Saturday, February 20, 2010

2010 Online Consciousness Conference

It's all up and looks like some good stuff - see it all at the Consciousness Online site. In the coming days I'll be blogging about some of these - two in particular look very much like my kind of thinking, Joseph Neisser, Grinnell College, Correlates, Causes, and the Neurobiology of Consciousness and Adam Pautz, University of Texas, Austin, Why Consciousness Can’t Just be in the Head: A New Argument against Biological Theories.

Here is the 2010 program:

Program -2010

The Second Annual Online Consciousness Conference is now officially underway! It is scheduled to last until March 5th 2010. To attend a session just click on the title. Please email me at with any questions or problems. Enjoy! Richard

Welcome & Opening Remarks –Richard Brown, Conference Organizer

Special Session on Higher-Order Consciousness

Invited Colloquium on the State of the Art in Brain Decoding

Contributed Sessions

Owen Flanagan on Happiness

Nice video for a Saturday morning.

Owen Flanagan - Preview of the full interview.


Dr. Owen Flanagan is the James B. Duke Professor of Philosophy and Professor of Neurobiology at Duke University. He has done work in philosophy of mind, philosophy of psychology, philosophy of social science, ethics, contemporary ethical theory, moral psychology, as well as Buddhist and Hindu conceptions of the self.

Flanagan has written extensively on consciousness and has been realistic about the difficulty of consciousness as a scientific and philosophical problem, but optimistic about the chance of solving the problem. One of the problems in a study of consciousness is the hidden way in which conscious states are dependent on brain states. Flanagan has proposed that there is a "natural method" to go about understanding consciousness that involves creating a science of mind

To learn more about Owen's work, go to:


Watch the whole video here.

The Dalai Lama on Working with Anger

A Handbook for Living
by His Holiness the Dalai Lama
and Howard C. Cutler, M.D.

Dalai Lama Quote of the Week

Q: Let's say that someone makes you angry. Your natural response to being hurt, your immediate response, is to get angry.... You might think about the event later, even much later, and every time you think about it you become angry all over again. How would you suggest dealing with that kind of situation?

Dalai Lama: If you look from a different angle, then surely the person who caused this anger in you will have a lot of other positive aspects, positive qualities.

Q: But what about if you look for the positive angles of a person or event and can't find any?

DL: Here, I think, we would be dealing with a situation where you might need to make some effort. Spend some time seriously searching for a different perspective on the situation. Not just in a superficial way. But in a very pointed and direct way. You need to use all your powers of reasoning and look at the situation as objectively as possible.

For instance, you might reflect on the fact that when you are really angry at someone you tend to perceive them as having 100 percent negative qualities. Just as when you are strongly attracted to someone the tendency is to see them as having 100 percent positive qualities. But this perception does not correspond with reality. If your friend, who[m] you view as so wonderful, were to purposely harm you in some way, suddenly you would become acutely aware that they aren't composed of 100 percent good qualities.

Similarly, if your enemy, the one you hate, were to sincerely beg your forgiveness and continue to show you kindness, it's unlikely that you would continue to perceive them as 100 percent bad. So, even though when you are angry at someone you might feel that the person has no positive qualities, the reality is that nobody is 100 percent bad. They must have some good qualities if you search hard enough. So, the tendency to see someone as completely negative is due to your own perception based on your own mental projection, rather than the true nature of that individual.

In the same way, a situation that you initially perceive as 100 percent negative may have some positive aspects to it. But I think that even if you have discovered a positive angle to a bad situation, that alone is often not enough. You still need to reinforce that idea. So you may need to remind yourself of that positive angle many times, until gradually your feeling changes.

Generally speaking, once you're already in a difficult situation, it isn't possible to change your attitude simply by adopting a particular thought once or twice. Rather it's through a process of learning, training, and getting used to new viewpoints that enables you to deal with the difficulty.

--from The Art of Happiness: A Handbook for Living by His Holiness the Dalai Lama and Howard C. Cutler, M.D.

Friday, February 19, 2010

Owen Flanagan - Mind and Reality Symposium Keynote Address

Excellent - Owen Flanagan is one of the newish people I am reading - thanks to Dr. Ron Pies at Psychiatric Times, who suggested his book, The Problem of the Soul: Two Visions of Mind and How to Reconcile Them.
Owen Flanagan - Keynote I
1:09:46 - 2 years ago
For two days in February of 2006, twenty-four remarkable scholars crossed departmental lines to convene in Columbia University's historic Low Rotunda for a lively discussion on mind, body, and human consciousness at, MIND & REALITY: A MULTIDISCIPLINARY SYMPOSIUM ON CONSCIOUSNESS This video is part of series from that event.
For more details, please visit:
This speaker in this video is Owen Flanagan, the James B. Duke Professor of Philosophy and Co-Director of the Center for Comparative Philosophy at Duke University. He is also Professor of Psychology and Brain Science, and Professor of Neurobiology also at Duke.
Find out more here:

University of Arizona Campus Health Service Presents: "Love Your Body Day"

Hmmm . . . . a former Miss America talking about loving your body. Well, that's one way to draw a crowd. She looked pretty skinny here when she won the title in 2008, which is not my idea of a healthy body. Maybe she will talk about the destructive nature of beauty pageants on female body image?

One of the sponsors is Sierra Tucson, an in-patient treatment facility that works with eating disorders, among many other things.

The University of Arizona Campus Health Service Presents: "Love Your Body Day"


6 PM

Student Rec Center, 1400 E 6th Street


Kirsten Haglund

Miss America 2008

"FREEDOM FROM PERFECTION:Overcoming Body Wars, Diet Culture, and Taking Back our Souls"

Q & A to follow talk

Sponsors include:

Campus Health Service, Campus Rec, Remuda Ranch

Rosewood Centers for Eating Disorders and

Sierra Tucson Treatment Center

For More information:

Two Additional Articles on Mindfulness

It seems like a mindfulness morning here at the Cafe. Here are a couple of articles that have come up in the last day or two. First up, Karen Kissel Wegela talks about Practicing Mindfulness Without Meditating: How to cultivate mindfulness without meditation. Then a brief article from Sharp Brains by Alvaro Fernandez looks at the benefits of mindfulness on mood and working memory.
How to cultivate mindfulness without meditation
by Karen Kissel Wegela, Ph.D.

As a Contemplative Psychotherapist, one who bases my psychotherapy practice on the Buddhist understanding of mind, I am especially interested in helping my clients to develop mindfulness. While the most direct way to cultivate mindfulness is the sitting practice of mindfulness-awareness meditation, not everyone is ready for, or interested in, doing that.

As I've written about before (see my previous blog entry), there are often good reasons for me not to become the meditation instructor for my clients. When I have clients who are interested in learning how to do formal meditation practice, I usually tell them how to connect with people, classes, or books that can get them started.

Some clients have other formal contemplative practices like yoga, tai chi, or contemplative prayer. These kinds of practices are already designed to help their practitioners become more mindful and attentive to their moment to moment experience. Together we explore how they can apply what they know from their contemplative practices to the rest of their lives.

Still others have what I like to call "informal mindfulness practices." These are the everyday activities of life that can support the cultivation of mindfulness.

For example, a man I know plays a lot of golf. He has learned a great deal about how to work with his mind as a result. He knows, for example, that he needs to pay attention to what he is doing with his body when he swings a golf club. He pays attention to where his head is, how he twists his body at the beginning of the swing and how he moves through it to the end of his swing. He attends to the placement of his feet and the shifting of his weight.

At the same time, he also pays attention to his mind. He knows that if he is thinking too much about what he's doing or getting distracted by memories of how he has played well or badly in the past, he will mess up this present drive. He has learned something about how to let go of thoughts and come back to the present moment.

In addition, he has learned the important lesson of not holding his mind and his body either too tight or too loose. If he tries too hard to get everything right, he will become tense and awkward. If he doesn't try at all, it won't work well either.

Finally, he knows that he also needs to let go of the drive once it's completed, no matter how it turned out. If he tries to do exactly what he's done before, he won't be present for the next stroke.

All of these things he's learned are principles of good mindfulness practice:

1. Paying attention to the moment-to-moment details of experience
2. Paying particular attention to the body and one's experience of it
3. Recognizing the experience of mind and not getting caught in memories of the past or plans for the future
4. Trying neither too much nor too little
5. Letting go of distractions and paying attention to the present moment
6. Noticing one's experience without judging it

I work with my clients to identify the activities that they already engage in that can become occasions for practicing mindfulness. Most people have a number of possibilities. Practically all sports can work: basketball, baseball, soccer, volleyball, and so on. What's it like to stand at the foul line before you try to make a free throw?

Other physical activities can be used, too: biking to work in traffic, walking the dog, going for a jog, shoveling the driveway, buying groceries, picking out what to wear, putting on make-up, driving the car. What these activities have in common is the opportunity to pay attention to sense perceptions in the present moment: what one can see, hear, smell, taste or touch.

When we engage in these activities, especially if we are willing to let go of distractions like listening to an iPod or playing the car radio, they give us the chance to tune into what is happening right now. We can pay attention to our sense perceptions, our emotions, and our thoughts.

I often walk our dogs in the morning. When I am using my walk time as a mindfulness practice, I pay attention to all my senses. This time of year the branches are bare, and the ground is often icy in patches. I pay attention to where I place my feet. This takes even more awareness when I have to dogs with me, running one way and another in their eagerness to check out all the smells. I guess they are doing their own sniffing practice! I pay attention to the movement of the dogs, the sloshy sounds of the traffic nearby on the wet street, the crows that caw from dumpster behind the market. I notice smells -sometimes the moist earth, other times the smell of dog poop as I pick it up in a newspaper bag. I feel the cold air on my face and the thoughts about wishing I'd worn my warmer hat. As we move along, the sights, smells, sounds and feelings change. My emotions how my irritation with Sadie, as she pulls on the leash and barks as she tries to get to the neighbor's dog, changes to delight as she bounces happily along soon afterward. I notice tenderness as Sunny starts to limp, and I remove the burr she's picked up on her paw. I note the sharp pinch as I get stuck by the burr myself. When I find my mind wandering to the meeting I have later at school, I simply come back to the present moment with the dogs.

Other activities that lend themselves to cultivating mindfulness are cleaning the house, cooking dinner, working on the car, paying attention to people as we speak with them at work, filing papers, typing. We can also pay attention to body experiences when we feel well or when we feel ill. Bringing mindfulness to physical pain is particularly illuminating. We may find that we have added tension to what might otherwise be a tolerable experience and made it worse.

We can attend to our emotions when we feel uneasy, happy, sad, scared. There's a whole range of emotions we can attend to. In fact, in therapy, this is often our work together: bringing mindfulness to the experience of emotions as they are arising. Some experiences are more difficult to do this with, and it's best to practice bringing mindfulness to easier ones first. For example, it's quite difficult to bring mindfulness to intense experiences of anger. Still, the more we attend to our present experience, the more we cultivate the courage to be present with whatever experience we are having.

With all of these activities, we begin by setting an intention to be mindful of our experience. It's best to pick a particular activity as your mindfulness practice. Getting too ambitious and thinking we can bring mindfulness to everything right away is, for most people, trying too hard.

As always, it is important to be gentle but also steady. So pick a particular activity and set a particular amount of time when you're going to use it as a practice. Then, gently pay attention to the sensations in your body; note your sense perceptions, your emotions, and your thoughts as they come and go. Notice when you hang on to a feeling or thought. Let it go when you can. If you forget that you're practicing mindfulness, just start again without giving yourself a hard time.

There's really no limit to the different activities that can become opportunities to practice and cultivate mindfulness. Happy practicing!
And now a short article on how mindfulness changes the brain. But you can follow the link to the full PDF of the research article.

Mindfulness Meditation can impact Mood and Working Memory

By: Alvaro Fernandez

Very interesting and relevant recent study on the impact of mindfulness meditation (noticed thanks to heads up by SharpBrains reader John):

Building Fit Minds Under Stress (Science Daily)

  • “high-stress U.S. military group preparing for deployment to Iraq has demonstrated a positive link between mindfulness training, or MT, and improvements in mood and working memory”
  • The study also suggests that sufficient mindfulness training (MT) practice may protect against functional impairments associated with high-stress challenges that require a tremendous amount of cognitive control, self-awareness, situational awareness and emotional regulation

Please note that this wasn’t a properly randomized study, so in fact much/ most of the effect may be due to the placebo effect, but still the findings seem to be consistent with a growing body of evidence on the brain-based effects of structured mental training in the form of meditation (usually mindfulness meditation).

Full study Here (opens PDF).

The Science of Mindfulness - Daniel J. Siegel

The current issue of Shambhala Sun is focused on mindfulness.

Inside the March 2010
of the Shambhala Sun

Here you can view full articles and excerpts from the new "Mindful Living Guide" issue of the Shambhala Sun, as well as related web-only exclusives.

Just click on any title to start exploring.

Editorial: Why We're Taking Mindfulness to Heart

By Barry Boyce, Senior Editor of the Shambhala Sun.
Mindfulness is a hot topic in both books and blogs so it's great that they have put together a great group of teachings, including this one from the hottest neuroscientist in the field, Dan Siegel.

Siegel's most recent book is The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being and Mindsight: The New Science of Personal Transformation has just been released.

The Science of Mindfulness

Daniel J. Siegel, M.D. looks for the “active ingredient” that makes mindfulness so beneficial to our health, psyche, and overall quality of life.

The practice of intentional, nonjudgmental awareness of moment-to-moment experience has been practiced since ancient times in both East and West. Wisdom traditions have for thousands of years recommended mindful practice in a variety of forms to cultivate well-being in an individual’s life. Now science is confirming these benefits. Here, we’ll explore the common elements of these practices and review the research findings which affirm that daily mindfulness practice is good for your health. We’ll then explore a new field called interpersonal neurobiology that integrates a wide range of sciences and other ways of knowing about reality into a common language that illuminates the subjective world of the human mind.

Mindful awareness practices include yoga, tai chi, qigong, centering prayer, chanting, and mindfulness meditation derived from Buddhist tradition. The science of mindfulness could have delved into any of the practices of intentionally focusing on the present moment without judgment, but through the impact of the Buddhist-inspired program of Mindfulness-Based Stress Reduction, much of our in-depth research on the impact of mindful awareness on brain and immune function, as well as psychological and interpersonal changes, has emerged from the study of mindfulness meditation.

Jon Kabat-Zinn, a microbiology Ph.D. then teaching at the University of Massachusetts Medical Center, was inspired in the late 1970s to apply the basic principles of mindfulness meditation to patients in a medical setting. His work developing the MBSR program proved effective in helping alleviate the suffering of chronic and previously debilitating medical conditions such as chronic pain. It also served as fertile ground for a systematic set of research investigations in collaboration with one of the founders of the field of affective neuroscience, Richard Davidson of the University of Wisconsin at Madison.

Kabat-Zinn repeatedly clarifies in his writings and teachings that MBSR, despite its Buddhist roots, is a secular application of mindfulness, which is a practice of carefully focusing attention, not a form of religion. Indeed, each of the mindfulness practices mentioned above share common, secular elements: cultivating an awareness of awareness and paying attention to intention.

Studies show that the ways we intentionally shape our internal focus of attention in mindfulness practice induces a state of brain activation during the practice. With repetition, an intentionally created state can become an enduring trait of the individual as reflected in long-term changes in brain function and structure. This is a fundamental property of neuroplasticity—how the brain changes in response to experience. Here, the experience is the focus of attention in a particular manner.

A question that is raised regarding the specific features of MBSR is what is the “active ingredient” in its powerful effects. Naturally, the experience of joining with others to reflect on life’s stresses, listen to poetry, and do yoga may each contribute to the program’s scientifically proven effectiveness. But what specific role does meditation itself play in the positive outcomes of the MBSR program? One clue is that those practicing mindfulness meditation during light-treatment for psoriasis revealed four times the speed of healing for the chronic skin condition. And in other studies, long-term improvements were seen and maintained in proportion to the formal reflective meditation time carried out at home in their daily practice.

Further research will be needed to verify the repeated studies affirming that long-term improvements are correlated with the mindfulness practice, and are not just the effect of gathering in a reflective way as a group. Sara Lazar and her colleagues at Massachusetts General Hospital have found that people who have been mindfulness meditators for several decades have structural features in their brains that are proportional to their number of hours of practice. But this finding, too, along with studies of “adepts”—those who have spent often tens of thousands of hours meditating—need to be interpreted with caution as to cause and effect. Are those with differing brain activity and structure simply those who’ve chosen to meditate, or has the meditation actually changed their brains? These questions remain open and in need of further studies.

MBSR has proven an excellent source of insight into these questions because it enables novices to engage in new practices which can then be identified as the variables that induce the positive changes that follow. What are these changes, whatever their specific causes? Studies of MBSR have consistently found several key developments that demonstrate its effectiveness as a health-promoting activity. These may be key to the “science of mindfulness.”

First, a “left-shift” has been noted in which the left frontal activity of the brain is enhanced following MBSR training. This electrical change in brain function is thought to reflect the cultivation of an “approach state,” in which we move toward, rather than away from, a challenging external situation or internal mental function such as a thought, feeling, or memory. Naturally, such an approach state can be seen as the neural basis for resilience.

Second, the degree of this left-shift is proportional to the improvement seen in immune function. Our mind not only finds resilience, but our body’s ability to fight infection is improved. At the University of California, Los Angeles, David Cresswell and his colleagues have found that MBSR improves immune function even in those with HIV. Improved immune system function may help explain the increase in healing found in the psoriasis treatment studies with mindful reflection during treatment.

Preview our entire March 2010 "Mindful Living" issue

Featuring Thich Nhat Hanh, Jon Kabat-Zinn, Judith Simmer-Brown, Karen Maezen Miller, Daniel Goleman, and many more — all addressing how to bring mindfulness into all the major aspects of your life.

Thursday, February 18, 2010

The State of the Science on Antidepressants

In yesterday's post on grief in the DSM-V, I made a blanket statement about antidepressants being ineffective. Ronald Pies, MD, Editor in Chief of Psychiatric Times, left a comment asking readers to consider his recent article in rebuttal to Sharon Begley's Newsweek story about antidepressants being only as effective as placebos.

This is a brief quote from Begley's widely covered article:
The moral dilemma was this: oh, yes, I knew of 20-plus years of research on antidepressants, from the old tricyclics to the newer selective serotonin reuptake inhibitors (SSRIs) that target serotonin (Zoloft, Paxil, and the granddaddy of them all, Prozac, as well as their generic descendants) to even newer ones that also target norepinephrine (Effexor, Wellbutrin). The research had shown that antidepressants help about three quarters of people with depression who take them, a consistent finding that serves as the basis for the oft-repeated mantra "There is no question that the safety and efficacy of antidepressants rest on solid scientific evidence," as psychiatry professor Richard Friedman of Weill Cornell Medical College recently wrote in The New York Times. But ever since a seminal study in 1998, whose findings were reinforced by landmark research in The Journal of the American Medical Association last month, that evidence has come with a big asterisk. Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.
This article was covered widely in the press and the blogs, with the conclusion that SSRIs do not work for anything other than severe depression. This is the article that Dr. Pies wrote in response to Begley's mainstream piece.

Newsweek’s Topsy-Turvy Take on Antidepressants

By Ronald Pies, MD, Editor in Chief | February 8, 2010

Imagine, as a psychiatrist, hearing this story from a beloved friend or relative:

“I’ve been terribly depressed for the last month—can’t focus, can’t get out of bed, and I’m barely eating. Nothing really gives me pleasure anymore. I haven’t showered in 2 weeks. Sometimes I think I’d be better off dead. I asked my family doctor if an antidepressant might help. She said I’d do just as well taking a sugar pill, and it’s a lot cheaper!”

I hope you would be both alarmed and outraged by this doctor’s dismissive attitude. Yet if the doctor—or your loved one—had read the article on antidepressants in the February 8 Newsweek (The Depressing News About Antidepressants), she might well have concluded that antidepressants are largely worthless.

Let’s credit Newsweek and the usually careful science writer, Sharon Begley, with bringing the problem of clinical depression before a wide audience. The clever cover of the magazine allows one to read either “Antidepressants Don’t Work” or “Antidepressants Do Work,” depending on which title is on top. Sadly, the article itself is a bit topsy-turvy, and may do less to educate the general public than to confuse or alarm it. (A nice rebuttal by psychiatrist Robert Klitzman, MD follows the Begley article).

Essentially, after a superficial analysis of 2 recent studies, Begley concludes that antidepressants are “basically expensive Tic Tacs” (sugar pills). Begley then struggles with whether it might be “a kindness” to keep patients “in the dark about the ineffectiveness of antidepressants, which for many are their only hope…"

The studies in question—by Kirsch and colleagues1 and Fournier and colleagues2—found that antidepressants were not substantially more effective than placebo, except for the most severe types of depression. The lay press promptly proclaimed—sometimes with barely suppressed glee—“Antidepressants No Better than Sugar Pill!”

Both the Kirsch and Fournier studies are “meta-analyses” of various individual antidepressant trials. Meta-analyses suffer from all the problems common to such “number-crunching” methods: if the individual studies are flawed, the meta-analysis is flawed. For example, the Kirsch meta-analysis looked only at studies carried out before 1999. The much-publicized Fournier study examined a total of 6 antidepressant trials (n=718) using just 2 antidepressants, paroxetine and imipramine. Two of the imipramine studies used doses that were either subtherapeutic (100 mg/day) or less than optimal (100 to 200 mg/day). Moreover, the design of the Fournier study intentionally excluded individual studies involving a “placebo washout” phase, which attempts to reduce the number of placebo-responders receiving active medication. By excluding such studies, the Fournier meta-analysis may have reduced the difference between placebo and antidepressant response rates.

The Newsweek article also misrepresented the nature of placebo controls. Begley repeatedly describes a placebo as a “dummy pill”—but subjects in the placebo group of most major antidepressant studies receive much more than a sugar pill. As research psychiatrist Dr. Sheldon Preskorn recently wrote me, “… there is much more treatment [provided] by being on a placebo in a study than most depressed patients get in routine clinical practice, particularly in the primary care setting” (personal communication, 2/03/10). Indeed, Preskorn estimates that in a typical 8-week trial, a subject in the placebo group may receive 10 to 12 hours of contact time with knowledgeable and empathic healthcare practitioners. In effect, the placebo control is a kind of substantive, supportive intervention. Furthermore, placebo group response rates in depression studies have been mysteriously and substantially rising in recent decades3—perhaps in part because less severely depressed subjects are being recruited. Since mildly depressed subjects are more likely to be placebo responders, such a recruitment artifact could be shrinking the difference between antidepressant and placebo response rates.

Moreover, the Newsweek article—like many professional journals—also ignores an important underlying reason for the diminishing drug-placebo difference, as we move from more severe to milder forms of depression. As Preskorn explains, “The ‘finding’ that antidepressants do not work as well in mild as in severe depression is a ‘floor’ effect. [One] could not show that antidepressants worked in non-depressed individuals, and the lower the severity score, the closer the participants are to the ‘floor’” (personal communication, 1/19/10).

Begley acknowledges the benefit of antidepressants in severely depressed patients, but minimizes its importance, noting that only 13% of patients meet this severity threshold. But based on a 2004 SAMHSA study,4 “only” 13% means that about 2 million adults in the United States may suffer from severe depression in a given year. Even by the lights of the Fournier study, that’s 2 million people who would probably respond well, acutely, to an antidepressant. Furthermore, as Preskorn notes, acute efficacy studies, in contrast to maintenance studies, “…overestimate the efficacy of ‘placebo’ treatment. On average, 3 out of 10 fewer patients will relapse in 1 year if they are continued on medication, as opposed to being switched to placebo.”5

Yes, antidepressants are “oversold” in those Big Pharma ads, adorned with chirping birds and fluttering butterflies—in truth, antidepressants don’t work as well or as specifically as we’d like.5 Given the frequent side effects of many antidepressants, it is usually wise to initiate treatment with psychotherapy, in cases of mild-to-moderate, non-melancholic depression.6 Alas, psychotherapy is often difficult for patients to obtain or afford.7 Despite Newsweek’s supposedly “depressing news” about antidepressants, psychiatrists have good reason to keep these medications in their armamentarium--and patients with severe unipolar depression8 have good reason to consider taking them.

Acknowledgment: My thanks to Dr Sheldon Preskorn for his helpful comments and suggestions.

1.Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008;5:e45.
2.Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303:47-53.
3. Walsh BT, Seidman SN, Sysko R, et al. Placebo response in studies of major depression: variable, substantial, and growing. JAMA. 2002;287:1840-1847.
4. NSDUH Report: Depression among adults. Accessed February 8, 2010.
5. Preskorn S. A dangerous idea. J Prac Psych Behav Health. 1996;2:231-234.
6. Brown WA. Treatment response in melancholia. Acta Psychiatr Scand Suppl. 2007;433:125-129.
7. Pies R. Antidepressants work, sort of—our system of care does not. J Clin Psychopharmacol In press; April, 2010.
8. Pies RW. Pseudoresistant bipolar depression. J Clin Psychiatry. 2009;70:1476.
I am largely in agreement with Dr. Pies in his response to the Begley article. Still, there are reasons to be skeptical of the blanket use of SSRIs. To be fair, Dr. Pies is opposed to the overuse of these drugs and would rather see therapists and psychiatrists try psychotherapy much of the time before going to drugs (with the obvious exceptions of severe depression and suicidality).

However, I have posted other articles on the issues with SSRIs, and there are reasons to question the benefits of these drugs. This is the most compelling research I have seen, from this blog, December, 2009:

Most Antidepressants Miss Key Target of Clinical Depression

Way back in what now seems like the dark ages of depression medications, the most effective and widely used drugs were MAOIs, or monoamine oxidase inhibitors. The MAOIs have some serious risks for those who do not avoid certain foods in their diets:

When ingested orally, MAOIs inhibit the catabolism of dietary amines. When foods containing tyramine are consumed (so-called "cheese syndrome"), the individual may suffer from hypertensive crisis. If foods containing tryptophan are consumed, hyperserotonemia may result. The amount required to cause a reaction varies greatly from individual to individual, and depends on the degree of inhibition, which in turn depends on dosage and selectivity.

The exact mechanism by which tyramine causes a hypertensive reaction is not well understood, but it is assumed that tyramine displaces norepinephrine from the storage vesicles.[4] This may trigger a cascade in which excessive amounts of norepinephrine can lead to a hypertensive crisis. Another theory suggests that proliferation and accumulation of catecholamines causes hypertensive crises.
Here is an explanation of how the MAOIs work, from the Mayo Clinic:

How MAOIs work

Researchers believe MAOIs relieve depression by preventing the enzyme monoamine oxidase from metabolizing the neurotransmitters norepinephrine (nor-ep-ih-NEF-rin), serotonin (ser-oh-TOE-nin) and dopamine (DOE-puh-mene) in the brain. As a result, these levels remain high in the brain, boosting mood.

Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate — an organic compound of a nonessential amino acid — in check. This increased support of nerve cells decreases glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to anxiety and depression.

Therapeutic effects of antidepressants may vary in people, due in part to each person's genetic makeup. It's thought that people's sensitivity to antidepressant effects, especially selective serotonin reuptake inhibitor effects, can vary depending on:

  • How each person's serotonin reuptake receptor function works
  • His or her alleles — the parts of chromosomes that determine inherited characteristics, such as height and hair color, that combine to make each person unique

Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.

Because of the risks involved with these drugs, and based on the unsupported assumption that serotonin is the most important neurotransmitter in depression, the selective serotonin reuptake inhibitors (SSRI) were developed to address this element of brain chemistry. They do not work for many people, and sometimes figuring out which one might work takes several trials. They do have fewer severe risks, but as many or more overall side effects, most notably weight gain (they interfere with glucose metabolism, i.e., cause diabetes in some people) and loss of sexual desire/function.

Turns out, according to this new study, that SSRIs might simply be making us stoned on serotonin (as argued by Peter Breggin in Medication Madness), not addressing the real issues of depression in our brain chemistry.

It seems the original idea, that the MAO inhibitors address the neuro-chemistry of depression, might be the best approach if we can make them safer.

Most Antidepressants Miss Key Target of Clinical Depression, Study Finds

ScienceDaily (Dec. 8, 2009) — A key brain protein called monoamine oxidase A (MAO-A) -- is highly elevated during clinical depression yet is unaffected by treatment with commonly used antidepressants, according to an important study published in the Archives of General Psychiatry. The study has important implications for our understanding of why antidepressants don't always work.

Researchers at the Centre for Addiction and Mental Health (CAMH) used an advanced brain imaging method to measure levels of the brain protein MAO-A. MAO-A digests multiple brain chemicals, including serotonin, that help maintain healthy mood. High MAO-A levels excessively remove these brain chemicals.

Antidepressant medications are the most commonly prescribed treatments in North America, yet 50 per cent of people do not respond adequately to antidepressant treatment. Dr. Jeffrey Meyer the lead investigator explains, "Mismatches between treatment and disease are important for understanding why treatments don't always work. Rather than reversing the problem of MAO-A breaking down several chemicals, most antidepressants only raise serotonin."

Understanding the Problem of a Persistent Illness

Depression ranks as the fourth leading cause of disability and premature death worldwide, according to the World Health Organization. Recurrent illness is a major problem. Even under the most optimal treatment circumstances, recurrence rates for clinical depression are at least 20 per cent over two years.

The new study also focused upon people who had fully recovered from past episodes of clinical depression. Some people who appeared to be in recovery actually had high levels of MAO-A. Those with high levels of MAO-A then had subsequent recurrence of their depressive episodes.

This new idea of high levels of MAO-A lowering brain chemicals (called monoamines), then falling into a clinical depression is consistent with the historical finding that medications which artificially lower monoamines can lead to clinical depression as a side effect. In the 1950's some medications to treat high blood pressure also lowered monoamines and people began to experience depressive episodes. When the medications were removed, people recovered.

From Technology to Treatment

VP of Research Dr. Bruce Pollock highlights the study's use of advanced brain imaging technology. "CAMH has the only positron emission tomography (PET) centre in the world that is dedicated solely to mental health and addiction treatment and research. As a consequence, we were able to develop this new technology to measure MAO-A levels."

Virginia Wilson knows first-hand the struggle it can be to find effective medication. After being diagnosed with depression, eight years passed before a medication was developed that worked well for her. "During this time I was on every type of antidepressant available. This process was enormously frustrating, painful -- and took a great toll on my personal life." The current research into depression gives Virginia hope for others who struggle as she did. "Understanding of the biochemical mechanisms behind depression is so important and can really improve the treatments that are available -- it can save lives."

Some early antidepressant medications did target MAO-A, but these MAO-A inhibitors fell out of favour in the 1970s due to adverse interactions with certain foods. There have been advances that overcome these problems, but the vast majority of antidepressant development and use has overlooked the MAO-A target.

According to Dr. Meyer, "Since most antidepressants miss MAO-A, we are counting on the brain to heal this process of making too much MAO-A, and that doesn't always happen. The future is to make treatments that tell the brain to make less MAO-A, even after the antidepressant treatment is over, to create better opportunities for sustained recovery."

~ Dr. Meyer is a Canada Research Chair in the Neurochemistry of Depression and the Head of the Neurochemical Imaging Program in Mood Disorders. The study was funded by the Canadian Institutes of Health Research, the Ontario Mental Health Foundation, and the Canadian Foundation for Innovation.

Journal Reference:

  1. Meyer et al. Brain Monoamine Oxidase A Binding in Major Depressive Disorder: Relationship to Selective Serotonin Reuptake Inhibitor Treatment, Recovery, and Recurrence. Archives of General Psychiatry, 2009; 66 (12): 1304 DOI: 10.1001/archgenpsychiatry.2009.156
I am not willing to disregard the SSRIs yet. For me, as someone with social anxiety disorder, Paxil (paroxetine) has been the best thing that ever happened to me - after years of therapy, mindfulness practice, meditation, and herbal approaches, I can now speak in front of people with a panic attack.

I'm sure there are many people who have felt the same relief from depression with these drugs - if they were prescribed the right one, or found the right one through trial and error. I'm waiting for the day when we can match drugs to the genetic profile of the patient - that is when we know for sure how well these drugs treat depression.

Tony Wright - The molecular origins of our species wide insanity: The fundamental causality of our self inflicted suffering

Left in the Dark

Left in the Dark ~ Tony Wright & Graham Gynn

Interesting stuff - I am attracted to the concept of consciousness as an emergent property, so this essay offers some food for thought.

Here is the basic argument in a nutshell:

The accepted evidence for the structural basis of our
insanity is staring us in the face, as might be expected
we fail to recognise its profound significance.

Our own sex hormones retard the development
of the dominant side of our brain!


Our flavonoid rich ancestral diet inhibited the action
of our sex hormones during the evolution of our brain!


I'm not sure about all of this without reading the book, but it's an interesting idea that deserves some attention. I have no doubt that our current lifestyle is not good for our health - the nutritional correlates with mental illness are too varied and common.

Left in the Dark

Science of the Mind — POSTED BY Tony Wright on November 17, 2009 at 10:25 am

While a student at Edinburgh Botanic Gardens and preparing a short dissertation entitled ‘The Genetic Manipulation of Plants’ the subconscious seeds of a revolutionary new theory were sown in Tony Wright’s mind. Over the next 20 years a mixture of scientific curiosity and radical self-experimentation resulted in the development of a simple idea that explains the emergence of increasingly anomalous traits in human evolution. From the rapid and accelerating expansion of our large brain to the mysteries of our mind and the origins of spiritual practice he has developed a new context in which we may understand who we are and has provided a framework for the reunification of the academic and spiritual science of consciousness.

Working independently and alone, the fruits of his labour are only now beginning to reach a wider audience through the recent publication of ‘Left in the Dark’, despite the major practical and philosophical implications initial reaction has been exceptionally favourable. Tony is now focused on bringing this modern translation of very ancient wisdom into mainstream culture in the hope that it may help provide a way out of the self-imposed madness we currently mistake as normality.

The following article was written exclusively for Brainwaving:

Consciousness and the Direction of Structure

The molecular origins of our species wide insanity
The fundamental causality of our self inflicted suffering

By Tony Wright (pdf version)

Solving the mystery of human evolution using Darwin’s basic theory required no more than a simple reinterpretation of existing data and the application of basic biological principles. The same approach simultaneously resolves several other major enigmas in disciplines rarely considered within the same context. By following in the footsteps of William of Ockham, the path of least resistance leads to a simple, coherent and elegant explanation for our unique physiological traits and sheds light on the state of our mind.

Your ability to read and understand this article, your perception, state of mind and sense of self is directly related to the co-ordinated real time variations in structure and cascading flood of chemical and electrical chain reactions in your brain. That is not to say your consciousness is the structure, rather one facilitates the other. Forget for now the so-called hard problem, how does consciousness arise or emerge from a large glob of fatty stuff, or the esoteric realms of physics where the nature of matter and energy is indeterminate. Let us begin with a model based on the concept of structure, in this case the microstructure and molecular arrangement of our brain as an understanding at this level may shed light on some of the more esoteric mysteries.

A single brain cell is more complex by many orders than anything most of us have ever imagined, a comparison with the best of our technology would be laughable. Sub atomic, atomic and molecular engineering of extraordinary elegance, a whole dynamic ecosystem in constant yet precisely orchestrated flux.

These diagrams (borrowed from Wikipedia) provide some concept of the scale, complexity and the engineering marvel that we are when compared to the best of our technological innovation. However they fail to do justice to the dynamic reality and wonders of bio-molecular engineering, more on that later.

Take around 100 billion or so of these supremely advanced organic machines and organise them into a coherent interconnected and self-regulating whole and we have the human brain. It manages its biological support systems, processes and translates sensory input into something comprehensible and appears to give rise to or at least facilitate a sense of ‘I’. The correlation between structure and function is very good, the tiniest change in its structure can and usually does result in major changes in our sense of who or what we are. From congenital defects in the developmental process to minor accidents as small as a pinprick through to the use of appropriately termed mind altering molecules the result is always the same, micro change in structure, macro change in consciousness. So for this model to develop we will assume the brain acts like a lens for our sense of self or consciousness. The arrangement of the molecular architecture directly relates to its resolution or the quality of consciousness in the same way the design and structural integrity of a telescope lens and mirror relates to its ability to resolve light and the sharpness of the image it produces.

If we take the lens analogy as read it would be useful to look at its design and how it evolved and developed. Not quite the current paradigm re human evolution rather a modern translation of an earlier paradigm when somewhat circuitously the theory outlined below predicts the archaic traditions on which it is based would be more accurate than much of what is currently in vogue. So sit back and enjoy the ride and lets see if it correlates with the world you inhabit or whether it offers any practical insights as to where we go next….


During the latter stages of its evolution the human brain was on a rapid and accelerating curve of expansion. This exceptionally rare phenomenon was the by-product of an increasingly symbiotic and co-evolutionary relationship with flowering plants that resulted in the emergence of a number of unusual traits. These traits were the direct consequence of a heavily and progressively modified transcription environment at all stages of growth and development. Rather than selective adaptation working on DNA mutation the primary mechanism was a form of genetic engineering or more accurately epigenetic engineering. The increasing dependence on a bio-chemically complex diet, very rich in transcription altering, endocrine disrupting and neuro-active flavonoids drove the expansion of the brain. As the brain enlarged and its fuel requirement disproportionally increased the expansion cocktail was liberally laced with simple sugars. In order meet its appetite for fuel it was compelled to ingest an ever-greater amounts of the chemicals that were responsible for its growth in the first place.

New structure

The tumour like proliferation of the new brain, the neo-cortex, increasingly freed from the constraints of specialised differentiation and survival related function took a quantum leap in its development. It had acquired highly advanced cognitive abilities and begun acting as an executive layer with built in automatic enhancing capabilities for earlier more primitive neural structures. It had also reached sufficient complexity to experience self recognition, not the self we ‘think’ we are today, rather a self we would now describe as something wholly other. In addition and related to its self recognition capacity its experience of itself could be described in terms of rapture, a perpetual sense of profound wonder and intense sensual joy.


Then around two hundred thousand years ago the rapid expansion of our brain abruptly stalled and turned to contraction. The huge reduction and near loss of the wet tropical forests during the driest period of the last ice age pulled the plug on the fomenting cauldron of chemicals that had been responsible for re-designing, re-organising and re-engineering the evolutionary development of our brain. When the last of our lineage were ejected from the forests womb like protection that had hot housed our evolution, the neural system it had nurtured was exposed to the kinds of hostile ecological and biochemical environments it had not encountered for millions of years. The physiological traits that had emerged and were dependent on a heavily modified transcription environment inevitably began to regress.

Catastrophic failure

Since that time our brain has suffered a progressive and catastrophic failure in its development, massive loss of its structural integrity at a molecular and cellular level and near total loss of the most complex biochemical cocktail in evolutionary history essential for its optimum function. Archaic genetic specialisation asymmetrically encoded between the cerebral hemispheres resulted in the predisposition of one side of the brain to fail more quickly than the other. Paradoxically as the developmental retardation progressed the more retarded side assumed control, its greater loss of function and the associated psychology of fear provided the drive to dominate. Finally as sex steroids such as testosterone are fundamental in brain development and the evolutionary effect of flavonoids significantly modified their activity the severity of the symptoms is gender related with males exhibiting a more extreme spectrum of symptoms than females.

Ancient treatment

Our ancestors being significantly more functional than we are, were acutely aware of their predicament. They developed a number of ingenious practices and techniques in an attempt to treat the emerging symptoms of their neurodegenerative disease and slow its rate of progression. Through the insight of their minds alone they achieved a high science of consciousness now largely forgotten and dismissed as the mythological ramblings of our ‘primitive’ forebears. They were faced with a condition so insidious it is difficult for us to imagine, symptoms include the inability to accurately perceive reality and a progressive blindness to the nature and severity of the condition itself. Ultimately their best efforts failed, though the relics of their treatments can offer a powerful insight into the specific nature of the condition when considered within a neurological framework.

The lights went out, there is no one home

From the most advanced consciousness system this side of the Milky Way the human brain has been reduced to a zombie like state, unable to recognise itself, paralysed by a profound sense of paranoia, plagued by deeply rooted psychosis and driven to control anything beyond its rapidly diminishing experiential capacity. In the most recent and severe period of degeneration, what we now refer to as recorded history (a necessary response to the failure of our eidetic memory) it has created a world in its own demented image. The stratification of society along neurodegenerative lines resulted in the emergence of hierarchical and patriarchal structures that reward delusion and dysfunction with power and control. This has further accelerated our plunge into a culture dominated by fear where the least functional members of society inevitably end up creating a world that reflects their underlying dysfunction. Ironically labelled civilisation, built on foundations of deep psychosis, devoid of reality, empathy or any sense of beingness, a living hell where only the deluded sense of being in control at any cost provides temporary respite from the self inflicted nightmare.
Read the whole article.