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Psychiatry is changing and moving into the realm of real science with an emerging understanding of the brain’s complex neural circuitry. In depression, this brain circuitry is dysfunctional.  In essence, the plumbing is broken.

Advanced brain imaging is being used to identify the parts of this important neural circuitry.

One is Area 25 ( the subcollosal cingulate region) which mediates the unconscious and motor responses to emotional input. The other area is the right anterior insula where self awareness and interpersonal experience integrate.

These two areas connect to the hypothalamus which influences sleep, sex drive and appetite, the amygdala influencing emotional salience, the hippocampus that impacts memory and prefrontal cortex regulating self esteem. All these regions are dysfunctional with depression.

Studies have shown that brain imaging with depressed persons with low activity in the right anterior insula have been helped by cognitive behavioural therapy (CBT)  that reframes feelings in a more positive way.

This proves that CBT and psychotherapy are biological treatments. They produce lasting and detectable physical changes in brain activity. This is strong research proof for the use of psychotherapy in depression.

Similarly with depressed persons with high activity in the right anterior insula, anti depressants can help.

Professor Helen Mayberg at Emory University was able to predict which type of therapy (CBT or anti-depressants) would work based on the imaging of the right anterior insula.

Current research on a new anti-depressant that is in clinical trials has shown that this new drug will treat depression and at the same time improve cognition ( the quality of thinking).

Drug plan design is very important because the design of the drug plan can force the substitution of what are perceived to be therapeutic equivalents.

Instead of the insured getting the new anti-depressant that improves mood and cognition, they might get an older drug that may not even work because the activity in the right anterior insula is low.

This is equivalent to rolling the dice in the serious business of managing depression.

Let’s rely on real science to support the use of these new and exciting anti-depressants.

Reference- The Age Of Insight 2012 by Eric Kandel, Professor Mortimer B Zuckerman Mind Brain Behaviour Institute at Columbia University.