Answer: Last night on The Agenda with Steve Paikin, an expert on the aging brain reminded us that hits on the head or brain injury predispose someone to dementia. I have heard it many times in my years as a physician. That means it is a risk factor, not necessarily that all brain injured people develop clinical dementia. I don't, however, have the dementia studies at hand. At the simplest level though, we have bony skulls around our brains because they are jelly-like, soft tissue, and require protection, and whacking the head can shear, cut nerves, or disrupt cell bodies. Some people think Muhammad Ali developed early Parkinson's because he took so many poundings in the ring. Tune in Sunday night, to Wipeout, on TVO, and COMA, to see how dangerous concussions can be in the short-term, and you will get a sense of what the long term dangers might be.

Answer: Yes there are several studies on meditation. One is by Richard Davidson, and there is a second that is even better, and they show that meditators alter the insula in their brain, a part that has to do with concentration. I'm sure there are other beneficial effects. I don't know about the pineal gland though. Does this mean the brains are younger? Some would argue that they feel refreshed, and function more like they did when they were younger, but chronologically, the brains are still aging. So here is some advice: don't aim for the impossible, to be younger; but accept you are aging, and that you now have to work a bit harder than you did when you were younger to maintain good functioning and paradoxically, you may find you feel younger.

Answer: The biggest causes of brain damage, as I recall, are actually chemicals such as mercury, or heavy metal poisoning. An instance of brain toxicity that became well known, was alleged to have been caused by the medication (which is over the counter is some places, prescription in others) of tryptophan, which is a generally harmless molecule. Some people reported poisoning, and it was taken off the market -- very quickly -- in the US. But investigation showed that the problem was with the vats in which it was made, in Japan as I recall. Fortunately, it wasn't taken off the market in Canada.



But there are cases of "irreversible side effects." Unfortunately, some of the older antipsychotic medications alter the movement centres in the brain, permanently. Not always, and we are better able to predict when this is happening, and so can take people off them, at the first sign, and if we do, we can often reverse the damage. And we are better able to predict who is prone to this very bad side effect. So why, you may ask, do we use these drugs? Because sometimes the illness they are treating is so terrible, that we have to weigh the risk to the patient's life in not treating the illness, against the risk of the side effect. We live in an imperfect world, and often our best decisions are the ones with the least serious risk. Still, with all that, we are lucky to have some of these medications -- until something better comes along.

Answer: A tic is a sudden, mostly involuntary, activation of the motor or movement system in the brain, and can involve funny movements, or even saying certain things. Many of us get transitory tics, when we are tired, or falling asleep. They are harmless.



I've said they are mostly involuntary, but only because people with tics can sometimes feel the pressure to move, and can, sometimes, delay it at bit; but they can become irresistible. These are often confused with certain voluntary movements that are called "stereotype movements" in children with autistic disorders. It seems children use these movements to get a sense of control of their bodies, their sense of orientation, and to handle anxiety. (Which isn't to say that autistic children don't get regular tics, only that they are famous for these other kinds of movements.)



Tourette's disorder gives rise to often complex tics, that occur in some situations, but may suddenly stop in others. A number of concert pianists have Tourette's, for instance, but these seem to remit when they play the piano. This is not for "psychological reasons" and doesn't mean they are faking their tics. It seems that tics can be inhibited when we activate certain of our motor programs, which inhibit other programs.



I'm not sure we know why people get tics, but they are small discharges of the brain, like small little seizures, perhaps, of a small brain function. We know that children with autism are more prone to seizures than those without. If you keep in mind that the brain works by firing off neuronal signals, it is not surprising that it would be prone, at times to fire when it shouldn't.

Answer: Lately I have heard reports that neurofeedback, in the hands of a good practitioner, can help some people with Chronic Fatigue. I would google "eeg spectrum" and their website for information on this. They post a few studies as well.

Answer: Many things have been suggested over the years, and everyone's needs are different, but I like the approach in Richard Brown's, Stop Depression Now, with its emphasis on omegas and vitamins. There are some suggestions that a subgroup of depressives with bipolar disease do well with intensive vitamin regimens, if they are missing some minerals in their diets. Remember, Lithium, which is the main mainstream drug to treat bipolar disease is a mineral.

Answer: Yes. People who are seriously depressed, have parts of their brains partially turned off, and a whole range of biological changes, including changes in the amount of brain chemicals. Gradually, if it is severe, the hippocampus, which is responsible for turning short-term memories into long, and thus certain kinds of learning, actually begins to shrink. That is why treatment is so important. And, amazingly, treatment, when it works reverses all these changes, and even increases the volume of the hippocampus.

Answer: Yes, it can, and does. There are different epochs of brain plasticity. In infancy, the core structures are completed, in our teens unused parts are pruned away, in our early twenties our frontal lobes are completed, and even in old age, we process things in different areas than we did when younger.



We learn by sculpting new connections in our brains. But the brain is always a balance between change and stability. Too much change too quickly is a problem. Plasticity can also lead to ruts. It's like snow on a hill in winter -- because it is pliable, you can take many paths down the hill. But, if you keep taking the same path, because the snow is pliable, you can create ruts.



Our left hemisphere, and our dopamine system tends to reinforce habitual behaviour and thus, presumably, the same kinds of connections. This is what I call "The plastic paradox." That plasticity can give rise to both flexible and rigid behaviours, depending on how you use your brain. So if you want to keep your brain fit and changing, try new things. The Brain That Changes Itself includes scores and scores of examples of people rewiring their brains in the most challenging situations. Yet it is also in our everyday life experiences that our brains rewire themselves -- as we learn and experience.

Answer: Good question. Watch TVO on Friday night to see the airing of "Brain Man," a documentary focusing on highly functioning autistic Daniel Tammet.



Daniel is a considerate, warm, loving person, who was born with autism. He was higher functioning than many, but still he was autistic spectrum, and he was able to train himself, with his family's help (and multiple siblings for social stimulation) to function beautifully.



The issue with autism is that it covers such a wide spectrum, and so many levels of difficulty, that you have to go on a case by case basis. I'm a fan of The Child With Special Needs, by Dr. Stanley Greenspan, whose technique 'Floortime', has helped a lot of parents help their children connect socially and psychologically. not by "getting them to behave" but by awakening the social abilities within. You might also want to take a look at Daniel Tammet's book, Born On A Blue Day.

Answer: The brain is always rewiring itself, and the anxious brain is no different in that. The problem can be that after outbreaks of anxiety, certain circuits, which involved the amygdala, get hyper-activated. We know that successful treatments deactivate those particular circuits.


Anxiety, per se, is normal, and gets us to attend to threats but sometimes, we can't turn the system off, or it is over-active or over-generalizing. The tendency for that to happen does appear to run in families, and that can mean it has a genetic source, but not necessarily. We might be learning the anxious behaviours from those around us too.



The general sense in psychiatry, is that for full-blown anxiety disorders there is often a family history suggestive of a genetic component. It is rarely, if ever, simply either nature or nurture, biology or experience. A better question might be "how much nature and how much nurture?" For instance, in many situations, "overly anxious parents" are not just "teaching their kids the wrong thing." They may have strong genetic predispositions to anxiety themselves.



Most anxious people have their anxieties triggered by certain life events or fears, initially. And because some therapies can help control this tendency, we know experience can help a person regain control over these circuits. Anxiety disorders can be so unremitting and so painful. But the good news is that we can often make progress with many of them over time.

Answer: Let me preface my answer with the following. If someone has correctly diagnosed hyperactivity, and they are having real difficulties, that will stress their brain and cause problems for it over the long haul.



That said, there have not been nearly enough studies. There is a general clinical consensus among psychiatrists, based not on studies, but anecdotal treatments, that for the right patient, there is little evidence of harm, and that stimulants have been around a long-time, and their side effects well-known (in children decreased appetite, temporary disruption of growth, and insomnia, for instance. The stunted growth is thought to be reversible, or can, at least, be minimized with breaks).



I know of one small study in animals that showed, with higher than clinical doses, that cancers can develop. But this study, to my knowledge, has not been seen as persuasive enough to be sufficient to change patterns for drug prescribing.



As with my answer for antidepressants: drug companies have no motive, to study long-term effects once short term efficacy has been established, because once the drug is used, there is a risk that a long-term study could show it does cause problems. As well, they put a lot of research dollars into developing the drugs, which in our system, come off patent after 25 years, so the inventors have no incentive to see how the drug will do in the long-term, because by then, anyone can make it. We have a real problem in the system, and it would fall on academic centres to do these studies.



But clinicians are not generally using these drugs mindlessly. We try to take patients off them, and often see that they don't function nearly as well as they did on them. And key to this question: is the diagnosis correct? The problem with the diagnosis of ADD is a deep one. It is a real disorder, but so often, children with all sorts of learning disorders and difficulties are given the diagnosis, and they shouldn't be, because any kid who has, say, a math learning disorder, and is having trouble "getting it" will start to squirm, get distracted, act out, and not pay attention. They then get stuck with the ADD label when they have cognitive problems. These kids often need cognitive exercises, as provided by specialized centres -- I am interested in The Learning Centre, in Toroto, for some problems, and the Arrowsmith School for others. There is also a computer program, called CogMed, which I haven't looked at yet, but which claims to exercise and train attention. These are non-medication approaches. To repeat, for these disorders: medication when necessary, but not necessarily medication. Some good books to look at: Delivered From Distraction, by Ratey, and When Listening Comes, by Paul Madaule.

Answer: In my book The Brain That Changes Itself, I wrote about this, and developed a theory about it. People often report, in studies, feeling more tired than depressed after watching television. Television, in the last few years, is constantly changing point of view with the camera, or using sex, aggression, or novelty to get our attention. It's a cheap trick, but it triggers an ancient part of the brain called the "orienting response" which makes us feel alert so that we can attend to the sudden novelty, sexual possibility or danger. A typical commercial fires the orienting response about once a second! Now imagine what this does to you: you soon feel fried. Walking down a city street in New York will do the same thing, which is why we long for time at a cottage or in nature, where there's less constant stimulation.



Without a doubt it has a cumulative effect on the brain. But everything we do rewires our brain. The media is especially good at it because it, like our brains, is an electrically based communication system. As Marshall McLuhan brilliantly showed us, the specific way we take in information, actually changes our perceptual systems. As I show in The Brain That Changes Itself, in the appendices, Jean Jacques Rousseau was probably the first to guess this was possible. But recent brain scan studies show, for instance, that a different part of your brain is accessed (and thus develops) when we read a book, or listen to it on tape, and so the processing is different. I believe that attention spans have dropped since the rise of television. Last night on The Agenda with Steve Paikin, Barbara Arrowsmith, who treats children with learning disorders, stated that 30 years ago few of the children had "frontal lobe" and attentional problems, and now most do.

Answer: Yes, acupuncture techniques can be used to help people suffering from PTSD, though this is not yet widely known. When President Nixon went to China, in the 1970's, the reporter covering the trip for the New York Times, James Reston, had an attack of appendicitis and needed emergency surgery, and as part of his treatment got acupuncture, and was amazed at how it limited his pain. News of this treatment came to the West and a brilliant chiropractor, George Goodheart, who I had the privilege to meet, began integrating Eastern and Western medical techniques. Eastern medicine didn't draw as firm a line between mind and body as we have in the West of recent years. Some of Goodheart's students noticed that people with emotional problems often had associated physical ones. One student, Roger Calaghan, working with a woman with a phobia who got nervous in her stomach, thought of getting her to tap the acupuncture spot for the stomach, and her phobia went away. The procedure has become very sophisticated, and in the hands of an expert, is quite amazing. One such expert is Dr. Fred Gallo, who wrote books for senior people, and also a self-help book for treating PTSD, with tapping acupuncture points. This technique is now being used on soldiers returning from Afghanistan, to good effect.

Answer: Yes it has changes. We now know that in many, if not most, addictions, a switch is thrown in the brain of the person who becomes an addict, leading to plastic change in the brain. That switch is in the delta fos B molecule. Once thrown, it seems it can't be changed back, so that person has to avoid that substance for life. I can't say there are more pleasure pathways -- an interesting idea -- but I do think that they are triggered by substances, instead of by the way they evolved to be triggered: accomplishing a goal in life.

Answer: That's a big question. There are many ways to classify memory, and many levels. There are memories that are for facts and stories, memory systems for procedures (such as riding a bike) and there are even unconscious memories, that we can't access but which influence us. What you describe is like the "tip of the tongue" phenomenon, when we know there is a word for something, but can't get it. What is happening there is that a specific aspect of memory, called, "retrieval" is not working, but another aspect of memory, "recognition" is. We recognize that the word exists, but can't retrieve it. These are two different stages of memory, and recognition is probably an earlier more basic one, and retrieval requires the brain's ability to categorize and organize our "files" of memory.

Answer: I'm presuming you are saying you are now more adept at languages than you were before the stroke. That sounds incredible, but I believe that this can happen. Much of what our brain does, in a minute to minute way, is inhibitory. We can do so much, that, parts of the brain, like an orchestra conductor silencing the brass to hear the violins, are always inhibiting other parts, from functioning at their maximum potential. We know that people with fronto-temporal dementia, in the left hemisphere, can sometimes develop great artistic skill spontaneously, and this is thought to occur because the left hemisphere is no longer inhibiting the visual-spatial right.

Oliver Sacks describes a man who was struck by lightning who developed spontaneous musical interests and abilities and who became a composer. We know that using TMS (Transcranial magnetic stimulation) to block certain brain areas, other skills, such as proof-reading, can develop rapidly. These are cases of a part of the brain getting out of the way of another part, so it can develop plastically. But all the brain is plastic, and indeed, that is how the brain works.

Answer: In recent years, the term spiritual has come, for many people to replace the words piety or religion, so it is hard at times to know what people mean by "spiritual." My best guess -- and it is an intelligent guess only -- is that there are many factors that attribute to this openness some people experience. I do think that there are suggestions that the left hemisphere leads to a kind of analytic focused attention, that is very habitual, that may cut us off from the kinds of insights which are more "whole picture" insights, that the right hemisphere seems capable of. But the right hemisphere at times also can be critical and function as "the devil's advocate" in the brain, an aspect of it that is not widely known by people who think of the right as creative and only the source of good things. In fact, people who have strokes in their right hemispheres often lose the critical capacity, and make use of a lot of denial. So it is not all, a left/right explanation.



We know, too, that people with temporal lobe epilepsy often have religious-like, or mystical kinds of experiences in their seizures, that pass when the seizures pass, and we have temporal lobes on both sides of the brain. I believe, we also see a tremendous amount of wishful thinking behind some religious and spiritual experience that can't be denied: as in the old saying, there are no atheists in foxholes. When we feel desperate and isolated (and what greater sense of isolation is there than approaching death, for some people) the mind can construct a fantasy of connection. That is not to say that this proves that religion is all about wishful thinking or fantasy; but nor should we deny that there is a tremendous amount of it in religion. We see these when we think of other people's religions, which often seem so fantastical to us, not so much when we think of our own. Sometimes the views others have of heaven is obviously a place that satisfies all their very personal wishes. Psychologically, we see wish-fulfillment working in dreams very frequently, perhaps almost every night, when the brain regresses to earlier modes of thought, and our wishes are granted. This may be because the brain, almost by default, seems to have to imagine a wish fulfilled, to inspire us to turn these wishes into goals. It may also be that some people have simply had different experiences than others, and their personal histories open them up to this.

Answer: There have been very few studies of the long-term effects of antidepressants. Unfortunately, most drug companies and research institutions have done short-term studies, which show efficacy, especially in severe depressions in some people, but they haven't done very many long term studies at all. Drug companies invest a lot in developing medications, and they only stay on patent for a limited period of time, and by the time they are off patent, and become generic, the companies are on to making new drugs. There is, alas, little incentive to see whether they have long-term negative side effects, or whether they "poop out". That said, for some people these medications are life-savers. And that absence of knowledge has to be weighed against the strong evidence that we have that depression is very bad for the brain, and it alters key brain structures, shrinking the hippocampus, for instance (which is essential for memory). It also has to be weighed against the clinical evidence we have that some people who try to go off antidepressants (especially those, it seems with a strong genetic history of depression) often get ill again.

So, given that we know that depression is terrible for the brain, and that clinicians who have had patients on antidepressants for many years often find their patients do better on them than off, there continues to be a role for these medications -- if, as far as I'm concerned, there is some psychotherapy involved, and it isn't just a case of pushing pills.



There are also suggestions that antidepressants help to foster neuroplastic growth and change in certain parts of the brain. Psychotherapy fosters neuroplastic change as well. But we also know that SSRI antidepressants, in a large number of people, can lead to a decreased sex drive, and in some people forms of apathy -- and this took a long time to recognize because depression can lead to both as well.

In my opinion, the approach should be antidepressants, if necessary, but not necessarily antidepressants if the patient can be helped with psychotherapy or other interventions.

Answer: I don't know of any specific studies, but I would imagine that, in principle, since Down Syndrome kids can do some learning, they would benefit from the properly targeted program. There are reading training programs, including one out of Peterborough, that tries to help kids with Down Syndrome, who are often visual learners. It tries to help them learn to read in a new visual way. It is not necessarily based on neuroplasticity research and I haven't investigated it, but it might be worth looking into and judging for yourself -- www.outoftheboxreading.com.