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preventive mental health treatments: new research into brain signalling could have the answer
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the chemicals the brain uses to communicate can also impact the health of critical brain regions.
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as the saying goes, an ounce of prevention is worth a pound of cure. but when it comes to preventive treatment for mental health concerns, there aren’t many options beyond therapy and a living a healthy lifestyle.
now, scientists are beginning to understand the inner workings of the brain and how the over- or under-availability of chemicals — called neurotransmitters — that help parts of the brain communicate can lead to mental disorders later on in life. this information, researchers hope, may one day be able to help us prevent conditions like psychosis or ptsd.
research in italy has found that people with a genetic predisposition to schizophrenia may have an imbalance of glutamate and gaba (gamma-aminobutyric acid), two main neurotransmitters found in the brain. this imbalance may also be damaging the hippocampus, a critical area of the brain associated with memory and emotion, which in turn can lead to psychotic symptoms.
the study authors point out that while there has been extensive focus on the dysregulation of the feel-good dopamine neurotransmitter and its relation to mental health, investigating these two brain chemicals can promote early detection and intervention.
for the study, published in biological psychiatry, researchers used imaging and measurement tools to estimate levels of glutamate, glutamine and gaba in the brains of 60 individuals at genetic risk of psychosis and 45 healthy control subjects. participants with a genetic risk for psychosis had lower levels of gaba in the hippocampus and higher levels of glutamate and glutamine in the hippocampus and superior temporal cortex, an area of the brain associated with auditory and language processing, and social cognition.
it turns out that, over time, the research indicates that higher levels of glutamate and glutamine in the hippocampus correlated with volume loss in this brain region over time. they also started to experience psychotic symptoms such as hallucinations and delusions, lead researcher valentina mancini at the university of geneva school of medicine stated in a news release.
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mancini also noted that, given the essential role of the hippocampus in memory processes, preventing the imbalance and volume loss could potentially reduce cognitive decline in psychotic patients.
understanding more about neurotransmitters and mental health
“what’s really compelling about this study is that it’s going right to the source by understanding the fundamental neurotransmitters, glutamate and gaba, and directly implicating those for a predictive role in psychosis,” says neuroscientist mark cembrowski at the djavad mowafaghian centre for brain health in vancouver.
“if you crack open an old-school neuroscience textbook and look at the fundamental neurotransmitters in the brain, glutamate and gaba, which are associated with excitatory and inhibitory neurons in particular, those are the classical neurotransmitters. that’s basically the two languages of the brain. dopamine is there, too, but oftentimes dopamine is thought of as something that’s called a neuromodulator, not something that has necessarily direct effects, but something that can toggle the effects of glutamate and gaba.”
cembrowski says that brain communication requires a balance of excitation and inhibition. if you have too much excitation, for example, seizures can happen. “you can have runaway activity in your brain and it manifests as a seizure,” he explains, while too much inhibition in your brain starts to shut down the signalling.
“so the brain is always trying to find the right balance of excitation and inhibition. and broadly, especially within the last decade, it’s becoming quite clear that an imbalance between excitation and inhibition underpins a whole range of disorders and diseases in the brain for psychosis and other types of mood disorders, autism spectrum disorder, epilepsy — all of these are believed to emerge from the same mechanism. and this study really nicely nails that down.”
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towards preventive treatments for mental health conditions
by nature, we’re hardwired to learn from our experiences for self-preservation, basically to be better prepared for challenges as they come along. cembrowski’s lab is dedicated to understanding the innerworkings of the hippocampus by focusing on how people form and store memories.
“knowing what to fear is essential. it’s critical for our survival and just our day-to-day well-being of keeping us in a safe place and having a good quality of life,” he says. “it turns out that in experimental settings, because fear is so powerful, it provides a great perspective into understanding how memories are formed, your initial learning and then later on your recall. because it doesn’t take much to instill things that have a fearful component to them. so it’s a really powerful way of studying memory in the brain.”
right now, his team is looking at post-traumatic stress disorder and changing the hippocampus in a way that will prevent those fear memories from taking hold so people won’t relive the trauma over and over. other research has shown that, like people with schizophrenia, the volume of the hippocampus can change in people who experience a ptsd-inducing event.
“the moon shot idea is if one goes through something traumatic, like a motor vehicle accident, there are first responders who go to the scene to help people with their physical injuries. potentially, this is also a window where these first responders could pharmacologically intervene in a way to administer something akin to a pill that would prevent these memories from moving from short-term to long-term memory. this would help with the long-term mental ramifications.”
though it’s still early days for all of this, the research into brain biology is pivoting how scientists are viewing some mental illnesses and therapeutic strategies. the hope is that by focusing more energy and resources, people with mental health issues will live very different lives in the future.
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“we can’t treat any one of these brain regions in isolation as a silo,” adds cembrowski. “each one of these brain regions has their own unique features. and by understanding those components, we can potentially do things like pharmacological manipulations, which are like sledgehammer-based approaches. but if we could do those manipulations in a way that targets a certain brain region, that sledgehammer slowly becomes a scalpel. and that allows us to do much more targeted interventions.”
karen hawthorne is a toronto-based writer.
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