June 27, 2023 • 13 mins
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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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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Thanh (00:01):
Welcome to the Y in Psychiatry, your go-to 15 minute
pragmatic podcast where we delveinto the intricate nuances of
psychiatric topics.
Each episode features interviewstyle discussions that explore
the intersection of the mindmedicine and the human
experience.
(00:21):
Together we'll uncover thehidden why and the
groundbreaking discovery shapingthe psychiatric landscape.
So grab a seat, warm beverage,tune in, and let's embark on
this journey to unlock themysteries of the human psyche.
Only on the why in psychiatry.
(00:48):
A question that puzzles us all.
Why does the mind falter whenall seems well and vice versa?
the human brain, an organs socomplex that it has managed to
remain somewhat of a mysteryeven in the age of technology.
but what if we told you we'repulling back the veil of some of
these enigmatic processes?
(01:11):
What if we can help youunderstand why some of us
grapple with the shadow ofdepression?
Imagine a world where psychiatryisn't so much hocus pocus, but
rather more focus.
Focus.
Intrigued you should be.
Today on the Y Psychiatry, weventure into the realm of mood
disorders.
How the salience network, theexecutive network, and the
(01:32):
default mode network, allintermingle during when mood
goes right and when mood goeswrong.
We'll try to answer the questionof why does it happen?
What is going on in the brain?
Sit tight as we delve into someserious brain business.
with our regular host, Dr.
Amayo, or known as Miracle, andDr.
(01:53):
Hendratta.
Let's unravel the why inpsychiatry shall we.
Miracle (02:00):
Welcome To the Y in psychiatry.
As usual, today I haveHandratta, with us.
Dr. H (02:07):
How are you guys doing?
Miracle (02:09):
We are doing great and bonus today.
We are all recording fromdifferent time zones.
I think it's amazing things wecan do with technology.
All right, so jumping right into today's topic, I found
myself, you know, multiple timestalking to a patient or talking
to the family, trying to explainwhat depression is and why their
(02:35):
loved one or themself havedepression.
And I think sometimes I've usedeither the genetic model or I've
used the chemical imbalancemodel, but I actually, actually
don't think I know why peopleget depression.
Is that.
Is that something you can helpus with Dr.
(02:56):
Handratta?
Dr. H (02:57):
Yeah, absolutely.
No, that's a really goodquestion.
so we'll actually divide itactually.
so definitely the neurochemicalsdo play a role, but it's not the
only thing that causes a personto get depressed, like in a
layman's term.
What I usually tell patients isthat if you take away reward
from your brain and you do notreplace the reward and you
(03:19):
deprive the brain or the reward,people usually get depressed.
Right?
That's a very simple answer forwhy people actually get
depressed.
Like for example, when we loseour loved ones, we won't
actually have the reward oftalking to them anytime we want
to or seeing them, right?
So you're deprived of your brainof the reward.
So why do we get depressed?
(03:39):
So there are different reasonswhy we get depressed.
It could be genetics because wealways ask for a family history
of depression.
It does run in the family.
Adverse childhood events.
The more number of adverseevents you have during your
childhood, the more likely youare actually going to get
depressed if you have thegenetic predisposition for
depression and plus researchdata shows that adverse events
(04:02):
in childhood changes your brainchemistry, the way the brain is
connected to each other and theytalk to each other different
areas of the brain.
Then you have psychosocialstressors, right?
we have the bio-psychosocial MOmodel in psychiatry.
So if we have the geneticpredisposition, you have a lot
of adverse childhood event, andthen you expose them to a lot of
stress in adult life, you areactually creating the perfect
(04:26):
storm.
Then we also look at differentother factors, which can make
you depressed.
Like use of substance use,right?
Alcohol, benzos, opiates, ormedical conditions.
The commonly known condition islike Cushing syndrome,
hypothyroidism, pancreaticcancer.
Actually, depression is actuallycomes first before the cancer is
(04:47):
diagnosed.
Medications, long-term use ofsteroids can make you depressed,
right?
And then you have differenttypes of depression, like
seasonal component ofdepression.
Premenstrual dyshoric disorder,postpartum depression.
Right?
So these are some of the reasonswhy people get depressed.
And then we'll talk about themonoamine theory as we talk
about the treatment ofdepression.
(05:08):
Does it make sense?
Miracle (05:09):
So we have what causes the depression, but what happens
in the brain when there's adepression?
Right?
Dr. H (05:17):
So that's actually, it's still a research work going on
it's still, it's in, in itsinfancy, but we know more than
what we knew a decade ago.
So to understand what happens inthe brain in depression, we need
to actually focus on three majornetworks in the brain, right?
Because the brain doesn't workas like individual frontal lobe,
(05:39):
parietal lobe, temporal lobeoccipital.
It basically works as network.
So, The most important network,that we are gonna talk about is
the Salience Network, theexecutive network, and the
default point network.
Miracle (05:51):
So a net a network is a combination of brain parts
working together to achieve acommon goal.
Dr. H (06:00):
absolutely right Now let's make it very simple.
So salience network is basicallyit in most different brain
areas.
As the name suggests, isresponsible for detecting
salience in the environment,right?
It's responsible for absorbingor processing all the sensory
information that we are getting.
So it could be like sensoryinformation from inside the
(06:21):
body, which we call asinterceptive signals.
Or it could be from outside thebody called extraceptive
signals.
So in interceptive signals islike 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, yourinsular cortex the reward area
(06:43):
of the brain called nucleusaccumbens.
And the dopamine that entersinto this nucleus accumbens from
ventral segmental area and theamygdalla, they all actually
formed the salience network.
Does it make sense?
Miracle (06:54):
That makes sense.
Yes, sir.
Dr. H (06:55):
So what the salience network does is that it usually
gets these information.
So the extra receptiveinformation is like your vision,
your hearing, your smell, yourproper reception, vibration,
sensation.
So everything enters into thesalience network right now.
Once it enters into the saliencenetwork, then our brain tries to
actually figure out what can wedo with this information?
(07:19):
So what it does is that it'llactually recruit your executive
network as the name suggest isresponsible for executive
functioning.
So that involves your doslateral prefrontal cortex, and
your posterior parietal cortex.
Now, these areas of the brainare located very close to your
sensory and motor area, so it'sresponsible for stimulating the
psychomotor activity that isrequired to achieve a goal
(07:44):
depending upon the signal you'rereceiving.
Right, and we'll actually talkabout an example, and it's also
responsible for executivefunctioning that is your
planning and organization.
Miracle (07:53):
Okay.
Dr. H (07:54):
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 adefault mode, you're just
sitting and lazing around.
You're dreaming, you'rementalizing, you're fantasizing,
right?
Miracle (08:08):
It's also as the lounge and network.
Dr. H (08:11):
Exactly.
That's actually the default modenetwork, right?
So it basically involves yourmidline brain structure, that is
your medial prefrontal cortexand your posterior cingulate
cortex and your prete.
So that's your default modenetwork.
It's also activated when you'reactually like thinking or you're
basically, uh, writing a poetry.
And plus it's also responsiblefor knowing who you are and also
(08:33):
responsible for autobiographicalmemory.
Everything that you've done inyour life, right?
Miracle (08:38):
Would that be the right, the right brain, left
brain, thing?
Dr. H (08:43):
It's on both sides.
Miracle (08:44):
It's on both sides.
Dr. H (08:45):
Yes.
So these are the three mainnetworks.
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 atsomething else.
So for example, you're sittingin your office or you're
actually sitting in yourresidency, lounge, and the code
blue comes on, right?
So there's a speakerannouncement.
(09:06):
So there is the auditoryinformation actually entering it
your salience network, sayingthat there's a code blue in room
1 0 3.
Just imagine.
So what happens is that as soonas the salience network gets
that information, it'll recruityour executive network.
So what you do is that you'renot gonna sit in your seat and
(09:26):
mentalize or fantasize, you'regoing to actually run, so your
psychomotor center isstimulated.
So you run towards the room 1 03 to see what's going on with
the patient, and then you useyour executive function that is
planning an organization to runthe code blue.
Right?
Miracle (09:43):
That's that's if you're not a psych resident, of course.
I will not.
Right.
Listen, is, sorry.
Dr. H (09:48):
No, no, no.
This is good.
This is good.
Miracle (09:50):
You're absolutely right.
Dr. H (09:51):
No.
Let's look at depression.
What happens?
So when a person is depressed,People with depression are very,
very tuned to the introceptivesignals.
What happens inside the body,right?
Like the heart rate going up anddown, your breathing going up
and down, the change of the bodytemperature right?
Now, what happens actually indepression is that the salience
(10:12):
network is usually responsiblefor processing, reward and
punishment.
So the area of the saliencenetwork that processes reward
becomes inactive and thatprocess' punishment becomes
overactive.
So then what happens now, thesalience network gets hardwired
or connected to your defaultmode network.
(10:34):
So instead of activating yourexecutive network depression,
it'll actually keep you in thedefault mode network.
Now, what happens here is thatsince you're in the default mode
network, you start ruminating.
You start actually likeruminating about sad memories
and thoughts that has beenstored in your hippocampal area,
(10:56):
right?
You actually start feelingshame, feeling of guilt, feeling
of remorse, right?
So you're stuck in the defaultmode network and you're not able
to recruit the executivenetwork.
So what happens if you recruitthe executive network when
you're sad you, you actuallystimulate the psychomotor
activity.
You'll go out.
Go to the mall, go to the go fora walk, call your friends.
(11:19):
You can't do it.
Miracle (11:20):
So they just like behavior activation.
Dr. H (11:23):
Exactly right.
So what happens is that sinceyour central executive network
is not working, you do apsychomotor retardation.
Very common in depression,right?
You actually don't have theexecutive functioning.
You can't make decisions, youcan't plan, you cannot organize,
right?
So that is what happens actuallyin depression.
And these networks are modulatedby your monoamines.
(11:44):
Your glutamate, your gaba, sowhen they go out of whack, you
have a dysfunction of thisentire network.
So you're stuck in your defaultmode network.
Does it make sense?
Miracle (11:54):
Let me see if I can understand.
So things that cause depression,uh, things like genetics,
adverse childhood events medicalcauses, psychosocial causes.
And so I guess that in a wayprimes our salience network more
seen towards negative things.
So if you have an adversechildhood event, you are more
sensitive towards the negativeaspects of life.
(12:16):
And so now our salience network.
Then becomes more connected toour default mode as opposed to
our executive network.
And now since our saliencenetwork is more sensitive to the
negative part, it's stimulatedquite often by negativity.
And that leads to us instead oftaking an executive decision,
(12:36):
leads to us taking a moredocile, default, relaxing
decision.
And I guess that leads towardsour, the neuro vegetative
symptoms that we might see indepression.
Um, And also the, the guilt, theguilt, the shame rumination, the
indecision that we see indepression.
So yeah, that, that, that makesa lot of sense.
Dr. H (12:57):
Dr.
Amayo, you said it actuallybetter than me.
I, I don't think so.
You did, you did.
That was excellent summary.
Katrina (13:08):
Thank you for joining us on today's episode.
Feel free to tap that subscribebutton, show your salience
network, who's boss, probablyyour executive network.
Our tireless team is alreadyhard at work, cobbling together
another potpourri.
Fascinating discussion for nextweek, so be sure to tune in,
visit our website and ourpodcast feed and let us know
your thoughts on the episode.
(13:29):
Until next time, keep smiling,keep shining, and stay curious.
Welcome to the Y in Psychiatry, your go-to 15 minute
pragmatic podcast where we delveinto the intricate nuances of
psychiatric topics.
Each episode features interviewstyle discussions that explore
the intersection of the mindmedicine and the human
experience.
(00:21):
Together we'll uncover thehidden why and the
groundbreaking discovery shapingthe psychiatric landscape.
So grab a seat, warm beverage,tune in, and let's embark on
this journey to unlock themysteries of the human psyche.
Only on the why in psychiatry.
(00:48):
A question that puzzles us all.
Why does the mind falter whenall seems well and vice versa?
the human brain, an organs socomplex that it has managed to
remain somewhat of a mysteryeven in the age of technology.
but what if we told you we'repulling back the veil of some of
these enigmatic processes?
(01:11):
What if we can help youunderstand why some of us
grapple with the shadow ofdepression?
Imagine a world where psychiatryisn't so much hocus pocus, but
rather more focus.
Focus.
Intrigued you should be.
Today on the Y Psychiatry, weventure into the realm of mood
disorders.
How the salience network, theexecutive network, and the
(01:32):
default mode network, allintermingle during when mood
goes right and when mood goeswrong.
We'll try to answer the questionof why does it happen?
What is going on in the brain?
Sit tight as we delve into someserious brain business.
with our regular host, Dr.
Amayo, or known as Miracle, andDr.
(01:53):
Hendratta.
Let's unravel the why inpsychiatry shall we.
Miracle (02:00):
Welcome To the Y in psychiatry.
As usual, today I haveHandratta, with us.
Dr. H (02:07):
How are you guys doing?
Miracle (02:09):
We are doing great and bonus today.
We are all recording fromdifferent time zones.
I think it's amazing things wecan do with technology.
All right, so jumping right into today's topic, I found
myself, you know, multiple timestalking to a patient or talking
to the family, trying to explainwhat depression is and why their
(02:35):
loved one or themself havedepression.
And I think sometimes I've usedeither the genetic model or I've
used the chemical imbalancemodel, but I actually, actually
don't think I know why peopleget depression.
Is that.
Is that something you can helpus with Dr.
(02:56):
Handratta?
Dr. H (02:57):
Yeah, absolutely.
No, that's a really goodquestion.
so we'll actually divide itactually.
so definitely the neurochemicalsdo play a role, but it's not the
only thing that causes a personto get depressed, like in a
layman's term.
What I usually tell patients isthat if you take away reward
from your brain and you do notreplace the reward and you
(03:19):
deprive the brain or the reward,people usually get depressed.
Right?
That's a very simple answer forwhy people actually get
depressed.
Like for example, when we loseour loved ones, we won't
actually have the reward oftalking to them anytime we want
to or seeing them, right?
So you're deprived of your brainof the reward.
So why do we get depressed?
(03:39):
So there are different reasonswhy we get depressed.
It could be genetics because wealways ask for a family history
of depression.
It does run in the family.
Adverse childhood events.
The more number of adverseevents you have during your
childhood, the more likely youare actually going to get
depressed if you have thegenetic predisposition for
depression and plus researchdata shows that adverse events
(04:02):
in childhood changes your brainchemistry, the way the brain is
connected to each other and theytalk to each other different
areas of the brain.
Then you have psychosocialstressors, right?
we have the bio-psychosocial MOmodel in psychiatry.
So if we have the geneticpredisposition, you have a lot
of adverse childhood event, andthen you expose them to a lot of
stress in adult life, you areactually creating the perfect
(04:26):
storm.
Then we also look at differentother factors, which can make
you depressed.
Like use of substance use,right?
Alcohol, benzos, opiates, ormedical conditions.
The commonly known condition islike Cushing syndrome,
hypothyroidism, pancreaticcancer.
Actually, depression is actuallycomes first before the cancer is
(04:47):
diagnosed.
Medications, long-term use ofsteroids can make you depressed,
right?
And then you have differenttypes of depression, like
seasonal component ofdepression.
Premenstrual dyshoric disorder,postpartum depression.
Right?
So these are some of the reasonswhy people get depressed.
And then we'll talk about themonoamine theory as we talk
about the treatment ofdepression.
(05:08):
Does it make sense?
Miracle (05:09):
So we have what causes the depression, but what happens
in the brain when there's adepression?
Right?
Dr. H (05:17):
So that's actually, it's still a research work going on
it's still, it's in, in itsinfancy, but we know more than
what we knew a decade ago.
So to understand what happens inthe brain in depression, we need
to actually focus on three majornetworks in the brain, right?
Because the brain doesn't workas like individual frontal lobe,
(05:39):
parietal lobe, temporal lobeoccipital.
It basically works as network.
So, The most important network,that we are gonna talk about is
the Salience Network, theexecutive network, and the
default point network.
Miracle (05:51):
So a net a network is a combination of brain parts
working together to achieve acommon goal.
Dr. H (06:00):
absolutely right Now let's make it very simple.
So salience network is basicallyit in most different brain
areas.
As the name suggests, isresponsible for detecting
salience in the environment,right?
It's responsible for absorbingor processing all the sensory
information that we are getting.
So it could be like sensoryinformation from inside the
(06:21):
body, which we call asinterceptive signals.
Or it could be from outside thebody called extraceptive
signals.
So in interceptive signals islike 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, yourinsular cortex the reward area
(06:43):
of the brain called nucleusaccumbens.
And the dopamine that entersinto this nucleus accumbens from
ventral segmental area and theamygdalla, they all actually
formed the salience network.
Does it make sense?
Miracle (06:54):
That makes sense.
Yes, sir.
Dr. H (06:55):
So what the salience network does is that it usually
gets these information.
So the extra receptiveinformation is like your vision,
your hearing, your smell, yourproper reception, vibration,
sensation.
So everything enters into thesalience network right now.
Once it enters into the saliencenetwork, then our brain tries to
actually figure out what can wedo with this information?
(07:19):
So what it does is that it'llactually recruit your executive
network as the name suggest isresponsible for executive
functioning.
So that involves your doslateral prefrontal cortex, and
your posterior parietal cortex.
Now, these areas of the brainare located very close to your
sensory and motor area, so it'sresponsible for stimulating the
psychomotor activity that isrequired to achieve a goal
(07:44):
depending upon the signal you'rereceiving.
Right, and we'll actually talkabout an example, and it's also
responsible for executivefunctioning that is your
planning and organization.
Miracle (07:53):
Okay.
Dr. H (07:54):
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 adefault mode, you're just
sitting and lazing around.
You're dreaming, you'rementalizing, you're fantasizing,
right?
Miracle (08:08):
It's also as the lounge and network.
Dr. H (08:11):
Exactly.
That's actually the default modenetwork, right?
So it basically involves yourmidline brain structure, that is
your medial prefrontal cortexand your posterior cingulate
cortex and your prete.
So that's your default modenetwork.
It's also activated when you'reactually like thinking or you're
basically, uh, writing a poetry.
And plus it's also responsiblefor knowing who you are and also
(08:33):
responsible for autobiographicalmemory.
Everything that you've done inyour life, right?
Miracle (08:38):
Would that be the right, the right brain, left
brain, thing?
Dr. H (08:43):
It's on both sides.
Miracle (08:44):
It's on both sides.
Dr. H (08:45):
Yes.
So these are the three mainnetworks.
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 atsomething else.
So for example, you're sittingin your office or you're
actually sitting in yourresidency, lounge, and the code
blue comes on, right?
So there's a speakerannouncement.
(09:06):
So there is the auditoryinformation actually entering it
your salience network, sayingthat there's a code blue in room
1 0 3.
Just imagine.
So what happens is that as soonas the salience network gets
that information, it'll recruityour executive network.
So what you do is that you'renot gonna sit in your seat and
(09:26):
mentalize or fantasize, you'regoing to actually run, so your
psychomotor center isstimulated.
So you run towards the room 1 03 to see what's going on with
the patient, and then you useyour executive function that is
planning an organization to runthe code blue.
Right?
Miracle (09:43):
That's that's if you're not a psych resident, of course.
I will not.
Right.
Listen, is, sorry.
Dr. H (09:48):
No, no, no.
This is good.
This is good.
Miracle (09:50):
You're absolutely right.
Dr. H (09:51):
No.
Let's look at depression.
What happens?
So when a person is depressed,People with depression are very,
very tuned to the introceptivesignals.
What happens inside the body,right?
Like the heart rate going up anddown, your breathing going up
and down, the change of the bodytemperature right?
Now, what happens actually indepression is that the salience
(10:12):
network is usually responsiblefor processing, reward and
punishment.
So the area of the saliencenetwork that processes reward
becomes inactive and thatprocess' punishment becomes
overactive.
So then what happens now, thesalience network gets hardwired
or connected to your defaultmode network.
(10:34):
So instead of activating yourexecutive network depression,
it'll actually keep you in thedefault mode network.
Now, what happens here is thatsince you're in the default mode
network, you start ruminating.
You start actually likeruminating about sad memories
and thoughts that has beenstored in your hippocampal area,
(10:56):
right?
You actually start feelingshame, feeling of guilt, feeling
of remorse, right?
So you're stuck in the defaultmode network and you're not able
to recruit the executivenetwork.
So what happens if you recruitthe executive network when
you're sad you, you actuallystimulate the psychomotor
activity.
You'll go out.
Go to the mall, go to the go fora walk, call your friends.
(11:19):
You can't do it.
Miracle (11:20):
So they just like behavior activation.
Dr. H (11:23):
Exactly right.
So what happens is that sinceyour central executive network
is not working, you do apsychomotor retardation.
Very common in depression,right?
You actually don't have theexecutive functioning.
You can't make decisions, youcan't plan, you cannot organize,
right?
So that is what happens actuallyin depression.
And these networks are modulatedby your monoamines.
(11:44):
Your glutamate, your gaba, sowhen they go out of whack, you
have a dysfunction of thisentire network.
So you're stuck in your defaultmode network.
Does it make sense?
Miracle (11:54):
Let me see if I can understand.
So things that cause depression,uh, things like genetics,
adverse childhood events medicalcauses, psychosocial causes.
And so I guess that in a wayprimes our salience network more
seen towards negative things.
So if you have an adversechildhood event, you are more
sensitive towards the negativeaspects of life.
(12:16):
And so now our salience network.
Then becomes more connected toour default mode as opposed to
our executive network.
And now since our saliencenetwork is more sensitive to the
negative part, it's stimulatedquite often by negativity.
And that leads to us instead oftaking an executive decision,
(12:36):
leads to us taking a moredocile, default, relaxing
decision.
And I guess that leads towardsour, the neuro vegetative
symptoms that we might see indepression.
Um, And also the, the guilt, theguilt, the shame rumination, the
indecision that we see indepression.
So yeah, that, that, that makesa lot of sense.
Dr. H (12:57):
Dr.
Amayo, you said it actuallybetter than me.
I, I don't think so.
You did, you did.
That was excellent summary.
Katrina (13:08):
Thank you for joining us on today's episode.
Feel free to tap that subscribebutton, show your salience
network, who's boss, probablyyour executive network.
Our tireless team is alreadyhard at work, cobbling together
another potpourri.
Fascinating discussion for nextweek, so be sure to tune in,
visit our website and ourpodcast feed and let us know
your thoughts on the episode.
(13:29):
Until next time, keep smiling,keep shining, and stay curious.
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Are You A Charlotte?
In 1997, actress Kristin Davis’ life was forever changed when she took on the role of Charlotte York in Sex and the City. As we watched Carrie, Samantha, Miranda and Charlotte navigate relationships in NYC, the show helped push once unacceptable conversation topics out of the shadows and altered the narrative around women and sex. We all saw ourselves in them as they searched for fulfillment in life, sex and friendships. Now, Kristin Davis wants to connect with you, the fans, and share untold stories and all the behind the scenes. Together, with Kristin and special guests, what will begin with Sex and the City will evolve into talks about themes that are still so relevant today. "Are you a Charlotte?" is much more than just rewatching this beloved show, it brings the past and the present together as we talk with heart, humor and of course some optimism.