Saturday, November 29, 2008

Area 25

I've been wanting to write about this for awhile, and now it's a quiet Saturday afternoon, after a day-long retreat, in which I broke "silence" not to talk but to post my new website. Still, I got a lot of meditation and dharma reading in, along with yoga, much needed, as I had cramps yesterday and today, too, though lesser than they would be because of the yoga.

So what is AREA 25?
Some of you already know, and those who know I've been reading a lot on neuroscience lately know that it's likely not a scifi or government conspiracy reference.

From Wikipedia (full name is Brodmann Area25, by the way):
"One study has noted that BA25 is metabolically overactive in treatment-resistant depression and has found that chronic deep brain stimulation in the white matter adjacent to the area is a successful treatment for some patients"

In fact, recent research has gone beyond that "one study" and numerous doctors and scientists are finding that BA25 is not just significant for those with "treatment-resistant" depression (and that deep brain stimulation they are citing is electro-shock therapy, by the way), but also that it plays a role in humdrum, ordinarily medicine-aided depression.

Here's the woman who made that link, named Helen Mayberg, on why the deep brain stuff works, and why the meds might work, too:
"There are a number of converging lines of experimental evidence. Both Cg25 [cingulate area 25] and the prefrontal cortex have emerged as critical regions mediating depression remission. A series of PET experiments have demonstrated both decreased subgenual cingulate activity and increased prefrontal activity with successful antidepressant treatment. [THIS MEANS THEY THINK THE TWO OF THESE ARE LINKED. SO AREA 25 AND THE LEFT FRONTAL CORTEX, HOME AND NEST TO WHAT CAN OTHERWISE BE CALLED "THE CRITIC"]

Of interest, although frontal changes appeared to be a correction of baseline underactivity, the subgenual cingulate changes are decreases below normative levels. The subgenual cingulate changes are seen not only with antidepressant medication, but also with response to ECT and even to placebo medication, suggesting an important role in clinical recovery. In fact, patients in our study who failed to respond to treatment showed no subgenual cingulate changes. In addition, subgenual cingulate activity has shown marked increases in activity during states of profound negative mood (ie, sadness) in nondepressed volunteers, suggesting a further critical role in regulating acute and chronic negative mood states in both healthy patients and those with disease. IN OTHER WORDS, EVEN YOUR REGULAR RUN OF THE MILL SADNESS SEEMS TO TRIGGER THE SAME SPOTS

We postulated a reciprocal set of changes in cortex and subgenual cingulate with DBS, namely, suppression of area 25 and disinhibition of frontal cortex, consistent with past findings of effective response to other antidepressants."

My therapist told me about this - actually, my prescriber, who caught on quickly that I love the science aspect of all of this, though of course my therapists often have to get me down from that tree to talk about my emotions. She pointed me to the pictures and articles, and drew her own diagrams for me. Here's a translation, totally layperson, of the above excerpt:

Area 25 is part of the limbic, or emotional, system. It's job is to sort of react and send out hormones when we are sad. No biggie. It's true for everyone, not just chronically depressed folks or folks who need meds. They've known about it for awhile. But what they didn't know is that it seems to have a really tight relationship with the left frontal cortex. This is the part of the brain which ostensibly distinguishes us from other animals. "We can think, we can reason, we can read", as the theme song for LAPR's "Bookworm" says. As most of us know, that reasoning can actually be a problem sometimes. However, as authors like Jill Bolte Taylor have made more and more popularly evident, it's not as simple as demonizing the logical mind. We *need* that order - it helps to tell us to put socks on before shoes, to cite her example, or, to "hey. no need to keep being sad. it's over now," in the case of this research. So what do they think "goes wrong" with depression?

Basically, Area 25 is on high drive. Because of childhood circumstances (which do affect how one's brain works, as we are not born without changing afterwards, and in fact, this area 25 is believed to not be fully formed until the mid-twenties, which explains how none of us over 30 would ever go back to that time period!), genetics, and all the other things that shape our brains and emotional reactions, some folks' Area 25 isn't "self-regulating". It doesn't turn off, connects ordinarily just slightly sad or frustrating circumstances into out and out depressions. But it's not just Area 25 at work.

What happens, they think, is that that pre-frontal cortex serves as a regulatory agent. If Area 25 (or other parts of the limbic system) get out of whack like I describe above, the pre-frontal should be there like a guard to shut it off. In "bad" scenarios it could shut it off with judgment "You are so depressed, you'll never get better, etc" and in the best of situations it is cleaner than that "Huh. There's no reason to feel this way. Ok. I'll let it go." But in folks who have temporary sadness to a high degree (including mourning) or those with ongoing depression, not only is Area 25 overactive, but the pre-frontal is disfunctional, not reacting, or reacting in a way which only contributes to the depression. It's a loop, a great feminine image, and the loop is off its sine wave and out in outer space.

She told me about all this and my mind was sparking all over. Then she continued:
"What they find also helps are two other things: exercise (ok, yep, I can see that) and any service activity or part of your life that can turn you "outwards". In other words, like anyone who suffers from depression will tell you, the sense is of constantly turning INWARDS - eating one's own tail, not being able to relate to the world, feeling totally f-ing alone. And this is part of the CHEMICAL experience."

"So volunteering, talking to a friend, reaching out to the world, taking a walk - these might not cure depression, but they help - CHEMICALLY?"
"Yes. That's what they think." she responded.

So wait. Buddhists have something like this, too. "If you want to be happy, help others," is a common saying. At first I hated this saying, seeing only self-sacrifice in it, but over time I've gotten a deeper - though still shallow - understanding that this could point to our inter-dependence, how there is no YOU and ME so of course if I am really helping "You" I can't help but help "Me". Ok, fine. But chemically changing the situation?

"Have you ever heard of Tonglen?" I asked her.
"No, I don't believe so."
"Here's how it works, or how it has worked for me. I am suffering, feeling a lot of pain, or someone I know is suffering, and I sit down and try to make real contact with that pain - visualizing black, dark, claustrophobia; feeling it in my heart. Then I try to send out spaciousness, whiteness, clarity. At first the practice felt like I was "faking it til I made it" but now when I do it I feel SO much better. For instance, if I am feeling depressed, I can realize I am not the only one, that others feel it, too, and that we could all stand to have a lot more space and openness. You begin the practice with you, then a close friend then a "neutral" (as Pema Chodron jokes, "space aliens" of your everyday life) then move onto someone you feel icky about, then someone you "hate". In other words, you reach out, out, out. Continuously. This certainly hasn't cured my depression, but it compliments meds and therapy, for sure, and really helps a lot "on the spot" to reset my buttons and help me to see the bigger picture."
"Sounds like loving-kindness, Metta," she said.
"Similar, only focused around direct pain, not just wishing everyone well."
We stared at each other for almost a full minute, then she laughed.
"You know about brain plasticity, right?"
"Of course," I answered, "Richie Davidson, on this campus, with other scientists, showing how meditation can actually CHANGE OUR BRAINS - amongst other activities."
"Wow. I had never heard of that practice. You realize what this means, right? That that - "
We both stared at each other some more.

So it can turn Area 25 back on. Help us to realize we are not alone, and realizing we are not alone is the key. The big key. The key to the city, to our hearts. Turn out and you will help what's going on inside. Wow, indeed.

AND THIS JUST IN - right after I published this post I went to "Shambhala Sun Space" which is a cool extension of the Shambhala Sun magazine, brand new, online, and they had THIS as a title article, on benefits of meditation:


  1. Hey, Miriam! I like your blog! This is a very thought-provoking entry. I have a question re. this part:

    You begin the practice with you, then a close friend then a "neutral" (as Pema Chodron jokes, "space aliens" of your everyday life) then move onto someone you feel icky about, then someone you "hate". In other words, you reach out, out, out. Continuously.

    Question: So does this mean that you imagine space/whiteness/clarity for you, then for the close friend, neutral, etc? Or do you imagine the darkness, then the spaciousness for each? Or am I missing it?

  2. Jodi - thanks, and sorry about delay. Great question.

    The idea is of always breathing in the darkness, claustrophobia, from everyone's viewpoint, since we all experience it, then always breath out lightness, spaciousness, which we all need.

    In order, you can start further out and come in or vice versa, but you'd spend a couple of minutes on each. So a couple of minutes on me, in dark and out light, then a couple of minutes on a close friend, in and out, then a couple of minutes on a "neutral", then someone you don't like, then someone you hate, then everyone...

    Does that help?