Treating Nystagmus in the Down Syndrome Population

What is Nystagmus?

Nystagmus is an involuntary "flutter" or movement of the eyes (like the actor in "The Crying Game"). Ten percent of people with Down syndrome have nystagmus, while in the typical pediatric population, it occurs in about .015 percent.

Jett seemed to be born with it--at least it appeared occasionally very early on, just a tiny bit in both eyes. I don't know exactly when it first started, but I always knew when to change his diaper because the flutter seemed to coincide with peeing. It turns out that other moms with babies with DS and nystagmus have also seen it appear when their child is doing something physical as well, like trying to lift his/her head during tummy time.  Jett's flutter never stayed for longer than a couple of seconds. His was a very fast, right to left motion, eventually only in his left eye. When he crossed his eyes to focus on something close, it stopped. And then, soon after his heart surgery, at 6 months old, it was in one eye constantly--a fast horizontal flutter. I was concerned, not only because it was giving him poor sensory input, much needed for learning, but because I didn't want an additional barrier between him and the people who might want to befriend him. So, it was important to me to fix it as soon as possible!

If you've looked online and asked your doctors--like I did--they all probably said nystagmus is incurable with 272 possible reasons as to why your child may have it. And the treatment mentioned probably included contact lenses and glasses, medication and/or surgery, none of which completely cure the problem.

"Incurable" is pretty meaningless to me, so I tracked down two people online who were able to cure their nystagmus -- one was a mom named Ali, with a child with DS and nystagmus, who used essential oils; and one was a man in China who found success through a Traditional Chinese Medicine (TCM) practitioner. I found a reputable TCM locally from a recommendation by Jett's pediatrician. She's a licensed Acupuncture Physician (A.P.) and a certified Diplomat in TCM on the national level. She used acupressure instead of acupuncture (since he was a baby) and she gave him the "Free the General" herbal tea blend (brand name Si Jin Boa). But it's probably not a one size fits all... She seemed to know right away what to do. I took him to her once a week (maybe twice a week, at first) and then once every two weeks. It took a while, but it gradually went away within about three months. And it has NEVER come back; he's almost four years old now. 

TCM absolutely worked for Jett. If you choose to go that route, make sure you find a good TCM practitioner. I would be happy to give you Jett's TCM's info (in the Orlando area) in case you are near her or if the one you find would want to correspond with her.

Where can you find a qualified TCM Practitioner?

The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) website has a national directory of all acupuncturists and TCM practitioners that hold NCCAOM certification. Since NCCAOM certification is a prerequisite for licensure in most states, this is a reliable and reputable source of information about practitioners who have met established standards of competency.

Do eye supporting oils and supplements work?

Ali used supplements that support the eyes to get results: Vitamin C, DHA, flax seed oil, Evening Primrose Oil, a small amount of vitamin E, cod liver oil, beta carotene, milk thistle and lutein. (Now I've found out that the DS population should avoid lutein, so I'd skip that one and use astaxanthin instead.) Ali says:

"Within two days, our son was back. He was able to focus on us mentally and visually. He began to play and vocalize better than ever. The nystagmus backed off and showed only when he looked far to the side and some days it didn't show up at all. I am still going to supplement him with some oils even as we give him a nutritional formula designed for DS kids. I'm hoping we can keep the nystagmus at bay."

I use many of these supplements for Jett's eye health including Vitamin C, DHA, vitamin E, fermented cod liver oil and astaxanthin.

Thiamine is the next one I will consider. Thiamine deficiency can cause problems with overall brain health, nystagmus and apraxia.  Thiamine appears to be possibly deficient in people with Down syndrome.

https://books.google.com/books?id=ZniNNDDXDjMC&pg=PA56&dq=thiamine+deficiency+and+nystagmus&hl=en&sa=X&ved=0CB0Q6AEwAGoVChMI2pKo2vSIyAIVxj4-Ch2ULwak#v=onepage&q=thiamine%20deficiency%20and%20nystagmus&f=false

https://books.google.com/books?id=ZniNNDDXDjMC&pg=PA79&dq=thiamine+deficiency+and+apraxia&hl=en&sa=X&ved=0CB0Q6AEwAGoVChMI456Om_WIyAIVTDQ-Ch0bQAWd#v=onepage&q=thiamine%20deficiency%20and%20apraxia&f=false

http://www.ncbi.nlm.nih.gov/pubmed/14514503
"Down's syndrome subjects had smaller corpus callosum areas and hippocampal volumes relative to age-matched healthy comparison subjects"

From one survey I did of 24 moms with children with DS who have nystagmus, two more cures were uncovered: one child's issue disappeared once thyroid treatment began and another's child went away with manipulation from a DO (Doctor of Osteopathy). Since hypothyroidism can lead to low muscle tone, perhaps fixing her child's thyroid also fixed the muscle tone which in turn cured the nystagmus. 

 
Can it just disappear?

Two parents said that it just disappeared after about two years. This description sounds like they had spasmus nutans, which usually occurs between 6 months and 3 years of age and resolves spontaneously between 2 and 8 years of age. Children with this form of nystagmus often nod or tilt their head to compensate for the eye movement. Their eyes may move in any direction. Personally, I wouldn't want to wait and see...

Can some supplements make it worse?

Several parents saw nystagmus appear when using anti-seizure drugs or when giving ginkgo. Discontinuing the products stopped this type of eye flutter altogether.

Can patterning, crawling or walking help?

The direct cause of nystagmus is instability in the motor system that controls the eyes. When nystagmus develops in early childhood (as it seems to in people with DS), it can be caused by a problem with the visual pathway from the eye to the brain. From what I could piece together, the type of nystagmus Jett had may have been due to a problem in his brain stem, not surprising for a child with DS. Since Jett was fresh out of heart surgery and could not yet crawl, I did patterning (manually mimic the motions of cross patterned crawling) with him which, from what I read, helps stimulate that part of the brain. It makes sense that his nystagmus worsened right when he should be learning to crawl, but was delayed. Some moms surveyed saw improvements through creeping (4 point crawling) and walking, which also targets that area. Mom, Jaime, commented:

"My child started crawling last June and has recently begun creeping like crazy. I kind of blame the majority of his progress on creeping and crawling. For sure, once he started crawling, [the nystagmus] improved. I know because I've been paying attention. Now, it's nearly undetectable. At his last eye appointment, the ophthalmologist commented on how hugely it had improved. I found that interesting because at our first appointment, the previous year, she had suggested that they rarely improve!" 

Another way to help trigger the brain stem in an older child, other than crawling, would be to chew gum at the back of the jaw. (A neurodevelopmentalist would be able to give more tips.)

Craniosacral therapy and nystagmus

Other moms are seeing improvements through using craniosacral therapy, exercising with vision therapy and patching the stronger eye. One child had a combination of muscle tightening/alignment and ear tube surgery. This child may have had inner ear inflammation, yet another possible cause of nystagmus. The flutter was lessened with each of these approaches, but none of these have completely relieved their child of the nystagmus. (Yet, anyway!) Most said it's now barely noticeable or appears only when the child is tired or sick.

Other types of nystagmus can be up and down (vertical) or move in a circular fashion (rotatory), but, interestingly, all of the moms reported their child has/had horizontal nystagmus in both eyes except for the children who had cataract surgery. Those children had it in the weakest eye, only when patched and both had nystagmus appear only after cataract surgery. Mom, Julia, explained it this way:  

"[The nystagmus was] made 97% better, at this point, by increased patching. The [Pediatric Ophthalmologist] suspects a "searching motion" due to immature neurological connections...."

Most moms said that it seemed to get worse when their child was tired, also indicating a possible muscle issue. As far as whether or not the nystagmus temporarily corrected itself while focused on something was split 50/50. 

Studies have shown that downbeat nystagmus (type of vertical nystagmus) may occur from a partial deficiency of the metabolic cofactors, magnesium and thiamine (B1).  And that a B12 deficiency has also been known to cause nystagmus. Our kids are usually deficient in all three of these vitamins, but I haven't encountered anyone with DS who exhibits it vertically.

Please feel free to comment to add your input to the survey. The questions are:
1) When did the nystagmus first appear? When did it disappear?
2) Is it in both eyes or one eye?
3) Is it horizontal, vertical or rotary?
4) Is it about the same speed, or changes speed (jerky)?
5) Is it worse when your child is tired?
6) Is it better or worse when your child focuses on something?
7) Have you noticed anything making it better or worse?
8) What have you done to treat it?


Sources

http://www.healthline.com/galecontent/nystagmus#2

http://www.cancercare.lahey.org/Departments_and_Locations/Departments/Endocrinology,_Diabetes_and_Metabolism/Ebsco_Content/Hypothyroidism.aspx?chunkiid=100682 

http://archneur.jamanetwork.com/article.aspx?articleid=580158

http://teddybrain.wordpress.com/2013/01/16/what-nystagmus-can-tell-you-in-neurology-clinical-approach-to-nystagmus/

http://www.whale.to/w/b12.html



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Vitamin C Plays Important Role in Brain Function

This discovery is exciting and important to the DS community for several reasons — one, it reinforces how important common vitamins are, which supports the use of TNI (Targeted Nutrition Intervention) — two, it reminds us of the connection between eye dysfunction and brain dysfunction so we will recognize and treat it as a symptom of a brain disorder in the central nervous system and not just as a sensory issue — three, it reminds us that brain receptors and cells can be protected from premature breakdown by antioxidants such as vitamin C and — four it offers us an additional way to treat GABA overexpression, which is a major problem in individuals with T21 (presently addressed with Ginkgo Biloba). My notes are in italics. I also bolded parts I felt are significant.

Additionally, Vitamin C is great for increasing the level of glutathione in the body, which is much needed in individuals with DS. See studies below.

Also this linked study shows that treatment with vitamin C can dissolve the toxic protein aggregates that build up in the brain in Alzheimer’s disease.

OHSU scientists discover new role for vitamin C in the eye — and the brain

07/14/11 Portland, OR

In a surprising finding, vitamin C is found to prolong proper function of retinal cells.

Nerve cells in the eye require vitamin C in order to function properly — a surprising discovery that may mean vitamin C is required elsewhere in the brain for its proper functioning, according to a study by scientists at Oregon Health & Science University recently published in the Journal of Neuroscience.

“We found that cells in the retina need to be 'bathed' in relatively high doses of vitamin C, inside and out, to function properly,” said Henrique von Gersdorff, Ph.D., a senior scientist at OHSU's Vollum Institute and a co-author of the study. “Because the retina is part of the central nervous system, this suggests there's likely an important role for vitamin C throughout our brains, to a degree we had not realized before.”

The brain has special receptors, called GABA-type receptors, that help modulate the rapid communication between cells in the brain. GABA receptors in the brain act as an inhibitory “brake” on excitatory neurons in the brain. (These receptors do not work properly in people with Down syndrome.) The OHSU researchers found that these GABA-type receptors in the retinal cells stopped functioning properly when vitamin C was removed.

Because retinal cells are a kind of very accessible brain cell, it’s likely that GABA receptors elsewhere in the brain also require vitamin C to function properly, von Gersdorff said. And because vitamin C is a major natural antioxidant, it may be that it essentially ‘preserves’ the receptors and cells from premature breakdown, von Gersdorff said. (Premature breakdown of brain cells and receptors is also a concern for individuals with DS.)

The function of vitamin C in the brain is not well understood. In fact, when the human body is deprived of vitamin C, the vitamin stays in the brain longer than anyplace else in the body. “Perhaps the brain is the last place you want to lose vitamin C,” von Gersdorff said. The findings also may offer a clue as to why scurvy — which results from a severe lack of vitamin C — acts the way it does, von Gersdorff said. One of the common symptoms of scurvy is depression, and that may come from the lack of vitamin C in the brain. (Also interesting because Prozac, used to treat cognitive problems in DS, heals depression while regenerating neurons. If vitamin C relieves depression then it makes you wonder if it may effect neurogenesis as well.)

The findings could have implications for other diseases, like glaucoma and epilepsy. (In DS, the prevalence of patients with glaucoma was 11.5%, significantly higher [P = 0.014] than that in the Non-DS control group, 1.1%.) Both conditions are caused by the dysfunction of nerve cells in the retina and brain that become over excited in part because GABA receptors may not be functioning properly. (Jett had nystagmus which is an eye flutter. His TCM said that she was concerned about the possibility of seizures because of the presence of the nystagmus. Her concerns make much more sense to me now.)

“For example, maybe a vitamin C-rich diet could be neuroprotective for the retina — for people who are especially prone to glaucoma,” von Gersdorff said. “This is speculative and there is much to learn. But this research provides some important insights and will lead to the generation of new hypotheses and potential treatment strategies.”
----------

Scientists and students in von Gerdorff's lab in OHSU's Vollum Institute are dedicated to basic neuroscience research. The vitamin C research work was done using goldfish retinas, which have the same overall biological structure as human retinas.

The retina research work was done by Ph.D. student Evan Vickers, working as part of the von Gersdorff lab. The work was in collaboration with Cecilia Calero in the lab of Dr. Daniel J. Calvo from the University of Buenos Aires, Argentina, and Gustavo Cid and Luis Aguayo from the University of Concepcion, Chile.

The work was funded by the Consejo Nacional de Investigaciones Científicas y Tecnicas (Argentina), the Pew Foundation, the International Brain Research Organization and the National Eye Institute of the National Institutes of Health.

The study was published online in the June 29 issue of the Journal of Neuroscience, which is the official journal of the Society for Neuroscience.

About the Vollum Institute

The Vollum Institute is dedicated to basic research focusing on gene regulation, structural biology, cell signaling, molecular neuroscience and synaptic modulation with implications for human diseases ranging from autism and other neurodevelopmental disorders to Parkinson's disease, multiple sclerosis, psychiatric diseases and mechanisms of drug addiction.

Dosage

How much vitamin C should our loved one get and in what form?

A recommended dose of vitamin C is 250-2000 mg (not the US government's recommendation) for adults. So, just to give you an idea, 150 lbs = 250-2000 mg; 75 lbs = 125-1000 mg; 37 lbs = 62-500 mg; 19 lbs = 31-250 mg; 9 lbs = 15-125 mg, etc. Vitamin C is safe – too much simply causes diarrhea. Try increasing the amount until it causes loose stools, then reduce the dose slightly so it does not. This is called taking vitamin C to "bowel tolerance". Using muscle testing might be an easy and effective way to find out how much vitamin C your child can tolerate.

Jett weighs 20.6 lbs and he takes 3,750 mg of vitamin C, twice a day. Your child may not need that much, or may need more! I figured out this dose by increasing it "to bowel tolerance." I slowly increased his dose until his stool became loose. Once this happened, I lowered the dose until he was regular and his stool consistency was normal. Bonus: Jett's constipation is gone! 
(See Constipation: Causes and Cures, if needed.)

I started Jett on the Nature's Way Alive Vitamin C which I was happy with but he needed so much that it became too bulky.  

Once he's at least 60 lbs,I may try the liposomal vitamin C, to maximize my dollar. It's very strong stuff, so if you use it, use very little and slowly work your way up to the maximum dose.

Even though Vitamin C is commonly supplemented, you'll still need to introduce it slowly and in small amounts. The initial doses of C may trigger an immune response in your child. (It can "kick-start" a sleeping immune system.) For Jett, he got a runny nose in the night. (I had to wake up and clean out his nose.) He'd never been sick and doesn't have runny noses, so this was significant for him. In other children I know who start on C, they actually got colds. Or at least the symptoms of a cold: runny nose, fever, etc. So, do ease your child into the dose. And pick a time when you don't have an upcoming recital or event where you'll need your child to be 100%. Also give him plenty of fluids throughout the day to help his body get rid of whatever the C has found to fight off. Update: At the same time that I had tried the C, I also was seeing if he could tolerate a little dairy. So when I stopped the dairy, and continued the C, the runny nose stopped. So, in Jett's case, it was the dairy and not the C.

Another possible side effect is gas. The Vitamin C will kill off yeast. This "die off" may cause gas. If your child still eats things that promote yeast like sugar, you may have more gas. Jett's diet is pretty clean and doesn't seem to have a problem with yeast, so he hasn't had this side effect. A teen that I know had terrible gas at first because he has a yeast-supporting diet.

Products

The most powerful and fast acting form of vitamin C is as ascorbic acid. If your child is sensitive to the acidity, you may want to purchase buffered C (Perque Potent C Guard is the only one not derived from corn) or by adding baking soda to your Vitamin C Powder from Vitacost or The Vitamin C Foundation Brand (which is not sourced from China). If it's still a problem, you can try a powdered fruit which is high in Vitamin C like Camu Camu or Amla. Jett uses camu camu because amla didn't muscle test well for Jett.


Be sure to get $10 off your first Vitacost vitamin order.

Details

Nature's Way Alive Vitamin C is easily absorbed, gentle on the stomach, non-GMO and free of common food allergens. It's just pure vitamin C complex from four 100% organic fruit sources: acerola, goji, amla (amalaki) and kiwi. You can get it in vegetarian capsules or in powder form. One capsule is 125 mg, when I started, I gave him a capsule a day and saw how that went for a week.

I then was using Vitacost brand Buffered C Complex because Jett's need for vitamin C was greater than I realized and I had to give too many of the Nature's Way capsules (6) which was becoming too bulky for him to have to eat mixed in his food. Once he can take capsules, I would like to go back to find an organic source. So, now, Jett weighs 20.6 lbs and he takes 3,750 mg of vitamin C. I figured out this dose by increasing it "to bowel tolerance." I slowly increased his dose until his stool became loose. Once this happened, I lowered the dose until he was regular and his stool consistency was normal.

Then I used Vitamin C Powder but it is derived from corn so I discontinued. It also isn't buffered so it can be hard on tooth enamel. This product is the best kind because it's properly buffered and is not derived from corn: Perque Potent C Guard another choice to consider would be the product from 
The Vitamin C Foundation. The Ester C didn't work at all, by the way.

At four years old, I'm just using camu camu powder over ascorbic acid for Jett, at one teaspoon twice a day, more only if there's any constipation. Originally, I was avoiding ascorbic acid because of the sour taste, but I read that, after long term use, it could break down into oxalates in the intestines which may lead to oxalate stones like kidney stones. The findings are debatable, see here for details.

According to the makers of Lypo Spheric Liposomal Vitamin C, it provides maximum assimilation and bio-availability because there are no binders, fillers, gelatins, capsule materials, dyes, sweeteners or flavorings common with tablet and capsule supplements. Plus, if you take more than 2 to 3 grams of traditional Vitamin C, the ascorbic acid in the intestines can cause gastric distress -- gas, cramps, and diarrhea. Often Vitamin C will be eliminated via very loose stool. By using this brand, you can supposedly avoid the degradation and discomfort associated with traditional forms of Vitamin C and protect the lower G.I. Tract - hence, no gastric upset, no diarrheal flushing effect. Lastly, the liposomes quickly journey to the bloodstream and are circulated throughout the body and "grabbed" by the damaged cells that need it.

You will need to observe your child and go very slowly, especially if using the powerful Liposomal Vitamin C.

http://www.amazon.com/s/?ie=UTF8&keywords=lypo+spheric+vitamin+c&tag=googhydr-20&index=aps&hvadid=6340275787&ref=pd_sl_79vyvtto3p_b

How I got Jett to take his Vitamin C

I put 1/4 teaspoon in a little honey and a couple of large spoonfuls of applesauce. I give with a little bit of coconut water (for the potassium) and 1/4 teaspoon of chokeberry powder (for the other minerals needed for the C to be best ingested). Jett hates the sour taste, but takes it like this just fine. He'll even feed it to himself. He gets it three times a day.  Later, I added his fermented cod liver oil and choline which he is taking fine. At four years old, I just put camu camu in with his other supplements in his applesauce. (I need to start teaching him how to take capsules!)

Vitamin C Overdose

Since it's a water soluble vitamin, there isn't a high level of risk associated with an overdose. The excess amount that your body does not needs gets excreted out through urine so it does not cause much of a problem. However, that does not mean that you should continue with high C foods or supplements in excess if overdose symptoms appear.

Someone who has taken too much vitamin C may have a strong smell during urination, bloating or gas, nausea and an upset stomach. He might also experience sores on the inside of his mouth. Diarrhea could also occur. It was once believed to cause kidney stones, but experts now say there is no solid evidence of dangerous side effects from vitamin C.

In a more severe case of overdose, you might notice the following symptoms: a greater need for oxygen and deficiencies in B vitamins as well as copper. These symptoms usually only show up in more severe cases in which at least 6,000 mg of vitamin C has been consumed, or when someone takes a large amount of vitamin C and other vitamins or minerals. If you see any of these symptoms and believe that the cause may be a severe overconsumption of vitamin C, simply reduce the intake of vitamin C.

Sources

http://www.ohsu.edu/xd/about/news_events/news/2011/07-14-ohsu-scientists-discover.cfm
http://www.springerlink.com/content/47335275002817q2/
http://goldentigerlipids.com/lyvic.html
http://www.the-natural-path.com/vitamin-requirement.html
http://www.overdosesymptoms.com/vitamin_c_overdose/vitamin_c_overdose.html
http://www.vitamincoverdose.org/
http://chemo.net/newpage35.htm
http://www.vitamincfoundation.org//cart/index.php?main_page=product_info&products_id=2&zenid=54b7cbb5c429ce86374cf7a6c1f9bb6f

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Prozac Cures Lazy Eye!

Scroll to bolded text.

By Jonah Lehrer
July 6, 2008

PROZAC IS ONE of the most successful drugs of all time. Since its introduction as an antidepressant more than 20 years ago, Prozac has been prescribed to more than 54 million people around the world, and prevented untold amounts of suffering.
But the success of Prozac hasn't simply transformed the treatment of depression: it has also transformed the science of depression. For decades, researchers struggled to identify the underlying cause of depression, and patients were forced to endure a series of ineffective treatments. But then came Prozac. Like many other antidepressants, Prozac increases the brain's supply of serotonin, a neurotransmitter. The drug's effectiveness inspired an elegant theory, known as the chemical hypothesis: Sadness is simply a lack of chemical happiness. The little blue pills cheer us up because they give the brain what it has been missing.

There's only one problem with this theory of depression: it's almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people's serotonin levels does not make them depressed, nor does it worsen their symptoms if they are already depressed.

In recent years, scientists have developed a novel theory of what falters in the depressed brain. Instead of seeing the disease as the result of a chemical imbalance, these researchers argue that the brain's cells are shrinking and dying. This theory has gained momentum in the past few months, with the publication of several high profile scientific papers. The effectiveness of Prozac, these scientists say, has little to do with the amount of serotonin in the brain. Rather, the drug works because it helps heal our neurons, allowing them to grow and thrive again.

In this sense, Prozac is simply a bottled version of other activities that have a similar effect, such as physical exercise. They aren't happy pills, but healing pills.

These discoveries are causing scientists to fundamentally reimagine depression. While the mental illness is often defined in terms of its emotional symptoms - this led a generation of researchers to search for the chemicals, like serotonin, that might trigger such distorted moods - researchers are now focusing on more systematic changes in the depressed brain.

"The best way to think about depression is as a mild neurodegenerative disorder," says Ronald Duman, a professor of psychiatry and pharmacology at Yale. "Your brain cells atrophy, just like in other diseases [such as Alzheimer's and Parkinson's]. The only difference with depression is that it's reversible. The brain can recover."

Given the prevalence of depression - more than 16 percent of people will suffer from a major depressive episode at some point in their lives - a more accurate scientific understanding of the disease is of immense value. In fact, this research is already being used to develop more effective treatments for the mental illness, some of which are currently in clinical trials.

The progress exemplifies an important feature of modern medicine, which is the transition from a symptom-based understanding of a disease - depression is an illness of unrelenting sadness - to a more detailed biological understanding, in which the disease is categorized and treated based on its specific anatomical underpinnings.

In the 19th century, the "fever" was a common medical illness. Of course, doctors now realize that a fever is merely a common symptom of many different diseases, from the flu to leukemia.
Likewise, when Richard Nixon declared a "War on Cancer" in 1971, scientists largely defined cancer in terms of its most tangible characteristic: uncontrolled growth leading to a tumor. As a result, every cancer was treated with the same blunt tools. Over time, of course, scientists have discovered that cancer is not a single disease with a single biological cause. Breast cancer, for instance, can be triggered by a wide variety of genes and environmental risk factors. Because doctors can look beyond the superficial similarities of the symptoms - all tumors are not created equal - they are able to tailor their treatments to the specific disease.

Neuroscience is only beginning to catch up. Thanks to a variety of new experimental tools, such as brain scanners and DNA microarrays, researchers are now refining their understanding of mental illness. In many instances, this means recategorizing disorders, (like DS as a neurobiological disorder) so that patients are no longer diagnosed solely in terms of their most obvious symptoms.
"We used to think there was only one kind of anemia," says Arturas Petronis, a scientist at the University of Toronto who investigates the underlying causes of schizophrenia. "But now we know there are at least 15 different kinds. We'll likely learn the same thing about many mental illnesses."
. . .
One of the first cracks in the chemical hypothesis of depression came from a phenomenon known as the "Prozac lag." Antidepressants increase the amount of serotonin in the brain within hours, but the beneficial effects are not usually felt for weeks.

This led neuroscientists to wonder if something besides serotonin might be responsible. Duman, for instance, began to study a class of proteins known as trophic factors, which help neurons grow and survive. Trophe is Greek for nourishment; what sunlight and water do for trees, trophic factors do for brain cells. Numerous studies had shown that chronic stress damages the brain by suppressing the release of trophic factors. In a series of influential papers published earlier this decade, Duman demonstrated that the same destructive hallmark is seen in depression, so that our neurons are deprived of what they need.

"The mental illness occurs when these stress mechanisms in the brain spiral out of control," he says.

Once that happens, the brain begins to shut itself down, suppressing all but the most essential upkeep. Not only do neurons stop growing, but the brain seems to stop creating new cells. A 2003 study, led by Columbia University neuroscientist Rene Hen, found that when the birth of new brain cells was blocked with low doses of radiation in "depressed" rats, antidepressants stopped working.

A recent study by Italian researchers, published in the journal Science, helps to reveal another mechanism by which antidepressants reverse the damage of depression. The scientists were interested in seeing if fluoxetine, the active ingredient of Prozac, could increase the potential of brain cells in the adult rat. They studied animals with severe cases of "lazy eye," a condition characterized by poor vision in one eye due to underdevelopment of the visual cortex. The scientists showed that fluoxetine gave brain cells the ability to take on new roles and form new connections, which erased the symptoms of the disorder. (Jett had nystagmus, which is an eye flutter and occasional eye crossing. Although western medicine says that nystagmus is incurable, his nystagmus is gone [maybe from acupressure and Traditional Chinese Medicine?]. He also had occasional eye crossing which rarely occurs now on Prozac.)

"The drug appears to make brain cells quite young," says Jose Vettencourt, a lead author. The scientists are currently repeating the experiment with humans, raising the possibility that fluoxetine will soon be used to treat lazy eye and related conditions.

"Even five years ago, this would have seemed like a very strange idea," Vettencourt says.
Duman's lab has demonstrated, in a paper published earlier this year, that physical exercise seems to stimulate the same regenerative pathways. Mice given access to running wheels not only showed reduced anxiety and stress, but also increased levels of the same trophic factors activated by antidepressants. When the activity of these trophic factors was blocked, the benefits of exercise disappeared. The mice stayed stressed, even when they were allowed to run on their wheel.

It is jarring to think of depression in terms of atrophied brain cells, rather than an altered emotional state. It is called "depression," after all. Yet these scientists argue that the name conceals the fundamental nature of the illness, in which the building blocks of the brain - neurons - start to crumble. This leads, over time, to the shrinking of certain brain structures, like the hippocampus, which the brain needs to function normally.

In fact, many scientists are now paying increased attention to the frequently neglected symptoms of people suffering from depression, which include problems with learning and memory and sensory deficits for smell and taste. (Common problems in autism and DS. Young autistic children are often treated with SSRI's to reestablish these pathways). Other researchers are studying the ways in which depression interferes with basic bodily processes, such as sleeping, sex drive, and weight control. Like the paralyzing sadness, which remains the most obvious manifestation of the mental illness, these symptoms are also byproducts of a brain that's literally withering away.
"Depression is caused by problems with the most fundamental thing the brain does, which is process information," says Eero Castren, a neuroscientist at the University of Helsinki. "It's much more than just an inability to experience pleasure."

This new scientific understanding of depression also offers a new way to think about the role of drugs in recovery. While antidepressants help brain cells recover their vigor and form new connections, Castren says that patients must still work to cement these connections in place, perhaps with therapy. He compares antidepressants with anabolic steroids, which increase muscle mass only when subjects also go to the gym.
"If you just sit on your couch, then steroids aren't going to be very effective," he says. "Antidepressants are the same way: if you want the drug to work for you, then you have to work for the drug."
Jonah Lehrer is an editor at large at Seed magazine and the author of "Proust Was a Neuroscientist." He is a regular contributor to Ideas.
© Copyright 2008 Globe Newspaper Company.

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