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.

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.

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.

On September 24, a video surfaced that appears to show UTSC psychology professor Steve Joordens playing a pornographic video on the projector screen by accident.

The incident, which apparently took place at the start of the lecture, was recorded by one of the students in the class via a Snapchat video and subsequently posted onto Reddit, where, along with many memes made about the event, it instantly went viral.

“When I saw the [pornographic] video, I was surprised,” the original poster, a first-year student studying Philosophy, wrote to The Varsity.

“I was not expecting that especially this early in the morning… I found the whole situation funny and he made a lot of people laugh. ”

The class, which was reportedly PSYA01 — Introduction to Biological and Cognitive Psychology, had about 500 students in the lecture hall. As seen in the video posted by the student, many students in the class were laughing, though others could be seen walking out of the room.

In a statement to The Varsity, Joordens wrote, “With respect to the event that happened prior to my class on Monday the 24th, I want to be clear that what happened was completely unintentional and I feel absolutely terrible about it.”  

“I have apologized to my class and now I want to move on. Thanks to my students, colleagues and my amazing family for their support and understanding.”

Don Campbell, Media Relations Officer at UTSC, told The Varsity in a statement that the university is aware of the incident and are looking into it, but that they can’t discuss personnel matters.

“We encourage students who may be feeling unsettled by the incident to speak with their registrar or staff at the Health & Wellness Centre,“ Campbell said.

Joordens started teaching at UTSC in 1995. Since then, he has won numerous teaching awards including the Canadian Post-Secondary #EdTech Professor of the Year in 2017 and the 3M National Teaching Fellowship in 2015.

“Everyone makes mistakes so I can’t blame him,” said the student who posted the video. “I hope nothing bad happens in the future and this can just be a thing to laugh about, I hope his job isn’t affected or anything in his personal life either.”

Editor’s Note (September 25, 2:10pm): This article has been updated to include a statement from UTSC.

Editor’s Note (September 28, 12:20pm): This article has been updated to include a statement from Joordens.

I am sitting at my maternal grandmother’s house in New Delhi, India. Masi, my aunt, has prepared a dish for me that she promises I will love. I don’t particularly like surprises, but I wait outside the kitchen.

I catch a whiff of something sweet. I can’t place it but it’s familiar. I close my eyes and I know it’s a smell from my childhood. Then it hits me. My Masi is making an Indian confection called almond halwa using my grandmother’s recipe.

This connection that I made — that we all make — between odour and memories, is explained in a study published in Nature Communications. The study, led by Afif J. Aqrabawi, a PhD candidate in the Department of Cell & Systems Biology at U of T, sheds light on this connection and how it could help develop new diagnostic tests for Alzheimer’s disease.

The hippocampus (HPC) is essential to episodic memory. It organizes memories of sensory events, including smell, in terms of space and time. The HPC stores the condition of the brain when said events take place, and then retrieves and recreates cerebral cortex activity of the original memory’s context when we encounter the sensation again.

The anterior olfactory nucleus (AON) is the largest source of feedback projections in the olfactory cortex, and the anatomical junction where the connection between olfactory and contextual information is made. HPC projections into the AON can alter the way smells are perceived and what behaviours are associated with specific odours.

Aqrabawi and Department of Psychology Professor Jun Chul Kim had determined that inputs from the HPC to the AON are necessary for the retrieval of odour memory based on spatial and temporal contexts. They knew the AON played a role in connecting spatial and olfactory events, but they did not know the exact function of the AON-HPC junction.

Thereafter, Aqrabawi and Kim found a neural pathway between the HPC and AON and they were able to define its role in memory retrieval. This pathway is responsible for contextual retrieval of odours and is affected in patients with Alzheimer’s.

In the study, mice whose AON-HPC junction was blocked kept returning to investigate the same scent even after being exposed to it several times prior. This was an indication that the AON plays a significant role in memory retrieval.

On the other hand, mice whose junctions were left to function normally spent less time smelling familiar odours because of the episodic memories associated with them. Inhibition of the HPC-AON pathway results in a loss of the odour memory linked to a given context in space and time.

This is the first study that demonstrates that inputs from the HPC to the olfactory cortex are necessary for forming and retrieving episodic odour memories. Findings from the study also show that the anatomical location of AON behind the olfactory bulb is an ideal bridge between olfactory and contextual information.

Multiple studies have reported a loss of olfactory function in Alzheimer’s patients. In fact, diagnostic smell tests are currently used to detect the earliest symptoms of the disease. This olfactory dysfunction is due to the neurodegeneration of the AON, which stores episodic odour engrams, during the early stages of Alzheimer’s disease.

Future research involving these findings will likely aim to better understand the connection between smell and memory, and particularly the neural circuits involved in this association.

A new study by U of T PhD Student Ping Dong and Assistant Professor Spike W. S. Lee posits that hand wipes may be used for more than on-the-go cleaning. Their research, published in the Journal of Experimental Psychology earlier this year, revealed that physical cleansing reorients goals and shifts priorities.

Dong and Lee investigated four different groups ranging from 103 to 242 undergraduate students. The subjects were divided into two categories: those who were given hand wipes and those who were not. Both groups were primed to focus on certain goals by completing word games or short surveys.

The results of these four experiments demonstrated that the use of hand wipes made prior goals seem less important than subsequent ones. “This research extends the logic of previous studies showing that physical cleansing can reduce the influence of numerous psychological experiences,” Dong wrote in an email to The Varsity.

Dong and her colleague had observed certain behaviours relating to hand cleaning that inspired them to conduct this research. “Wash their hands, and people feel less guilty about their immoral behavior… Use some soap and people feel like they’ve washed away their good luck from their winning streak in gambling.”

“Our conceptual hypothesis was that there’s one common mechanism underlying all these different cleansing effects across domains,” Dong explained. “Specifically, cleansing should function as what we call an ‘embodied procedure of psychological separation.’”

Physical cleansing detaches traces, such as dirt, from target objects, like hands. This resembles the psychological separation of previous experiences from the present self. Dong and Lee’s research provided evidence supporting this theoretical account in the context of pursuing goals.

Their paper, unlike its predecessors, shows “that a bodily experience like cleansing not only activated metaphorically associated concepts like morality, but functions as a highly domain-general procedure.” This means that cleansing is not specific to physical domains, but also influences psychological ones.

The research predicts that using hand sanitizers, wipes, or other forms of physical cleansers will ease the switch between tasks that require different mental procedures. “[People] become less influenced by past primes but more influenced by future ones,” Dong said.

The study has some limitations, according to Dong. The participants were solely undergraduate students, rather than the general public. The importance of goals was measured immediately after physical cleansing so the short-term nature of the experiment may have also restricted its results. Long-term effects were not examined.

Dong, who will join Northwestern University’s Kellogg School of Management as an assistant professor of marketing in September 2017, emphasized that in business settings or organizations, both the managers and employees must often shift between several goals.

“Little help is available from empirical work, as it has yet to identify any temporary manipulation for enhancing [the] ability [to shift between multiple tasks],” she said. “Given what we found, we suggest that physical cleansing may be a handy way to help people adjust their goal pursuit effectively.”

The sixth annual Mind Matters conference, hosted by U of T’s Buddhism & Psychology Students’ Union in conjunction with the U of T Jungian Society, took place last Saturday morning at Victoria College’s Isabel Bader Theatre. Titled “Altered States,” this year’s event brought a group of reputed scientists and thinkers together to engage in a lively intellectual discussion on the implications of psychedelics in medicine and psychology. 

The psychology conference, which attracted a full house audience and required almost 40 staff to organize, is the largest of its kind in Canada. Despite the packed house, Ammar Ijaz, one of the many student organizers, described it as a “community” gathering.  General admission tickets for the event sold out within six hours of being made available, while the supply of student tickets was exhausted after thirteen minutes.

Panelists for the event included Professors Dan Dolderman, John Vervaeke, and Jordan Peterson, all prominent thinkers in the field of psychology. American ethnopharmacologist Dennis McKenna joined the U of T lecturers on stage. The focus of this year’s conference revolved around altered states of consciousness. Topics of discussion included psychedelic medicine, meditation, lucid dreams, trance states, and mystical experiences.

The award winning lecturer, Professor Vervaeke, who is a five-time veteran of the conference, opened the conference with an exploration of what he described as the “meaning crisis of modernity.” Vervaeke invoked and interpreted the likes of Friedrich Nietzsche and other philosophers by way of delivering his point, observing a fundamental difference between wisdom and knowledge, ultimately concluding, “knowledge is about overcoming ignorance, wisdom is about overcoming foolishness.” He ended his presentation to a round of applause with an endorsement of the pursuit of altered states of mind for their potential to enhance human understanding and consciousness.

Professor Dolderman picked up after a brief intermission and schedule change. “This talk,” he said, “is a call to awakening … a call to battle” he exclaimed. “There is no altered state,” he said. “I’m not interested in ethics or morals. I’m interested in how I experience the world;” adding that, “we feel first, then reason later [but we] don’t feel deeply enough.” 

By listing a series of everyday interactions with seemingly mundane ideas and objects such as steaks, eggs, the War on Terror, and the economy, Dolderman argued that, “what we experience isn’t exactly the real world. Not experientially but rather simply intellectually.” Steaks do not magically become slabs of meat on our dinner plates. Rather, the reality is the mistreatment of cows. Wars are as connected to freedom and liberty as they are to death, he observed.

The speakers each presented academic theories on the potential of psychedelics in psychology and medicine, informed by current research and elucidated through term definitions and analogies, to a visibly engaged audience. Discussion on stage was supplemented with lively social media engagement, moderated by a dedicated team of volunteers, through the use of an official Mind Matters Twitter hashtag,

The event was initially supposed to consist of five speakers with intermissions for coffee, a provided lunch, and an interactive panel discussion. Unfortunately, a slight change of schedule was required since one of the speakers, Lee Maracle, fell ill and was unable to attend.

In a post-event interview, an exhausted, but pleased, Ijaz described some of the challenges he faces every year in organizing the conference. “Funding is always a big challenge.” This year, they were able to crowd fund a quarter of the projected conference costs. They were also successful in acquiring sponsorship for subsided student tickets.

Ijaz expressed his surprise at how quickly the event sold out. They had hoped to find a venue for 1,000 attendees, but were unable to find the necessary funding. He also drew attention to the conference organizers’ efforts to bring a broad range of perspectives to the selection of the event’s speakers after a comment on Twitter criticized the conference’s lack of visible diversity.  “We strive for incredible diversity,” noted Ijaz, though he conceded that, despite their best efforts, the event fell a “little bit short of the mark.”

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Editor’s Note (March 10th, 2016): An earlier version of this article misattributed a quote to David Taylor.