A new chapter in the healing ways of the brain

MEDICAL MATTERS:Dr Harry Barry's second book concentrates on how various treatments affect the brain

DR HARRY Barry's first book, Flagging the Problem: A new approach to mental health, broke new ground by introducing the public to the brain's mood system in a way that made psychological illness much more accessible.

So, when a review copy of his follow-up publication, Flagging the Therapy, landed on my desk, I was interested to see that he had focused this time on anxiety and depression and how various treatments work.

An important concept running right through the book is that of brain plasticity – the ability of the brain’s pathways to change in response to both disease and to effective treatments.

Although wary of condensing a book into a single sentence, it would not be unreasonable to say that Barry’s latest contribution shows how various treatments work by strengthening the brain’s healing pathways.

Early in the book, Barry discusses empathy and a part of the brain called “the mirror nervous system”.

These brain cells allow us to mirror or reflect back the actions of others.

They are especially important in parts of the brain that deal with social interaction and empathy.

Researchers have identified the mirror system as a key to the relationship between a patient and a therapist they trust.

“It is a meeting of two mirror systems: a brain-to-brain passage of emotional information from one human being to another. We begin to build a new picture of ourselves through this mechanism,” Barry writes.

We know that talk therapies work in the upper brain circuit – the parts dealing with logic and memory – and eventually a calming effect extends to the more active lower brain circuit where the “stress box” is located.

Essentially, talk therapies help the logical brain regain control over the emotional one.

In contrast, drug therapies act more quickly and help restore energy, sleep, appetite and other physical symptoms of depression. But antidepressants have an additional, albeit delayed, role: about six months into treatment, they prevent further damage to brain cells by stimulating a plasticity response through a protein that improves the connectivity between neurons.

These complementary actions of talking and drug therapies are a powerful argument for a combined approach to the treatment of depression.

Indeed, elsewhere in the book, Barry explores the additional benefits of diet and exercise in helping and maintaining recovery.

I had not been aware of the existence of a “resilience gene” until I read this book.

It is a fascinating concept, but one that helps to explain how, in a group of people exposed to severe psychological stress, some develop anxiety and depression, while others appear to be naturally more resistant.

The resilience gene controls the level of a protein called SERT. We are born with either short or long versions of the gene.

Those with short gene versions produce fewer SERT proteins in the brain, so that part of the messenger system becomes “over hyped”.

The end result is that the stress box in the brain is in a constant state of hyper-vigilance, even when it is not being directly affected by stress.

People with long versions of the gene do not show this vulnerability; their resilience is essentially fireproofed.

In a link with our childhood environment, it seems that if we grow up in a deprived, abusive or very anxious household, pathways develop early on in life that predispose us to anxiety when we become adults.

If we have a short version of the resilience gene, our stress box is more likely to go into overdrive in response to stressful triggers.

Throughout the book, Harry Barry remains committed to a holistic approach to treatment, using what’s best for the individual.

“We must concoct different menus for each individual. This approach offers the best chance of recovery. The real journey in mental health is assisting people not just to feel better but to get better, not just to get well but to stay well,” he writes.

“This has to be our goal. There are two components: the person in distress must develop empathy with their doctor/therapist, and from the beginning must be actively involved on their own recovery”.

Dr Houston is pleased to hear from readers at mhouston@irishtimes.com but regrets he is unable to reply to individual medical queries