
The Y in Psychiatry
"The Y in Psychiatry" – a pragmatically endearing podcast talking to the med students, residents, fellows, and attendings of the medicine world about the nuances of psychiatry.
Each episode features focused discussions that explore the intersection of the mental health, medicine, and the human experience.
Together, we'll uncover the hidden "Y" – the compelling reasons, profound insights, and groundbreaking discoveries shaping the psychiatric landscape.
So grab a seat, warm beverage, tune in, and let's embark on this journey to unlock the mysteries of the human psyche, only on "The Y in Psychiatry."
The Y in Psychiatry
E1 - Bridging the Mood Gap: A Neuro-Tour of the Major Brain Networks
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Hold tight as we take a whirlwind tour into the moody labyrinth of depression on "The Y in Psychiatry" express, with Dr. H and Miracle in the driver's seat. This is not your typical clinical field trip - it's a rollercoaster ride through brain inheritance battles, childhood monsters, medical conundrums, and psychosocial puppetry. We shine the neuro-flashlight onto the salience, executive, and default mode networks, making sense of the science, symptoms, and synaptic circus of depression. Perfect for white-coat warriors and knowledge-hungry cats alike, we're serving up a hearty helping of depression insight with a side of giggles. Buckle up and bring your sense of humor - we're about to explore the wild side of brain networks in mood disorders!
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Welcome to the Y in Psychiatry, your go-to 15 minute pragmatic podcast where we delve into the intricate nuances of psychiatric topics. Each episode features interview style discussions that explore the intersection of the mind medicine and the human experience. Together we'll uncover the hidden why and the groundbreaking discovery shaping the psychiatric landscape. So grab a seat, warm beverage, tune in, and let's embark on this journey to unlock the mysteries of the human psyche. Only on the why in psychiatry. A question that puzzles us all. Why does the mind falter when all seems well and vice versa? the human brain, an organs so complex that it has managed to remain somewhat of a mystery even in the age of technology. but what if we told you we're pulling back the veil of some of these enigmatic processes? What if we can help you understand why some of us grapple with the shadow of depression? Imagine a world where psychiatry isn't so much hocus pocus, but rather more focus. Focus. Intrigued you should be. Today on the Y Psychiatry, we venture into the realm of mood disorders. How the salience network, the executive network, and the default mode network, all intermingle during when mood goes right and when mood goes wrong. We'll try to answer the question of why does it happen? What is going on in the brain? Sit tight as we delve into some serious brain business. with our regular host, Dr. Amayo, or known as Miracle, and Dr. Hendratta. Let's unravel the why in psychiatry shall we.
Miracle:Welcome To the Y in psychiatry. As usual, today I have Handratta, with us.
Dr. H:How are you guys doing?
Miracle:We are doing great and bonus today. We are all recording from different time zones. I think it's amazing things we can do with technology. All right, so jumping right in to today's topic, I found myself, you know, multiple times talking to a patient or talking to the family, trying to explain what depression is and why their loved one or themself have depression. And I think sometimes I've used either the genetic model or I've used the chemical imbalance model, but I actually, actually don't think I know why people get depression. Is that. Is that something you can help us with Dr. Handratta?
Dr. H:Yeah, absolutely. No, that's a really good question. so we'll actually divide it actually. so definitely the neurochemicals do play a role, but it's not the only thing that causes a person to get depressed, like in a layman's term. What I usually tell patients is that if you take away reward from your brain and you do not replace the reward and you deprive the brain or the reward, people usually get depressed. Right? That's a very simple answer for why people actually get depressed. Like for example, when we lose our loved ones, we won't actually have the reward of talking to them anytime we want to or seeing them, right? So you're deprived of your brain of the reward. So why do we get depressed? So there are different reasons why we get depressed. It could be genetics because we always ask for a family history of depression. It does run in the family. Adverse childhood events. The more number of adverse events you have during your childhood, the more likely you are actually going to get depressed if you have the genetic predisposition for depression and plus research data shows that adverse events in childhood changes your brain chemistry, the way the brain is connected to each other and they talk to each other different areas of the brain. Then you have psychosocial stressors, right? we have the bio-psychosocial MO model in psychiatry. So if we have the genetic predisposition, you have a lot of adverse childhood event, and then you expose them to a lot of stress in adult life, you are actually creating the perfect storm. Then we also look at different other factors, which can make you depressed. Like use of substance use, right? Alcohol, benzos, opiates, or medical conditions. The commonly known condition is like Cushing syndrome, hypothyroidism, pancreatic cancer. Actually, depression is actually comes first before the cancer is diagnosed. Medications, long-term use of steroids can make you depressed, right? And then you have different types of depression, like seasonal component of depression. Premenstrual dyshoric disorder, postpartum depression. Right? So these are some of the reasons why people get depressed. And then we'll talk about the monoamine theory as we talk about the treatment of depression. Does it make sense?
Miracle:So we have what causes the depression, but what happens in the brain when there's a depression? Right?
Dr. H:So that's actually, it's still a research work going on it's still, it's in, in its infancy, but we know more than what we knew a decade ago. So to understand what happens in the brain in depression, we need to actually focus on three major networks in the brain, right? Because the brain doesn't work as like individual frontal lobe, parietal lobe, temporal lobe occipital. It basically works as network. So, The most important network, that we are gonna talk about is the Salience Network, the executive network, and the default point network.
Miracle:So a net a network is a combination of brain parts working together to achieve a common goal.
Dr. H:absolutely right Now let's make it very simple. So salience network is basically it in most different brain areas. As the name suggests, is responsible for detecting salience in the environment, right? It's responsible for absorbing or processing all the sensory information that we are getting. So it could be like sensory information from inside the body, which we call as interceptive signals. Or it could be from outside the body called extraceptive signals. So in interceptive signals is like a heart rate, the breathing rate, your body temperature, your bowel movements, those are all internal signals. And then external signal. You don't have to remember this, but just for simplicity the anterior cingulate cortex, your insular cortex the reward area of the brain called nucleus accumbens. And the dopamine that enters into this nucleus accumbens from ventral segmental area and the amygdalla, they all actually formed the salience network. Does it make sense?
Miracle:That makes sense. Yes, sir.
Dr. H:So what the salience network does is that it usually gets these information. So the extra receptive information is like your vision, your hearing, your smell, your proper reception, vibration, sensation. So everything enters into the salience network right now. Once it enters into the salience network, then our brain tries to actually figure out what can we do with this information? So what it does is that it'll actually recruit your executive network as the name suggest is responsible for executive functioning. So that involves your dos lateral prefrontal cortex, and your posterior parietal cortex. Now, these areas of the brain are located very close to your sensory and motor area, so it's responsible for stimulating the psychomotor activity that is required to achieve a goal depending upon the signal you're receiving. Right, and we'll actually talk about an example, and it's also responsible for executive functioning that is your planning and organization.
Miracle:Okay.
Dr. H:Then you have something called as a default mode network, as the name suggests, your brain is in this particular network, when you're in a default mode, you're just sitting and lazing around. You're dreaming, you're mentalizing, you're fantasizing, right?
Miracle:It's also as the lounge and network.
Dr. H:Exactly. That's actually the default mode network, right? So it basically involves your midline brain structure, that is your medial prefrontal cortex and your posterior cingulate cortex and your prete. So that's your default mode network. It's also activated when you're actually like thinking or you're basically, uh, writing a poetry. And plus it's also responsible for knowing who you are and also responsible for autobiographical memory. Everything that you've done in your life, right?
Miracle:Would that be the right, the right brain, left brain, thing?
Dr. H:It's on both sides.
Miracle:It's on both sides.
Dr. H:Yes. So these are the three main networks. Now let's put that into play. So let's actually look at this. Let's look at. Depression. And let's, let's, let's look at something else. So for example, you're sitting in your office or you're actually sitting in your residency, lounge, and the code blue comes on, right? So there's a speaker announcement. So there is the auditory information actually entering it your salience network, saying that there's a code blue in room 1 0 3. Just imagine. So what happens is that as soon as the salience network gets that information, it'll recruit your executive network. So what you do is that you're not gonna sit in your seat and mentalize or fantasize, you're going to actually run, so your psychomotor center is stimulated. So you run towards the room 1 0 3 to see what's going on with the patient, and then you use your executive function that is planning an organization to run the code blue. Right?
Miracle:That's that's if you're not a psych resident, of course. I will not. Right. Listen, is, sorry.
Dr. H:No, no, no. This is good. This is good.
Miracle:You're absolutely right.
Dr. H:No. Let's look at depression. What happens? So when a person is depressed, People with depression are very, very tuned to the introceptive signals. What happens inside the body, right? Like the heart rate going up and down, your breathing going up and down, the change of the body temperature right? Now, what happens actually in depression is that the salience network is usually responsible for processing, reward and punishment. So the area of the salience network that processes reward becomes inactive and that process' punishment becomes overactive. So then what happens now, the salience network gets hardwired or connected to your default mode network. So instead of activating your executive network depression, it'll actually keep you in the default mode network. Now, what happens here is that since you're in the default mode network, you start ruminating. You start actually like ruminating about sad memories and thoughts that has been stored in your hippocampal area, right? You actually start feeling shame, feeling of guilt, feeling of remorse, right? So you're stuck in the default mode network and you're not able to recruit the executive network. So what happens if you recruit the executive network when you're sad you, you actually stimulate the psychomotor activity. You'll go out. Go to the mall, go to the go for a walk, call your friends. You can't do it.
Miracle:So they just like behavior activation.
Dr. H:Exactly right. So what happens is that since your central executive network is not working, you do a psychomotor retardation. Very common in depression, right? You actually don't have the executive functioning. You can't make decisions, you can't plan, you cannot organize, right? So that is what happens actually in depression. And these networks are modulated by your monoamines. Your glutamate, your gaba, so when they go out of whack, you have a dysfunction of this entire network. So you're stuck in your default mode network. Does it make sense?
Miracle:Let me see if I can understand. So things that cause depression, uh, things like genetics, adverse childhood events medical causes, psychosocial causes. And so I guess that in a way primes our salience network more seen towards negative things. So if you have an adverse childhood event, you are more sensitive towards the negative aspects of life. And so now our salience network. Then becomes more connected to our default mode as opposed to our executive network. And now since our salience network is more sensitive to the negative part, it's stimulated quite often by negativity. And that leads to us instead of taking an executive decision, leads to us taking a more docile, default, relaxing decision. And I guess that leads towards our, the neuro vegetative symptoms that we might see in depression. Um, And also the, the guilt, the guilt, the shame rumination, the indecision that we see in depression. So yeah, that, that, that makes a lot of sense.
Dr. H:Dr. Amayo, you said it actually better than me. I, I don't think so. You did, you did. That was excellent summary.
Katrina:Thank you for joining us on today's episode. Feel free to tap that subscribe button, show your salience network, who's boss, probably your executive network. Our tireless team is already hard at work, cobbling together another potpourri. Fascinating discussion for next week, so be sure to tune in, visit our website and our podcast feed and let us know your thoughts on the episode. Until next time, keep smiling, keep shining, and stay curious.