A surgeon’s account of physician burnout and depression

How the social dynamics of Canada’s health care system may obstruct patient care

A surgeon’s account of physician burnout and depression

The growth in mental health awareness and advocacy around the globe has exposed the psychological limits that individuals can reach in academic- and career-based paths. Terms like “burnout” — the intense emotional, physical, and mental exhaustion connected to excessive stress — are often linked to depression and anxiety.

In sensationalized careers like medicine, it might come as a surprise that burnout plagues the medical world to a staggering extent. A 2018 national survey by the Canadian Medical Association indicates that one in four physicians experience elevated levels of burnout, while one in three screen positive for depression.

In a recent editorial published in the Canadian Urological Association Journal, Dr. Martin Koyle, the Head of the Division of Urology at The Hospital for Sick Kids, recounted his personal experiences grappling with burnout and depression as a physician.

The Varsity sat down with Koyle to discuss his challenges with depression and burnout in his lifelong career in medicine. He contended that his experiences stem less from the practice of medicine itself and more from the bureaucracy and social dynamics entangled within the Canadian health care system.

Koyle’s experience in the medical system

Koyle’s recollections began in 1976, when, as a fresh medical school graduate, he moved from Canada to the United States to begin his long and accomplished career. He’s practiced medicine in Los Angeles, Texas, San Francisco, Denver, and Seattle. He was employed in positions varying from academic faculty to Chief of Pediatric Urology and Renal Transplantation.

While practicing in the United States, Dr. Koyle spoke highly of the Canadian universal single-payer health care system, placing it on an esteemed pedestal which he hoped the US could one day emulate. 

However, the intense public scrutiny that came along with his position as Division Chief at the Seattle Children’s Hospital, coupled with a personal family tragedy and a physical injury, led him to return to Canada in 2011. In Toronto, he began his practice as the Head of the Division of Urology at The Hospital for Sick Kids.

Upon returning to Canada, Koyle promptly realized that the Canadian health system was quite different than the romanticized version he had been promoting during his time in the US.

“I realized from day one that all that I was, was a number,” he said. The system, although advertised as universal, lacked strongly in quality of patient care and career gratification. In the US, Koyle discussed his feeling of belonging to a “community” and being “part of a family.” He personally knew other physicians, and trusted them with his patients when referring them to other specialists. He also felt a general feeling of gratification and mutual appreciation within this supportive network.

In Canada, however, this community aspect was lacking for Koyle. He especially felt uncertain of who would assess his patients in the future. “I didn’t know any of my patients. They didn’t know me. I didn’t know who would see them in follow up,” he said. These factors were further discouragement which added to the climate of emotional hardship.

Koyle also mentioned that the sense of entitlement to health care in Canada contrasts to that of the US, where patients failing to respect wait lines and no-shows are more common, causing other patients to wait longer in order to receive the care they need. To top it all off, recent intense hospital budgeting in Ontario has undercut the quality of patient care available, in ways such as limiting operation times for patients during surgery.

As Koyle summed up his contrasting experience practicing in Canada: “My support from the institution is very different, my control in my environment is very different, my relationship with my patients and with their families and with their providers is very different, and the outcomes are very different in that in the States where my primary physician… was the quarterback in the system in that patient’s care.”

“Here, the buck stops at me… I’m not providing the healthcare that I want to provide to people [due to these social dynamics of the Canadian health care system].”

Koyle’s experiences in a wider context

Although Koyle emphasizes that these experiences are his own, and that some aspects of his burnout and depression are connected to personal challenges faced in his life, he is most certainly not alone in his experiences with mental health challenges in medical careers.

A recent review underscores the factors contributing to Koyle’s burnout: most cases of physician burnout in Canada are neither related to patient care, nor to the practice of medicine itself. Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role. 

Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role [in physician burnout, compared to the practice of medicine itself].

Notably, with physicians expected to constantly project a “healthy” image, it’s not surprising that studies show that only eight per cent of urologists suffering from burnout seek professional help. This strikes a chord for Koyle, who recalled his own hesitation and fear in initiating regular appointments with his now-psychiatrist.

“You’re afraid that somebody will find out, that you’ll go in and somebody will say, ‘he’s crazy.’” But Koyle, who is now open to discussing his appointments, has found that his psychiatrist has helped him to a great extent, in addition to his yoga and practice of meditation. Today, he is a strong mental health advocate, and encourages those battling with burnout and depression to seek the help that they need.

When asked about his thoughts on hope for the future, Koyle is cautiously optimistic. Having recently finished a Master’s degree in Quality Improvement Patient Safety, with another Master’s connected to international health policy and leadership underway, he aims to develop a skillset to change the climate of the system he works in — both for the benefit of patients under the system’s care, as well as for physicians who impart treatment.

Release of 13 Reasons Why linked to increased youth suicides in the United States

Youth suicides rose by 13 per cent in three months after release, finds U of T-affiliated study

Release of <i>13 Reasons Why</i> linked to increased youth suicides in the United States

Content warning: discussions of depression and suicide.

The release of Netflix’s 13 Reasons Why has been severely criticized by mental health advocates for potentially harmful depictions of mental illness and suicide, which they say could lead to higher suicide risk among viewers.

These warnings were substantiated by a recent U of T-affiliated study published in JAMA Psychiatry that correlated the release of the series to an uptick in youth suicides in the United States over the three-month period following its release on March 31, 2017.

Results of the study

The study found that the number of reported deaths by suicide among 10 to 19-year-olds in the United States was 13 per cent higher than projected based on a “time series analysis” which took into account pre-existing trends. This is the equivalent of 94 more deaths than expected.

This sudden and significant increase in suicides was observed only in youth, and most prominently in young women, wrote co-author Dr. Mark Sinyor, Assistant Professor at U of T’s Department of Psychiatry, to The Varsity.

“The first season of 13 Reasons Why failed to show that suicide most commonly arises from a treatable mental illness,” wrote Sinyor.

“[Our research team] can’t definitively prove that the show caused the rise, but this is precisely what we anticipated we would see if the show was causing harm,” he wrote.

To Sinyor, the results of the study are not surprising.

This was an unfortunate yet predictable outcome,” he wrote, “because past scientific research has repeatedly established that media dissemination of the kind of content depicted in the show can lead to increased suicide rates.”

Sinyor noted that the series has violated guidelines recommended by mental health experts to media producers intended to avoid irresponsible suicide portrayal.

“The first season of 13 Reasons Why failed to show that suicide most commonly arises from a treatable mental illness,” wrote Sinyor.

“It romanticized the suicide, depicted suicide methods, presented the suicide as inevitable, and even [achieved] positive results in that it appeared to punish those who had hurt the show’s protagonist. It also presented the school’s mental health expert as incompetent.”

“There’s no single reason people take their own lives,” says Netflix

Netflix responded to The Varsity’s inquiry concerning the study.

“Experts agree that there’s no single reason people take their own lives — and that rates for teenagers [dying by suicide] have tragically been increasing for years,” Netflix wrote. “These two studies raise important issues but directly conflict with each other, even though they’re based on the same US government data.”

After inquiring about the second study referenced in Netflix’s reply, which supposedly conflicts with Sinyor’s findings, The Varsity did not receive a response.  

“And they don’t explain the increases [in suicides] for girls in November 2016 and boys in March 2017 — before the show had launched,” continued Netflix.

13 Reasons Why tackles the uncomfortable reality of life for many young people today and we’ve heard from them, as well as medical experts, that it gave many viewers the courage to speak up and get help.”

To follow up, The Varsity also requested the names of medical experts who have said this to be the case. Netflix did not respond to The Varsity’s request for comment.

Remedies to the potential impact of media involving suicide

To ensure that the entertainment industry observes best practices with the influence it can have on the public, Sinyor urged for greater collaboration between the industry and suicide prevention experts.

He further underscored the importance of sharing messages of hope and distributing information on ways in which to seek help in order to decrease the number of deaths by suicide.

“The overwhelming majority of young people who think about suicide do not die by suicide and even those youth suicides that do occur should always be viewed as preventable tragedies,” he wrote. “That is the message that we need to disseminate.”

“The key is to find and present identifiable stories of resilience rather than stories of deaths. As only one example, J.K. Rowling has said in the popular press that she was depressed and suicidal and sought therapy which she credits with helping her overcome those feelings.”

“There are many other such stories in both celebrities and non-celebrities and we need to encourage the media to help us spread them in addition to crisis resources such as the new national crisis line in Canada.”

If you or someone you know is in distress, you can call:

  • Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
  • Good 2 Talk Student Helpline at 1-866-925-5454
  • Ontario Mental Health Helpline at 1-866-531-2600
  • Gerstein Centre Crisis Line at 416-929-5200
  • U of T Health & Wellness Centre at 416-978-8030.

Warning signs of suicide include:

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious, agitated, or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.

Discovery of special proteins in brain opens new pathway to treating depression

From MAO-A to B, protein discoveries may lead to a new types of antidepressants

Discovery of special proteins in brain opens new pathway to treating depression

Neuroscientists at the Centre for Addiction and Mental Health (CAMH) have found that patients with depression may have elevated levels of a particular protein in the brain, opening a pathway for developing a new type of antidepressant medication.

The research team, led by Dr. Jeffrey Meyer, the Head Scientist of the Neurochemical Imaging Program in Mood and Anxiety Disorders at CAMH, found that the MAO-B protein — short for monoamine oxidase B — was found in heightened levels in the prefrontal cortex area of the brains of depressed patients.

How Meyer’s research team first discovered the protein

The breakthrough of Meyer’s research team that led to this study was the discovery of elevated levels of the MAO-A protein in women who had recently delivered a baby.

Originally, researchers considered both MAO-A and MAO-B as the same protein, MAO, as they both break down the molecule tyrosine. However, medications developed to treat early postpartum depression – a mood disorder associated with childbirth – revealed that despite a 70 per cent overlap in the structures of the two proteins, the medications only affected the MAO-A enzyme.

Neuroscientists have therefore since considered MAO-A and MAO-B to be different types of chemicals.

The link between MAO-B levels and clinical depression

The recent study by Meyer’s research team evaluated images taken from the brains of 40 patients over a period of four years. Half of the volunteers had experienced episodes of major depression, while the remaining 20 were considered healthy controls.

Through positive emission tomography, a type of brain imaging, the researchers discovered that 50 per cent of the patients with depression had elevated levels of MAO-B compared to the healthy individuals.

The patients with depression were found to have, on average, a 26 per cent increase in the volume of MAO-B in the prefrontal cortex region compared to those without the condition. This region is primarily responsible for complex cognitive behaviour, personality regulation, decision-making, and moderating social behaviour and emotions.

The researchers also found a positive correlation between MAO-B levels and the duration of depressive episodes. That is, the longer the depressive episode, the higher the detected level of MAO-B in the prefrontal cortex and other brain regions.

While MAO-A breaks down serotonin, MAO-B promotes cell turnover by breaking down old and excess neurotransmitters, such as dopamine and norepinephrine, chemicals that are responsible for pleasure and reward.

Although this process is essential in maintaining a healthy brain, increased levels of MAO-B can lead to removing too much of the feel-good chemicals, which may lead to depression.

The limitations of current antidepressant medications

Although there are already antidepressants in the pharmaceutical market, they mainly only target serotonin. Meyer pointed out, in an email to The Varsity, that the current medications and treatment options are not effective for everyone with depression.

“While some people respond well to SSRI [selective serotonin reuptake inhibitors] medications half do not. A key problem is that there are subtypes of depression and we need to match treatments to the subtypes of depression better,” wrote Meyer.

There are already drugs on the market that inhibit MAO-B used for Alzheimer’s and Parkinson’s disease. The research team is looking for ways to direct them towards treating depression.

“There are medications purposed for other illness that shut down MAO-B and could be repurposed for depression,” wrote Meyer.

“With this study now in hand, published in what is traditionally the top psychiatric research journal, I am asking the companies that own the patent rights to these medications to use them for depression.”

How the discovery of MAO-B can lead to new antidepressant research

After the discovery of MAO-A, Meyer’s lab has made progress in developing a dietary supplement that would compensate for the sudden rise of MAO-A in early postpartum depression.

They are currently seeking to create a blood test that could detect monoamine type illnesses. This would help identify individuals who would respond better to MAO-targeted drugs as opposed to the usual antidepressant treatments.

“The main steps are to test medications in development and those available for use, (even if indicated for other illnesses) for their ability to shut down MAO-B. Then I would like to see if matching a medication that shuts down MAO-B to the subtype of depression with greater MAO-B would help increase the chance of cure,” wrote Meyer.

“We are also looking for low cost approaches to predict the subtype of clinical depression with the highest MAO-B level.”

Approximately 15 per cent of people are affected by depression at some point in their life and it is the main cause of disability around the  world.

Meyer wrote, “There is great reason for hope because we are increasingly understanding how the brain changes in clinical depression which is creating new opportunities for cures.”

How psychotherapy treats depression differently than antidepressants

A personal exploration into the science behind antidepressants and CBT

How psychotherapy treats depression differently than antidepressants

Content warning: discussions of depression and suicidal ideation.

The first time I walked through the door of my psychiatrist’s office, I was full of doubt. I had been feeling low for quite a while, and I had trouble believing that any treatment would truly help me feel better.

I had just completed my second year of university, and I felt broken and exhausted. A blend of burning out, experiencing depressive episodes, disengaging from pastimes I used to enjoy, and fantasizing about dying drove me to seek treatment at U of T’s Health & Wellness Centre.

As part of my initial assessment, which occurred over the course of several sessions, my psychiatrist asked me questions about practically every aspect of my life: recent events, medical history, sleep patterns, appetite, suicidal ideations, and more. After considering all my symptoms, she prescribed me Prozac, an antidepressant medication, and recommended cognitive behavioural therapy (CBT). Both are common treatments for depression.

I gave them both a try. I was fortunate to be able to see a therapist for CBT, which was covered by my family’s health insurance. At first, I was skeptical that it would work, but I decided to commit myself to at least a few sessions.

CBT, as I learned, is a short-term form of psychotherapy that helps people build skills for staying healthy. In essence, it helps people identify, question, and change distorted thoughts and beliefs they might have about themselves and the world. By recording their thoughts during upsetting situations, people examine how their unhelpful thoughts might contribute to problems like depression.

Research on how CBT compares to antidepressants

Dr. Zindel Segal, a U of T psychology professor and an expert in CBT, said in an interview with me that “when people are in certain mood states, they tend to have thoughts that are very compatible with those mood states. So, when someone’s feeling depressed, they’re more likely to feel hopeless, judge themselves, and be very critical.”

According to Segal, CBT provides a way of treating people’s thoughts and assumptions as hypotheses that can be tested, rather than as hard facts. “That can help people alleviate the impact that some of these thinking styles can have on their moods,” he elaborated.

For me, CBT was extremely challenging more so than any math or biochemistry course I have ever taken. Perceptions are simply hard to change. At the time, for example, I felt incredibly worthless and undeserving of love. In the face of this, CBT helped me stay objective and not always accept my perceptions as truth. Psychotherapy made me stand back from my thinking to consider situations from different viewpoints.

“In the face of [critical challenges], CBT helped me stay objective and not always take my perceptions as truth.”

However, distorted thoughts and beliefs are often not the only culprits of depression. Much is still unknown about the causes of depression, but researchers suspect that chemical imbalances in the brain play a role in maintaining low moods. Antidepressant medications are designed to address these chemical imbalances by boosting concentrations of neurotransmitters namely serotonin and norepinephrine in the brain.

At first, I was very reluctant to try antidepressant medication because I was wary of possible side-effects. However, my psychiatrist assured me that the starting dose was low, that I would be closely monitored, and that we could always adjust my treatment if the medication was not right for me. In the end, I experienced only minor side-effects and really benefited from the resulting stability in my mood.

The differences between CBT and antidepressants

So, what are the differences between CBT and antidepressants in treating depression, according to experts? Researchers like Segal, who recently co-authored a paper comparing the efficacy of CBT versus antidepressants, are working hard to answer this question.

Segal’s research team found that CBT and antidepressants target different symptoms of depression. Antidepressants were found to be best for treating symptoms specifically related to depressed mood, feelings of guilt, suicidal thoughts, and psychic anxiety.

On the contrary, CBT and antidepressants were equally effective in treating patients who struggled with other specific symptoms of depression, like changes in sleep and appetite. “This paper tries to address more of a symptom-to-patient matching approach so that people are getting antidepressants if they have a symptom profile that might be more responsive to the drug,” said Segal.

In my case, CBT and antidepressants were temporary treatments that helped me bounce back from a bout of depression and develop long-term skills in staying healthy. Each treatment helped me in different ways: CBT helped me build emotional resilience, whereas antidepressant medication gave me the extra energy to ‘get back on my feet’ and return to doing the things I love to do.

But whichever treatment people are prescribed, Segal stressed that depression is treatable. “Whether you have hypertension or depression, it is possible to get treatment.”

If you or someone you know is in distress, you can call:

  • Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
  • Good 2 Talk Student Helpline at 1-866-925-5454
  • Ontario Mental Health Helpline at 1-866-531-2600
  • Gerstein Centre Crisis Line at 416-929-5200
  • U of T Health & Wellness Centre at 416-978-8030.

Warning signs of suicide include:

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious, agitated, or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.

The promise of ketamine in overcoming treatment-resistant depression

Therapeutic potential of ketamine discussed in review by U of T medical researchers

The promise of ketamine in overcoming treatment-resistant depression

Content warning: Discussions of suicide in the context of treating major depressive disorder.

Ketamine is a promising medication that brings hope to patients struggling with severe depression, offering potential therapeutic effects for those who are non-responsive to standard antidepressants.

The dissociative anesthetic is currently used by physicians and veterinarians to cause fast-acting insensitivity to pain during medical procedures. It is also used illicitly as a recreational drug, causing feelings of disconnection and relaxation among users.

Yet in controlled settings, ketamine also shows potential as a medication to help patients who are suffering from major depressive disorder. In April, a research review by U of T researchers found that ketamine offers significant effects as an antidepressant.

The lead author of the paper, Dr. Joshua Rosenblat, discussed the review’s findings with The Varsity. As a clinician-scientist in the Department of Psychiatry, Rosenblat is currently studying the antidepressant effects of ketamine.

He explained three major effects that differentiate ketamine from standard antidepressants: a different mechanism of action, a rapid onset of effects, and a response in patients who are not positively affected by commonly prescribed antidepressants.

Ketamine affects depression via a novel mechanism of action

For the past several decades, standard antidepressants have worked by affecting levels of serotonin, norepinephrine, and dopamine, explained Rosenblat.

In generalized terms, serotonin is a chemical messenger thought to regulate mood, while norepinephrine controls alertness and arousal. Dopamine affects attention and emotion.

But ketamine affects the brain differently. Rather than targeting these neurotransmitters, it instead changes levels of glutamate – the main excitatory messenger in the brain.

Ketamine’s unique mechanism of action could therefore explain why it may positively affect patients suffering from treatment-resistant depression, who do not respond to standard antidepressants.

Ketamine could provide a more rapid onset of affects, versus standard antidepressants

Ketamine also provides a rapid onset of effects. Standard antidepressants, said Rosenblat, usually take two months of prescribed usage to take effect.

He explained that with ketamine, alleviation of depressive symptoms can appear within two hours of consumption. This is especially promising as an option for patients suffering from suicidal thoughts.

A decrease in suicidal thoughts can plausibly reduce the number of suicidal attempts; however, Rosenblat noted that the evidence is currently too limited to make a conclusion. He explained that studies are lacking, as only a small percentage of patients affected by such thoughts attempt to commit suicide.

Ketamine could also be used for special applications. Depression is very common among patients facing terminal cancer, explained Rosenblat.

“If you were to start them on an antidepressant and they only have one month left to live, for example, [the patients may] only experience the side effects, and never get the benefits.”

Rosenblat is currently leading a clinical trial at Princess Margaret Hospital to research the use of ketamine for improving the final months of life for patients affected by terminal cancer.

The risks and drawbacks of ketamine as an antidepressant

While the prospect of applying ketamine for treating depression is promising, there are several discouraging factors to its application.

To start, ketamine carries the risk of substance abuse. While ketamine is not strongly addictive, said Rosenblat, recreational users of the drug can develop a dependence.

Ketamine may also be prohibitively expensive for potential patients, as it is not covered by OHIP. Furthermore, as a medicine that is only available for research study or private use, it cannot currently be prescribed by most physicians.

There are also limited studies on the rare side effects of ketamine. In the short-term, the main known side effects are disassociation, a daydream-like state, and nausea which may occur during the administration of ketamine.

“We don’t know what we don’t know,” said Rosenblat. It is unclear whether ketamine may cause rare, adverse reactions in some patients. Long-term side effects of ketamine are also unclear.

Rosenblat therefore does not encourage self-medication for U of T students suffering from mental health challenges, as ketamine is not sufficiently studied.

Only a “very small percentage” would likely positively benefit from ketamine, explained Rosenblat, compared to standard treatment options supported by a much wider body of research.

The future of ketamine research

Although ketamine is not fully studied and is currently only used in special situations, it still brings “a message of hope,” said Rosenblat.

While ketamine is still not approved as an antidepressant, the U.S. Food and Drug Administration has approved esketamine, a structurally similar compound, as a nasal spray antidepressant. This became the first antidepressant of its kind to be used in the United States.

While Rosenblat notes that much more future research needs to be done with ketamine, he agrees that preliminary results are “very promising.” With a new avenue of research in treating severe depression, the future of research in the field seems optimistic.

U of T receives $20 million for depression research

Research to focus on biological causes of depression

U of T receives $20 million for depression research

The Labatt family has recently donated $20 million to U of T to support research into biological causes of depression. This field is regarded as the next frontier of depression research.

The donation has been used to create the Labatt Family Network for Research on the Biology of Depression, which also involves the Centre for Addiction and Mental Health (CAMH) and the Hospital for Sick Children (SickKids), both of which are partners of U of T. The network has established two chair positions at U of T with links to these institutions to further research.

Professor Benoit Mulsant of U of T’s Department of Psychiatry is serving as the inaugural Labatt Family Chair. According to Mulsant, the donation will fund more academic fellowships, help attract talent to U of T’s clinical research effort, and enable mentor residency opportunities. Mulsant’s research primarily focuses on the treatment of elderly people with severe mental disorders. He is also a Clinician Scientist at CAMH’s Campbell Family Mental Health Research Institute.

In Canada, mental health-related research at large receives about one third of the money that is invested in cancer-related research. From 2008–2015, the Canadian Institute of Health Research invested about $44.7 million a year in mental health-related research, compared to $133.8 million a year for cancer-related research.

A myriad of biological factors can result in mood changes and trigger mental health issues. In the human body, the nervous system, the endocrine system, and the immune system work in tandem, and any changes to these could result in behavioural changes that may manifest as depression or other mental health disorders. These changes can be wrought by physical stressors, like changing seasons, or psychological stressors, like abuse.

In 2007, the Labatt family donated $30 million to SickKids to support the Brain Tumour Research Centre and establish the Labatt Family Heart Centre, a facility dedicated to heart research, cardiology, and providing care for children with congenital heart disease.

Depression changes the brain over time

Research from CAMH calls for different approach in therapeutic treatment

Depression changes the brain over time

A recent study by researchers at the Centre for Addiction and Mental Health (CAMH) showed that the brain changes with the progression of depression, suggesting that depression needs to be treated differently at every stage of the illness.

The team, led by Dr. Jeffrey Meyer, showed that people with longer periods of untreated depression — defined as lasting more than a decade — had significantly more brain inflammation compared to those who had less than 10 years of untreated depression.

This study is the first in its field to show biological evidence for how the brain changes in persistent depression. Consequently, it reveals that depression is not a static condition but is instead a degenerative brain disease like Parkinson’s or Alzheimer’s.

They examined how the total distribution volume of translocator protein (TSPO), which is a marker of microglial activation, correlated with the duration of untreated major depressive disorder, total illness duration, and antidepressant exposure.

It was important to study microglial activation, because microglia are involved in the brain’s normal inflammatory responses to trauma or injuries. However, too much inflammation has been associated with degenerative illnesses as well as depression.

Participants from the age of 18–75 were recruited for the study. They were from the Toronto area and CAMH, and they either had major depressive episodes or were healthy. This research was supported by the Canadian Institutes of Health Research, the Brain and Behavior Research Foundation, and the Neuroscience Catalyst Fund.

Using the Positron Emission Tomography, the researchers scanned three primary grey matter regions of interest and 12 additional regions to measure the total distribution volume of TSPO. The researchers also investigated the duration of untreated major depressive disorder, and the combination of total duration of disease and duration of antidepressant treatment.

The research found that the TSPO levels were about 30 per cent higher in different brain regions among those with long-lasting untreated depression, compared to those with shorter periods of untreated depression. The group with long-term depression also had higher TSPO levels than those with no depression.

“An implication of our study is that the current approach for antidepressant treatment isn’t addressing the issue that the illness is changing over time,” said Meyer.

Currently, no matter how long a person has had depression, they are treated with the same approach at every level. Meyer advocates that treatment methods should address the illness differently as it progresses.

However, there is still a lack of evidence in how to treat depression in its later phases. “People can certainly respond to treatment after not responding to previous treatments, but the rate is lower so clinical trials often exclude people who have not responded to a few previous treatments,” said Meyer.

“We are testing whether current treatments for other illnesses could be applied in depression to influence inflammation to make it more curative. There are also new treatments being developed by companies for depression for the same intent,” said Meyer.

Meyer noted that one study is not enough to change the treatment, but he is hopeful that their work will have this impact soon.

Science in brief

A round-up of the top science stories from around the university

Science in brief

Dangerous driving

What may seem obvious to any good driver can now be backed up by statistics: dangerous drivers are more likely to hit children on their way to school.

Researchers from York University, the University of Toronto, and The Hospital for Sick Children camped out in front of schools during their morning drop-off hours, measuring pedestrian traffic and scanning the road for hazardous driving habits. Their observations were compared with 12 years of police data on pedestrian-motor vehicle collisions (PMVCs) near Toronto elementary schools. The study revealed that collisions involving children happen more often near schools with dangerous driving trends.

The most common offense? Of the 118 schools studied, 88 per cent displayed instances of unsafe parking and improper drop-offs, such as children being released from the wrong side of the street. Trends were higher in schools near high-speed roadways. Researchers urge the city to employ new strategies to alleviate traffic around school zones.

— Alastair McNamara


Study shows depression affects alertness more than lack of sleep

A new study lead by Azmeh Shahid of the Sleep Research Laboratory in U of T’s Department of Psychiatry is the first of its kind to connect depressive symptoms with impaired alertness.   

The researchers used the Toronto Hospital Alertness Tests (THAT), a scale asssessing alertness, to evaluate 60 healthy adults against 264 diagnosed patients. The participants’ average score (on a scale of zero to 50) was around 35 for the control group. A score below 20.5 is the cut-off point for THAT and it indicates “clinically significant” decreases in levels of alterness.   

This cut-off was used to define the patients as either having “normal” or “impaired” alertness. The results showed that daytime sleepiness is not the same as poor alertness, and that depressive symptoms like fatigue had a stronger effect on alertness levels than tiredness. 

Dr. Shahid said the results of the study “did not surprise” the research team, as other clinical patients have been observed to experience daytime sleepiness and alertness at the same time. 

Dr. Shahid explained the results of the study are “very exciting” because THAT can be used to differentiate alertness from sleepiness, which can aid in future studies. The first quantitative definition of “normal levels of alertness” was proposed by the study, but more research is still needed to solidify this definition. 

“I think this will have huge impact in clinical practice,” Dr. Shahid added.

— Sophia Savva 

Don’t Worry, Be Happy

With the loonie sinking and the world economy sputtering, it is hard not to worry about world issues. A new study warns against worrying too much, lest our brains turn to mush. 

Dr. Linda Mah of the University of Toronto and her colleagues examined recent studies of stress and anxiety in animal models and healthy individuals. Surprisingly, they found that chronic stress and anxiety can cause long-lasting damage in the brain.

Stress is a normal part of life, but if anxiety becomes chronic, it can lead to the degeneration and impairment of the brain’s hippocampus and prefrontal cortex. The former is known to play an important role in memory and the regulation of emotions, while the latter has been associated with personality distinction.   

The stress-induced damage to these parts of the brain leads to increased risk for depression and even dementia. 

The study concludes on a hopeful note by suggesting that stress-induced damage is “not completely irreversible.” Antidepressant treatment and physical activity may reverse brain damage, as these treatments have been found to increase the rate of hippocampal recovery. Either way, don’t worry about your worrying.

— Hariyanto Darmawan