Reflections on Psychiatry & Psychology

Introduction:  In the intricate landscape of neuroscience, the lateral habenula (LHb) stands out as a critical structure in understanding depression. This blog explores the LHb's role, its connection to depressive symptoms, and how ketamine therapy offers new hope. The Lateral Habenula: A Critical Brain Structure The lateral habenula (LHb) is a small, symmetrical, paired nucleus located deep within the brain, nestled between the two thalamic bodies. It is intricately connecte

The 2024 Oxford Ketamine Conference gathered global experts to discuss ketamine’s science and clinical use in mental health. Key themes included its rapid antidepressant effects, mechanisms of action, and improving treatment approaches, highlighting interdisciplinary collaboration and future research.

Psychosocial treatment for bipolar disorder includes psychoeducation, CBT, social rhythm therapy, family therapy, and group work. These target stress, routines, cognition, and relationships to reduce relapse. Early intervention and stress prevention—especially after childhood adversity—may improve course and outcomes.

Treatment The treatment of BD is complex.   Psychosocial treatments are necessary but rarely sufficient for controlling relapse or acute symptoms.  From my observations, the treatment of BD is as much of an art as it is a science, with different researchers and clinicians having different ideas as to what is the appropriate formulation.   Critically important is the assessment of suicide throughout the treatment.  Suicidal ideation and suicide completion is a very real possib

Stress is closely linked to bipolar disorder (BD), though its role in causation is unclear. BD is highly heritable. The Kindling theory suggests early stress triggers first episodes, after which episodes may become autonomous or stress-sensitized. Early trauma predicts earlier onset, greater severity, and poorer outcomes.

The Comorbidity of Bipolar Disorder and Stress disorders   Comorbidity is common in BD, further complicating the diagnosis.  In one study, a comorbid disorder was found in all of the samples, and in 59% the condition preceded the onset of BD symptoms (Kessler, Rubinow, Holmes, Abelson, & Ahao, 1997).  Common among the comorbid disorders are anxiety, substance abuse, ADHD, Oppositional-Defiant Disorder, Bulimia, Social Phobia, Panic Disorder, and Obsessive Compulsive Disorder 

It is generally agreed in the literature that stress affects the course and severity of Bipolar Disorder. Diagnosis is particularly difficult, because those with BD often do not recognize their episodes and so do not report their presence.

Methylfolate, the active form of folate (B9), supports serotonin and dopamine production and may help depression, especially in people with MTHFR variants or treatment-resistant cases. It can cause GI upset or insomnia and should be used cautiously, especially with SSRIs, under medical supervision.

The serotonin theory of depression has been around for a good 60 years and is often used as justification for the use of antidepressants, specifically selective serotonin re-uptake inhibitors (SSRIs). Understandably, a review published recently by psychiatric researcher Joanna Moncrieff, which concluded that there was no consistent evidence of an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin act

Zuranolone (Zurzuvae) is the first oral GABA-modulating antidepressant for postpartum depression. Taken for 14 days, it can improve symptoms within 3 days; benefits may last weeks. Common side effects include drowsiness and dizziness.

There are several exciting developments in the field of antidepressants, with various drugs currently in the pipeline. still in various stages of development. Clinical trials are ongoing to evaluate their safety, effectiveness, and potential side effects.

Dextromethorphan (DXM), found in cough meds, acts like mild ketamine. Combined with bupropion to slow its breakdown, it works quickly for depression. This combo was FDA-approved in 2022 as Auvelity.

Drugs disrupt brain homeostasis by hijacking the dopamine-based reward system, producing powerful reinforcement and cravings. Repeated use causes brain adaptations, impaired impulse control, and stress-driven relapse. Genetics and environment increase risk, but recovery is possible through strengthened top-down control.

Bipolar II disorder alternates between depression and hypomania but is hard to diagnose because patients often enjoy or fail to recognize hypomania and seek help only during depression. Recollections may be distorted, so collateral history from others is often crucial for accurate diagnosis.

Study of 252 cocaine-dependent patients tested whether early therapeutic alliance predicts drug-treatment outcomes across several therapies. Alliance weakly predicted outcomes (better for depression than drug use). Design issues—many variables and mixed treatments—may have limited conclusions.

Years of trial-and-error approach can be averted by this relatively new tool in mental health assessment. The psychiatrist will be able to devise an effective treatment, without side effects.

Research shows a two-way gut–brain link: gut bacteria shape brain development and influence mood. Dysbiosis may contribute to anxiety and depression. Probiotics show mental health benefits, but aren’t yet FDA-regulated or reliable stand-alone treatments.

Suicide is the 10th leading US death. Predicting it is hard; only clozapine, lithium, and ketamine reduce risk. Genetics, stress, and access to means all contribute.

After quitting drugs, many feel bored because drugs flood the brain with dopamine, dulling natural rewards. With time and practice engaging in healthy activities, the brain can relearn to find pleasure in everyday life.

Lavender, used since antiquity, may ease anxiety. Its compounds (linalool, linalyl acetate) act on serotonin and NMDA receptors. Silexan (Calm-Aid) is a studied extract; consult your doctor due to potential drug interactions.