1. ““Therapeutic Lifestyle ChangesTherapeutic Lifestyle Changes””//
””Natural AntidepressantsNatural Antidepressants””
Evolutionary biology and neurophysiology psychoeducation
for patients and their families
Dr Peter Parry
Consultant Child & Adolescent Psychiatrist,
LCCH, CYMHS, Brisbane, Queensland
Senior Lecturer, University of Queensland
Visiting Senior Lecturer, Flinders University
Gwinganna October 2015
2. Leon EisenbergLeon Eisenberg
Chair APA Section of Child PsychiatryChair APA Section of Child Psychiatry
(amongst innumerable posts and honours)(amongst innumerable posts and honours)
Brainless Psychiatry
v
Mindless Psychiatry
6. Chief-editorsChief-editors
• Horton (The Lancet): How tainted has
medicine become? Lancet 2002 – “heavily and
damagingly so”.
• Angell (NEJM): Drug Companies & Doctors: A
story of Corruption New York Review of Books 2009
• Smith (BMJ): Medical journals have become
an extension of the marketing arm of
pharmaceutical companies. PLoS Med 2005
9. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
• “Yoga of the East and West: Integrating
Breath Work and Meditation into Clinical
Practice.”
– Patricia Gerbarg, M.D., Richard Brown, M.D.
– www.breath-body-mind.com
10.
11. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
12. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
13. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
15. Pneumogastric NervePneumogastric Nerve
• Charles Darwin (1872): • The Expression of
Emotions in Man and
Animals
– Heart, guts and brain
communicate intimately
via the "pneumogastric"
nerve, the critical nerve
involved in the expression
and management of
emotions in both humans
and animals.
16. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
17. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
18. Lifestyle treatment of depressionLifestyle treatment of depression
• Evolutionary paradigm.
– Hunter-gatherer tribe.
23. Evolutionary perspective on depressive reactionsEvolutionary perspective on depressive reactions
•Attachment Loss –
Grief – moving on and
reattaching – survival of
tribe/group
•Status Loss – Survival
•Unmet expectations –
demoralisation -
Survival
26. Lifestyle treatment of depressionLifestyle treatment of depression
• Inflammatory theory of depression
– Acute stress is manageable. HPA system swings
into gear with sympathetic nervous system
response followed by parasympathetic relaxation
and repair phase.
– Chronic stress is bad. Stress (current and
unresolved), inactivity, poor sleep, poor diet, toxic
load (tobacco, alcohol, obesity), sympathetic
overdrive. → HPA axis dysfunction.
– HPA dysfunction leads to inflammation – body and
nervous system.
– Pro-inflammatory cytokines.
28. Engaging young people in using aEngaging young people in using a
breathing-relaxation techniquebreathing-relaxation technique
• “Has a teacher or counsellor ever taught you how to
use slow breathing techniques to help…”
• “yeah, I’ve tried that – it doesn’t work for me!!”
• OK I believe you – it hasn’t worked for you when
you’ve tried it – up to now. But actually it has
worked for you when you haven’t tried it – I’ll tell
you why… {come in with the sales spiel}
29. ““The Spiel”The Spiel”
• Draw brain and spinal cord plus eye and optic
nerve and schematic body with heart, lungs, guts,
diaphragm muscle.
• within brain draw brainstem = autonomic N.S.
“autopilot” = ‘reptilian brain’
• draw hemispheric limbic system with amygdalas
(‘alarms’) = ‘mammalian brain’
• draw frontal lobes = ‘thinking/verbal brain’
• Describe fight/flight/freeze
• Sympathetic N.S., adrenalin, amygdalas, frontal lobes switch
off = ‘survival/stress N.S.’
• Need a circuit breaker to turn it off = parasympathetic
“peaceful N.S.” = vagus nerve
30. Breath and the Vagus NerveBreath and the Vagus Nerve
• Vagus nerve = feedback from diaphragm
– amygdalas will listen
– “I know for certain you already use this breathing-
relaxation technique!”
– ??? (their expression)
– yawning, sighing, laughing, sobbing…yawning, sighing, laughing, sobbing…
– the ‘valsalva manoevre’ stimulates vagus.
• Enact a yawn, sigh etc
– how this is same as a “yoga breath”
– dogs, chimpanzees – use of yawning as
communication
– humour helps!!
31. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
32. Breath and the Vagus NerveBreath and the Vagus Nerve
• “victorious”
33. Breath and the Vagus NerveBreath and the Vagus Nerve
• Elite athletes are trained to use it.
– AFL/NRL footballers lining up for goals
– Olympic runners & swimmers
– Johnny Wilkinson in Rugby, David Beckham in Soccer
• Singers and performers e.g. Australia’s Got Talent, X Factor
etc
• Politicians making speeches
– Julia Gillard speaking with slow diaphragmatic breathing and
exaggerated Australian drawl
34. Breath and the Vagus NerveBreath and the Vagus Nerve
• Show how similar “breathing-relaxation” is to
yawning.
– the sound “ocean breathing” on the lengthened out-
breath.
• Practice it in session (incl parents)
• Self-disclosure
– for sleep, daily stress, exams etc
– You shouldn’t preach this if don’t practice it!
35. Course at APA, San Francisco, 2009Course at APA, San Francisco, 2009
36.
37. Mindfulness is an Open SkyMindfulness is an Open Sky
Mindfulness is a MountainMindfulness is a Mountain
39. Lifestyle treatment of depressionLifestyle treatment of depression
• Sleep
– Draw graph sleep architecture – level 1 to 4
– Explain value of deep sleep – cell repair, clear inflammatory debris
(cytokines)
– EEG patterns – delta rhythm stage 4.
– CSF flushing of neurons with resolvins - clean out debris
– Teens need 9 ½ hrs average for full dose stage 4 ‘hardware’ clean up
and full dose REM stage 1 dreaming “software’ cleanup.
• Circadian Rhythm
– Pineal gland, Supra-chiasmatic nucleus (SCN)
– Melatonin = sleep chemical, SCN = clock
– Need for sunshine in day and darkness at night
– Computer/TV @ night (blue light/amber glasses)
• ISRT – Interpersonal Social Rhythm Therapy
41. Lifestyle treatment of depressionLifestyle treatment of depression
• Exercise
– Superoxide Dismutase (SOD)
– Brain derived neurotrophic factor (BDNF)
– Tiredness to help sleep
– Better insulin sensitivity, energy and weight control
– Endorphins for mood
• Diet
– Omega-3/omega-6 ratio of 1:1 in paleolithic hunter gatherers
– Omega-3 building blocks for “resolvins” & neuroprotectin
– Sugar, metabolic syndrome and inflammation
– Nutrients, including antioxidants, and protein – lean meat, vegetables,
fruit, berries, nuts
46. Lifestyle treatment of depressionLifestyle treatment of depression
• Natural environments
– “Nature Deficit Disorder”
– Mobile fractal patterns vs linear regularity
– Korean CBT in forest study 5.21.61, hrv, salivary cortisol.
• Human touch
– Evolved from apes who endlessly groomed eachother
– Andaman islanders
– Massage therapies
• Attachment and socialising
– Friendships – face-to-face
– Talking therapies
50. Consider the
physical
intimacy of
the maternal-
infant
relationship
Slide courtesy Prof
J McKenna
…socially and
medically
obscured by
western
culture
Balinese
Mother
and infant
51. Parent child holdingParent child holding
The Welsh ShawlThe Welsh Shawl
Tradition of long holding and
carrying of infants was in West
too.
