Dr Leaf has been promoting her food philosophy lately, but yesterday and today, she has come back to one of her favourite neuroscience topics.
Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. It’s her belief that “as triune beings made in God’s image, we are spirit, mind(soul) and body – and our brain being part of the body does the bidding of the mind …”.
This is one of the flaws that terminally weakens her teaching, and leads to scientifically irrational statements like yesterday’s meme:
“God has designed the mind as seperate from the brain. The brain simply stores the information from the mind and your mind controls your brain.”
On what basis does she make such a claim? I’ve reviewed the scripture relating to the triune being hypothesis. The Bible doesn’t say that our mind is seperate to our brain, nor that it dominates and controls our brain. Dr Leaf’s statement yesterday is simply assumption based on more assumption. It’s like an intellectual house of cards. The slightest puff of scrutiny and the whole thing comes crashing down on itself.
To try and reinforce her message today, Dr Leaf quoted Dr Jeffrey Schwartz, psychiatrist and neuroscientist, “The mind has the ability to causally affect and change pathways in the brain.” Jeffrey M. Schwartz is an OCD researcher from the UCLA School of Medicine. It appears he lets his Buddhist anti-materialism philosophy cloud his scientific judgement.
Well Dr Leaf, I see your expert and I raise you. Dr David Eagleman is an author and neuroscientist at Baylor College of Medicine in Texas. He has written more than 100 scientific papers on neuroscience, and has published numerous best-selling non-fiction books including ‘Incognito, The Secret Lives of the Brain’ which was a New York Times best-seller. He isn’t an irrational anti-materialist.
He said, “It is clear at this point that we are irrevocably tied to the 3 pounds of strange computational material found within our skulls. The brain is utterly alien to us, and yet our personalities, hopes, fears and aspirations all depend on the integrity of this biological tissue. How do we know this? Because when the brain changes, we change. Our personality, decision-making, risk-aversion, the capacity to see colours or name animals – all these can change, in very specific ways, when the brain is altered by tumours, strokes, drugs, disease or trauma. As much as we like to think about the body and mind living separate existences, the mental is not separable from the physical.” https://goo.gl/uFKF47
This statement makes much more logical sense. The functions of the mind are all vulnerable to changes in the brain. Take medications as one particular example. Caffeine makes us more alert, alcohol makes us sleepy or disinhibited. Marijuana makes it’s users relaxed and hungry, and sometimes paranoid. Pathological gambling, hypersexuality, and compulsive shopping together sound like a party weekend in Las Vegas, but they’re all side effects linked with Dopamine Agonist Drugs, which are used to treat Parkinson’s disease. There are many other examples of many other physical and chemical changes in the brain that affect the mind.
Conversely, there is limited evidence of the effect of the mind on the brain. Sure, there is some evidence of experienced meditators who have larger areas in their brain dedicated to what they meditate on, but the same effect has been shown in other parts of the brain unrelated to our conscious awareness.
But since the mind is a function of the brain, whatever effect the ‘mind’ has on the brain is, in reality, just the brain effecting itself.
So Dr Leaf can cherry-pick from her favourite authors all she wants, but quoting a supportive neuroscientist doesn’t diminish the crushing weight of scientific evidence which opposes her philosophical assumptions. If she wants to continue to proffer such statements, she would be better served to come up with some actual evidence, not just biased opinion.
Have you ever found yourself about to give a speech or sit an exam, and one of your friends tries to calm you down by saying, “Stop worrying … just don’t think about it!” Does that ever work? Not usually! The more you try to intentionally block it from your mind, the more it wants to pop up again.
Why is that? It seems intuitive that if you don’t want to think about something, all you need to do is to take control and block it out of your mind, right?
“Saito: If you can steal an idea, why can’t you plant one there instead? Arthur: Okay, this is me, planting an idea in your mind. I say: don’t think about elephants. What are you thinking about? Saito: Elephants?”
This is a great little dialogue about thought suppression. Thought suppression is the process of consciously trying to avoid certain thoughts, either by trying to replace the unwanted thought with another thought, or simply trying to repress the unwanted thought.
Our minds tend to focus on the content of a subject. If the subject is elephants, no matter what words I put in front of it, your mind will think about elephants. Like if I say, “I love elephants, or I say “Don’t think about elephants”, your brain hears, “blah blah blah elephants.” And having been sensitized to the idea of not thinking about elephants, when your mind inevitably brings it up again, you’re primed to pay even more attention to it, “D’oh, I’ve just thought about elephants again … stop thinking about elephants …”.
This phenomenon is even more pronounced if your mind has already been focusing on the subject. If you’re mind is going over and over a speech you have to give and I say, “Oh, don’t worry about that speech”, all your mind registers is, “blah blah blah SPEECH”.
Although it’s been discussed in the psychological sciences for decades, it’s only been since the late 1980’s that considerable attention has been given to the concept of thought suppression. Despite our natural tendencies to try it or recommend it to people, the conclusion of nearly all the research is the same: thought suppression doesn’t work.
Wenzlaff and Wegner, two American psychology researchers, looked at all of the different research on thought suppression and came to the following conclusion,
“What has compelled the interest of the scientific and clinical communities is that suppression is not simply an ineffective tactic of mental control; it is counterproductive, helping assure the very state of mind one had hoped to avoid. The problem of thought suppression is aggravated by its intuitive appeal and apparent simplicity, which help mask its false promises.” [1]
I’m not really sure why we naturally gravitate to thought suppression. Perhaps it’s part of our natural delusion of control. Perhaps it’s a throwback from the pop-psychology assumptions that we can control our destiny, or the common myth that our mind is in control of our brain.
Whatever the reason, as time has passed, researchers are coming to understand why thought suppression is so unhelpful. This quote from Magee and his colleagues helps to explain why:
“This shift in focus parallels advances in cognitive theories of intrusive thoughts, which suggest that having intrusive thoughts is a normative phenomenon; instead, the way an individual interprets those thoughts is expected to lead to benign versus serious outcomes … Similarly, having difficulties with thought suppression is a common experience … it is the way an individual interprets that experience that may be key. Previous discussions of thought suppression have frequently implied that people having difficulties with thought suppression often ascribe negative meaning to their difficulties.” [2]
We naturally struggle to suppress intrusive thoughts because intrusive thoughts are normal. Trying to suppress them is like trying to suppress any other normal biological process. Try to stop breathing for any length of time and you’ll see what I mean – it’s impossible, and trying is simply counterproductive.
The key is how we react to or feel about our thoughts. If we feel like our thoughts might be somehow causing us harm, then our failure to stop them from bubbling up to the surface of our consciousness is going to cause us distress. It’s a double whammy – we’re stressed because we’re expecting the negative consequences of our thoughts, and we’re distressed by our ‘failure’ to stop them.
Since it first started more than a century ago, the death toll from the famous Pamplona event, “Running of the Bulls” currently stands at 13. Countless others have been gored and trampled. Who are the people who get injured during the event? Certainly not the smart ones standing behind the barriers on the edge of the streets, or the ones watching it broadcast on TV? Only the morons who try to outrun the pack of foot-long bony skewers attached to the half-ton lumps of very cranky steak.
Similarly, the best way to manage our thoughts is to learn not to fight with them in the first place. By non-judgmentally observing them, we can simply observe our thoughts for what they are … just thoughts. By stepping back from our thoughts and giving them room, we find that they don’t have any real power over us. Stepping back away from our thoughts and letting them be is the skill of defusion, one part of the process of psychological acceptance. It’s the first step in living a life abundant in meaning and significance.
So just remember: don’t try to suppress an unwelcome thought. Having intrusive thoughts is actually a normal process, not a sign of disease or mental weakness. They’re not toxic or harmful, they’re just thoughts. Give them space, like you would a charging angry bull (or elephant!)
References
[1] Wenzlaff RM, Wegner DM. Thought suppression. Annual review of psychology 2000;51(1):59-91.
[2] Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clinical psychology review 2012 Apr;32(3):189-201.
“He’s not the messiah, he’s a very naughty boy, now go away!”
Ah, Monty Python – six university students with a penchant for satire who changed the face of comedy. They say that “Imitation is the sincerest form of flattery”, and if that’s the case, Monty Python should be very flattered! Nearly five decades later, you still hear people throwing around lines from their sketches and getting a laugh.
Their movie, “The Life of Brian” remains one of the most critically acclaimed and most controversial of all movies. It was the story of Brian, born in the stable next door to Jesus, and who later in life unintentionally becomes the focus of a bunch of people who mistakenly believe he’s the messiah. One morning he opens his window to find a large crowd of people waiting for him outside his house, leaving his mother to try and dismiss the crowd with that now famous rebuke.
The crowd at Brian’s window aptly demonstrates a quirk in our collective psyche. We humans have a bipolar tendency to latch on to something that seems like a good idea at the time and blow it’s benefits out of all proportion, only to later discover it wasn’t as good as our overblown expectations and unfairly despise it on the rebound.
Anti-depressant medications are a bit like Monty Python’s Brian. Back in the late 1980’s when Prozac first came on the market, doctors saw it as the mental health messiah. Prozac improved cases of long-standing severe depression and was much safer in overdose compared to older classes of psychiatric medications. The idea that depression and other mental illnesses were related to chemical imbalances fit nicely with the cultural shift away from the Freudian psychotherapy model that was prevalent at the time. People were describing life changing experiences on Prozac: “One morning I woke up and really did want to live … It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on.” [1] Prescribing for Prozac and other SSRI anti-depressants took off.
Fast forward to the present day, where the pendulum has swung back violently. Anti-depressants are considered by some to be nothing more than over-prescribed placebo medications used by a pill-happy, time-poor culture demanding simple cures for complex problems. Some commentators have gone so far as to label anti-depressants as an evil tool of the corrupt capitalist psychiatric establishment.
“Anti-depressants are not the messiah, they’re very naughty boys, now go away!” they exclaim.
But are anti-depressants really the enemy, or could they still be friendly, even if they’re not the messiah?
In the Medical Journal of Australia this month, two Australian psychiatrists, Christopher Davey and Andrew Chanen, carefully review the place of anti-depressants in modern medicine [2]. It’s a very balanced and pragmatic view.
They bring together all the evidence to show that while anti-depressants aren’t the elixir of happiness that we once assumed, they also don’t deserve the accusation that they’re nothing but fakes.
When drugs are scientifically tested, they’re usually studied in placebo-controlled trials. The medications are given to one target group of people and a fake medicine is given to a similar group. In the best trials, the patients aren’t aware of which they’re actually getting, and the physicians aren’t aware either. That way personal bias and expectations can be reduced. To reduce these biases even further, other scientists can pool all of the quality research on a topic in what’s called a meta-analysis.
Trials on anti-depressants initially showed very strong positive results, or in other words, the patients on the drug did much better than those on the placebo. Anti-depressants lost a lot of their shine in the last decade or so as researchers began pointing out that the placebo effect, the number of patients improving on the fake medicine, was also very high.
There was also the serious, and largely legitimate accusation that drug companies ignored trials with less favourable results to make their drugs look better. The reputation of anti-depressants was forever tarnished.
One of the most out-spoken critics of anti-depressants, Harvard psychologist Irving Kirsch, tried to show that when all of the trials on anti-depressants were taken together, the placebo effect wasn’t just close to the effectiveness of the real medicine, but was actually the same.
The problem with Kirsch’s analysis is that not all trials are created equal. Some have negative results because they were poor trials in the first place. When experts reapplied Kirsch’s methods to the best quality trials, the results suggested that anti-depressants are still effective, but for moderate and severe depression [1]. Anti-depressants for mild depression weren’t of great benefit.
This is take home point number one:Don’t believe the hype. Anti-depressants are useful, but not for all cases of depression. #happypillshelp
So if anti-depressants aren’t useful for all cases of depression, are other therapies better? This is where psychological therapies come in to the equation. Those who are the most vocal opponents of modern psychiatry and psychiatric medications are also the most vocal promoters of the benefits of talking therapies. They won’t admit it, but there’s usually an ideological bias or financial incentive driving the feverish worship of talking therapies and their overzealous defence.
Though in the cold hard light of evidence-based science, talking therapies aren’t much of a panacea either. Pim Cuijpers, a professor of Clinical Psychology in Amsterdam lead a team who reviewed the effectiveness of trials of psychotherapy, and found that their effectiveness has also been overstated over the last few decades. Quality studies show that talking therapies are equivalent in effectiveness compared to anti-depressants for depression [3].
What’s important to understand about talking therapies in general is that any benefit they have is related to changing behaviour, but that’s not dependent on changing your thoughts first [4-6]. Talking and thinking differently is fine, but unless that results in a change to your actions, there will probably be little benefit.
This is take home message number two:Talking therapies help, but you don’t need to change your thinking, you need to change your actions. #walkthetalk
The million-dollar question is how to apply all of this. If talking therapies have the same benefit as anti-depressants, then do we go for tablets before talking or the other way around? Are both together more powerful than each one alone?
In their paper, Davey and Chanen outline what has become the generally accepted pecking order for anti-depressant therapy. They recommend that all patients should be offered talking treatments where it’s available. Medication should only be considered if:
a person’s depression is moderate or severe;
a person doesn’t want to engage with talking therapies; or
talking therapies haven’t worked.
Some overseas guidelines recommend this order based on projected bang for your buck. While talking therapies are initially more expensive, they seem to have a more durable effect than medications, which are initially cheaper and easier, but have a greater cost with prolonged use [7]. In other words, if you learn better resilience and coping skills, you’re less likely to fall back into depression, compared to the use of the medications.
This is take home message number three:Use talking therapies first, with medications as a back up. #skillsthenpills
At this point in history, we seem to finally be finding some balance. Just as anti-depressants aren’t the messiah, they’re not the devil either, despite the vocal minority doing their best to demonise them.
With a few decades of research and clinical experience since Prozac was first released on to the market, we’re finally getting an accurate picture of the place of talking therapies and medications in the treatment of depression. Both are equally effective, and each have their place in the management of mental illness in our modern world.
References
[1] Mukherjee S. Post Prozac Nation – The Science and History of Treating Depression. The New York Times. 2012 Apr 19
[2] Davey CG, Chanen AM. The unfulfilled promise of the antidepressant medications. Med J Aust 2016 May 16;204(9):348-50.
[3] Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological medicine 2010 Feb;40(2):211-23.
[4] Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[5] Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[6] Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.
[7] Anderson I. Depression. The Treatment and Management of Depression in Adults (Update). NICE clinical guideline 90.2009. London: The British Psychological Society and The Royal College of Psychiatrists, 2010.
IMPORTANT
If you have questions about what treatment type might be better for you in your situation, please talk to your local GP, psychologist or psychiatrist, or if you need urgent crisis support, then:
In Australia
you can call either Lifeline on 13 11 14,
BeyondBlue provides a number of different support options
the BeyondBlue Support Service provides advice and support via telephone 24/7 (call 1300 22 4636)
In Proverbs 12:25, the incredibly wise King Solomon wrote that, “Worry weighs us down; a cheerful word picks us up.”
Today, Dr Leaf posted to her social media stream that “An undisciplined mind is filled with worries, fears and distorted perceptions – These lead to degeneration of the mind and body.”
Well, that’s about as uplifting as a lead balloon.
Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. I’m sure her heart was in the right place when she posted her latest jewel of wisdom, but it may not be as encouraging or as helpful as she may have intended.
The biggest problem is her opening premise, “An undisciplined mind is filled with worries, fears and distorted perceptions”. So … that’s not really accurate. The normal human mind is filled with worries, fears and distorted perceptions. It really doesn’t matter whether you discipline your mind or not, you won’t shift these ‘negative’ thoughts.
That’s because we’re meant to experience appropriate levels of fear and worry. They’re a survival mechanism. Without a certain amount of fear, we’d end up as a Darwin Award. And as human beings, we’re naturally inclined to so many different cognitive biases that there’s a very long list (although ironically, those with the strongest confirmation bias will probably be the least likely to accept this).
By erroneously linking normal cognitive function to the concept of mental ill-discipline, Dr Leaf is simply setting people up for an unrealistic struggle with their normal psyche as they unnecessarily try to discipline it.
And for the people who really do struggle with excessive or inappropriate worry, fear or incorrect perceptions – i.e. people who suffer from formal anxiety disorders – this sort of statement is misleading because again, their issue isn’t mental ill-discipline. Anxiety is the result of a genetic predisposition and increased vulnerability to stress.
The second part of Dr Leafs meme is as unhelpful as the first. For a start, it’s not true that worries, fears and distorted perceptions cause degeneration of the mind and body. There may be a correlation between stress and some long term health problems, but correlation does not equal causation. As Cohen and colleagues noted, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [1] Dr Leaf’s claim seems little more than a scare tactic, which can only lead to increased anxiety not increased motivation.
The important things to remember here are: 1. Experiencing worries, fears and distorted perceptions is normal, and not something that can be changed by disciplining your mind. Don’t fall into the trap of trying to treat something that isn’t a disease. 2. If you do suffer from an anxiety disorder, don’t blame yourself. That sets up a spiral of struggle. Thoughts are just words. They have no power over you unless you engage with them. Instead of trying to repress every worry and every fear, allow your thoughts to bubble away in the background, and instead, focus your energy on taking values based committed action which will ultimately help you live a life of meaning, not just struggling.
References
[1] Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA: the journal of the American Medical Association 2007;298(14):1685-87.
Floating across my Facebook feed this morning was an article on the possible link between depression and inflammation. Its premise was that depression, the joyless soul-sucking disease affecting millions of people around the world, is related to inflammation. If that were true, might mean that we could cure depression with medications that stop inflammation. Maybe we should be consuming an aspirin a day to keep the doctor away, and not the proverbial apple?
Inflammation is a hot topic right now. Inflammation in the medical sense refers to a normal body process to promote healing and recovery from sickness or injury. It’s a complex dance of chemical signals which is triggered by damage to tissue. Inflammation is essential to life. Without it, we would be unable to repair our tissues if they were damaged.
When tissues are damaged, a number of local cells in the damaged area release pro-inflammatory cytokines which then trigger a cascade of responses; increase in the size of the local blood vessels to allow greater blood flow to the area, attracting pus-cells (neutrophils) to the area, and increasing the ‘leakiness’ of the blood vessels to allow the pus cells into the area. This response is governed by a number of chemical mediators throughout the body, including histamine, serotonin, complement system, kinins, substance P, prostaglandins and leukotrienes, cytokines and nitric oxide. Anti-inflammatory cytokines balance out the process, keeping the pro-inflammatory cytokines in check so that the process doesn’t spiral out of control.
Despite the literal plethora of chemical reactions going on simultaneously, most of the time the reaction eventually runs out of noxious agents, the anti-inflammatory cytokines dampen down the reaction, and the tissue returns to either normal, or at least functional. Though inflammation isn’t just limited to repairing damage but also preparing for damage –psychological stress prepares the inflammation system for potential damage. Physical stress triggers the inflammation system to repair any damage.
Chronic inflammation occurs when the acute illness or injury does not fully resolve and continues to smoulder, the natural healing pathway is obstructed, or the body remains in a psychological state in which it is always expecting a fight. In chronic inflammation, the processes of active inflammation, tissue destruction and attempts at healing occur simultaneously. In terms of cytokines, the anti-inflammatory cytokines can’t balance out the excess pro-inflammatory cytokines.
There’s a theory about depression which is gaining momentum within the scientific community, that depression and a number of other psychiatric and neurodegenerative conditions are the result of chronic inflammation which occurs because of chronic stress.
Remember when I said before that psychological stress readies the inflammatory system for potential damage? Well, what if that damage never comes? If there’s chronic psychological stress, the system is constantly being worn down, and never getting a chance to recover. This seems to make sense – chronic stress reduces new nerve cell production and growth, and may interfere with the action of nerve growth factors like BDNF and neurotransmitters like serotonin. Hence why this article by Feelguide seems to ring true.
But is it true? Is depression fundamentally an inflammatory disease, and if so, can we treat it with medications that decrease inflammation, like aspirin?
Let’s go through the various statements made in the Feelguide article and see what the medical evidence says.
First, a necessary correction to avoid confusion. The Feelguide article says that, “New research is revealing that many cases of depression are caused by an allergic reaction to inflammation.” Depression is not an allergic reaction. A true allergy is an antibody response which releases a chemical called histamine from cells called mast cells. If the current theory about depression and inflammation is true, then depression is related to cytokines, chemicals that are entirely different to histamine. It may be really annoying to sneeze like you’re demon possessed if a cat’s been in the same room a week ago, but it’s not going to make you depressed.
Is inflammation caused by obesity, high sugar diets, high quantities of trans fats, unhealthy diets in general? There’s limited evidence that the foods you eat result in inflammation. Most of the positive data comes from observational studies which are relatively weak. Better, stronger studies generally give conflicting information [1]. For example, if high fat, sugary foods were really the cause of low grade inflammation, then diets like the Palaeolithic diet, which replace sugary, fatty processed foods with a bucket load of vegetables should improve inflammation. Yet there have been no statistically significant changes in inflammatory markers recorded in subjects following the Palaeolithic diet [2].
The Feelguide article claims that, “By treating the inflammatory symptoms of depression – rather than the neurological ones – researchers and doctors are opening up an exciting new dimension in the fight against what has become a global epidemic”, but let’s not get too excited. Again, there’s precious little evidence that medications or supplements reported to reduce inflammation make any difference to depression. For example, the article mentions omega-3 and curcumin as having some benefit in the treatment of depression, which is half-right. There’s some evidentiary support that EPA-predominant omega-3 supplements may have some effect on depression, but none at all for DHA omega-3’s [3] or curcumin [4].
When it comes to other medications with an anti-inflammatory effect, the results are similarly mixed. The issue seems to be the specific cellular action of the medication on a particular immune cell in the brain called the microglial cell. For example, normal anti-inflammatory medications like aspirin and other Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) increased the activity of these special microglial cells which resulted in an increase in depressive symptoms in otherwise healthy individuals, whereas a medication called minocycline has been noted to decrease the activity of these microglia, and reduced the risk of depressive symptoms (in animal studies at least) [5].
So we really can’t say whether medications believed to have an anti-inflammatory effect really have any significant benefit. As neuroscientists, Dr Dora Brites and Dr Adelaide Fernandes wrote,
“Nevertheless, we should be cautious in believing that depression can be treated by therapies targeting inflammation. Further studies are required to evaluate whether a combined therapy with anti-inflammatory compounds and antidepressants will result in additional clinical benefits.” [5]
That’s really because we don’t know whether inflammation causes depression, or if depression causes inflammation. The article by Feelguide seem pretty confident, but the science is still a long way from being settled.
The final word is this:
1. Depression is complicated and still poorly understood.
2. It may be related to inflammation, but please don’t rely on herbs or medications that claim to have anti-inflammatory or “immune boosting” properties.
3. If you really want to try and treat your depression without pharmaceutical medications, take some EPA Omega 3 supplements by all means, although I’d encourage you to exercise and engage with a good psychologist too, both of which have more evidence of benefit overall.
References
[1] Minihane AM, Vinoy S, Russell WR, et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. The British journal of nutrition 2015 Oct 14;114(7):999-1012.
[2] Pitt CE. Cutting through the Paleo hype: The evidence for the Palaeolithic diet. Aust Fam Physician 2016 Jan-Feb;45(1):35-8.
[3] Hallahan B, Ryan T, Hibbeln JR, et al. Efficacy of omega-3 highly unsaturated fatty acids in the treatment of depression. The British journal of psychiatry : the journal of mental science 2016 Apr 21.
[4] Andrade C. A critical examination of studies on curcumin for depression. J Clin Psychiatry 2014 Oct;75(10):e1110-2.
[5] Brites D, Fernandes A. Neuroinflammation and Depression: Microglia Activation, Extracellular Microvesicles and microRNA Dysregulation. Front Cell Neurosci 2015;9:476.
Dr C. Edward Pitt 