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.

Op-ed: Effective mental health advocacy is needed at U of T

A March summit hosted by Jack.org U of T calls upon students to promote positive change

Op-ed: Effective mental health advocacy is needed at U of T

Jack.org U of T is hosting its first annual regional mental health summit on March 24. The summit, titled “Impact,” will bring postsecondary students from across the GTA together with experts across mental health fields. The goal of this summit is to build skills and relationships in the spirit of furthering mental health advocacy and learning how to advocate effectively.

Numerous conversations surrounding mental health issues are becoming more prevalent in the current cultural consciousness. They are part of our University of Toronto culture, like the recent discussion surrounding the university’s mandatory leave policy, and they are part of Canada’s national culture, with programs like Bell Let’s Talk growing yearly across the nation.

As laudable as the efforts have been to bring about change in our communities, what we are doing is not yet equal to the task at hand. The need for effective mental health advocacy right now is crucial. Still, there are students with mental illnesses who suffer silently, who walk past primary care facilities with signs that read “accepting new patients” — but the signs aren’t offering mental health care. These illnesses may lead to crisis or even death, and while patients wait for months to see someone, the common cold can be treated 365 days a year on a walk-in basis without the need for a referral.

This is but one symptom of an issue that at times can seem vaster than empires. There are issues of stigma both structural and social that make it hard to even discuss mental health, whether in the context of illness, or even in the context of how individuals should care for their mental health. Jack.org is dedicated to abolishing these stigmas through education and empowering youth leaders to improve their communities.

The “Impact Summit” is one way we seek to do this. We aim to bring students and mental health experts together in a communal learning environment, in the hopes of developing and improving the conversations that we are already having in order to more effectively bring about desperately needed social change.

“Impact” will be the largest student-led summit of its kind in Canada, open to 200 postsecondary students across the GTA. The summit’s theme is effective mental health advocacy, and it will feature skills workshops, a panel of individuals that have pioneered mental health initiatives in our community, a keynote address from U of T’s Psychiatrist-in-Chief of Health & Wellness, and a collaborative case competition. The full details are listed on our chapter website, jackchapteruoft.org.

Join us on March 24 and help us drive effective and positive change within our community. Let us alter attitudes about mental health — not just for the one in five, but for everyone.

Sean Smith is a fourth-year student at Woodsworth College studying English, Philosophy, and Writing and Rhetoric. He is the Chapter Lead of Jack.org U of T.

UTM event promotes open conversations on mental health

Let’s Talk UTM includes resource fair, multimedia exhibits

UTM event promotes open conversations on mental health

Coinciding with the annual Bell Let’s Talk Day, UTM’s Health and Counselling Centre hosted Let’s Talk UTM Day on January 31, a campus initiative to open the conversation around mental health.

#BellLetsTalk is a national social media campaign run by Bell Canada to encourage discussion of mental health issues. Let’s Talk UTM is the first campus-wide initiative of its kind at U of T; the University of St. Michael’s College also hosted a Bell Let’s Talk event on January 31.

The Let’s Talk UTM event featured a mental health resource fair and multimedia exhibits promoting open dialogue around mental health. The event also offered free coffee, self-care bags, and Bell Let’s Talk toques.

Designed for accessibility, the event was stationed in the CCT atrium from 10:00 am to 4:00 pm and attracted a steady stream of students all day.

Let’s Talk UTM was organized with the help of student wellness ambassadors, who were there to provide information on mental health resources, including the Canadian Mental Health Association, Jack.org, the Centre for International Experience, Career Centre, and Accessibility Services. A mental health nurse, dietician, and counselor from the Health and Counselling Centre were also present to speak to students.

Organizer and UTM health education coordinator Ravi Gabble told The Varsity that these experts were at the event because it was important to adopt a holistic approach to talking about mental health, saying that it “intersects with all these different areas.”

“They recognize that, so they’re out here to provide information to students about the different services and resources available to students on campus,” said Gabble.

At the core of the event was a photo exhibit called The Stories of Resiliency, which served to showcase student, staff, faculty, and alumni participants’ stories of overcoming mental illness.

According to Gabble, “The biggest message we want people to take away is that you’re not alone, that everybody has mental health struggles. It’s supposed to be inspirational and really emphasizes resiliency as a skill.”

“We realize there’s a stigma to mental health,” organizer and wellness ambassador Ogogho Ajari told The Varsity. “Essentially with this campaign we open that ground for conversation, make it easy for someone to talk about what they’re going through.”

While organizers intended to leverage the now nationally recognized day for mental health, they expressed hopes that the conversation will continue long-term.

“We always saw this as a year-long thing,” said Gabble. “We’re going to continue to populate the Stories of Resiliency photos throughout the year and share them over social media and then probably build up again towards 2019.”

The truths and myths of Blue Monday

Although recognized as pseudoscience, the phenomenon sheds light on SAD

The truths and myths of Blue Monday

The holiday cheer has finally worn off and we find ourselves in the most bleak time of the winter season. According to former Cardiff University lecturer Dr. Cliff Arnall, there are certain factors that make the third Monday in January the most depressing day of the year.

Arnall determined this date, dubbed ‘Blue Monday,’ through a series of mathematical calculations that take into account other potential causes of a dismal day. These include the arrival of post-holiday credit card statements, broken new year’s resolutions, and the age-old distaste for Mondays. But the calculations behind Blue Monday have been criticized for being pseudoscientific.

Arnall was commissioned to develop his equation by a British travel agency in 2005 and was tasked with determining when people were most likely to book a summer holiday — the rationale behind this being that people are more likely to book a summer vacation when sad.

While the factors that Arnall used in his equation are depressing truths, there is hardly scientific legitimacy to one day of the year being more depressing than all others. As useful as it would be to see depression coming from a mile away, the illness is too complex to be predicted in such a way, and Arnall’s mathematical jargon is useful only as a marketing gimmick. Still, the entire concept is not a complete myth, as there is one component with some merit that deserves attention: winter weather can cause mood fluctuations — and this can be serious.

Seasonal affective disorder (SAD) — colloquially dubbed ‘winter depression’ — is a mood disorder subtype that many understand to be a result of the colder weather. “There are [biological] theories as to why that is… which have to do with some people having a brain that is more wired to be sensitive to changes in light,” said U of T psychiatry professor Ari Zaretsky.

It has been hypothesized that serotonin levels are affected by light and that during the wintertime, the system is insufficiently activated due to decreased sunlight hours. The consequently lowered serotonin levels can lead to unregulated moods and depressive episodes.

Zaretsky explained that the occurrence of SAD can vary based on geography: approximately one per cent of Florida’s population develops SAD in the fall and winter, whereas almost nine per cent of the population in areas such as Yukon or Alaska experience it. For Toronto, the number lies at three per cent.

Light therapy is a common treatment method for SAD, which involves exposure to a light that gives off the same wavelength as sunlight for a minimum of 20–60 minutes each day, preferably in the morning.

Treatments for this disorder, unlike its causes, are not strictly biological.

Psychological and behavioural interventions are just as effective — Zaretsky pointed out that patients participating in cognitive behavioural therapy developed specifically for SAD have demonstrated significant improvements. “It’s important to recognize that just because something has a biological basis doesn’t mean that psychological interventions or behavioural interventions can’t make a difference — they can.”

There is a misconception that SAD is not as distressing as classical clinical depression, and myths like Blue Monday can perpetuate these flawed assumptions. Critics of the Blue Monday phenomenon have become more vocal about their concerns, fearing that it is skewing public knowledge of mental health and discounting the gravity of depression.

“I think [Blue Monday] develops a life of its own because there is a kind of fundamental truth to the fact that people find it difficult to face day upon day of darkened lighting circumstances,” said Zaretsky. “It’s almost like something that becomes part of the culture through media [and] advertising.”

Being faced with yet another year of companies capitalizing on bad science, there is hope that Blue Monday might at least generate conversations about and bring awareness to mental health.

Breaking down the University-Mandated Leave of Absence Policy

The proposed policy gives sweeping powers to university administration with few accountability mechanisms and little student input

Breaking down the University-Mandated Leave of Absence Policy

It’s time to talk about the new University-Mandated Leave of Absence Policy. The policy, which originated as a response to the Report of the University Ombudsperson 2014–15, gives U of T administrators unprecedented power to unilaterally place students with mental health issues on an involuntary leave of absence. This power can be invoked in virtually any situation where a student is struggling, academically or personally, and by Divisional Heads, registrars, and other administrative staff without the consent of the student and, in many cases, without their input.

This policy has drawn the ire of students, mental health awareness groups, and campus organizers, and these are only some of the many concerns expressed by students in the past few weeks.

The Report of the University Ombudsperson 2014–15 highlighted the problematic use of the Code of Student Conduct, a punitive policy, to address scenarios in which students suffering from mental wellness issues were causing direct harm to themselves or others. The report recommended the creation of a separate policy to address these situations without officially suspending students under the code.

There is an inherent tension between the principles that inform this policy. The Ombudsperson’s report highlights that “the right to personal autonomy, self-determination and dignity is as significant for people with mental health disabilities as for others, and must be respected.” At the same time, the Ombudsperson affirms the right of the university under Bill 168 to “protect the safety of its staff and students by excluding a person from campus.” These are necessarily exclusionary practices: the university treads on the right to personal autonomy and self-determination each time they remove a student against their will.

Furthermore, the current writing of the policy extends far beyond the extreme cases in which Bill 168 already permits the university to intervene.

Under the policy, there are two ‘scenarios’ in which a university-mandated leave of absence can be applied. Scenario one deals with students who pose “a risk of harm to self or others, including but not limited to a risk of imminent or serious physical or psychological harm.” Scenario two deals with students who are “unable to engage in activities required to pursue an education at the University notwithstanding accommodations or supportive resources that may be available,” even if they are not at any risk of direct harm.

This second scenario is absolutely unnecessary. If this policy is meant to deal only with the most extreme cases, as recommended by the Ombudsperson’s report, then the first scenario already accomplishes that. The addition of the second scenario is either a case of reckless policy overreach or a deliberate attempt to place conditions on the autonomy of students.

There is genuine cause for concern about the second scenario. The phrase “unable to engage in activities required to pursue an education at the University” could theoretically extend to virtually any student dealing with depression, anxiety, low motivation, or a handful of other symptoms of mental illness. There is no clarifying language present in the policy, which gives full discretion to administrative staff in how to interpret it. The second scenario provides the university with a unilateral mechanism for removing struggling students from their academic and social activities.

This approach could also lead to students’ aversion to engaging with deans, registrars, or mental wellness liaisons within college and divisions. The policy does not set any guidelines for when administrative personnel should inform the Division Head about a potential case. This leaves the student in flux. If a student is cognizant of the fact that their registrar or supportive staff may, immediately after hearing their concerns, forward them to a Divisional Head for the purposes of considering a leave of absence, they will be less likely to trust administrative personnel or to come to them with concerns about mental wellness.

While many will argue that in practice, administrative staff will not act in such reckless ways, the point is that nothing in the policy prevents them from doing so. This problem is magnified by the fact that there is no requirement that medical professionals be consulted anywhere in the process.

Instead, these major decisions are left in the hands of university administrators, with no requirement that they have even a baseline understanding of mental health issues. The policy allows the Vice-Provost Students to unilaterally appoint a Student Case Manager (SCM) or Student Support Team (SST) to assist with the process. Although these people may include “student service representatives, registrarial personnel, medical professionals, academic administrators, campus safety personnel, campus police or others,” they do not have to be medical professionals or even trained in handling sensitive situations related to mental health.

The student also has no say in determining who will be their SCM or SST. This means that, under the current policy, a group of unfamiliar, potentially non-experts have a large say about whether a vulnerable student gets to continue their education. Further, the policy permits the Vice-Provost Students to delegate the duties of overseeing the cases of students going through the procedure to “their delegate” without specifying who is qualified to serve as the delegate or how they can be held accountable.

Fortunately, the policy is not yet set in stone. Discussion is scheduled to take place at the University Affairs Board on November 20 and then at the Governing Council on December 14. Students can register to speak at these meetings. The St. George Round Table and the University of Toronto Students’ Union are also accepting feedback online or via email, which will be submitted to the Office of the Vice-Provost Students.

Additionally, a grassroots movement has developed in the form of a Facebook group called the Mandatory Leave Policy Response Group, which is compiling a document where students can provide their own analysis line-by-line on the policy. That document will be shared with every member of the University Affairs Board and the Governing Council in advance of their debates on the issue. This group is also planning a series of broad public consultations where students can share their concerns with like-minded peers and organize collective responses.

Students can, and should, voice any concerns about the policy in these venues, as well as directly to registrars’ and deans’ offices. Only by consistently providing the students’ perspective on this policy, in as many forums as possible, can we make it work for students.

Adrian Huntelar is a third-year student at Trinity College studying Peace, Conflict and Justice Studies and Political Science. He is a member of the University of Toronto Students’ Union Board of Directors.

Academic Board issues new report on mandatory leave of absence policy

Last board meeting before policy to go to recommendation stage

Academic Board issues new report on mandatory leave of absence policy

The University of Toronto is currently considering a university-mandated leave of absence policy that would affect students with mental issues that impact their academic engagements or pose a serious threat to themselves or people surrounding them. The university has been considering the policy since 2015, when it was part of the Ombudsperson’s 2014–2015 report.

Among the items discussed at the October 5 Academic Board meeting was the discussion on the leave of absence policy. Vice-Provost Students Sandy Welsh presented the policy.

According to the meeting report, “the proposed Policy was a result of a great deal of consultation and related to the Ombudsperson’s report over the past several years, which had identified the need for a policy like this. The proposed Policy had a built-in mechanism to ensure fair process and provides for a review and appeal.”

The document has circulated through several governance structures for information and discussion, first through the University Affairs Board, then the UTSC and UTM campus councils, and finally the Academic Board. The document will then go through the same cycle for approval before going to the Executive Committee for an endorsement and then the Governing Council.

In an interview with The Varsity, Welsh said that if the Academic Board does not recommend the motion, then it would not go to Governing Council.

Welsh justified the proposed guidelines of the policy, citing precedent in Canada and in the United States. “There are many Canadian and US universities that have this as a stand-alone policy or it’s part of a broader policy around students’ conduct or student issues,” she said.

If the policy were implemented, the financial aid status of students, including whether they receive OSAP, would be taken into consideration when imposing the mandated leave. Consultations between the student, their case manager, and the university’s financial aid office would occur. Similar talks would take place for international students being considered for mandated leave — with their student case manager, they would work with an international student advisor on their case. Students are expected to be actively enrolled in their program of study during the validity of their Study Permit, and they could face consequences during extended mandatory leave of absences.

“What we do know is that a leave may provide more options than a student simply withdrawing from their studies,” said Welsh. “A leave is a way that we’re able to look at what our options to support the international students are while they’re getting the care that they need.”

The university currently uses the Code of Student Conduct for potential leaves of absence. “In urgent situations involving serious threats or violent behaviour, the code allows for a student to be suspended under the interim measures of the clause of the code,” she said. The code is designed to be punitive; the proposed policy is not.

The university currently has no institution-wide leave of absence policy. According to Welsh, the School of Graduate Studies allows students to go on a voluntary leave of absence for reasons of serious health or personal programs. Members of the Faculty of Law and students in the MD program of the Faculty of Medicine wishing to take a leave can request one voluntarily, but requests will only be evaluated on a case-by-case basis and are not guaranteed.

Understanding mental health services at U of T

Students, know your rights

Understanding mental health services at U of T

A 2016 survey conducted by the Canadian Association of College & University Students Services estimated that nearly a fifth of Canadian post-secondary students struggle with mental health. The University of Toronto is certainly not an exception to this; its intense, competitive academic atmosphere can leave students feeling isolated.

The spontaneity of symptoms of mental health issues can make it difficult for students to complete their work on time or plan with professors for adjustments.

Mathias Memmel, President of the UTSU, told The Varsity, “The administration’s primary focus is academic excellence, sometimes at the expense of students’ well-being. U of T was one of the last universities to start taking mental health issues seriously.” Memmel added that things are slowly improving, but the university’s “instutitional priorities” remain a barrier.

U of T is obliged to follow the Accessibility for Ontarians with Disabilities Act, and it has committed itself to following the Ontario Human Rights Commission’s guidelines on accessible education. Internally, the university’s Statement of Commitment Regarding Persons with Disabilities states that “the University will strive to provide support for, and facilitate the accommodation of individuals with disabilities so that all may share the same level of access to opportunities, participate in the full range of activities that the University offers, and achieve their full potential as members of the University community.”

If you are a student struggling with your mental health, you are guaranteed fundamental rights to make education accessible. The following rights represent only a portion of those afforded to you.

You have the right to register with the Accessibility Services office on your campus. While you are required to provide documentation of your disability and its related functional limitations, you do not need to disclose your specific diagnosis to instructors.

You may have the right to make-up tests, extensions on coursework, alternative evaluation formats, and exam rescheduling. These adjustments are made on a case-by-case basis depending on your condition and recommendation from documentation from health providers.

You have the right to use service animals and support persons on campus. Possible exceptions are service animals being prohibited from areas where food is stored and served, and when their presence endangers another person’s health and safety.

You have the right to access Health and Wellness Centre services, which include individual psychotherapy, pharmacotherapy, and group therapy. Students with disordered eating also have the right to access a dietician on campus.

Finally, whether or not you have accessibility needs, you have the right to file a petition for extensions on term work and final exams or for other special circumstances. UTM and UTSC students can file with their registrar offices, and UTSG students can file with their faculty. If your petition is denied, you have the right to appeal.

For students who feel their rights have been violated, the Office of the Ombudsperson serves as an impartial, confidential, independent, and accessible third party. They analyze problems, identify possible solutions, and provide advice on how to proceed.

Memmel mentioned the UTSU’s recently-launched online help desk service, which aims to connect students to the right resources and provide one-on-one consultation for any academic, financial, or service issues they may experience.

Additionally, the Association of Part-Time Undergraduate Students (APUS) has formed a mental health coalition with the goal of presenting “a more student-focused and holistic set of recommendations to the University to address student stress and distress, and to advocate for better resources and supports for students.” Both the University College Literary and Athletic Society and the UTSU have mental wellness commissions, and the engineers’ Skule has a director dedicated solely to mental health initiatives for students in its faculty.

For crisis situations, more information on resources, or advice on dealing with mental illness, students can access Good2Talk, a helpline dedicated to student mental health, open 24 hours per day, 365 days per year.

Disclosure: Joshua Grondin is the Associate to the Vice-President External at the UTSU.

Students with mental health issues may be subjected to mandatory leave

Policy drafted for situations of deteriorating academic performance, harmful behaviour

Students with mental health issues may be subjected to mandatory leave

A proposed university-mandated leave of absence policy is currently being considered for students who, due to mental illness, display significant impairments in their academic performance or aggressive behaviour toward themselves or others.

This process, currently described in a draft policy, would only occur if supportive resources and other accommodations were not available to the student or were unsuccessful.

The university has been considering the policy “for a few years” according to a Governing Council memo. Its importance initially emerged in the Ombudsperson’s 2014–2015 report. If the Executive Committee endorses the policy on December 5, then it will go before Governing Council on December 14 for approval. The administration expects the policy to be implemented starting in January 2018. The policy will apply to all domestic and international students.

Discussions with registrar’s offices, academic administrators, deans of students, health, wellness and counselling staff, faculty, and student groups are ongoing; revisions of the current draft will be based on the feedback received.

According to the draft policy, if a student’s behaviour requires intervention, the academic division heads will notify the Vice-Provost Students, who decides whether to apply the policy. “I really expect that, if it’s used, it would be used only a very small number of times, in a given year,” said Vice-Provost Students Sandy Welsh.

The student will be encouraged to seek a voluntary leave of absence. “The hope is that the student will be in a position to be well enough and be working with us to consider a voluntary leave,” said Welsh. She added that if the student does not agree to go on a voluntary leave and the university still has concerns regarding their mental health, the mandated leave will be applied.

Welsh emphasized that the mandated leave is not punitive or disciplinary; rather, it is a policy of last resort. However, the mandated leave policy allows the student in question to appeal the Vice-Provost Student’s decisions to the University Tribunal’s Discipline Appeals Board.

The policy also cannot be applied to students who already have a treatment plan and are able to attend and participate in their classes.

Both mandatory and voluntary leaves of absence have terms and conditions that may include any limitations to the student’s access to campus premises or activities, the addition or removal of any notation of the student’s academic transcript, financial implications, alternative housing arrangement if the student lives in a university residence, consideration of the student’s access to a campus Health and Wellness Centre, and a verification that it is safe for the student to return.

The applicability of terms and conditions of the voluntary leave would be recommended by the student support team, usually comprised of representatives from the student’s program, registrar’s office, and other on-campus support and resources. They are then agreed to by the Vice-Provost Students.

The student will also be assigned a case manager involved in the recommendation of the terms and conditions, responsible for supporting the student, providing them with resources, and facilitating between them and the university.

The policy allows the university to implement the leave more efficiently and grants the student more access to the help they need. In the past, U of T used the Code of Student Conduct to enforce the leave; Welsh believes that its use is a disciplinary policy and is not appropriate if students have serious mental health issue.

“We’re very impressed with the policy,” wrote Mathias Memmel, President of the University of Toronto Students’ Union. “We’ve discussed it at length with the Vice-Provost, Students, and the university has implemented many of our suggestions.”

Although Memmel stated that the policy is “clearly a very positive development,” he believes that the decision to mandate the leave should only be made in consultation with a medical professional. He also suggested that the university produce two guides to the policy: one specifically for medical professionals and one for students.