘partial depression’, the idea being that the monolithic concept of depression is misleading unless it is used as a convenient catch-all to embrace many cross-cutting or traversing modes of feeling, thinking, emoting and hence acting. For myself currently there are frankly bizarre contradictions going on in that, for example, I am both sleepy and too excited to sleep. I’m full of ideas but every time I go to write something in a sustained way, I jump off to yet new ideas! Anyone who is following this blog will know that in my last post I confidently stated that I possessed both the intellectual acuity and power of concentration to produce such sustained writing. What contradictory grandiosity!

 

Still, I have made some progress in researching LSD, as promised. The reason for doing so is not because of an interest in the drug per se, although there will be reference to the relatively recent revival of interest in its neurochemical effects and potential for treating ‘mental illness’, but mainly to work through some of the labyrinthine conceptual maps that confuse the field of understanding health, well being, and such confusion as internalised to making difficult an understanding of myself.

One area about medication that interests me greatly is its highly variable success rate in different people, and, related to this, its majority usage as a sole agent of therapy without concomitant support in the way of non-chemical methods, or even simple explanations and information. A second area that fascinates me is the political critique of the rise of medication to numb in the broad sense ‘alienation’ (in various guises), and more immediately to numb in the narrow sense distress and suffering caused by unemployment, poverty, low income, housing issues, the factors of social inclusion, and all the other contextual aspects of a person’s well or ill being.

The Temple of Delight

I have had with the Duloxetine (an antidepressant) some shifts to spells of what I must describe as happiness (and, hopefully, the Depakote which is a mood stabiliser will prevent any such spells developing into periods of unrealistic euphoria).  From a philosophical point of view, importantly my philosophical point of view, happiness is a fleeting state anyway, something which although I rarely experience it I would think comes and goes. Very possibly this view is influenced by a romantic attachment to Melancholy – “in the very temple of delight veil’d melancholy has her sovreign shrine” as Keats put it in his ode – but there are other reasons to subscribe to this view, taken from my own study of the philosophy and psychology of emotions and  feelings.

Nevertheless, although equanimity, stability, moderate contentment and, I suppose, stoicism, are my ideal, I do wonder whether for most people the glimpses I have of happiness are not more characteristic of their general view of the world? Let me describe some of the sttributes of this happiness. It feels good, firstly, of course: essentially there are only two important feelings, feeling good or feeling bad. It is optimistic, it looks forward to the future and provides a smooth momentum to reaching looked forward to goals. It removes anxiety, nagging worries, stuttering impediments and tangles that lead to stuckness and introspective worry. It lifts self worth, and consequently perhaps enables much more satisfactory social relations. It is outward looking, curious, excited even. related to this last point, and most astonishingly, it shifts one’s world view, not entirely but perceptibly, from a nihilist and cynical position to a more floursihing sense of growth and thriving.

I think it was William James who said that some people seem to be born with a glass of champagne too few and others are blessed with a genetically preordained bubbly personality from the start. I think that I am temperamentally (at the descriptive level) of a lugubrious nature.  However, not only must I live with that, I can live with that and do so happily during such periods as now when although not experiencing a celebratory mode do still feel the resonance of such gleams of lightness and grace that permeate what otherwise too readily becomes smoke and shadow.

After Depression: what next?

The new medication I started on last week (Duloxetine 60mg) has definitely lifted my mood after having been on it only ten days. There are still some sudden tumbles downwards and now also glimpses of peaks of euphoria set in a brilliant sky. Overall, a certain stability now and momentum to move through days with purpose. However. There is always an “however”.

There are times, too, at the end of the day which seem meaningless and empty. I have lost the ability to read (or write much) over the past month, and this is still the case. Although calm in terms of mood, and certainly without the almost physical sense of depression, I do survey the arid wastes of nothing very much and ponder. As I mentioned previously, I am returned to existential questions. To some extent being fully depressed is a form of sickness like any other that keeps you insulated from such aridity. I am remind of Eliot’s “Winter kept us warm with forgetful snow” as the cruel April brings the first green shoots through. I also get a much more pragmatic view of my situation regarding things such as unemployment, income, ageing. All of this is bearable but I wonder whether for some the lifting out of the level of depression which responds to chemicals can lead to a clarity which is of a different quality but possibly devestating in its impact?

I am thinking of people who have underlying multiple situational problems. I’ll leave aside the complex questions arising around causation and proceed just on the basis of correlation. If one takes all the factors that impact on “wellbeing” into account, any point of entry can be made into the complex. Relationships, physical health, housing, income, crime record, unemployment, substance dependence, education, social life, friendships, cultural engagement, factors of stigmatisation, mental health, and all the aspects of social exclusion. You cannot lift someone out of depression with a pill and expect them to be thereafter ‘undepressed’: there are many layers of the experience of depression. It may be for some the “mind forg’d manacles” of past and present life structures are unbearable even to look at. It makes complaining about existential aridity somewhat nugatory.

New Med

I saw a different psychiatrist yesterday, the fifth one I’ve ever seen. He was the best. He kept to the rigour of the others but allowed more open responses. He suggested four or five medications to tackle the depression, including antipsychotics. I’ve opted for duloxetine as that seems quickest to work and can be a relatively short term option.

Full on head cold with chest infection but feeling quite pleasantly tired and allowing a wallow in temporary incapacity. My coffee intake has been halved over past five days, but little progress in other areas such as exercise and diet.