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How Common Is Addiction Alongside Mental Health Disorders?

Introduction

According to a range of US governmental agencies devoted to healthcare studies, addiction and mental health disorders are deeply intertwined. It is not uncommon for someone seeking treatment for substance use to also be managing symptoms of depression, anxiety, trauma, or another psychiatric condition. 

This combination is referred to as a co-occurring disorder or dual diagnosis. In Arizona specifically, the latest research from the Arizona Department of Human Services relays the following: 71 % of Arizona treatment providers reported offering dual‑diagnosis/co‑occurring services.

Understanding how common these conditions are, and how they interact, is key to getting the right help. Whether you are researching for a loved one or trying to make sense of your own experience, we provide a brief outline for you in this article.

We will review what you need to know about the prevalence, causes, and treatment of addiction alongside mental health disorders.

According to the Substance Abuse and Mental Health Services Administration, genetics  significantly influence both mental illness and substance use disorders (SUDs). Shared genetic factors – such as those affecting brain reward systems – can increase risk for both conditions.

The Overlap Between Addiction and Mental Illness

Addiction does not occur in a vacuum. Many individuals who struggle with drugs or alcohol also experience underlying mental health conditions.

According to the National Institute on Drug Abuse “About half of the people who experience a substance use disorder also experience a mental illness at some point during their lifetime, and vice versa.”

In Arizona, this rate tends to be even higher. According to SAMHSA’s 2019 Behavioural Health Barometer, Arizona reports that 4-5% of adults experienced both SUD and any mental illness. These percentages surpass the national average of 3.8%.

Why Do These Conditions Co-Occur?

There are several reasons why mental health disorders and addiction commonly appear together:

  • Self-medication: SAMHSA explains that mental health problems can lead some individuals to misuse substances “as a form of self‑medication” to alleviate distressing symptoms like anxiety or depression.
  • Shared risk factors: Genetics contribute significantly, according to the National Centre for Biotechnology Information: Epigenetic changes triggered by trauma or stress can modify gene expression in ways that increase sensitivity to both mental health issues and substance use.
  • Addiction-induced symptoms: SAMHSA states that substances “can cause people with an addiction to experience one or more symptoms of a mental health problem.” These symptoms may mirror anxiety, depression, psychosis, or mood disturbances during intoxication or withdrawal—and may persist until diagnosed and treated appropriately.

The relationship is rarely one-directional. Sometimes addiction leads to worsening mental health. Other times, unresolved trauma or an undiagnosed condition paves the way for substance use.

Common Mental Health Conditions Seen with Addiction

While co-occurring disorders can take many forms, certain psychiatric conditions are more frequently associated with substance use disorders.

Depression and Substance Use

Depression is among the most common co-occurring disorders. Nationally, SAMHSA states that depression is one of the most frequent mental–substance use co-occurring disorders, underscoring how individuals may self-medicate depressive symptoms with alcohol or sedatives, which then exacerbate depression over time.

Anxiety Disorders

Generalised anxiety disorder, panic disorder, and social phobia frequently appear alongside alcohol use, benzodiazepine misuse, or stimulant addiction. These substances can seem like a quick escape from anxiety but often reinforce the cycle of fear and dependence. 

The National Institute of Mental Health confirms that GAD and social anxiety disorder are “commonly associated with alcohol and substance misuse”.

Post-Traumatic Stress Disorder (PTSD)

PTSD is closely linked to addiction, especially among veterans, first responders, and survivors of abuse. Arizona has a large population of military personnel and veterans who may face both PTSD and addiction, requiring trauma-informed, dual diagnosis care. 

The US Air Force Medical Service materials state: withdrawal and stress can trigger PTSD symptoms (like flashbacks or hyperarousal), reinforcing substance use through emotional conditioning.

Bipolar Disorder

SAMHSA emphasizes that co-occurring SUD and bipolar symptoms create clinical ambiguity, often obscuring whether substance use or mood fluctuations came first. 

Substance use can make it harder to diagnose and treat bipolar disorder accurately. During manic episodes, individuals may take risks with drugs or alcohol. 

During depressive episodes, they may self-isolate or engage in harmful use patterns.

Schizophrenia and Psychotic Disorders

Though less common, individuals with schizophrenia or schizoaffective disorder can also struggle with substance use. According to the NCBI, NIDA and SAMHSA note that schizophrenia and other psychotic disorders, including schizoaffective disorder, are “highly prevalent” comorbid conditions with SUDs.

Specialized care is essential, particularly when symptoms of psychosis overlap with those caused by drug use (such as methamphetamine-induced psychosis, which has become more common in parts of Arizona). According to the Department of Justice,  Methamphetamine abuse is increasing in Arizona, making more persons at risk for methamphetamine-induced psychosis.

Recognising the Signs of a Co-Occurring Disorder

It can be challenging to identify a co-occurring disorder—especially because addiction can mimic or mask psychiatric symptoms. Here are some warning signs SAMHSA indicates that a dual diagnosis might be present:

  • Sudden mood swings or emotional numbness.
  • Isolation from family and friends.
  • Risky behaviour that escalates over time.
  • Trouble managing daily responsibilities.
  • Using substances to sleep, relax, or feel normal.
  • History of trauma or prior psychiatric diagnosis.

In many cases, individuals with co-occurring disorders will not fully respond to addiction treatment alone unless their mental health needs are also addressed.

The Importance of Integrated Treatment in Arizona

When both mental health and substance use disorders are present, integrated treatment is essential. This means treating both conditions at the same time, in the same setting, by the same clinical team.

Why Integrated Treatment Works

Research and clinical experience consistently show that individuals with co-occurring disorders do better when they receive:

  • A comprehensive psychiatric evaluation.
  • Medication management (when appropriate).
  • Individual and group therapy focused on dual diagnosis.
  • Psychoeducation about the interaction between mental health and addiction.
  • Trauma-informed care and relapse prevention strategies.

In Arizona, dual diagnosis treatment is offered by specialized providers who understand the unique cultural and logistical barriers residents may face—especially those in rural areas or on AHCCCS (Arizona’s Medicaid programme). For support using AHCCCS, those struggling can find an accredited facility that handles trauma and addiction treatment in Phoenix.

Access to Care in Arizona

Arizona has expanded mental health and substance use services through various public and private efforts, including:

  • AHCCCS coverage for dual diagnosis treatment at both inpatient and outpatient levels.
  • Designated behavioural health facilities offering psychiatric stabilization and addiction care under one roof.
  • Outreach efforts in underserved communities and tribal regions.

Still, waitlists and transportation issues remain barriers for some individuals, making early intervention all the more important.

Addressing Stigma Around Dual Diagnosis

Stigma remains one of the biggest obstacles to care. Some people may feel ashamed to seek help for either addiction or mental health concerns—let alone both at once. Families may misunderstand the symptoms and assume their loved one just needs “more willpower.”

The truth is that co-occurring disorders are medical conditions, not moral failings. Treatment works, and recovery is possible. In fact, when both mental health and addiction are addressed together, individuals are more likely to achieve long-term stability and improved quality of life.

What to Look for in a Dual Diagnosis Programme

If you or someone you care about in Arizona is dealing with both addiction and mental health challenges, finding the right treatment setting is key.
Look for programmes that offer:

  • Medical detox with psychiatric support.
  • A licensed mental health team (psychiatrists, therapists, counsellors).
  • Evidence-based therapies like CBT, DBT, and EMDR.
  • Support groups focused on co-occurring disorders.
  • A structured discharge and aftercare plan.

Ask whether the programme accepts your insurance, especially if you are using AHCCCS, Health Choice, or another Arizona-based plan.

When to Seek Help

You don’t need to have everything “figured out” to start. Many people begin treatment unsure of whether they have a co-occurring diagnosis – and that is okay. A quality provider will help you uncover the full picture through assessment and ongoing care.

If substance use is interfering with your ability to function, and you have noticed symptoms of anxiety, depression, trauma, or mood instability, it is time to reach out. Waiting for things to get worse only increases the risk of crisis or overdose.

Summary

No matter where you are in the process: searching for answers, feeling stuck, or finally ready to act – help is available. With the right support, healing from both addiction and mental health struggles is not only possible but deeply rewarding.

If you are exploring options for dual diagnosis care in Arizona, do not hesitate to ask questions. A conversation with the right provider can open the door to lasting change: for you or your loved one.

What is Phenylpiracetam?

Introduction

Phenylpiracetam, also known as fonturacetam (INNTooltip International nonproprietary name) and sold under the brand names Phenotropil, Actitropil, and Carphedon among others, is a stimulant and nootropic medication used in Russia and certain other Eastern European countries in the treatment of cerebrovascular deficiency, depression, apathy, and attention, and memory problems, among other indications. It is also used in Russian cosmonauts to improve physical, mental, and cognitive abilities. The drug is taken by mouth.

Side effects of phenylpiracetam include sleep disturbances among others. The mechanism of action of phenylpiracetam was originally unknown. However, it was discovered that (R)-phenylpiracetam is a selective atypical dopamine reuptake inhibitor in 2014. In addition, phenylpiracetam interacts with certain nicotinic acetylcholine receptors. Chemically, phenylpiracetam is a racetam and phenethylamine and is structurally related to piracetam.

Phenylpiracetam was first described by 1983. It was approved for medical use in Russia in 2003. Development of (R)-phenylpiracetam (code name MRZ-9547) in the West as a potential treatment for fatigue related to Parkinson’s disease began by 2014.

Brief History

Phenylpiracetam was first described in the scientific literature by 1983. It was developed in 1983 as a medication for Soviet cosmonauts to treat the prolonged stresses of working in space. Phenylpiracetam was created at the Russian Academy of Sciences Institute of Biomedical Problems in an effort led by psychopharmacologist Valentina Ivanovna Akhapkina (Валентина Ивановна Ахапкина). Subsequently, it became available as a prescription drug in Russia. It was approved in 2003 for treatment of various conditions.

Pilot-cosmonaut Aleksandr Serebrov described being issued and using phenylpiracetam, as well as it being included in the Soyuz spacecraft’s standard emergency medical kit, during his 197-days working in space aboard the Mir space station. He reported:

“the drug acts as the equalizer of the whole organism, “tidying it up”, completely excluding impulsiveness and irritability inevitable in the stressful conditions of space flight.”

Medical Uses

Phenylpiracetam is used in the treatment of a variety of different medical conditions. It is specifically approved in Russia for treatment of cerebrovascular deficiency, depression, apathy, attention deficits, and memory decline. It is used to improve symptoms following encephalopathy, brain injury, and glioma surgery. The drug has been reported to improve symptoms of depression, anxiety, asthenia, and fatigue, as well as to improve cognitive performance and memory. It also has anticonvulsant effects and has been used as an add-on therapy in epilepsy.

Phenylpiracetam is typically prescribed as a general stimulant or to increase tolerance to extreme temperatures and stress.

Clinical use of phenylpiracetam has shown to be more potent than piracetam and is used for a wider-range of indications.

A few small clinical studies have shown possible links between prescription of phenylpiracetam and improvement in a number of encephalopathic conditions, including lesions of cerebral blood pathways, traumatic brain injury and certain types of glioma.

Clinical trials were conducted at the Serbsky State Scientific Centre for Social and Forensic Psychiatry. The Serbsky Centre, Moscow Institute of Psychiatry, and Russian Centre of Vegetative Pathology are reported to have confirmed the effectiveness of phenylpiracetam describing the following effects: improvement of regional blood flow in ischemic regions of the brain, reduction of depressive and anxiety disorders, increase the resistance of brain tissue to hypoxia and toxic effects, improving concentration and mental activity, a psycho-activating effect, increase in the threshold of pain sensitivity, improvement in the quality of sleep, and an anticonvulsant action, though with the side effect of an anorexic effect in extended use.

Available Forms

Phenylpiracetam is available in the form of 100 mg oral tablets.

Contraindications

Phenylpiracetam has a number of contraindications, such as individual intolerance.

Side Effects

Side effects of phenylpiracetam include insomnia or sleep disturbances, psychomotor agitation, flushing, a feeling of warmth, and increased blood pressure, among others.

Overdoses

Overdose has not been reported.

Pharmacology

Pharmacodynamics

Phenylpiracetam is a racetam and is described as a stimulant. Racetams have a variety of different pharmacological activities and have varying effects. For example, phenylpiracetam is a stimulant, piracetam is a nootropic, and levetiracetam is an anticonvulsant. The mechanisms of action of most racetams, with some exceptions, are unknown.

Phenylpiracetam is a racemic mixture.4-Phenylpiracetam is the most active enantiomer and is much more potent in stimulating locomotor activity than (S)-phenylpiracetam, which is ineffective. However, (S)-phenylpiracetam retains some activity in most pharmacological tests. On the other hand, in one animal test, the passive avoidance test, (S)-phenylpiracetam appeared to be antagonistic of (R)-phenylpiracetam.

Dopamine Reuptake Inhibitor

Experiments performed on Sprague-Dawley rats in a European patent for using phenylpiracetam to treat sleep disorders showed an increase in extracellular dopamine levels after administration. The patent asserts discovery of phenylpiracetam’s action as a dopamine reuptake inhibitor as its basis.

The peculiarity of this invention compared to former treatment approaches for treating sleep disorders is the so far unknown therapeutic efficacy of (R)-phenylpiracetam, which is presumably based at least in part on the newly identified activity of (R)-phenylpiracetam as the dopamine re-uptake inhibitor

Both enantiomers of phenylpiracetam, (R)-phenylpiracetam and (S)-phenylpiracetam, have been described in peer-reviewed research as dopamine transporter (DAT) inhibitors in rodents, confirming the patent claim. Their actions at the norepinephrine transporter (NET) vary: (R)-phenylpiracetam acts as a dual norepinephrine–dopamine reuptake inhibitor (NDRI), with 11-fold lower affinity for the NET than for the DAT, whereas the (S)-enantiomer is selective for the DAT. However, whereas (R)-phenylpiracetam stimulates locomotor activity, (S)-phenylpiracetam does not do so. This variation in effects has also been seen with other dopamine reuptake inhibitors.

Other atypical dopamine reuptake inhibitors include modafinil, mesocarb (Sydnocarb), and solriamfetol.

Other Actions

Phenylpiracetam binds to α4β2 nicotinic acetylcholine receptors in the mouse brain cortex with an IC50Tooltip half-maximal inhibitory concentration of 5.86 μM.

Racetams generally, but including phenylpiracetam, have been described as AMPA receptor potentiators.

Animal Studies

Research on animals has indicated that phenylpiracetam may have anti-amnesic, antidepressant, anxiolytic, and anticonvulsant effects.

Phenylpiracetam has been shown to reverse the sedative or depressant effects of the benzodiazepine diazepam, increases operant behaviour, inhibits post-rotational nystagmus, prevents retrograde amnesia, and has anticonvulsant properties in animal models.

In Wistar rats with gravitational cerebral ischemia, phenylpiracetam reduced the extent of neuralgic deficiency manifestations, retained the locomotor, research, and memory functions, increased the survival rate, and lead to the favouring of local cerebral flow restoration upon the occlusion of carotid arteries to a greater extent than did piracetam.

In tests against a control, Sprague-Dawley rats given free access to less-preferred rat chow and trained to operate a lever repeatedly to obtain preferred rat chow performed additional work when given methylphenidate, dextroamphetamine, and phenylpiracetam. Rats administered 100 mg/kg phenylpiracetam performed, on average, 375% more work than rats given placebo, and consumed little non-preferred rat chow. In comparison, rats administered 1mg/kg dextroamphetamine or 10 mg/kg methylphenidate performed, on average, 150% and 170% more work respectively, and consumed half as much non-preferred rat chow.

Present data show that (R)-phenylpiracetam increases motivation, i.e. the work load, which animals are willing to perform to obtain more rewarding food. At the same time consumption of freely available normal food does not increase. Generally this indicates that (R)-phenylpiracetam increase motivation […] The effect of (R)-phenylpiracetam is much stronger than that of methylphenidate and amphetamine.

Pharmacokinetics

The pharmacokinetics of phenylpiracetam in humans are unpublished. In any case, the drug is described as having an oral bioavailability of approximately 100%, as having an onset of action of less than 1 hour, as not being metasbolised, as being excreted unchanged about 40% in urine and 60% in bile and sweat, and as having an elimination half-life of 3 to 5 hours. In rodents, its absorption occurs within 1 hour with oral administration or intramuscular injection and its elimination half-life is 2.5 to 3 hours.

Chemistry

Phenylpiracetam, also known as 4-phenylpiracetam, is a racetam (i.e. a 2-oxo-1-pyrrolidine acetamide derivative) and the 4-phenyl-substituted analogue of piracetam. In contrast to piracetam and most other racetams however, phenylpiracetam contains β-phenylethylamine within its chemical structure and hence can additionally be conceptualised as a substituted phenethylamine.

Phenylpiracetam is a racemic mixture of (R)- and (S)-enantiomers, (R)-phenylpiracetam (MRZ-9547) and (S)-phenylpiracetam.

Derivatives

RGPU-95 (4-chlorophenylpiracetam) is a derivative of phenylpiracetam described as having 5- to 10-fold greater potency. Cebaracetam (CGS-25248; ZY-15119) is a derivative of RGPU-95 in which the terminal amide has been replaced with a 2-piperazinone moiety.

Methylphenylpiracetam, including all four of its stereoisomers (especially the (4R,5S)-enantiomer E1R), is a positive allosteric modulator of the sigma σ1 receptor. It is currently the only known racetam demonstrating σ1 receptor modulation. Whereas phenylpiracetam stimulates locomotor activity in animals, the E1R enantiomer of methylphenylpiracetam does not do so at doses of up to 200 mg/kg.

Phenylpiracetam hydrazide is a hydrazide derivative of phenylpiracetam described as having anticonvulsant effects.

Other derivatives of phenylpiracetam have also been developed and studied.

Society and Culture

Availability

While not prescribed as a pharmaceutical in the West, in Russia and certain other Eastern European countries it is available as a prescription medicine under brand names including Phenotropil (also spelled Fenotropil, Phenotropyl, and Fenotropyl), Actitropil, and Nanotropil, among others.

Phenylpiracetam is not scheduled by the United States Drug Enforcement Administration (DEA) as of 2016.

Manufacturer

Phenylpiracetam is manufactured by the pharmaceutical companies Valenta Pharm and Pharmstandard (Pharmstandart) in Russia.

Doping in Sport

Phenylpiracetam has stimulant effects and may be used as a doping agent in sport. As a result, it is on the list of stimulants banned for in-competition use by the World Anti-Doping Agency (WADA). This list is applicable in all Olympic sports. Owing to its unique stimulant properties among racetams, phenylpiracetam is the only racetam on the WADA prohibited list.

Research

Phenylpiracetam has been studied in the treatment of stroke and glaucoma.

The more active enantiomer of phenylpiracetam, (R)-phenylpiracetam, was under development for fatigue related to Parkinson’s disease. However, no recent development has been reported. There was also interest in the compound for fatigue related to depression and other conditions, but this was not pursued. 6-Phenylpiracetam has been identified as a selective atypical dopamine reuptake inhibitor (DRIs), and similarly to other DRIs, shows pro-motivational effects in animals and reverses motivational deficits.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Phenylpiracetam >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Oxyprothepin Decanoate?

Introduction

Oxyprothepin decanoate, sold under the brand name Meclopin, is a typical antipsychotic which was used in the treatment of schizophrenia in the Czech Republic but is no longer marketed.

Outline

It is administered by depot injection into muscle.

The medication has an approximate duration of 2 to 3 weeks.

The history of oxyprothepin decanoate has been reviewed.

What is Perphenazine Enanthate?

Introduction

Perphenazine enanthate, sold under the brand name Trilafon Enantat among others, is a typical antipsychotic and a depot antipsychotic ester which is used in the treatment of schizophrenia and has been marketed in Europe.

Outline

It is formulated in sesame oil and administered by intramuscular injection and acts as a long-lasting prodrug of perphenazine.

Perphenazine enanthate is used at a dose of 25 to 200 mg once every 2 weeks by injection, with a time to peak levels of 2 to 3 days and an elimination half-life of 4 to 7 days.

What is Oxcarbazepine?

Introduction

Oxcarbazepine, sold under the brand name Trileptal among others, is a medication used to treat epilepsy. For epilepsy it is used for both focal seizures and generalised seizures. It has been used both alone and as add-on therapy in people with bipolar disorder who have had no success with other treatments. It is taken by mouth.

Common side effects include nausea, vomiting, dizziness, drowsiness, double vision and trouble with walking. Serious side effects may include anaphylaxis, liver problems, pancreatitis, suicide ideation, and an abnormal heart beat. While use during pregnancy may harm the baby, use may be less risky than having a seizure. Use is not recommended during breastfeeding. In those with an allergy to carbamazepine there is a 25% risk of problems with oxcarbazepine. How it works is not entirely clear.

Oxcarbazepine was patented in 1969 and came into medical use in 1990. It is available as a generic medication. In 2022, it was the 167th most commonly prescribed medication in the United States, with more than 3 million prescriptions.

Brief History

First made in 1966, it was patent-protected by Geigy in 1969 through DE 2011087. It was approved for use as an anticonvulsant in Denmark in 1990, Spain in 1993, Portugal in 1997, and eventually for all other EU countries in 1999. It was approved in the US in 2000. In September 2010, Novartis, of which Geigy are part of its corporate roots, pleaded guilty to marketing Trileptal for the unapproved uses of neuropathic pain and bipolar disorder.

Medical Uses

Neurology

Oxcarbazepine is an anticonvulsant used to reduce the occurrence of epileptic episodes, and is not intended to cure epilepsy. Oxcarbazepine is used alone or in combination with other medications for the treatment of focal (partial) seizures in adults. In paediatric populations, it can be used by itself for the treatment of partial seizures for children 4 years and older, or in combination with other medications for children 2 years and older. There is some evidence to support its effectiveness in reducing seizure frequency when used as an add-on therapy for drug-resistant focal epilepsy but there are concerns over tolerability.

Psychiatry

Oxcarbazepine (brand name Trileptal), has been historically used off-label by psychiatrists as a mood stabiliser. However, due to the limited data supporting efficacy it is typically reserved for patients for whom other medications have not worked or are contraindicated.

Side Effects

Side effects are dose-dependent. The most common include dizziness, blurred or double vision, nystagmus, ataxia, fatigue, headaches, nausea, vomiting, sleepiness, difficulty in concentration, and mental sluggishness. The incidence of movement disorders appears to be lower compared to carbamazepine.

Other, rare, side effects of oxcarbazepine include severe low blood sodium (hyponatremia), anaphylaxis / angioedema, hypersensitivity (especially if experienced with carbamazepine), toxic epidermal necrolysis, Stevens–Johnson syndrome, and thoughts of suicide.

Measurement of serum sodium levels should be considered in maintenance treatment or if symptoms of hyponatremia develop. Low blood sodium is seen in 20–30% of people taking oxcarbazepine, and 8–12% of those experience severe hyponatremia. Some side effects, such as headaches, are more pronounced shortly after a dose is taken and tend to fade with time (60 to 90 minutes). Other side effects include stomach pain, tremor, rash, diarrhoea, constipation, decreased appetite, and dry mouth. Photosensitivity is a potential side-effect and people could experience severe sunburns as a result of sun exposure.

Oxcarbazepine may lead to hypothyroxinemia. The well-known reduction in free and total thyroxine concentration may be due to both peripheral and central mechanisms.

Pregnancy

Oxcarbazepine is pregnancy category C in the US. There is limited data supporting its safety in pregnancy. Several alternative medications with similar efficacy profiles provide significantly more robust data to support safety during pregnancy. However limited recent research shows similar rates of foetal malformations in exposed pregnancies to the general non-teratogen exposed population. Careful consideration of the risks, benefits, alternatives, and expert advise is needed when considering Oxcarbazepine use during pregnancy.

Historically Oxcarbazepine was considered to be teratogenic in humans due to animal studies which have shown increased foetal abnormalities in pregnant rats and rabbits exposed to oxcarbazepine during pregnancy. Additionally it’s similar structure of to carbamazepine, raised concern as it is teratogenic in humans (pregnancy category D).

Breastfeeding

Oxcarbazepine and its metabolite licarbazepine are both present in human breast milk and thus, some of the active drug can be transferred to a nursing infant. When considering whether to continue this medication in nursing mothers, the impact of the drug’s side effect profile on the infant should be weighed against its anti-epileptic benefit for the mother.

Interactions

Oxcarbazepine, licarbazepine and many other common drugs influence each other through interaction with the cytochrome P450 family of enzymes. This leads to a cluster of dozens of common drugs interacting with one another to varying degrees, some of which are especially noteworthy.

Oxcarbazepine and licarbazepine are potent inhibitors of CYP2C19 and thus have the potential to increase plasma concentration of drugs, which are metabolised through this pathway. Other antiepileptics, which are CYP2C19 substrates and thus may be metabolised at a reduced rate when combined with oxcarbazepine, include diazepam, hexobarbital, mephenytoin, methylphenobarbital, nordazepam, phenobarbital, phenytoin, and primidone.

In addition, oxcarbazepine and licarbazepine are CYP3A4 and CYP3A5 inducers and thus have the potential to decrease the plasma concentration of CYP3A4 and CYP3A5 substrates, including calcium channel antagonists against high blood pressure and oral contraceptives. However, whether the extent of CYP3A4/5 induction at therapeutic doses reaches clinical significance is unclear.

Pharmacology

Oxcarbazepine is a prodrug, which is largely metabolised to its pharmacologically active 10-monohydroxy derivative licarbazepine (sometimes abbreviated MHD). Oxcarbazepine and MHD exert their action by blocking voltage-sensitive sodium channels, thus leading to the stabilisation of hyper-excited neural membranes, suppression of repetitive neuronal firing and diminishment propagation of synaptic impulses. Furthermore, anticonvulsant effects of these compounds could be attributed to enhanced potassium conductance and modulation of high-voltage activated calcium channels.

Pharmacokinetics

Oxcarbazepine has high bioavailability upon oral administration. In a study in humans, only 2% of oxcarbazepine remained unchanged, 70% were reduced to licarbazepine; the rest were minor metabolites. The half-life of oxcarbazepine is considered to be about 2 hours, whereas licarbazepine has a half-life of nine hours. Through its chemical difference to carbamazepine metabolic epoxidation is avoided, reducing hepatic risks. Licarbazepine is metabolised by conjugation with Glucuronic acid. Approximately 4% are oxidised to the inactive 10,11-dihydroxy derivative. Elimination is almost completely renal, with faeces accounting to less than 4%. 80% of the excreted substances are to be attributed to licarbazepine or its glucuronides.

Pharmacodynamics

Both oxcarbazepine and licarbazepine were found to show anticonvulsant properties in seizure models done on animals. These compounds had protective functions whenever tonic extension seizures were induced electrically, but such protection was less apparent whenever seizures were induced chemically. There was no observable tolerance during a four weeks course of treatment with daily administration of oxcarbazepine or licarbazepine in electroshock test on mice and rats. Most of the antiepileptic activity can be attributed to licarbazepine. Aside from its reduction in side effects, it is presumed to have the same main mechanism as carbamazepine, sodium channel inhibition, and is generally used to treat the same conditions.

Pharmacogenetics

The human leukocyte antigen (HLA) allele B*1502 has been associated with an increased incidence of Stevens–Johnson syndrome and toxic epidermal necrolysis in people treated with carbamazepine, and thus those treated with oxcarbazepine might have similar risks. People of Asian descent are more likely to carry this genetic variant, especially some Malaysian populations, Koreans (2%), Han Chinese (2–12%), Indians (6%), Thai (8%), and Philippines (15%). Therefore, it has been suggested to consider genetic testing in these people prior to initiation of treatment.

Structure

Oxcarbazepine is a structural derivative of carbamazepine, with a ketone in place of the carbon–carbon double bond on the dibenzazepine ring at the 10 position (10-keto). This difference helps reduce the impact on the liver of metabolising the drug, and also prevents the serious forms of anaemia or agranulocytosis occasionally associated with carbamazepine. Aside from this reduction in side effects, it is thought to have the same mechanism as carbamazepine — sodium channel inhibition (presumed to be the main mechanism of action) – and is generally used to treat the same conditions.

Oxcarbazepine is a prodrug which is activated to licarbazepine in the liver.

Research

Antiepileptics are a key pharmacological therapy used in the treatment of bipolar disorder. Research has investigated the use of oxcarbazepine as a mood stabiliser in bipolar disorder, with further evidence needed to fully assess its suitability. Oxcarbazepine used in conjunction with lithium has been shown to be effective in the maintenance phase.

It may be beneficial in trigeminal neuralgia.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Oxcarbazepine >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

New Scientist Articles: Sleeping Pills & Myths and Mental Illness

Introduction

I have attached two articles from the New Scientist’s 18 January 2025 magazine discussing:

  • A news article about how sleeping pills can disrupt the brain by Grace Wade.
  • A book review (titled Myths and Mental Illness) by David Robinson of Chemically Imbalanced by author Joanna Moncrieff.

I think you will agree that both make interesting reading.

What are Psychoplastogens?

Introduction

Psychoplastogens are a group of small molecule drugs that produce rapid and sustained effects on neuronal structure and function, intended to manifest therapeutic benefit after a single administration.

Several existing psychoplastogens have been identified and their therapeutic effects demonstrated; several are presently at various stages of development as medications including ketamine, MDMA, scopolamine, and the serotonergic psychedelics, including LSD, psilocin (the active metabolite of psilocybin), DMT, and 5-MeO-DMT. Compounds of this sort are being explored as therapeutics for a variety of brain disorders including depression, addiction, and PTSD. The ability to rapidly promote neuronal changes via mechanisms of neuroplasticity was recently discovered as the common therapeutic activity and mechanism of action.

Etymology and Nomenclature

The term psychoplastogen comes from the Greek roots psych- (mind), -plast (molded), and -gen (producing) and covers a variety of chemotypes and receptor targets. It was coined by David E. Olson in collaboration with Valentina Popescu, both at the University of California, Davis.

The term neuroplastogen is sometimes used as a synonym for psychoplastogen, especially when speaking to the biological substrate rather than the therapeutic.

Chemistry

Psychoplastogens come in a variety of chemotypes and chemical families, but, by definition, are small-molecule drugs. Ketamine has been described as, “the prototypical psychoplastogen”.

Pharmacology

Psychoplastogens exert their effects by promoting structural and functional neural plasticity through diverse targets including, but not limited to, 5-HT2A, NMDA, and muscarinic receptors. Some are biased agonists. While each compound may have a different receptor binding profile, signalling appears to converge at the tyrosine kinase B (TrkB) and mammalian target of rapamycin (mTOR) pathways. Convergence at TrkB and mTOR parallels that of traditional antidepressants with known efficacies, but with more rapid onset.

Due to their rapid and sustained effects, psychoplastogens could potentially be dosed intermittently. In addition to the neuroplasticity effects, these compounds can have other epiphenomena including sedation, dissociation, and hallucinations.

Psychedelics show complex effects on neuroplasticity and can both promote and inhibit neuroplasticity depending on the circumstances. Single doses of DMT, 5-MeO-DMT, psilocybin, and DOI have been found to produce robust and long-lasting increases in neuroplasticity in animals. Likewise, repeated doses of LSD for 7 days increased neuroplasticity. However, chronic intermittent administration of DMT for several weeks resulted in dendritic spine retraction, suggesting physiological homeostatic compensation in response to overstimulation. In addition, DOI has been found to decrease brain-derived neurotrophic factor (BDNF) levels in the hippocampus. The effects of psychedelics on neuroplasticity appear to be dependent on serotonin 5-HT2A receptor activation, as they are abolished in 5-HT2A receptor knockout mice. Non-hallucinogenic serotonin 5-HT2A receptor agonists, like tabernanthalog and lisuride, have also been found to increase neuroplasticity, and to a magnitude comparable to psychedelics.

In terms of neurogenesis, DOI and LSD showed no impact on hippocampal neurogenesis, while psilocybin and 25I-NBOMe decreased hippocampal neurogenesis. 5-MeO-DMT however has been found to increase hippocampal neurogenesis, and this could be blocked by sigma σ1 receptor antagonists.

Approved Medical Uses

Several psychoplastogens have either been approved or are in development for the treatment of a variety of brain disorders associated with neuronal atrophy where neuroplasticity can elicit beneficial effects.

Esketamine, sold under the brand name Spravato and produced by Janssen Pharmaceuticals, was approved by the FDA in March 2019 for the treatment of Treatment-Resistant Depression (TRD) and suicidal ideation. As of 2022, it is the only psychoplastogen approved in the US for the treatment of a neuropsychiatric disorder. Esketamine is the S(+) enantiomer of ketamine and functions as an NMDA receptor antagonist.

Clinical Development

Other psychoplastogens that are being investigated in the clinic include:

  • MDMA-assisted psychotherapy is being investigated for treatment of PTSD. A recent placebo controlled Phase 3 trial found that 67% of participants in the MDMA+therapy group no longer met the diagnostic criteria for PTSD whereas 32% of those in the placebo+therapy group no longer met PTSD threshold. MDMA-assisted psychotherapy is also currently in Phase 2 trials for eating disorders, anxiety associated with life-threatening illness, and social anxiety in autistic adults.
  • Psilocybin, a compound in psilocybin mushrooms that serves as a prodrug for psilocin, is currently being investigated in clinical trials of Hallucinogen-Assisted Therapy for a variety of neuropsychiatric disorders. To date studies have explored the utility of psilocybin in a variety of diseases, including TRD, smoking addiction, and anxiety and depression in people with cancer diagnoses.
  • LSD is being tested in phase 2 trials for cluster headaches and anxiety.
  • DMT is being studied for depression.
  • 5-MeO-DMT is being studied for depression and eating disorders.
  • Ibogaine and Noribogaine are being studied for addiction.

List of Known Psychoplastogens

  • Substituted tryptamines: psilocin (including psilocybin and 4-AcO-DMT/psilacetin), DMT, and 5-MeO-DMT.
  • Ergolines: LSD and lisuride.
  • Substituted phenethylamines: DOI, MDMA, methylone, and mescaline.
  • Dissociatives: ketamine (including esketamine and arketamine).
  • Iboga-derivatives: ibogaine, noribogaine, tabernanthine, and tabernanthalog (DLX-007).
  • Zalsupindole (DLX-001; AAZ-A-154) and DLX-159.
  • Scopolamine.
  • Rapastinel.
  • Tropoflavin (7,8-DHF) (including R7 and R13).
  • LY-341495.
  • Isoflurane.

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What is Activity-Dependent Plasticity?

Introduction

Activity-dependent plasticity is a form of functional and structural neuroplasticity that arises from the use of cognitive functions and personal experience. Hence, it is the biological basis for learning and the formation of new memories. Activity-dependent plasticity is a form of neuroplasticity that arises from intrinsic or endogenous activity, as opposed to forms of neuroplasticity that arise from extrinsic or exogenous factors, such as electrical brain stimulation- or drug-induced neuroplasticity. The brain’s ability to remodel itself forms the basis of the brain’s capacity to retain memories, improve motor function, and enhance comprehension and speech amongst other things. It is this trait to retain and form memories that is associated with neural plasticity and therefore many of the functions individuals perform on a daily basis. This plasticity occurs as a result of changes in gene expression which are triggered by signalling cascades that are activated by various signalling molecules (e.g. calcium, dopamine, and glutamate, among many others) during increased neuronal activity.

The brain’s ability to adapt toward active functions allows humans to specialise in specific processes based on relative use and activity. For example, a right-handed person may perform any movement poorly with their left hand but continuous practice with the non-dominant hand can cause one to become ambidextrous.

Brief History

The idea of neural plasticity was first proposed during 1890 by William James in Principles of Psychology. During the first half of the 1900s, the word ‘plasticity’ was directly and indirectly rejected throughout science. Many scientists found it hard to receive funding because nearly everyone unanimously supported the fact that the brain was fully developed at adulthood and specific regions were unable to change functions after the critical period. It was believed that each region of the brain had a set and specific function. Despite this, several pioneers pushed the idea of plasticity through means of various experiments and research. There are others that helped to the current progress of activity-dependent plasticity but the following contributed very effective results and ideas early on.

Pioneers of Activity-Dependent Plasticity

The history of activity-dependent plasticity began with Paul Bach y Rita. With conventional ideology, being that the brain development is finalized upon adulthood, Bach y Rita designed several experiments in the late 1960s and 1970s that proved that the brain is capable of changing. These included a pivotal visual substitution method for blind people provided by tactile image projection in 1969. The basis behind this experiment was to take one sense and use it to detect another: in this case use the sense of touch on the tongue to visualize the surrounding. This experiment was years ahead of its time and led to many questions and applications. A similar experiment was reported again by Bach y Rita in 1986 where vibrotactile stimulation was delivered to the index fingertips of naïve blindfolded subjects. Even though the experiment did not yield great results, it supported the study and proposed further investigations. In 1998, his design was even further developed and tested again with a 49-point electrotactile stimulus array on the tongue. He found that five sighted adult subjects recognized shapes across all sizes 79.8% of the time, a remarkable finding that has led to the incorporation of the tongue electrotactile stimulus into cosmetically acceptable and practical designs for blind people. In later years, he has published a number of other articles including “Seeing with the brain” in 2003 where Bach y Rita addresses the plasticity of the brain relative to visual learning. Here, images are enhanced and perceived by other plastic mechanisms within the realm of information passing to the brain.

Another pioneer within the field of activity-dependent plasticity is Michael Merzenich, currently a professor in neuroscience at the University of California, San Francisco. One of his contributions includes mapping out and documenting the reorganisation of cortical regions after alterations due to plasticity. While assessing the recorded changes in the primary somatosensory cortex of adult monkeys, he looked at several features of the data including how altered schedules of activity from the skin remap to cortical modelling and other factors that affect the representational remodelling of the brain. His findings within these studies have since been applied to youth development and children with language-based learning impairments. Through many studies involving adaptive training exercises on computer, he has successfully designed methods to improve their temporal processing skills. These adaptive measures include word-processing games and comprehension tests that involve multiple regions of the brain in order to answer. The results later translated into his development of the Fast ForWord programme in 1996, which aims to enhance cognitive skills of children between kindergarten and twelfth grade by focusing on developing “phonological awareness”. It has proven very successful at helping children with a variety of cognitive complications. In addition, it has led to in depth studies of specific complications such as autism and intellectual disability and the causes of them. Alongside a team of scientists, Merzenich helped to provide evidence that autism probes monochannel perception where a stronger stimulus-driven representation dominates behaviour and weaker stimuli are practically ignored in comparison.

Structure of Neurons

Neurons are the basic functional unit of the brain and process and transmit information through signals. Many different types of neurons can be identified based on their function, such as sensory neurons or motor neurons. Each responds to specific stimuli and sends respective and appropriate chemical signals to other neurons. The basic structure of a neuron is shown here on the right and consists of a nucleus that contains genetic information; the cell body, or the soma, which is equipped with dendritic branches that mostly receive the incoming inputs from other neurons; a long, thin axon that bears axon terminals which carry the output information to other neurons. The dendrites and axons are interfaced through a small connection called a synapse. This component of the neuron contains a variety of chemical messengers and proteins that allow for the transmission of information. It is the variety of proteins and effect of the signal that fundamentally lead to the plasticity feature.

Structures and Molecular Pathways Involved

Activity-dependent plasticity of one form or another has been observed in most areas of the brain. In particular, it is thought that the reorganization of sensory and motor maps involves a variety of pathways and cellular structures related to relative activity.

Many molecules have been implicated in synaptic plasticity. Notably, AMPA and NMDA receptors are key molecules in mechanisms of long and short-term potentiation between neurons. NMDA receptors can detect local activity due to activation and therefore modify signalling in the post-synaptic cell. The increased activity and coordination between pre- and post-synaptic receptors leads to more permanent changes and therefore result in plasticity. Hebb’s postulate addresses this fact by stating that synaptic terminals are strengthened by correlated activity and will therefore sprout new branches. However, terminals that experience weakened and minimal activity will eventually lose their synaptic connection and deteriorate.

A major target of all molecular signalling is the inhibitory connections made by GABAergic neurons. These receptors exist at postsynaptic sites and along with the regulation of local inhibitory synapses have been found to be very sensitive to critical period alterations. Any alteration to the receptors leads to changed concentrations of calcium in the affected cells and can ultimately influence dendritic and axonal branching. This concentration change is the result of many kinases being activated, the byproduct of which may enhance specific gene expression.

In addition, it has been identified that the Wg postsynaptic pathway, which is responsible for the coding and production of many molecules for development events, can be bidirectionally stimulated and is responsible for the downstream alteration of the postsynaptic neuron. When the Wg presynaptic pathway is activated, however, it alters cytoskeletal structure through transcription and translation.

Cell adhesion molecules (CAMs) are also important in plasticity as they help coordinate the signalling across the synapse. More specifically, integrins, which are receptors for extracellular matrix proteins and involved with CAMs, are explicitly incorporated in synapse maturation and memory formation. They play a crucial role in the feedback regulation of excitatory synaptic strength, or long-term potentiation (LTP), and help to control synaptic strength by regulating AMPA receptors, which result in quick, short synaptic currents. But, it is the metabotropic glutamate receptor 1 (mGlu1) that has been discovered to be required for activity-dependent synaptic plasticity in associative learning.

Activity-dependent plasticity is seen in the primary visual cortex, a region of the brain that processes visual stimuli and is capable of modifying the experienced stimuli based on active sensing and arousal states. It is known that synaptic communication trends between excited and depressed states relative to the light/dark cycle. By experimentation on rats, it was found that visual experience during vigilant states leads to increased responsiveness and plastic changes in the visual cortex. More so, depressed states were found to negatively alter the stimulus so the reaction was not as energetic. This experiment proves that even the visual cortex is capable of achieving activity-dependent plasticity as it is reliant on both visual exploration and the arousal state of the animal.

Role in Learning

Activity-dependent plasticity plays a very important role in learning and in the ability of understanding new things. It is responsible for helping to adapt an individual’s brain according to the relative amount of usage and functioning. In essence, it is the brain’s ability to retain and develop memories based on activity-driven changes of synaptic strength that allow stronger learning of information. It is thought to be the growing and adapting quality of dendritic spines that provide the basis for synaptic plasticity connected to learning and memory. Dendritic spines accomplish this by transforming synaptic input into neuronal output and also by helping to define the relationship between synapses.

In recent studies, a specific gene has also been identified as having a strong role in synapse growth and activity-dependent plasticity: the microRNA 132 gene (miR132). This gene is regulated by the cAMP response element-binding (CREB) protein pathway and is capable of enhancing dendritic growth when activated. The miR132 gene is another component that is responsible for the brain’s plasticity and helps to establish stronger connections between neurons.

Another plasticity-related gene involved in learning and memory is Arc/Arg3.1. The Arc gene is activity-regulated and the transcribed mRNA is localized to activated synaptic sites where the translated protein plays a role in AMPA receptor trafficking. Arc is a member of a class of proteins called immediate early genes (IEG) that are rapidly transcribed in response to synaptic input. Of the estimated 30-40 genes that comprise the total neuronal IEG response, all are prototypical activity-dependent genes and a number have been implicated in learning and memory. For example, zif268, Arc, beta-activin, tPA, Homer, and COX-2 have all been implicated in long-term potentiation (LTP), a cellular correlate of learning and memory.

Mechanisms Involved

There are a variety of mechanisms involved in activity-dependent plasticity. These include LTP, long-term depression (LTD), synaptic elimination, neurogenesis, and synaptogenesis. The mechanisms of activity-dependent plasticity result in membrane depolarisation and calcium influx, which in turn trigger cellular changes that affect synaptic connections and gene transcription. In essence, neuronal activity regulates gene expression related to dendritic branching and synapse development. Mutations in activity-dependent transcription-related genes can lead to neurological disorders. Each of the studies’ findings aims to help proper development of the brain while improving a wide variety of tasks such as speech, movement, comprehension, and memory. More so, the findings better explain the development induced by plasticity.

It is known that during postnatal life a critical step to nervous system development is synapse elimination. The changes in synaptic connections and strength are results from LTP and LTD and are strongly regulated by the release of brain-derived neurotrophic factor (BDNF), an activity-dependent synapse-development protein. In addition to BDNF, Nogo-66 receptors, and more specifically NgR1, are also involved in the development and regulation of neuronal structure. Damage to this receptor leads to pointless LTP and attenuation of LTD. Both situations imply that NgR1 is a regulator of synaptic plasticity. From experiments, it has been found that stimulation inducing LTD leads to a reduction in synaptic strength and loss of connections but, when coupled simultaneously with low-frequency stimulation, helps the restructuring of synaptic contacts. The implications of this finding include helping people with receptor damage and providing insight into the mechanism behind LTP.

Another research model of activity-dependent plasticity includes the excitatory corticostriatal pathway that is involved in information processing related to adaptive motor behaviours and displays long-lasting synaptic changes. The change in synaptic strength is responsible for motor learning and is dependent on the simultaneous activation of glutamatergic corticostriatal and dopaminergic nigrostriatal pathways. These are the same pathways affected in Parkinson’s disease, and the degeneration of synapses within this disorder may be responsible for the loss of some cognitive abilities.

Relationship to Behaviour

Intellectual Disability

Since plasticity is such a fundamental property of brain function due to its involvement in brain development, brain repair, and cognitive processes, its proper regulation is necessary for normal physiology. Mutations within any of the genes associated with activity-dependent plasticity have been found to positively correlate with various degrees of intellectual disability. The two types of intellectual disability related to plasticity depend on dysfunctional neuronal development or alterations in molecular mechanisms involved in synaptic organisation. Complications within either of these types can greatly reduce brain capability and comprehension.

Stroke Rehabilitation

On the other hand, people with such conditions have the capacity to recover some degree of their lost abilities through continued challenges and use. An example of this can be seen in Norman Doidge’s The Brain That Changes Itself. Bach y Rita’s father had a disabling stroke that left the 65-year-old man half-paralysed and unable to speak. After one year of crawling and unusual therapy tactics including playing basic children’s games and washing pots, his father’s rehabilitation was nearly complete and he went back to his role as a professor at City College in New York. This remarkable recovery from a stroke proves that even someone with abnormal behaviour and severe medical complications can recover nearly all of the normal functions by much practice and perseverance.

Recent studies have reported that a specific gene, FMR1, is highly involved in activity-dependent plasticity and fragile X syndrome (FraX) is the result of this gene’s loss of function. The FMR1 gene produces protein FMRP, which mediates activity-dependent control of synaptic structure. The loss or absence of this gene almost certainly leads to both autism and intellectual disability. Dr. Gatto has found that early introduction of the product FMRP results in nearly complete restructuring of the synapses. This method is not as effective, though, when introduced into a mature subject and only partially accommodates for the losses of FMR1. The discovery of this gene provides a possible location for intervention for young children with these abnormalities as this gene and its product act early to construct synaptic architecture.

Stress

A common issue amongst most people in the United States is high levels of stress and also disorders associated with continuous stress. Many regions of the brain are very sensitive to stress and can be damaged with extended exposure. More importantly, many of the mechanisms involved with increased memory retention, comprehension, and adaptation are thought to involve LTP and LTD, two activity-dependent plasticity mechanisms that stress can directly suppress. Several experiments have been conducted in order to discover the specific mechanisms for this suppression and also possible intervention methods. Dr. Li and several others have actually identified the TRPV1 channel as a target to facilitate LTP and suppress LTD, therefore helping to protect the feature of synaptic plasticity and retention of memory from the effects of stress.

Future Studies

The future studies and questions for activity-dependent plasticity are nearly endless because the implications of the findings will enable many treatments. Despite many gains within the field, there are a wide variety of disorders that further understanding of activity-dependent mechanisms of plasticity would help treat and perhaps cure. These include autism, different severities of intellectual disability, schizophrenia, Parkinson’s disease, stress, and stroke. In addition to a better understanding of the various disorders, neurologists should and will look at the plasticity incurred by the immune system, as it will provide great insight into diseases and also give the basis of new immune-centred therapeutics. A better perspective of the cellular mechanisms that regulate neuronal morphology is the next step to discovering new treatments for learning and memory pathological conditions.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Activity-dependent_plasticity >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Neuroplasticity

Introduction

Neuroplasticity, also known as neural plasticity or just plasticity, is the ability of neural networks in the brain to change through growth and reorganisation. Neuroplasticity refers to the brain’s ability to reorganise and rewire its neural connections, enabling it to adapt and function in ways that differ from its prior state. This process can occur in response to learning new skills, experiencing environmental changes, recovering from injuries, or adapting to sensory or cognitive deficits. Such adaptability highlights the dynamic and ever-evolving nature of the brain, even into adulthood. These changes range from individual neuron pathways making new connections, to systematic adjustments like cortical remapping or neural oscillation. Other forms of neuroplasticity include homologous area adaptation, cross modal reassignment, map expansion, and compensatory masquerade. Examples of neuroplasticity include circuit and network changes that result from learning a new ability, information acquisition, environmental influences, pregnancy, caloric intake, practice/training, and psychological stress.

Neuroplasticity was once thought by neuroscientists to manifest only during childhood, but research in the latter half of the 20th century showed that many aspects of the brain can be altered (or are “plastic”) even through adulthood. Furthermore, starting from the primary stimulus-response sequence in simple reflexes, the organisms’ capacity to correctly detect alterations within themselves and their context depends on the concrete nervous system architecture, which evolves in a particular way already during gestation. Adequate nervous system development forms us as human beings with all necessary cognitive functions. The physicochemical properties of the mother-foetus bio-system affect the neuroplasticity of the embryonic nervous system in their ecological context. However, the developing brain exhibits a higher degree of plasticity than the adult brain. Activity-dependent plasticity can have significant implications for healthy development, learning, memory, and recovery from brain damage.

Brief History

Origin

The term plasticity was first applied to behaviour in 1890 by William James in The Principles of Psychology where the term was used to describe “a structure weak enough to yield to an influence, but strong enough not to yield all at once”. The first person to use the term neural plasticity appears to have been the Polish neuroscientist Jerzy Konorski.

One of the first experiments providing evidence for neuroplasticity was conducted in 1793, by Italian anatomist Michele Vicenzo Malacarne, who described experiments in which he paired animals, trained one of the pair extensively for years, and then dissected both. Malacarne discovered that the cerebellums of the trained animals were substantially larger than the cerebellum of the untrained animals. However, while these findings were significant, they were eventually forgotten. In 1890, the idea that the brain and its function are not fixed throughout adulthood was proposed by William James in The Principles of Psychology, though the idea was largely neglected. Up until the 1970s, neuroscientists believed that the brain’s structure and function was essentially fixed throughout adulthood.

While the brain was commonly understood as a nonrenewable organ in the early 1900s, the pioneering neuroscientist Santiago Ramón y Cajal used the term neuronal plasticity to describe nonpathological changes in the structure of adult brains. Based on his renowned neuron doctrine, Cajal first described the neuron as the fundamental unit of the nervous system that later served as an essential foundation to develop the concept of neural plasticity. Many neuroscientists used the term plasticity to explain the regenerative capacity of the peripheral nervous system only. Cajal, however, used the term plasticity to reference his findings of degeneration and regeneration in the adult brain (a part of the central nervous system). This was controversial, with some like Walther Spielmeyer and Max Bielschowsky arguing that the CNS cannot produce new cells.

The term has since been broadly applied:

Given the central importance of neuroplasticity, an outsider would be forgiven for assuming that it was well defined and that a basic and universal framework served to direct current and future hypotheses and experimentation. Sadly, however, this is not the case. While many neuroscientists use the word neuroplasticity as an umbrella term it means different things to different researchers in different subfields … In brief, a mutually agreed-upon framework does not appear to exist.

Research and Discovery

In 1923, Karl Lashley conducted experiments on rhesus monkeys that demonstrated changes in neuronal pathways, which he concluded were evidence of plasticity. Despite this, and other research that suggested plasticity, neuroscientists did not widely accept the idea of neuroplasticity.

Inspired by work from Nicolas Rashevsky, in 1943, McCulloch and Pitts proposed the artificial neuron, with a learning rule, whereby new synapses are produced when neurons fire simultaneously. This is then extensively discussed in The Organization of Behavior (Hebb, 1949) and is now known as Hebbian learning.

In 1945, Justo Gonzalo concluded from his research on brain dynamics, that, contrary to the activity of the projection areas, the “central” cortical mass (more or less equidistant from the visual, tactile and auditive projection areas), would be a “manoeuvring mass”, rather unspecific or multisensory, with capacity to increase neural excitability and re-organize the activity by means of plasticity properties. He gives as a first example of adaptation, to see upright with reversing glasses in the Stratton experiment, and specially, several first-hand brain injuries cases in which he observed dynamic and adaptive properties in their disorders, in particular in the inverted perception disorder [e.g. see pp 260–62 Vol. I (1945), p 696 Vol. II (1950)]. He stated that a sensory signal in a projection area would be only an inverted and constricted outline that would be magnified due to the increase in recruited cerebral mass, and re-inverted due to some effect of brain plasticity, in more central areas, following a spiral growth.

Marian Diamond of the University of California, Berkeley, produced the first scientific evidence of anatomical brain plasticity, publishing her research in 1964.

Other significant evidence was produced in the 1960s and after, notably from scientists including Paul Bach-y-Rita, Michael Merzenich along with Jon Kaas, as well as several others.

In the 1960s, Paul Bach-y-Rita invented a device that was tested on a small number of people, and involved a person sitting in a chair, embedded in which were nubs that were made to vibrate in ways that translated images received in a camera, allowing a form of vision via sensory substitution.

Studies in people recovering from stroke also provided support for neuroplasticity, as regions of the brain that remained healthy could sometimes take over, at least in part, functions that had been destroyed; Shepherd Ivory Franz did work in this area.

Eleanor Maguire documented changes in hippocampal structure associated with acquiring the knowledge of London’s layout in local taxi drivers. A redistribution of grey matter was indicated in London Taxi Drivers compared to controls. This work on hippocampal plasticity not only interested scientists, but also engaged the public and media worldwide.

Michael Merzenich is a neuroscientist who has been one of the pioneers of neuroplasticity for over three decades. He has made some of “the most ambitious claims for the field – that brain exercises may be as useful as drugs to treat diseases as severe as schizophrenia – that plasticity exists from cradle to the grave, and that radical improvements in cognitive functioning – how we learn, think, perceive, and remember are possible even in the elderly.” Merzenich’s work was affected by a crucial discovery made by David Hubel and Torsten Wiesel in their work with kittens. The experiment involved sewing one eye shut and recording the cortical brain maps. Hubel and Wiesel saw that the portion of the kitten’s brain associated with the shut eye was not idle, as expected. Instead, it processed visual information from the open eye. It was “…as though the brain didn’t want to waste any ‘cortical real estate’ and had found a way to rewire itself.”

This implied neuroplasticity during the critical period. However, Merzenich argued that neuroplasticity could occur beyond the critical period. His first encounter with adult plasticity came when he was engaged in a postdoctoral study with Clinton Woosley. The experiment was based on observation of what occurred in the brain when one peripheral nerve was cut and subsequently regenerated. The two scientists micromapped the hand maps of monkey brains before and after cutting a peripheral nerve and sewing the ends together. Afterwards, the hand map in the brain that they expected to be jumbled was nearly normal. This was a substantial breakthrough. Merzenich asserted that, “If the brain map could normalize its structure in response to abnormal input, the prevailing view that we are born with a hardwired system had to be wrong. The brain had to be plastic.” Merzenich received the 2016 Kavli Prize in Neuroscience “for the discovery of mechanisms that allow experience and neural activity to remodel brain function.”

Neurobiology

There are different ideas and theories on what biological processes allow for neuroplasticity to occur. The core of this phenomenon is based upon synapses and how connections between them change based on neuron functioning. It is widely agreed upon that neuroplasticity takes on many forms, as it is a result of a variety of pathways. These pathways, mainly signalling cascades, allow for gene expression alterations that lead to neuronal changes, and thus neuroplasticity.

There are a number of other factors that are thought to play a role in the biological processes underlying the changing of neural networks in the brain. Some of these factors include synapse regulation via phosphorylation, the role of inflammation and inflammatory cytokines, proteins such as Bcl-2 proteins and neutrophorins, and energy production via mitochondria.

JT Wall and J Xu have traced the mechanisms underlying neuroplasticity. Re-organisation is not cortically emergent, but occurs at every level in the processing hierarchy; this produces the map changes observed in the cerebral cortex.

Types

Christopher Shaw and Jill McEachern (eds) in “Toward a theory of Neuroplasticity”, state that there is no all-inclusive theory that overarches different frameworks and systems in the study of neuroplasticity. However, researchers often describe neuroplasticity as “the ability to make adaptive changes related to the structure and function of the nervous system.” Correspondingly, two types of neuroplasticity are often discussed: structural neuroplasticity and functional neuroplasticity.

Structural Neuroplasticity

Structural plasticity is often understood as the brain’s ability to change its neuronal connections. New neurons are constantly produced and integrated into the central nervous system throughout the life span based on this type of neuroplasticity. Researchers nowadays use multiple cross-sectional imaging methods (i.e. magnetic resonance imaging (MRI), computerised tomography (CT)) to study the structural alterations of the human brains. This type of neuroplasticity often studies the effect of various internal or external stimuli on the brain’s anatomical reorganisation. The changes of grey matter proportion or the synaptic strength in the brain are considered as examples of structural neuroplasticity. Structural neuroplasticity is currently investigated more within the field of neuroscience in current academia.

Functional Neuroplasticity

Functional plasticity refers to the brain’s ability to alter and adapt the functional properties of network of neurons. It can occur in four known ways namely:

  • Homologous area adaptation.
  • Map expansion.
  • Cross-model reassignment.
  • Compensatory masquerade.

Homologous Area Adaptation

Homologous area adaptation is the assumption of a particular cognitive process by a homologous region in the opposite hemisphere. For instance, through homologous area adaptation a cognitive task is shifted from a damaged part of the brain to its homologous area in opposite side of the brain. Homologous area adaptation is a type of functional neuroplasticity that occur usually in children rather than adults.

Map Expansion

In map expansion, cortical maps related to particular cognitive tasks expand due to frequent exposure to stimuli. Map expansion has been proven through experiments performed in relation to the study: experiment on effect of frequent stimulus on functional connectivity of the brain was observed in individuals learning spatial routes.

Cross-Model Reassignment

Cross-model reassignment involves reception of novel input signals to a brain region which has been stripped off its default input.

Compensatory Masquerade

Functional plasticity through compensatory masquerade occurs using different cognitive processes for an already established cognitive task.

Changes in the brain associated with functional neuroplasticity can occur in response to two different types of events:

  • Previous activity (activity-dependent plasticity) to acquire memory; or
  • In response to malfunction or damage of neurons (maladaptive plasticity) to compensate a pathological event

In the latter case the functions from one part of the brain transfer to another part of the brain based on the demand to produce recovery of behavioural or physiological processes. Regarding physiological forms of activity-dependent plasticity, those involving synapses are referred to as synaptic plasticity. The strengthening or weakening of synapses that results in an increase or decrease of firing rate of the neurons are called long-term potentiation (LTP) and long-term depression (LTD), respectively, and they are considered as examples of synaptic plasticity that are associated with memory. The cerebellum is a typical structure with combinations of LTP/LTD and redundancy within the circuitry, allowing plasticity at several sites. More recently it has become clearer that synaptic plasticity can be complemented by another form of activity-dependent plasticity involving the intrinsic excitability of neurons, which is referred to as intrinsic plasticity. This, as opposed to homeostatic plasticity does not necessarily maintain the overall activity of a neuron within a network but contributes to encoding memories. Also, many studies have indicated functional neuroplasticity in the level of brain networks, where training alters the strength of functional connections. Although a recent study discusses that these observed changes should not directly relate to neuroplasticity, since they may root in the systematic requirement of the brain network for reorganisation.

Applications and Examples

The adult brain is not entirely “hard-wired” with fixed neuronal circuits. There are many instances of cortical and subcortical rewiring of neuronal circuits in response to training as well as in response to injury.

There is ample evidence for the active, experience-dependent re-organisation of the synaptic networks of the brain involving multiple inter-related structures including the cerebral cortex. The specific details of how this process occurs at the molecular and ultrastructural levels are topics of active neuroscience research. The way experience can influence the synaptic organisation of the brain is also the basis for a number of theories of brain function including the general theory of mind and neural Darwinism. The concept of neuroplasticity is also central to theories of memory and learning that are associated with experience-driven alteration of synaptic structure and function in studies of classical conditioning in invertebrate animal models such as Aplysia.

There is evidence that neurogenesis (birth of brain cells) occurs in the adult, rodent brain—and such changes can persist well into old age. The evidence for neurogenesis is mainly restricted to the hippocampus and olfactory bulb, but research has revealed that other parts of the brain, including the cerebellum, may be involved as well. However, the degree of rewiring induced by the integration of new neurons in the established circuits is not known, and such rewiring may well be functionally redundant.

Treatment of Brain Damage

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can be transferred to a different location; this can result from normal experience and also occurs in the process of recovery from brain injury. Neuroplasticity is the fundamental issue that supports the scientific basis for treatment of acquired brain injury with goal-directed experiential therapeutic programs in the context of rehabilitation approaches to the functional consequences of the injury.

Neuroplasticity is gaining popularity as a theory that, at least in part, explains improvements in functional outcomes with physical therapy post-stroke. Rehabilitation techniques that are supported by evidence which suggest cortical reorganisation as the mechanism of change include constraint-induced movement therapy, functional electrical stimulation, treadmill training with body-weight support, and virtual reality therapy. Robot assisted therapy is an emerging technique, which is also hypothesized to work by way of neuroplasticity, though there is currently insufficient evidence to determine the exact mechanisms of change when using this method.

One group has developed a treatment that includes increased levels of progesterone injections in brain-injured patients. “Administration of progesterone after traumatic brain injury and stroke reduces edema, inflammation, and neuronal cell death, and enhances spatial reference memory and sensory-motor recovery.” In a clinical trial, a group of severely injured patients had a 60% reduction in mortality after three days of progesterone injections. However, a study published in the New England Journal of Medicine in 2014 detailing the results of a multi-centre NIH-funded phase III clinical trial of 882 patients found that treatment of acute traumatic brain injury with the hormone progesterone provides no significant benefit to patients when compared with placebo.

Binocular Vision

For decades, researchers assumed that humans had to acquire binocular vision, in particular stereopsis, in early childhood or they would never gain it. In recent years, however, successful improvements in persons with amblyopia, convergence insufficiency or other stereo vision anomalies have become prime examples of neuroplasticity; binocular vision improvements and stereopsis recovery are now active areas of scientific and clinical research.

Phantom Limbs

In the phenomenon of phantom limb sensation, a person continues to feel pain or sensation within a part of their body that has been amputated. This is strangely common, occurring in 60–80% of amputees. An explanation for this is based on the concept of neuroplasticity, as the cortical maps of the removed limbs are believed to have become engaged with the area around them in the postcentral gyrus. This results in activity within the surrounding area of the cortex being misinterpreted by the area of the cortex formerly responsible for the amputated limb.

The relationship between phantom limb sensation and neuroplasticity is a complex one. In the early 1990s V.S. Ramachandran theorized that phantom limbs were the result of cortical remapping. However, in 1995 Herta Flor and her colleagues demonstrated that cortical remapping occurs only in patients who have phantom pain. Her research showed that phantom limb pain (rather than referred sensations) was the perceptual correlate of cortical reorganisation. This phenomenon is sometimes referred to as maladaptive plasticity.

In 2009, Lorimer Moseley and Peter Brugger carried out an experiment in which they encouraged arm amputee subjects to use visual imagery to contort their phantom limbs into impossible configurations. Four of the seven subjects succeeded in performing impossible movements of the phantom limb. This experiment suggests that the subjects had modified the neural representation of their phantom limbs and generated the motor commands needed to execute impossible movements in the absence of feedback from the body.

Chronic Pain

Individuals who have chronic pain experience prolonged pain at sites that may have been previously injured, yet are otherwise currently healthy. This phenomenon is related to neuroplasticity due to a maladaptive reorganisation of the nervous system, both peripherally and centrally. During the period of tissue damage, noxious stimuli and inflammation cause an elevation of nociceptive input from the periphery to the central nervous system. Prolonged nociception from the periphery then elicits a neuroplastic response at the cortical level to change its somatotopic organisation for the painful site, inducing central sensitisation. For instance, individuals experiencing complex regional pain syndrome demonstrate a diminished cortical somatotopic representation of the hand contralaterally as well as a decreased spacing between the hand and the mouth. Additionally, chronic pain has been reported to significantly reduce the volume of grey matter in the brain globally, and more specifically at the prefrontal cortex and right thalamus. However, following treatment, these abnormalities in cortical reorganisation and grey matter volume are resolved, as well as their symptoms. Similar results have been reported for phantom limb pain, chronic low back pain and carpal tunnel syndrome.

Meditation

A number of studies have linked meditation practice to differences in cortical thickness or density of gray matter. One of the most well-known studies to demonstrate this was led by Sara Lazar, from Harvard University, in 2000. Richard Davidson, a neuroscientist at the University of Wisconsin, has led experiments in collaboration with the Dalai Lama on effects of meditation on the brain. His results suggest that meditation may lead to change in the physical structure of brain regions associated with attention, anxiety, depression, fear, anger, and compassion as well as the ability of the body to heal itself.

Artistic Engagement and Art Therapy

There is substantial evidence that artistic engagement in a therapeutic environment can create changes in neural network connections as well as increase cognitive flexibility. In one 2013 study, researchers found evidence that long-term, habitual artistic training (e.g. musical instrument practice, purposeful painting, etc.) can “macroscopically imprint a neural network system of spontaneous activity in which the related brain regions become functionally and topologically modularized in both domain-general and domain-specific manners”. In simple terms, brains repeatedly exposed to artistic training over long periods develop adaptations to make such activity both easier and more likely to spontaneously occur.

Some researchers and academics have suggested that artistic engagement has substantially altered the human brain throughout our evolutionary history. D.W Zaidel, adjunct professor of behavioural neuroscience and contributor at VAGA, has written that “evolutionary theory links the symbolic nature of art to critical pivotal brain changes in Homo sapiens supporting increased development of language and hierarchical social grouping”.

Music Therapy

There is evidence that engaging in music-supported therapy can improve neuroplasticity in patients who are recovering from brain injuries. Music-supported therapy can be used for patients that are undergoing stroke rehabilitation where a one month study of stroke patients participating in music-supported therapy showed a significant improvement in motor control in their affected hand. Another finding was the examination of grey matter volume of adults developing brain atrophy and cognitive decline where playing a musical instrument, such as the piano, or listening to music can increase grey matter volume in areas such as the caudate nucleus, Rolandic operculum, and cerebellum. Evidence also suggests that music-supported therapy can improve cognitive performance, well-being, and social behaviour in patients who are recovering from damage to the orbitofrontal cortex (OFC) and recovering from mild traumatic brain injury. Neuroimaging post music-supported therapy revealed functional changes in OFC networks, with improvements observed in both task-based and resting-state fMRI analyses.

Fitness and Exercise

Aerobic exercise increases the production of neurotrophic factors (compounds that promote growth or survival of neurons), such as brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor (VEGF). Exercise-induced effects on the hippocampus are associated with measurable improvements in spatial memory. Consistent aerobic exercise over a period of several months induces marked clinically significant improvements in executive function (i.e. the “cognitive control” of behaviour) and increased gray matter volume in multiple brain regions, particularly those that give rise to cognitive control. The brain structures that show the greatest improvements in gray matter volume in response to aerobic exercise are the prefrontal cortex and hippocampus; moderate improvements are seen in the anterior cingulate cortex, parietal cortex, cerebellum, caudate nucleus, and nucleus accumbens. Higher physical fitness scores (measured by VO2 max) are associated with better executive function, faster processing speed, and greater volume of the hippocampus, caudate nucleus, and nucleus accumbens.

Deafness and Loss of Hearing

Due to hearing loss, the auditory cortex and other association areas of the brain in deaf and/or hard of hearing people undergo compensatory plasticity. The auditory cortex usually reserved for processing auditory information in hearing people now is redirected to serve other functions, especially for vision and somatosensation.

Deaf individuals have enhanced peripheral visual attention, better motion change but not colour change detection ability in visual tasks, more effective visual search, and faster response time for visual targets compared to hearing individuals. Altered visual processing in deaf people is often found to be associated with the repurposing of other brain areas including primary auditory cortex, posterior parietal association cortex (PPAC), and anterior cingulate cortex (ACC). A review by Bavelier et al. (2006) summarizes many aspects on the topic of visual ability comparison between deaf and hearing individuals.

Brain areas that serve a function in auditory processing repurpose to process somatosensory information in congenitally deaf people. They have higher sensitivity in detecting frequency change in vibration above threshold and higher and more widespread activation in auditory cortex under somatosensory stimulation. However, speeded response for somatosensory stimuli is not found in deaf adults.

Cochlear Implant

Neuroplasticity is involved in the development of sensory function. The brain is born immature and then adapts to sensory inputs after birth. In the auditory system, congenital hearing loss, a rather frequent inborn condition affecting 1 of 1000 newborns, has been shown to affect auditory development, and implantation of a sensory prostheses activating the auditory system has prevented the deficits and induced functional maturation of the auditory system. Due to a sensitive period for plasticity, there is also a sensitive period for such intervention within the first 2–4 years of life. Consequently, in prelingually deaf children, early cochlear implantation, as a rule, allows the children to learn the mother language and acquire acoustic communication.

Blindness

Due to vision loss, the visual cortex in blind people may undergo cross-modal plasticity, and therefore other senses may have enhanced abilities. Or the opposite could occur, with the lack of visual input weakening the development of other sensory systems. One study suggests that the right posterior middle temporal gyrus and superior occipital gyrus reveal more activation in the blind than in the sighted people during a sound-moving detection task. Several studies support the latter idea and found weakened ability in audio distance evaluation, proprioceptive reproduction, threshold for visual bisection, and judging minimum audible angle.

Human Echolocation

Human echolocation is a learned ability for humans to sense their environment from echoes. This ability is used by some blind people to navigate their environment and sense their surroundings in detail. Studies in 2010 and 2011 using functional magnetic resonance imaging techniques have shown that parts of the brain associated with visual processing are adapted for the new skill of echolocation. Studies with blind patients, for example, suggest that the click-echoes heard by these patients were processed by brain regions devoted to vision rather than audition.

Attention Deficit Hyperactivity Disorder

Reviews of MRI and electroencephalography (EEG) studies on individuals with ADHD suggest that the long-term treatment of ADHD with stimulants, such as amphetamine or methylphenidate, decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia, left ventrolateral prefrontal cortex (VLPFC), and superior temporal gyrus.

In Early Child Development

Neuroplasticity is most active in childhood as a part of normal human development, and can also be seen as an especially important mechanism for children in terms of risk and resiliency. Trauma is considered a great risk as it negatively affects many areas of the brain and puts a strain on the sympathetic nervous system from constant activation. Trauma thus alters the brain’s connections such that children who have experienced trauma may be hyper vigilant or overly aroused. However, a child’s brain can cope with these adverse effects through the actions of neuroplasticity.

Neuroplasticity is shown in four different categories in children and covering a wide variety of neuronal functioning. These four types include impaired, excessive, adaptive, and plasticity.

There are many examples of neuroplasticity in human development. For example, Justine Ker and Stephen Nelson looked at the effects of musical training on neuroplasticity, and found that musical training can contribute to experience dependent structural plasticity. This is when changes in the brain occur based on experiences that are unique to an individual. Examples of this are learning multiple languages, playing a sport, doing theatre, etc. A study done by Hyde in 2009, showed that changes in the brain of children could be seen in as little as 15 months of musical training. Ker and Nelson suggest this degree of plasticity in the brains of children can “help provide a form of intervention for children… with developmental disorders and neurological diseases.”

In Animals

In a single lifespan, individuals of an animal species may encounter various changes in brain morphology. Many of these differences are caused by the release of hormones in the brain; others are the product of evolutionary factors or developmental stages. Some changes occur seasonally in species to enhance or generate response behaviours.

Seasonal Brain Changes

Changing brain behaviour and morphology to suit other seasonal behaviours is relatively common in animals. These changes can improve the chances of mating during breeding season. Examples of seasonal brain morphology change can be found within many classes and species.

Within the class Aves, black-capped chickadees experience an increase in the volume of their hippocampus and strength of neural connections to the hippocampus during fall months. These morphological changes within the hippocampus which are related to spatial memory are not limited to birds, as they can also be observed in rodents and amphibians. In songbirds, many song control nuclei in the brain increase in size during mating season. Among birds, changes in brain morphology to influence song patterns, frequency, and volume are common. Gonadotropin-releasing hormone (GnRH) immunoreactivity, or the reception of the hormone, is lowered in European starlings exposed to longer periods of light during the day.

The California sea hare, a gastropod, has more successful inhibition of egg-laying hormones outside of mating season due to increased effectiveness of inhibitors in the brain. Changes to the inhibitory nature of regions of the brain can also be found in humans and other mammals. In the amphibian Bufo japonicus, part of the amygdala is larger before breeding and during hibernation than it is after breeding.

Seasonal brain variation occurs within many mammals. Part of the hypothalamus of the common ewe is more receptive to GnRH during breeding season than at other times of the year. Humans experience a change in the “size of the hypothalamic suprachiasmatic nucleus and vasopressin-immunoreactive neurons within it” during the fall, when these parts are larger. In the spring, both reduce in size.

Traumatic Brain Injury Research

A group of scientists found that if a small stroke (an infarction) is induced by obstruction of blood flow to a portion of a monkey’s motor cortex, the part of the body that responds by movement moves when areas adjacent to the damaged brain area are stimulated. In one study, intracortical microstimulation (ICMS) mapping techniques were used in nine normal monkeys. Some underwent ischemic-infarction procedures and the others, ICMS procedures. The monkeys with ischemic infarctions retained more finger flexion during food retrieval and after several months this deficit returned to preoperative levels. With respect to the distal forelimb representation, “postinfarction mapping procedures revealed that movement representations underwent reorganization throughout the adjacent, undamaged cortex.” Understanding of interaction between the damaged and undamaged areas provides a basis for better treatment plans in stroke patients. Current research includes the tracking of changes that occur in the motor areas of the cerebral cortex as a result of a stroke. Thus, events that occur in the reorganization process of the brain can be ascertained. The treatment plans that may enhance recovery from strokes, such as physiotherapy, pharmacotherapy, and electrical-stimulation therapy, are also being studied.

Jon Kaas, a professor at Vanderbilt University, has been able to show “how somatosensory area 3b and ventroposterior (VP) nucleus of the thalamus are affected by longstanding unilateral dorsal-column lesions at cervical levels in macaque monkeys.” Adult brains have the ability to change as a result of injury but the extent of the reorganization depends on the extent of the injury. His recent research focuses on the somatosensory system, which involves a sense of the body and its movements using many senses. Usually, damage of the somatosensory cortex results in impairment of the body perception. Kaas’ research project is focused on how these systems (somatosensory, cognitive, motor systems) respond with plastic changes resulting from injury.

One recent study of neuroplasticity involves work done by a team of doctors and researchers at Emory University, specifically Donald Stein and David Wright. This is the first treatment in 40 years that has significant results in treating traumatic brain injuries while also incurring no known side effects and being cheap to administer. Stein noticed that female mice seemed to recover from brain injuries better than male mice, and that at certain points in the oestrus cycle, females recovered even better. This difference may be attributed to different levels of progesterone, with higher levels of progesterone leading to the faster recovery from brain injury in mice. However, clinical trials showed progesterone offers no significant benefit for traumatic brain injury in human patients.

Ageing

Transcriptional profiling of the frontal cortex of persons ranging from 26 to 106 years of age defined a set of genes with reduced expression after age 40, and especially after age 70. Genes that play central roles in synaptic plasticity were the most significantly affected by age, generally showing reduced expression over time. There was also a marked increase in cortical DNA damage, likely oxidative DNA damage, in gene promoters with aging.

Reactive oxygen species appear to have a significant role in the regulation of synaptic plasticity and cognitive function. However age-related increases in reactive oxygen species may also lead to impairments in these functions.

Multilingualism

There is a beneficial effect of multilingualism on people’s behaviour and cognition. Numerous studies have shown that people who study more than one language have better cognitive functions and flexibilities than people who only speak one language. Bilinguals are found to have longer attention spans, stronger organisation and analyzation skills, and a better theory of mind than monolinguals. Researchers have found that the effect of multilingualism on better cognition is due to neuroplasticity.

In one prominent study, neurolinguists used a voxel-based morphometry (VBM) method to visualise the structural plasticity of brains in healthy monolinguals and bilinguals. They first investigated the differences in density of grey and white matter between two groups and found the relationship between brain structure and age of language acquisition. The results showed that grey-matter density in the inferior parietal cortex for multilinguals were significantly greater than monolinguals. The researchers also found that early bilinguals had a greater density of grey matter relative to late bilinguals in the same region. The inferior parietal cortex is a brain region highly associated with the language learning, which corresponds to the VBM result of the study.

Recent studies have also found that learning multiple languages not only re-structures the brain but also boosts brain’s capacity for plasticity. A recent study found that multilingualism not only affects the grey matter but also white matter of the brain. White matter is made up of myelinated axons that is greatly associated with learning and communication. Neurolinguists used a diffusion tensor imaging (DTI) scanning method to determine the white matter intensity between monolinguals and bilinguals. Increased myelinations in white matter tracts were found in bilingual individuals who actively used both languages in everyday life. The demand of handling more than one language requires more efficient connectivity within the brain, which resulted in greater white matter density for multilinguals.

While it is still debated whether these changes in brain are result of genetic disposition or environmental demands, many evidences suggest that environmental, social experience in early multilinguals affect the structural and functional reorganisation in the brain.

Novel Treatments of Depression

Historically, the monoamine imbalance hypothesis of depression played a dominant role in psychiatry and drug development. However, while traditional antidepressants cause a quick increase in noradrenaline, serotonin, or dopamine, there is a significant delay in their clinical effect and often an inadequate treatment response. As neuroscientists pursued this avenue of research, clinical and preclinical data across multiple modalities began to converge on pathways involved in neuroplasticity. They found a strong inverse relationship between the number of synapses and severity of depression symptoms and discovered that in addition to their neurotransmitter effect, traditional antidepressants improved neuroplasticity but over a significantly protracted time course of weeks or months. The search for faster acting antidepressants found success in the pursuit of ketamine, a well-known anaesthetic agent, that was found to have potent antidepressant effects after a single infusion due to its capacity to rapidly increase the number of dendritic spines and to restore aspects of functional connectivity. Additional neuroplasticity promoting compounds with therapeutic effects that were both rapid and enduring have been identified through classes of compounds including serotonergic psychedelics, cholinergic scopolamine, and other novel compounds. To differentiate between traditional antidepressants focused on monoamine modulation and this new category of fast acting antidepressants that achieve therapeutic effects through neuroplasticity, the term psychoplastogen was introduced.

Transhumanism and Bodyhacking

Bodyhacking, situated at the intersection of technology and biology, represents efforts to enhance human capabilities beyond natural limitations. Innovations in this field include vests that convert sound into vibrations for individuals with hearing impairments and advanced prosthetics capable of integrating with neural signals to mimic natural movement. Bodyhacking also encompasses sensory augmentation, such as implants that enable new forms of perception or interaction. While these developments demonstrate the potential to improve quality of life and expand human ability, they also raise ethical questions regarding accessibility, safety, and the integration of technology into the human body.

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What was STAR*D?

Introduction

Sequenced Treatment Alternatives to Relieve Depression (STARD) was a collaborative study on the treatment of depression, funded by the National Institute of Mental Health. Its main focus was on the treatment of depression in patients where the first prescribed antidepressant proved inadequate. A key feature of the study was its aim to be more generalisable to real clinical situations; this was done through the use of minimal exclusion criteria, incorporating patient preference, and not blinding the treatments (i.e. the patient and clinician both knew what treatment the patient was receiving).

The STARD trial included remission (the near-absence of symptoms, rather than simply a reduction in symptoms) as an outcome measure, as there is evidence that patients with depression who achieve remission function better and are less prone to relapse than those who achieve only partial improvement in symptoms.

This report had profound impact on the promotion of antidepressants but later accused of having been subjected to multiple levels of fraud.

Trial

The STAR*D trial enrolled 4,041 outpatients with nonpsychotic depression at 23 psychiatric and 18 primary care sites. The trial was completed in 2006, and data from it has been available since 2008.

The trial involved four different treatment levels, and patients were encouraged to enter the next level of treatment if they failed to achieve remission or response (50% reduction in symptoms) after a specified number of weeks.

In level one, patients received the selective serotonin reuptake inhibitor (SSRI) citalopram for up to 14 weeks, with adjustment of the dose being managed by their own physicians. If patients achieved remission or response during that time period, they could enter a 12-month naturalistic follow-up, during which time the researchers did not have any influence over the treatment plan. Non-remitters were encouraged to enter level two.

In level two, there were seven different treatment options, and cognitive behavioural therapy (CBT) was included as the psychotherapy option. There were three combination options (either an antidepressant or CBT added to citalopram), and four switch options (to either a different antidepressant or CBT). Those who remitted or responded were offered 12-month naturalistic follow-up; non-remitters after two medication trials were encouraged to enter level 3; other non-remitters entered level 2A, which involved a second antidepressant trial.

In level three, patients were offered the addition of lithium or triiodothyronine (a thyroid hormone) to their antidepressant, or a switch to another antidepressant (mirtazapine or nortriptyline). This continued for 12 weeks.

Level four consisted of the monoamine oxidase inhibitor tranylcypromine or a combination of venlafaxine and mirtazapine.

Results

For level one, the remission rate was 28-33% (depending on the symptom scale used), and the response rate was 47%. Higher remission rates were seen in patients who were Caucasian, female, employed, or had higher levels of income or education. Lower remission rates were seen in those with longer depressive episodes, co-occurring anxiety or substance use disorders, and more physical illness.

For level two, patients who received CBT, either alone or combined with citalopram, had similar response and remission rates compared to those who were receiving medication(s) only; however, for those patients who remained on citalopram, those who had another antidepressant added achieved remission more rapidly than those who had CBT added. Among the patients who were switched to a different antidepressant, there was no significant difference among the different antidepressants.

For level three, the remission rates based on the HAM-D symptom scale were 12.3% for mirtazapine and 19.8% for nortriptyline, although the difference was not large enough for statistical significance. The remission rates based on the HAM-D in the combination strategy were 15.9% for lithium and 24.7% for triiodothyronine, but the difference was not statistically significant. However, more patients receiving lithium than triiodothyronine left the study due to side effects.

For level four, the average remission rate was 13%, with no statistically significant difference between tranylcypromine and the venlafaxine/mirtazapine combination. More patients receiving tranylcypromine left the study due to side effects.

Overall, the study findings indicate that patients who do not achieve remission or response after several weeks of citalopram treatment could achieve those outcomes by the end of 14 weeks. The STAR*D researchers state that their data “suggest that a patient with persistent depression can get well after trying several treatment strategies, but his or her odds of beating the depression diminish as additional treatment strategies are needed.” With failed treatment at a higher step, the chances of remission were smaller – and this decrease was particularly significant after level two. For those who did achieve full remission, there was a decreased chance of relapse at 12-month (naturalistic) follow-up compared to those patients who only responded.

A reanalysis published in 2023 concluded that STAR*D’s cumulative remission rate was approximately half of that reported.

Criticism

Criticism of bias has been raised by certain researchers about the STAR*D trial:

  • The research contract provided for the assessment of depression by the HRSD and IDS-C30 scales. Instead, depression was assessed using an ex-nihilo study scale (QIDS-SR), which was used for both medical decision-making and scientific evaluation.
  • STAR*D changed the inclusion and exclusion criteria for subjects during the study, so 931 subjects were included when they met the exclusion criteria, and 370 subjects were excluded while they met the inclusion criteria. These changes resulted in an increase in the average score of the subjects: according to the inclusion and exclusion criteria provided by the original protocol, the remission rate was 38%; according to the inclusion and exclusion criteria implemented retrospectively, the remission rate is 67%.
  • Only 7% of subjects in remission remained stable and stayed in the study until the end. This represents only 3% of subjects according to the original inclusion and exclusion criteria (108 out of 3,671). This has not been specified.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/STAR*D >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.