Add this to the depression dilemma!
 

this is interesting and right in line with what we're discussing here:

Wed Oct 24, 6:27 PM ET

Hope springs eternal in the cingulate cortex
Source: http://news.yahoo.com/s/afp/20071024...sPriHScGKJOrgF

PARIS (AFP) - Scientists have for the first time pinpointed the neural networks in the brain that generate feelings of optimism, according to a study released Wednesday.

The findings could lead to a deeper understanding of depression, which is often characterised by the inability to imagine a brighter future for oneself, the study says.

Hope for the future is a common human trait, even when there is no evidence to support such expectations, previous research has shown.

Most humans, for example, believe that they will live longer, stay healthier and be more successful than average, a mindset experts call "optimism bias".

But until now the exact location in the brain of neuronal activity related to feelings of optimism -- and pessimism -- have remained obscure.

In experiments conducted in the United States, researchers used magnetic resonance imaging to observe the brains of 15 volunteers aged 18 to 36 as they were asked to think about specific future and past events such as "winning an award" or "the end of a romantic relationship."

The respondents were then asked to evaluate several aspects of their own reactions, including degree of arousal and vividness.

The study, published in the British journal Nature, showed enhanced activity in two regions, the amygdala and the rostral anterior cingulate cortex, both of which are known to play a critical role in the subjective evaluation of emotions.

The researchers, led by psychologist Elizabeth Phelps of New York University, conclude that even if optimism bias creates unrealistic expectation, a good dose of self-deception is probably a good thing.

"A moderate optimistic illusion can motivate adaptive behavior in the present toward a future goal, and has been related to mental and physical health," they write.

Marcello Costa, a professor of neurobiology at Flinders University in Adelaide, Australia, said the study broke new ground.

"This work establishes for the first time a correlation between optimistic and pessimistic thoughts with activity of certain brain regions," he said in a commentary, made available by Nature.

But while identifying which parts of the brain control feelings of optimism is an important step forward, Costa said, the study falls short of its claim to explain how the neural pathways function.

"It is premature to talk about mechanisms mediating optimism or pessimism," he said

hi indigogo
 

just to clarify - i am not trying to prove it is not a symptom, i am trying to show that - as far as i have been able to find, both on my own and in consultation with 'experts,' - that all of the supporting arguments of which i am aware are either effortlessly knocked down or irrelevant to begin with. and apparently, at least three out of four researchers i consulted - the fourth, irene richard, did not respond to my query - are also unaware of any more solid evidence, or i would imagine they would have put it forward.

regarding irene's piece in the fox foundation newsletter, if you read it again, you will see that she does not offer any evidence to support her assertion that it is a symptom - none, not a shred - just says "this is so," and thus, it was so.

so, i looked again for papers by her and found one i had missed before, in which, unlike the three preceding and several subsequent papers, the authors did address the question of depression as symptom - or perhaps i should be more precise because what we are really talking about in PD would be more accurately termed "depressive symptoms" (DS). in fact, i just stumbled across a statistic - in this very same paper - that put rates of actual, clinical depression in PD quite low - 3-8%, which is much lower than that of the general population, and i have to ask why THAT isn't drawing anyone's attention?

god do i get sucked into this research stuff - and ramble on too. i will try to get to the point of mentioning this paper.

the authors put forth the supporting arguments for DS being reactive and then cite studies to refute them - must read those cited studies.

then they put forth the supporting arguments for DS being a symptom - these are much more detailed and get into the nitty gritty of neurochemistry. but - someone tell me if i am crazy - please read the following bit from this paper:

"Parkinson disease patients with comorbid depression have smaller subcortical nuclei, which is similar to non-PD patients with depression."

and

"Decreased metabolism in the frontal cortex-basal gangliathalamic loop of Parkinson patients is similar to the pattern shown in metabolic studies of non-PD patients with major depression.”

call me crazy, but i thought the fundamental assertion here was that it was a symptom of the disease, which would have to mean that it is in some way measurably *different* from non-PD depression, not the *same!* pointing out similarities to physiological changes that occur in depression that *is* considered to be reactive as evidence to support one's assertion that PD depression is *not* reactive flies in the face oof logic, doesn't it?

anyway - i wander.

in short my argument is not that it is not a symptom but that there is zero definitive evidence to support the argument that it *is* a symptom.

this is important because there is a finite amount of PD funding out there, so it behooves us to be pretty darned sure of the validity of X before we start throwing money at it, because if we spend it on X, we can't spend it on Y.

and i am nowhere near convinced of the validity of X, so the gobs of research funding that are being lobbed at the problem of X are, in my opinion, premature and perhaps ultimately misguided.

and that concerns me, because there are plenty of facets of PD about which there is zero doubt that they are symptoms, and none of those has yet been effectively dealt with for anywhere near as long as people live with this disease.

peggy, i will look into what you are suggesting this weekend. i was supposed to be workiing all night and instead i did this!

b

non-motor for sure...hate the sweating...hate it...hate it...hate it :(

boann - the major motor symptoms of PD are not limited to just Parkinson's. You can have a tremor or dystonia or balance problems and not have Parkinson's. Just add depression to the list.

On the other hand, every person dx'd with PD does not have all of the PD symptoms. I have tremor, bradykinesia. Don't have balance problems or rigidity.

But, if you are looking for evidence of PD-specific depression, see zucciniflower's thread started today, Depression in PD: PET study, that cites the following paper http://brain.oxfordjournals.org/cgi/...128/6/1314#top

and concludes, "our results suggest that depression in Parkinson's disease is associated with a specific loss of dopamine and noradrenaline innervation of cortical and subcortical components of the limbic system. These results might help in understanding the functional anatomy of depression in Parkinson's disease and have therapeutic implications."

Motor versus non-motor?

For me, the non-motor symptoms would be my choice. Sure the rigidity, pain, bradykinesia, difficulty walking, and fatigue are awful. But, problems thinking, reasoning, remembering, and concentrating are what trouble me the most, because these define who I am.

There's so much talk about depression that it seems to get in the way. I think there are a lot of aspects of PD that seem like depression but aren't really depression. I'm trying to write about depression and just can't seem to get my thoughts in order. I guess I'll just conclude with my belief that PD is a complex disorder and adding depression to the discussion adds a lot more complexity. I have noted, as someone else said, that dopamine is the best antidepressant. That statement reduces the complexity considerably.

Karl

Co-occurrent
 

I abstain on the grounds that the whole syndrome is more deeply misunderstood by making the distinction. But. Who cares what motor symptoms you have if you're dead?

boann, I want to emphasize that depression is not about anything. Down-in-the-dumps is about discouragement, self-pity, or any other tag one can put on it. Real clinical depression is a physically-caused (endogenous) disorder as real and dangerous as a shattered femur. It is generally treatable to some extent, but the journey to relief can be torturous. Untreated, it is fatal.

By the way, I would love to never hear the term "mental illness" again, although the term has helped steer society away from the notion that "nonmotor" symptoms were the fault of a weak or indolent character--society, but not always our families!

I would posit that the difficulty of distinguishing the symptoms of depression from the symptoms of PD is contributing to your quandry. It takes a real expert sometimes, and the very terminology obfuscates the investigation. See Mov Disord. 2006 Feb;21(2):148-58. You were having trouble finding the research? I'm too asleep to quite follow, but searching PubMed on "depression Parkinson's" or "Parkinson's depression" yields tons of stuff. Or see the NINDS and/or NIMD websites.

Hope this doesn't obscure whatever it was...zzzzzzzzzz.....
Jaye

Thanks, Jaye!

I can't quite believe we are still having this conversation. Depression is a well established PD symptom; it's as nonsensical as if we were debating whether or not tremor is PD-related.

The societal stigma about mental illness is a huge barrier to treatment.

to indogogo and jaye
 

first, to jaye

i get the impression you think i am dissing the seriousness of depression. if you could point out to me where i did that, i would be really impressed, because, you see, i am still not fully recovered from a serious major depression, complete wth a suicide plan, and i am beginning to think i may never be the same person i was before. and this would be the second time i was nearly destroyed by depression - the first time i actually sent up a tiny trial balloon by cutting myself with a piece of broken glass to see how much it would bleed - i was going to slit my wrists, you see. fortunately, the tiny bit it bled scared the bejeesus out of me and i had to find another road, so yeah, i am fully aware of the seriousness of depression.

however, just because i have experience depression once while having pd and once loooong before is not conclusive evidence that it is a symptom. if it is, then so are uti's and collapsed discs and psoriasis, and several colds.

indogogo, you asked me a question, i answered without attitude or sarcasm. you can't believe you are still having this conversation? golly, don't stay on my account. but if you do, please be nice.

to everyone
 

thanks for playing! i am actually really more interested in my original question, even if you consider depression to be a symptom, so if anyone out there is still interested in answering, i would be much obliged. just to give a little background, there is a lot of talk about nonmotor symptoms these days, and they are somtimes even referred to as being even more disabling than motor symptoms. well, that is so far from my experience that i had a hard time believing it could be true.

but really i had no idea, since i have such little direct interaction with others with pd, so i thought i would just throw it out there, and lo and behold, i am NOT the center of the universe, and quite a large percentage of folks who have responded have said non motor is worse for them - who knew? well,now i do.

thank you,
b

My Social Security Disability claim was approved largely because I had well documented major depression - both diagnosed and under treatment. After I lost my job related medical insurance and applied for another policy, the fact that I was undergoing treatment for depression counted more points against me than my Parkinson's, and I was denied. The insurance industry is well aware of the disabling nature of depression.

Boann, you are strong to have been able to defeat your depression and keep working despite your PD. I, so far, am not able to do so. The PD is one matter; the depression I should be able to conquer.

I do not play nice when it comes to a challenge of the "legitimacy" of depression as a real and dangerous disease. That is what I assumed from your posts; obviously I read you wrong, and I apologize for that.

Here is a music video I made 5 years ago about how I see the impact of "non-motor" symptoms. It has taken years to get the PD organizational establishment to pay attention to us, and to even begin to understand how the so called secondary symptoms of PD destroys lives.

Don't worry - it goes fast, and, hopefully, you'll appreciate the humor
http://www.clognition.org/cccc.htm