How can science help those with mental health problems?

Liam Eyre.

Mental health can be a taboo topic, but in 2014 the Health Survey for England found that 26 percent of adults had been diagnosed with at least one mental health problem in their life[1].  The cause of mental health problems is not yet fully understood but with the advancement of brain imaging techniques, it can now be seen how the brain functions when dealing with these problems. The study of the brain is key in answering the biggest questions which surround the mystery of the physical cause of mental health.

In the middle ages, mental health problems were attributed to demons taking over the body and the treatment involved drilling holes in the skulls of those affected to allow the demons to escape. Exorcisms were also performed on the patient to banish the demons to where they came from. During and after World War 1, many soldiers would return home with a condition which was originally named shellshock, which now has been categorized as a type of post-traumatic stress disorder (PTSD). The symptoms of shellshock varied from uncontrollable shaking to mutism and sometimes even paralysis. Shellshock gained its name from the fact that doctors thought the condition was brought on by the shockwave caused by bombs. Cases of shellshock were also reported from soldiers who had not been on the front line or even heard the noise of bombing; these soldiers who returned home due to their injuries were thought to be cowards and shamed, some were even sent back to the war. The main treatments for shellshock were shaming, exercise and the infliction of pain. Electroshock treatment was often used and some patients were even re-exposed to the original cause of the condition as a form of therapy. For example, if loud noises were the trigger to the shellshock, patients were often locked in rooms with loud noises.

Thankfully, mental health issues are better understood by doctors and scientists today, with scientific research looking at how the brain functions differently for those affected by a mental health problem than those unaffected. One example of a study like this is looking to find if LSD can be a potential cure for depression and anxiety by Professor David Nutt. This study was partially crowdfunded on walacea.com. In this study, they gave volunteers LSD and imaged the brain using functional magnetic resonance imaging (fMRI) to see the effect the drug had on the brain in various situations. The result of this showed how the brain functions when under the influence of LSD and is a step forward in seeing if drugs like this can be used as a treatment for health problems. Gaining the permission to research these drugs is extremely difficult. LSD, cannabis and ecstasy are all banned in the UK, but all have been found to have medicinal properties. MDMA, the active ingredient in ecstasy, has been found to reduce the symptoms of Parkinson’s disease, but the government does not allow research using these drugs unless the researcher has a permit to do so. These permits can take years to obtain and cost thousands of pounds, deterring scientists from performing this research.

Modern brain imaging techniques are a great distance away from medieval ‘science’ and electroshock therapy. Magnetic resonance imaging (MRI) uses strong magnetic fields to produce images of the brain in 2 or 3 dimensions. Functional MRI (fMRI) is a type of MRI which can see which brain structures are activated when performing different tasks at a resting state. It can be used to reveal processes associated with thought and perception. The spatial resolution of a fMRI image is around 2-3mm and can only see which areas of the brain or activated, not individual transmitters. An example of brain imaging which can see individual transmitters in the brain in detail is Positron Emission Tomography (PET). For PET to be performed a radioactive tracer is injected in to the body. This tracer is most commonly F-18, a fluoride isotope which decays via positive beta decay with a half-life of approximately 110 minutes. This positron then travels a short distance through the tissue (approximately 1mm) and annihilates with an electron to produce a pair of gamma rays which are then detected. The position of the point of annihilation is then calculated. Bright spots in a PET scan are where more annihilation occurs and often shows damaged or diseased tissue. fMRI is more commonly used now than PET due to PET scans only being able to record data for a short period and, due to the radioactive properties of the tracer, cannot be performed on the same subject time and time again.

Throughout history, and even today, mental health problems have had a stigma surrounding them. 90% of people struggling with a mental health problem have faced stigma since being diagnosed. This stigma makes it more difficult for those suffering, especially men, to talk about their problems and seek help. In 2007 it was recorded that 19.7% of women and 12.5% of men were diagnosed with a common mental health problem[2], the most common of these problems being depression, anxiety, panic disorder and obsessive compulsive disorder. This lower percentage in men is thought to be due to there being more unreported and undiagnosed cases.  4 in every 5 suicides are carried out by a man. This contradicts the previous statement that fewer men have mental health problems than women. Suicide is a last resort, and in most cases, is a result of a serious mental health problem. In society, it can be thought as a weakness when men talk about their emotions and men are led to think that they must solve their problems on their own. This pressure on men to be ‘strong’ and independent can make it difficult for them to address their problems and see a doctor for help.

Depression is the most common mental health problem, affecting 10% of people at some point in their lifetime. Depression affects every individual in a different way and is not only having feelings of sadness for a prolonged period; there are also physical symptoms including constant tiredness, loss of appetite or sex drive and unexplainable aches or pains. These symptoms range from mild to severe for an individual. There are many causes of depression, but sometimes there is no trigger which can be attributed to the problem. There are 7 main known causes of depression for men and women: stressful events, personality, family history, giving birth, loneliness, alcohol and drug addiction and illness. Giving birth may seem strange to be a cause of depression for a man, but a study showed that 10% of new fathers suffer from post-natal depression, a lot more common than one would think[3].  The treatments for clinical depression depend on the severity of the symptoms. Mild depression is treated by a change in lifestyle, regular exercise or a change in diet and by attending self-help groups. Moderate depression is treated with cognitive behavioural therapy (CBT) or with antidepressants and severe depression is treated with antidepressants and then they are referred to a mental health team. A mental health team consists of psychologists, psychiatrists, special nurses and occupational therapists.

Antidepressants are drugs which can be used to treat a range of mental health problems. The Royal College of Psychiatrists suggests that antidepressants work 50-65% of the time for sufferers of depression[4]. Though this is larger than the placebo effect for this drug (20-25%) it is still not a fully effective treatment to the problem. The drug also has a large list of side effects which include: feeling agitated or anxious, dizziness, insomnia, low sex drive, diarrhoea, weight gain, blurry vision and drowsiness. Worst of all, in some extreme cases, taking antidepressants can lead to suicidal thoughts, although this is very rare[5]. Some of the symptoms to the drug may sound familiar as they are also the symptoms of depression. With the antidepressants being unreliable and that they may cause some of the symptoms they set out to reduce, surely there are other ways of treating the problem?

In theory, reducing the amount of stress in everyday life can reduce the chance of developing depression. Research has been performed which looks at the power of fractals in reducing the stress a person can feel. A fractal is an image which is self-similar, meaning that when the image is zoomed in, it exhibits the same structure as the entire image. Fractals are common in nature, examples of these being snowflakes, trees, clouds and Romanesco broccoli (shown in figure 1 below) and are a result of a chaotically driven system. A more surprising example of fractals are Jackson Pollock paintings, which are famous for dividing opinion in whether they are art or just drips on a canvas. Richard Taylor from the University of Oregon has researched Jackson Pollock paintings and found that they are in fact fractal in nature. Stating that Jackson Pollock’s early work has a fractal dimension which is similar to those found in nature. The fractal dimension is a way of categorizing fractals, if the fractal dimension of an image is between 1 and 2, then the image is indeed a fractal. Pollock’s works have been extensively studied and have been found to be fractal, with fractal dimensions ranging

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The National Union of Students (NUS) reported that 78% of students who responded to their survey for the student All-Party Parliamentary Group (APPG) had experienced mental health problems in the previous year[7]; this figure is extremely high compared to the national average of approximately 25%. This may be due to the difficulties in defining what a mental health problem is or could also be due to the high levels of stress a student feels. Students experience high pressure levels on a day to day basis as a result of their intense studies, with multiple deadlines hitting at once and the pressure of exam season. Students also are subject to increased levels of social pressure. Most students move away from home for the first time for university, not knowing anyone in a new city can be very lonely and having to be independent for the first time can be very difficult. This mix of stressful events and loneliness can be a trigger for depression and other mental health problems. A 2012 report stated that 0.7% of students had been diagnosed with mental health problems, from a sample of 150. This figure is a long way away from the 78% who said they were suffering in the NUS report. There is still a stigma towards mental health problems in universities, with researchers even being afraid of admitting their problem as it may affect the credibility of their work.from 1.3 to 1.7. Research in to the calming effect of fractal images used functional magnetic resonance imaging. It was seen which parts of the brain are stimulated when looking at different forms of fractals, either fractals formed by nature or a computer. It was found that looking at fractals can reduce stress by up to 60%[6]. The urban environments which many people live in do not possess this fractal nature, meaning people are not getting access to these natural stress reducers in their day to day lives.

The UK prime minister, Theresa May, has announced that more funding will be put in to the treatment of mental health problems and that she will help to fight the stigma that is associated with them. These problems are thought to cost the government 105 billion pounds a year. This policy is aiming to primarily help young people deal with these problems, with 50% of mental health problems starting in a person by the age of 16, and 75% starting by the age of 18. Schools will be given more training in how to identify the first signs of mental health problems and how to deal with this. This is a step in the right direction. But nowhere does it mention that there will be more funding in to research for new treatments or in to understanding the functionality of the brain in a person dealing with mental health problems.

I believe the key in treating mental health problems lies in the research of how the brain works and how different drugs and different surroundings can affect this. This means allowing people, like Professor Nutt, to access these drugs and safely use them on volunteers in studies.

[1] Health & Social Care Information Centre (December 2015a), Health survey for England 2014: Chapter 2: Mental health problems

[2] C. Deverill and M. King (2009), ‘Common mental disorders’, in Adult Psychiatric Morbidity Survey

[3] Paulson JF, Bazemore SD. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. The Journal of the American Medical Association, 303(19), pp. 1961–9.

[4] http://www.nhs.uk/conditions/Antidepressant-drugs/Pages/Introduction.aspx

[5] http://www.nhs.uk/Conditions/Antidepressant-drugs/Pages/Side-effects.aspx

[6] http://blogs.uoregon.edu/richardtaylor/2016/02/03/human-physiological-responses-to-fractals-in-nature-and-art/

[7] http://www.universitiesuk.ac.uk/blog/Pages/universities-mental-health.aspx

How can science help those with mental health problems?

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