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Does breath-holding cause permanent brain damage?

Does breath-holding cause permanent brain damage?



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My question is: Does voluntarily holding your breath at atmospheric pressure for a few minutes can cause brain damage? I'm talking about periods of time around 3 minutes.

I've read there are some studies showing brain damage in deep-water divers. However, it seems to me as insufficient evidence for breath-holding in general: it could be that frequent changes in pressure are the cause for damage, for example. Or the fact that the person cannot resurface immediately after feeling the need to breathe, which might cause them to hold their breath for a longer period of time than their body allows.

So are there any studies showing results for the effect on the brain in (healthy) humans holding their breath?


In order to reply to your question I (*) need to dissect it into 3 parts.

1 - Can you voluntarily hold your breath so long that damage actually occurs? There is evidence that apnoe-divers damage their brains while diving. In the above, the marker protein S100B, representing brain, damage was elevated. This marker had been found previously to be increased in stroke and other forms of brain damage. Therefore, it appears that brain damage occurs when trained freedivers hold their breath on average 335 s (range 281-403 s). I could not find published data on whether this results in cognitive changes. Another really interesting study I found was also on US Navy divers but with oxygen supply. Their cognition was tested and transient alterations in affect, visual focusing, and physical activity were temporarily seen for 10 days after diving. Pressure changes might have an impact on top of the lack of oxygen.

2 - To summarize a study from a good previous post, researchers measured oxygen saturation in the blood while subject were holding their breath. Oxygen saturation dropped as low as 75% (see original paper).

3 - Additional studies. A blood oxygen level dependent functional-MRI study in adults and children showed similar activated regions while holding their breath. Breath holding in childrens' brains causes stronger alterations. Their brains seem to be more vulnerable than adult brains. The insular cortex was identified as a specific region in the brain, being responsible for breathing again after holding breath. These findings originate from a positron-emission study which was able to localize air hunger to the insular cortex. The insula is part of the limbic system which regulates essential tasks in humans including temperature, nausea, and pain. Feeling shortness of breath is important for survival and therefore as shown with PET also located in the limbic system.

(*Note that I'm submitting this well researched answer for Tim, an MD, who took the time to write the text but doesn't have the time to sign up or reach the required reputation limit to post. I only filtered out some medical lingo and streamlined the text. The kudos are his.)


Effects of long-term benzodiazepine use

The effects of long-term benzodiazepine use include drug dependence and neurotoxicity as well as the possibility of adverse effects on cognitive function, physical health, and mental health. [1] Long term use is sometimes described as use not shorter than three months. [2] Benzodiazepines are generally effective when used therapeutically in the short term, [3] but even then the risk of dependency can be significantly high. There are significant physical, mental and social risks associated with the long-term use of benzodiazepines. [3] Although anxiety can temporarily increase as a withdrawal symptom, there is evidence that a reduction or withdrawal from benzodiazepines can lead in the long run to a reduction of anxiety symptoms. [4] [5] Due to these increasing physical and mental symptoms from long-term use of benzodiazepines, slow withdrawal is recommended for long-term users. [6] [7] [8] [9] Not everyone, however, experiences problems with long-term use. [10]

Some of the symptoms that could possibly occur as a result of a withdrawal from benzodiazepines after long-term use include emotional clouding, [1] flu-like symptoms, [5] suicide, [11] nausea, headaches, dizziness, irritability, lethargy, sleep problems, memory impairment, personality changes, aggression, depression, social deterioration as well as employment difficulties, while others never have any side effects from long-term benzodiazepine use. Abruptly or rapidly stopping benzodiazepines can be dangerous when withdrawing a gradual reduction in dosage is recommended, under professional supervision. [12] [13] [9]

While benzodiazepines are highly effective in the short term, adverse effects associated with long-term use, including impaired cognitive abilities, memory problems, mood swings, and overdoses when combined with other drugs, may make the risk-benefit ratio unfavourable. In addition, benzodiazepines have reinforcing properties in some individuals and thus are considered to be addictive drugs, especially in individuals that have a "drug-seeking" behavior further, a physical dependence can develop after a few weeks or months of use. [14] Many of these adverse effects associated with long-term use of benzodiazepines begin to show improvements three to six months after withdrawal. [15] [16]

Other concerns about the effects associated with long-term benzodiazepine use, in some, include dose escalation, benzodiazepine use disorder, tolerance and benzodiazepine dependence and benzodiazepine withdrawal problems. Both physiological tolerance and dependence can be associated with worsening the adverse effects associated with benzodiazepines. Increased risk of death has been associated with long-term use of benzodiazepines in several studies however, other studies have not found increased mortality. Due to conflicting findings in studies regarding benzodiazepines and increased risks of death including from cancer, further research in long-term use of benzodiazepines and mortality risk has been recommended most of the available research has been conducted in prescribed users, even less is known about illicit misusers. [17] [18] The long-term use of benzodiazepines is controversial and has generated significant debate within the medical profession. Views on the nature and severity of problems with long-term use of benzodiazepines differ from expert to expert and even from country to country some experts even question whether there is any problem with the long-term use of benzodiazepines. [19]


What Are Seizures? What Is Epilepsy?

Seizures involve uncontrolled electrical activity in the brain. There are different types of seizures, with varying symptoms and intensity of symptoms. For instance, focal seizures can result in unexplainable emotional changes, nausea, or even hallucination. Other types, such as generalized seizures, may result in:

  • Physical convulsion
  • Thought disturbances
  • Falling to the ground
  • Loss of consciousness
  • Massive muscle spasms

Many causes can trigger seizures, including stress, alcohol, lack of sleep, or other conditions. The types and symptoms of seizures depend on many factors, including:

  • Where the abnormal electrical activity is occurring in the brain
  • The patient’s age and general health
  • What the cause or trigger of the seizure is

Seizures can also be caused by head injuries (such as a blow to the head), brain tumors, various types of chemical exposure, genetic or infectious illness or fever. In about half of the patients with seizures, no cause can be found.

In comparison, “epilepsy” refers to a specific chronic medical condition. It is characterized by recurring, unprovoked seizures. A patient may be diagnosed with epilepsy if they have at least two unprovoked seizures that were not caused by a specific, known and reversible medical condition like low blood sugar. Diagnosis can also occur in cases where a person has one unprovoked seizure with the likelihood of having more.

Epileptic seizures are typically related to two main causes: brain injury, or genetic inheritance. In many cases, the cause is entirely unknown. The term “epilepsy” doesn’t specify any background about the cause or severity of the seizures. Many patients who have epilepsy may also have more than one type of seizure.


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I was rushed into hospital last July 2018, after having repeated seizure's, at home, in town they would just happen without warning. I'd not had anything like this before, only light dizzy spells, feeling weak and palpitations.

The day before I was rushed to hospital I'd had (worst run of them) another nine seizures in one day, that my doctor just put down to panic attacks/stress.

The following morning I woke feeling rather ill and collapsed in my daughters room, ambulance/paramedics came at first refused to take me (this didn't go down well with my family) eventually they did (good thing they did) after being taken in and just left in a wheelchair in the waiting area, 2 minutes later I went into full cardiac arrest lucky another paramedic noticed and rushed me to resuscitation room, where I was without oxygen to my brain for about five minutes, and needed to be shocked with the defibrillator twice.

Long story short, I was rushed to another hospital for emergency surgery to have a temporary heart pacing wire fitted, kept in the hospital nine days where in that time I needed to have a permanent pacemaker fitted, which still might need to be upgraded to a ICD in case my heart stops again, and put on Beta-blockers (Nadolol). They eventually diagnosed me with condition(s) called Long QT Syndrome Torsades de Pointes, COPD, and I also have asthma.

I have to be aware of what medications I can't take. At last count there were around 127 types of meds I cannot take. I am still learning about my illness and see my specialist very often. The slightest startling, stress etc. can affect my heart.

If anyone else has it or heard of it and knows some good websites to look at please tell me. Thank you. anon947011 April 23, 2014

My mum had a seizure and cardiac arrest brought on by alcoholism. She was down for 20 minutes, but the medical staff shocked her five times and got her back.

After treatment in ITC and HDU for four weeks, she is physically OK, but her short term memory has gone. She doesn't recognize people and forgets what you told her five minutes ago. This is heartbreaking to watch and I wonder if there is a chance she could recover as now needs to go into a 24 hour care home. She cannot keep her balance when standing and keeps falling. Can anyone advise, please? anon331193 19 hours ago

It seems a lot of posters are confused about why brain damage is delayed in a cold environment. The cold environment essentially acts to slow down time within the body. Cold temperatures slow the rates of chemical reactions down. In the body these consist of the many reactions like enzymatic activity and essentially all other cellular processes. Thus, for a given amount of time, the brain needs much less oxygen for a given period of time under very cold circumstances. Scientists understand the concept well.

Additionally, this concept has been employed as a surgical tool as well (a blood machine that dramatically lowers the temperature of the blood and then returns the cooled blood to the patient). This method greatly prevents brain damage and also gives the surgeon a larger time window which, is especially important in complex and lengthy surgical interventions. ysmina December 3, 2012

@turquoise-- That's a good question, I'm not sure if it works or not.

Like @feasting said though, there are cases of people who fell into extremely cold water, was without oxygen for a good number of minutes and recovered without any brain damage.

I think scientists are still studying how this is possible. This might become a new first aid technique in these sort of situations. Although I don't think it has been recognized as a precautionary measure or treatment yet. turquoise December 3, 2012 I've heard that if you apply something cold like ice to people's eyes when their heart has stopped, you can delay brain damage. Is this true? wavy58 December 3, 2012

I have to have an MRI once a year, and I have to hold my breath several times during the scan. Sometimes, it is just for 30 seconds, but other times, it is for nearly a minute.

After awhile, I start to panic a little. I lie there thinking that surely the technician will tell me to breathe soon, but sometimes, he doesn't, and I just can't take it anymore!

I guess the lack of oxygen to my brain is making it send signals to my diaphragm, because I feel it start to jump a little. I find myself taking tiny little breaths and exhaling the smallest amount possible, hoping that it will be imperceptible to the technician. feasting December 2, 2012

I find it amazing that a person who is dunked into cold water for several minutes can survive. I wonder if they exhibit brain damage symptoms, though.

I guess that extreme cold preserves the body somehow. I know that my lungs seem to go into shock even when I enter a swimming pool in early summer and the water is still pretty cool. This makes it hard to breathe, and it feels as if my lungs are paralyzed. kylee07drg December 2, 2012

@Oceana – I've read that there are tricks to this. I believe the world record for breath holding is 19 minutes, which seems an insane amount of time.

To keep the lack of oxygen from causing brain damage, people hyperventilate. As the carbon dioxide is building up in their bodies, they have to have a way to expel it, so they do these quick little bursts of hyperventilation to remove it from their lungs.

I would never try this, because even with the tricks, there is still a big risk of brain damage. It would also be a very uncomfortable thing to do. Oceana December 1, 2012

How do some people manage to hold their breath for several minutes? I've heard that there are actual competitions to see who can hold their breath the longest. How can they do this without suffering damage to the brain? burcidi December 1, 2012

My friend had a heart attack and her heart stopped. They got her heart beating again but close to twenty minutes passed in between.

When I saw her in the hospital, she was hooked up to all the machines because she couldn't breathe on her own. Twenty minutes was more than enough for brain damage from lack of oxygen.

Her family decided to let her go because they knew she wouldn't be better again. I hope she rests in peace.


Long-Term Narcissistic Abuse Can Cause Brain Damage

The effects of psychological and narcissistic abuse come with many devastating consequences, but there are two that almost no one knows aboutunless theyre a doctor or neuroscientist.

In fact, these two outcomes may be the most destructive result of emotional trauma over the long-term and is an added reason whyif you have children with a narcissistic partneryou should try to leave as soon as reasonably possible.

By now, most of us know that repeated emotional trauma leads to bothPTSD and C-PTSD, which should be reason enough to leave an abusive partner. But, what many people dontrealize is that over time, these repeated emotional injuriesshrink the hippocampus, which is responsible for memory and learning, while enlarging the amygdala, which houses primitive emotions such as fear, grief, guilt, envy, and shame.

Hippocampus basics

The hippocampus, which is Greek for seahorse, is a paired structure tucked inside each temporal lobe and shaped, in fact, like a pair of seahorses. It helps to store and release memory. The hippocampus is especially vital to short-term memory, the retaining in mind of a piece of data for a few moments, after which it either gets transferred to permanent memory or is immediately forgotten. Learningdependson short-term memory. [1]

Further, among the many analyses that have been conducted, one in particular shows very disturbing results. In a study conducted by a team of the University of New Orleans and Stanford University researchers, patients with the highest baseline cortisol (a stress hormone) and greater number of PTSD symptoms had the greatest decreases in hippocampal volume over time. [2]

In other words, the longer you stay with an emotionally abusive partner, the more deterioration you can expect of your hippocampus. It can be easily understoodhow this neurological process may enhance feelings of confusion, cognitive dissonance, andabuse amnesiain victims of narcissistic and psychopathic abuse.

Amygdala basics

Narcissists keep their victims in a constant state of anxiety and fear, which in turn causes their victims to react from his or her amygdala (or reptilian brain). The amygdala controls life functions such as breathing and heart rate and the basic emotions of love, hate, fear, and lust (all of which are considered primal emotions).

Its also responsible for the fight or flight reaction. Victims of narcissistic abuse live in this state almost daily. Over time, the amygdalae remember the things we felt, saw, and heard each time we had a painful experience. Subliminal hints of such stressful events (even photos) will set off the organs attack or escape routinestriggering avoiding behaviors or internal turmoil [3](another good reason to refrain from stalking your ex on social media).

Even after the toxic relationship has ended, victims suffer PTSD, C-PTSD, panic attacks, phobias, and more due to the triggering of their primal fears by their overactive amygdalae. Out of these fears, targets of narcissistic abuse often engage in primitive defense mechanisms including (but not limited to):

  • Denial Victims use denial to escape dealing with painful feelings or areas of their life they dont want to admit.
  • Compartmentalization Victims pigeonhole the abusive aspects of the relationship in order to focus on the positive aspects.
  • Projection Victims project their traits of compassion, empathy, caring, and understanding onto their abuser, when in fact, narcissists and other emotional abusers possess none of those traits.

Narcissistic abuse changes your brain

According to Goleman (2006), everything we learn, everything we read, everything we do, everything we understand, and everything we experience counts on the hippocampus to function correctly. The continual retention of memories demands a large amount of neuronal activity.

In fact, the brains production of new neurons and laying down connections to others takes place in the hippocampus (Goleman, 2006, p. 273). Goleman also stated, The hippocampus is especially vulnerable to ongoing emotional distress, because of the damaging effects of cortisol (p. 273). When the body endures ongoing stress, cortisol affects the rate at which neurons are either added or subtracted from the hippocampus. This can have grave results on learning. When the neurons are attacked by cortisol, the hippocampus loses neurons and is reduced in size. In fact,duration of stress is almost as destructive as extreme stress. Goleman explained, Cortisol stimulates the amygdala while it impairs the hippocampus, forcing our attention onto the emotions we feel, while restricting our ability to take in new information (pp. 273-274). Goleman adds,

The neural highway for dysphoria [4]runs from the amygdala to the right side of the prefrontal cortex. As this circuitry activates, our thoughts fixate on what has triggered the distress. And as we become preoccupied, say, with worry or resentment, our mental agility sputters. Likewise, when we are sad activity levels in the prefrontal cortex drop and we generate fewer thoughts. Extremes of anxiety and anger on the one hand and sadness on the other push brain activity beyond its zones of effectiveness.(p. 268) [5]

But, there is hope. There are reparative activities you can do to restore and rebuild your hippocampus and stop the hijacking of your psyche by your amygdala.

Luckily, as brain scans have now shown (thanks to the magic of neuroplasticity), it is possible for the hippocampus to regrow. An effective method includes the use of EMDR therapy (Eye Movement Desensitization and Reprocessing). One recent study showed that 8 to 12 sessions of EMDR for patients with PTSD showed an average of a 6% increase in the volume of their hippocampi. [6]

EMDR is also beneficial for counteracting the hyperarousal of the amygdala, allowing the brain to more appropriately direct what needs to happen rather than remain stuck and unnecessarily trigger problematic emotions.

Other methods that have been shown to repair both the hippocampus and amygdala include:

  • Guided meditationRecent studies from Harvard Universityshow that daily meditation can help repair the brain by actually rebuilding the brains gray matter. Study participants who spent an average of 27 minutes per day practicing mindfulness exercises showed a major increase in the density of the hippocampus and amygdala and associated reductions in stress, compared to a control group.
  • Aromatherapy and essential oilsArticle: AROMATHERAPY AND MEDITATION: ESSENTIAL STEPS IN RECOVERING FROM NARCISSISTIC ABUSE
  • Performing acts of kindness simple, daily practice of altruism can dramatically alter your outlook on the world.
  • EFT (Emotional Freedom Technique) helps correct the biochemical short-circuiting that occurs with chronic anxiety.

Of course, the first course of action would be to plan and implement an exit strategy. It takes time to recover from narcissistic abuse and one short encounter can set you back enormously.

Resources

[1]Goleman, D. (1995, July 31). Severe Trauma May Damage The Brain as Well as the Psyche. Retrieved October 17, 2017, from http://www.nytimes.com/1995/08/01/science/severe-trauma-may-damage-the-brain-as-well-as-the-psyche.html?pagewanted=all

[2]Stressing the Hippocampus: Why It Matters. (n.d.). Retrieved October 12, 2017, from http://blogs.scientificamerican.com/news-blog/stressing-the-hippocampus-why-it-ma/

[3]Thomas, E. (n.d.). The Amygdala & Emotions. Retrieved October 17, 2017, from http://www.effective-mind-control.com/amygdala.html

[4]Dysphoria. (2015, November 29). InWikipedia, The Free Encyclopedia. Retrieved 20:36, October 18, 2017, fromhttps://en.wikipedia.org/w/index.php?title=Dysphoria&oldid=692983709

[5]Effects of Stress on the Hippocampus. (2013, March 19). Retrieved October 17, 2017, from http://drgailgross.com/academia/effects-of-stress-on-the-hippocampus/

[6]Shapiro, F. (2012).Getting past your past: Take control of your life with self-help techniques from EMDR therapy. Emmaus, Pa.: Rodale Books.


The Shocking Results of Sleep Deprivation

Even more surprising - the mice in the extended wakefulness group showed a 25 to 30 percent loss of certain neurons. The researchers also observed an increase in what is known as oxidative stress, which can cause problems with neural communication.

Veasey notes that further research needs to be done to see if the phenomenon has the same impact on humans. Particularly, she notes, it is important to establish if the damage might vary among different individuals and whether things such as aging, diabetes, high-fat diets, and sedentary lifestyles might make people more susceptible to neural damage from sleep loss.

This news might be of particular interest to shift workers, but also to students who regularly miss sleep or stay up late. The next time you are thinking about staying up late to cram for an exam, just remember that chronic sleep-deprivation might result in damage to your brain.


2. Understanding E-Liquid Vapor and Its Dangers

When you think of the word “vapor,” it’s easy to brush it off, as it sounds like water. But this is far from the case – and it is this vapor that “smokers” are inhaling whenever they use an e-cigarette.

Here are some of the components found within e-liquid that are less than positive for the body: (1)

· Nicotine

You may know nicotine as the substance found in cigarettes that makes them addictive. The content may be a little lower, but it is still easy to get hooked. This means that vaping can be just as addictive as smoking – and nicotine is especially harmful to the mental development of teenagers.

While this allows vapes to be great for those looking for a safer alternative to their smoking addiction, it also means that people who have never smoked before can wind up addicted to vaping. So if you’ve never smoked but are curious about vapes, this is your warning not to start.

In addition to that, if you’re looking to stop smoking through the use of vapes, there is a much lower chance of you kicking the smoking habit altogether. Those who have never smoked cigarettes before are also more likely to start if they begin vaping.

· Volatile Organic Compounds

Volatile organic compounds, known also as VOCs, are responsible for a lot of health issues. They irritate your nose, eyes, and throat, and they put you at risk of nervous system damage. It can also lead to kidney disease, liver disease, and side effects like nausea and headaches.

· Glycol or Glycerin

In order for the vapor to appear very smog-like and thick, special chemicals have to be added to e-liquid. (Just compare the drama of a vape pen’s fog to the much thinner smoke that comes out of a cigarette.)

To create this effect, e-liquid contains either vegetable glycerin or propylene glycol – or, in some cases, both! These components can both cause irritation to your airways, including your lungs, leading to coughing and possible infection.

· Benzoic Acid

This preservative is often found in certain e-cig brands, including the famous JUUL brand. Benzoic acid may work well in preserving a product, but it also has links to a variety of problematic health issues, such as hyperactivity and asthma. You may also wind up with skin and eye irritation, nausea and vomiting, throat problems, and abdominal pain.

· Formaldehyde

Most people already know how dangerous inhaling formaldehyde can be. It isn’t in e-liquids, to begin with, but when a vape pen becomes overheated, it can release this substance.

This can also happen when insufficient e-liquid remains, causing a “dry puff.” Formaldehyde is known to increase the risk of cancer.

· Heavy Metals

According to a recent study, heavy metals were found in certain vapors from e-liquids in toxic amounts. Although not a majority, this indicates there is a good chance that you will come into contact with e-juice that contains too many heavy metals if you are a heavy vaper.

Heavy metals in toxic amounts are linked to liver disease and also to lung cancer, with both issues arising when you inhale them.

· Flavors

Lots of juuls contain interesting flavors that make them more palatable to users. This is what makes them so popular, especially among the younger crowd. Unfortunately, these flavor chemicals are not regulated, and some can be significantly toxic.

One such flavor is the type that contains diacetyl, which has been proven to be linked to bronchiolitis obliterans – a type of lung disease. Diacetyl is most commonly found in popcorn and butter-flavored juuls.

There are also other flavors that are dangerous, so don’t just avoid popcorn tastes while looking to the others with positive thinking! Fruit-flavored e-cigarettes tend to have high acrylonitrile content. Acrylonitrile is a known carcinogen. (2)

Cinnamon flavored products are also dangerous thanks to their cinnamaldehyde content. The same goes for honey flavors, known as pentanedione, and vanilla flavors, known as O-vanillin. All of these flavoring chemicals can negatively affect white blood cells.

But that’s not all. Menthol, strawberry, and coffee juuls are also bad for you because they are significantly dangerous to the cells of your lungs, according to research.

There is a possibility that, in the future, the FDA will begin to regulate the types of chemicals used in e-cigarettes. For now, though, there is nothing preventing manufacturers from using chemicals that can be harmful in the long term – and many do not disclose the full list of chemicals that they use.


The Startling Way Coronavirus Alters Your Brain, Doctors Warn

New research suggests COVID-19 can lead to permanent neurological damage.

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Of course you know about the havoc the coronavirus can wreak on your lungs. You might've also read about what it does to your blood, your kidneys, and your heart. But a new medical report has provided unsettling evidence as to how the COVID-19 contagion can enter one's brain and possibly cause permanent neurological damage.

The research, published in the Journal of American Medicine, focused on a 25-year-old coronavirus patient, whose brain scans revealed "viral brain invasion," which appears to have temporarily changed areas of her brain. The term for this is "neuroinvasion" and doctors believe that it may be partially responsible for the respiratory failure of coronavirus patients.

The patient in question is a radiographer who had been working in a COVID-19 ward, with no significant pre-existing conditions. After having a dry cough that lasted a day, she lost her sense of smell and taste, but had no other major symptoms such as a fever or shortness of breath. With no significant medical history—and other negative test results—a brain MRI was performed.

What the brain scans revealed led to what researchers believe to be "the first report of in vivo human brain involvement in a patient with COVID-19, showing a signal alteration compatible with viral brain invasion in a cortical region." In laymen's terms, the contagion is invading parts of neural cortex, which is affecting the patient's sense of taste, smell, and perhaps leading to larger respiratory problems. That said, according to the researchers, more studies are needed before any conclusions can be drawn.

"We know from previous research that some individuals who have had SARS-CoV-2 infection may develop neurological and psychiatric symptoms," John Hardy, chair of the Molecular Biology of Neurological Disease at the University College London, who was not involved in the study, said in a statement via Science Media Centre. "What remains to be seen is to what extent symptoms are due to viral infection of the brain itself, or secondary effects including inflammation in the brain triggered by the immune system's response to the virus."

The study concludes by saying that it's not clear that all coronavirus patients suffer from "neuroinvasion" of the COVID-19, or if this perhaps may just be an early stage of the ill-effects of the virus. And for more ways coronavirus affects you overall, check out Here's How Coronavirus Affects Your Body, From Your Head to Toes.


Depression and Anxiety Disorders Damage Your Brain

THE BASICS

Key Concepts:

2. Damage from Disorders

The second thing that has become clear from New Neuropsychiatry research is that psychiatric disorders are bad for your brain. Study after study show that clinical depression and anxiety disorders—not to mention severe conditions like schizophrenia and bipolar disorder and drug abuse—cause measurable changes in key areas of the brain.

This isn't just an abstract issue it is a serious and meaningful issue for people who have mood and anxiety disorders. Take depression as an example: Common symptoms include mood changes (obviously) but also difficulty with cognitive functioning—trouble remembering things, difficulty making decisions, planning, setting priorities, and taking action. These are symptoms that every therapist and psychiatrist, and other doctors, see on a daily basis in people with depression. Brain imaging studies using MRI scanning show that these common day-to-day depression symptoms are associated with abnormalities in specific areas of the brain, including the hippocampus (the memory center), the anterior cingulate (the brain's conflict-resolution area), and the prefrontal cortex (involved with planning and executing activities).

Recently, German researcher Thomas Frodl did an important study looking at the brains of people with depression and comparing them to people without depression. When he first looked at them, depressed people had abnormalities in several brain areas in comparison to healthy, non-depressed people, specifically in the hippocampus, cingulate, and prefrontal cortex. Frodl then followed both the depressed and non-depressed people for three years, and showed continued decrease in those brain areas in people with depression—in the dorsomedial prefrontal cortex, anterior cingulate, hippocampus, dorsolateral prefrontal cortex, and orbitofrontal cortex: "These reductions were found in patients with major depression but not in [healthy] controls."

This seems pretty depressing itself, but it's important to keep in mind the first principle of New Neuropsychiatry: The brain retains plasticity throughout life. As I will discuss in principle 3—the importance of remission—over time, treatment can protect from ongoing brain injury. In Frodl's words, "It is likely that an early start of treatment with antidepressants and psychotherapy may prevent neuroplastic changes that, in turn, worsen the clinical course."

Another interesting area of New Neuropsychiatry research looks at behaviors and thought patterns. One common symptom of depression is rumination—the tendency for depressed people to spend a lot of time thinking about how miserable they are. There are different definitions of ruminations—for instance, "repetitively thinking about the causes, consequences, and symptoms of one's negative affect" (Nolen Hokstema) or "repetitive thinking about sadness, and circumstances related to one's sadness." People who are depressed have a tendency to spend hours ruminating, and may justify time spent ruminating as "trying to sort things out," or to solve their problems. Yet research shows that rumination actually interferes with problem-solving and makes one's mood worse rather than better. Most likely time spent ruminating increases activity of the brain's fear system (the amygdala) and increases avoidant behavior, making it less likely that a person will get pleasure from life and have a chance of emerging from depression.

Such was the case with "Kenneth," whose case I discuss in Heal Your Brain. A widower in his late 60s, Kenneth had low-level depression for over 30 years that became severe after the death of his wife. He became a hermit, avoiding friends and relatives, and spent many hours obsessing and ruminating about how terrible his life was. A major part of his treatment was involved in getting him to stop obsessing, to get out of his easy chair and get involved in other behaviors, including volunteer work and spending time with his children and their families. Stop ruminating! I would tell him. Do something that gives you pleasure! Eventually, months into treatment, Kenneth was able to interrupt his tendency to ruminate and to choose more pleasurable activities—and to get a sense of enjoyment and pleasure in daily life for the first time in decades.


Brain damage caused by plasticisers

The plasticisers contained in many everyday objects can impair important brain functions in humans. Biologists from the University of Bayreuth warn of this danger in an article in Communications Biology. Their study shows that even small amounts of the plasticisers bisphenol A and bisphenol S disrupt the transmission of signals between nerve cells in the brains of fish. The researchers consider it very likely that similar interference can also occur in the brains of adult humans. They therefore call for the rapid development of alternative plasticisers that do not pose a risk to the central nervous system.

Bisphenols are plasticisers that are found in a large number of plastic products worldwide - for example, in food packaging, plastic tableware, drinking bottles, toys, tooth fillings, and babies' dummies. In recent years, numerous health risks have already been associated with them, especially with bisphenol A (BPA). The Bayreuth research team led by Dr. Peter Machnik at the Animal Physiology research group (led by Prof. Dr. Stefan Schuster) has now for the first time investigated the effects of plasticisers on signal transmission between nerve cells in the adult brain. The study covers not only BPA, but also bisphenol S (BPS), which is often considered less harmful to health. Their findings: Both plasticisers impair communication between the nerve cells of the brain.

Permanent damage to the nervous system

The harmful effects on the brain mainly affect the delicate balance between different neuronal functions. While some brain cells transmit signals that trigger a state of excitation in downstream cells, other brain cells have the function of inhibiting downstream cells. However, the coordination of both excitation and inhibition is essential for an intact central nervous system. "It is well known that numerous disorders in the nervous system of vertebrates are triggered by the fact that excitatory signals and inhibitory signals are not or only inadequately coordinated. So, it is all the more alarming that the plasticisers BPA and BPS significantly impair precisely this coordination," explains Dr. Peter Machnik, lead author of the study.

"We were surprised how many vital brain functions in fish are affected by the plasticisers used in numerous industries. This damage, as we were able to show, does not occur immediately. However, when the brain cells are exposed to small amounts of BPA or BPS for a month, the damage is unmistakable," says Elisabeth Schirmer, a doctoral student from Bayreuth and first author of the study. It turns out that the plasticisers influence the action potential of brain cells. They alter the chemical and electrical transmission of signals through the synapses. In addition, they disrupt the circuits that are important for the perception and processing of acoustic and visual stimuli.

Studies on Mauthner cells in goldfish

The discovery of the damage caused by plasticisers came from detailed studies on live goldfish. The focus was on the two largest nerve cells in fish brain, the Mauthner cells. They integrate all sensory stimuli, all of which must be processed quickly and in a precisely coordinated manner when predators approach. In this case, the Mauthner cells trigger life-saving escape reactions. Due to this function, which is essential for survival, they have become particularly robust in the course of evolution. Mauthner cells are able to ward off damaging influences to a certain extent, or to compensate for damage afterwards. This makes it all the more significant that plasticisers are able to cause considerable damage to these cells.

Transferability of the results to humans - Demand for alternative plasticisers

"The findings obtained through studies on fish brains justify the assessment that BPA and BPS can also seriously damage the brains of adult humans. Against this background, it is essential that science and industry develop new plasticisers to replace these bisphenols, while being safe for human health," says Dr. Peter Machnik. Prof. Dr. Stefan Schuster adds: "The efficiency of the research techniques we used in our study could, in addition, prove a valuable aid in the development of alternative plasticisers. They make it possible to quickly and inexpensively test how a substance under consideration affects brain cells."

The research was funded by the German Research Foundation (DFG) as part of a Reinhart Koselleck project.

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