Archive for the ‘Women’s Health’ Category.

SEASONS OF THE BRAIN: DEVELOPING BRAIN

The first season, the season of development, is when the main cognitive abilities and skills are formed, which is characterized by dramatic changes in the brain. This season begins before we are born and extends into the third decade of our life. Brain development is a complex and multifaceted process. It starts with neurogenesis, the birth of neurons, which are the brain cells most directly involved in information processing, and their migration, finding their proper places in the complex organization of the brain. For the most part, neurogenesis occurs during gestation, at somewhat different times for different brain structures. It was thought until recently that neurogenesis ran its course and ground to a complete halt sometime during gestation and the first few years of life. By that time, most brain structures have acquired their recognizable shape. Today we know, however, that neurogenesis continues throughout the lifetime, albeit not as vigorously as during the early period.

As the neurons are born and migrate to their proper locations in the brain, connections between neurons begin to develop. These connections, formed as protrusions emanating from the neuron bodies, are called axons and dendrites. They begin to develop during gestation, and the dendrites begin to sprout through the process called arborization. This process culminates during the first years of life.
Synapses, the tiny interfaces between the dendrites and axons emanating from different neurons, are critical for communication between neurons. Their formation is called synaptogenesis and its time course varies considerably for different parts of the brain. In the visual cortex, for instance, most of synaptogenesis is complete by the end of the first few years of life. By contrast, the synaptogenesis of the prefrontal cortex extends well into late adolescence and early adulthood.
Production of neural structures is complemented by the elimination of excessive neurons, dendrites, and synapses. This process, known as pruning or apoptosis, occurs after birth and also unfolds at different time courses for different parts of the brain, the frontal cortex being the last. Pruning is akin to sculpting, a process that the great sculptor Auguste Rodin described as “eliminating everything that does not belong.” Pruning is not random, but rather is a consequence of reinforcing heavily used neural structures and letting go of those underused or not used at all. These competitive processes of the brain molding itself are somewhat akin to natural selection, which was captured in the term “neural Darwinism,” coined by Gerald Edelman.
Neurons are not the only type of cells found in the brain. In fact, they account for only about one-third of all the brain cells. The remaining two-thirds are taken up by the glial cells, which serve various supporting functions and come in two kinds: astrocytes and oligodendrocytes. At a certain point in development the process of myelination begins: Oligodendrocytes begin to wrap around long axons, forming a fatty protective coating called myelin. Myelin is white, which gave rise to the term white matter (composed of all the long pathways covered with myelin), as opposed to gray matter (composed of all the neurons and short local nonmyelinated pathways). Myelin facilitates signal transmission along the axon, greatly enhancing and improving transmission of information within large coordinated neuronal ensembles. Dramatic increase in brain weight during the first years of life is largely due to myelination. The brain structures are not fully functional until the axons connecting them are insulated with myelin, and the time course of myelination varies vastly from structure to structure. As you can probably guess by now, myelination takes the longest in the frontal cortex, extending well into late adolescence and young adulthood, possibly until the age of thirty. The volume of the frontal lobe, and particularly of the prefrontal cortex, continues to grow at least until the age of eighteen and possibly longer, and this growth reflects an ongoing increase in white matter.
If nothing else, this brief review shows that brain development is the interplay among numerous processes unfolding at different time scales. This is a time of great flux in the life of the brain. This is also a time of great flux in the life of the mind— the time of learning, of accumulating the basic fund of mental skills and knowledge, and ultimately the time of forming our identities.
You may have noticed that the frontal lobes, the prefrontal cortex in particular, are the last to complete their biological maturation—only by young adulthood, sometime in the very end of the second decade and possibly even in the third decade of life. Modern society operates on the basis of certain tacit or explicit assumptions about the age of social maturity. This is the age of emergence of the cognitive and personality traits that we associate with social maturity, such as the capacity for impulse control, foresight, and critical self-appraisal. Like the biological maturation of the frontal lobes, these “adult” traits reach their full functionality sometime in the end of the second and the beginning of the third decades of life. Unsurprisingly, this age has been codified in virtually every modern society as the age of transition from social immaturity to social maturity. This is the approximate age (plus or minus a few years) when you are ready to assume a whole range of “mature” rights and responsibilities, such as driving, voting, getting married, buying alcohol, serving in the military, and finally being treated by the legal system as an adult and not a minor. What most people don’t realize is that the emergence of these “adult” traits is most likely caused by the maturation of the frontal lobes, a belief shared by an increasing number of neuroscientists. Thus, many neuroscientists find it useful to think of the completion of the maturation of the frontal lobes, particularly the myelination, as the watershed between the first and the second seasons of the brain: the stage of development and the stage of maturity.
*6\302\2*

POST-NATAL DEPRESSION

What is it?

A condition in which a woman becomes miserable or frankly depressed after having a baby. It is extremely common, with some surveys showing that eight out of ten women feel low, weepy and depressed, and are easily upset, in the first week or two after a birth. These emotions may or may not be accompanied by a feeling of anxiety around the time of taking the baby home from the hospital-a condition seen more commonly in first-time mothers.

Usually post-natal depression is not sufficiently serious to prevent the sufferer from functioning normally, but is very unpleasant for her. Such a woman typically cries at the slightest provocation, perhaps for no reason at all, feels she can’t cope with the baby, is critical or openly aggressive towards her partner, feels guilty about not loving her baby enough, goes off sex, loses her appetite, can’t sleep, has nightmares, and may have panic attacks.

A1975 study found that of sixty-six women having their first babies 84 per cent experienced post-natal depression of some kind and 77 per cent were anxious. Twenty-four per cent were frankly depressed.

Post-natal depression starts at any time after the birth but the common ‘baby blues’ is experienced in the first few days and lasts only for a couple of days. More severe forms of depression start from 2-3 weeks post-natally, but can first appear as much as six months later.

What causes it?

No one knows for sure but there are several theories:

• Hormonal theories have always been popular because the levels of progesterone rise during pregnancy and then fall very suddenly immediately after the birth. Superficially this appears to be a plausible explanation but it is difficult to see how this sudden fall in hormone level could cause depression weeks or months later. Also, these very same hormones are deemed to be the cause of pregnancy depression in which progesterone levels are high-not low.

It was noticed many years ago that there were certain similarities between premenstrual symptoms and post-natal depression. Dr Katherina Dalton, a pioneer in this field, wondered whether there might not be a connection-possibly a shortage of one of the circulating hormones. Unfortunately, it is not easy to measure hormones post-natally because the levels swing wildly until the menstrual cycle re-establishes itself. Whilst we still have a lot to learn about hormonal abnormalities, several researchers have meanwhile found other abnormalities. One of these is:

Inadequate vitamin B6. This vitamin now has a proven place in the management of premenstrual tension and it has also been tested in the post-natal situation. One researcher gave 100 mg of the vitamin for twenty-eight days to more than 100 women who had already had one baby (thus ruling out first-timers). The results showed that the B6 group had much less depression than did those given a placebo and that the effects were particularly marked in those women who had premenstrual symptoms. Depression has been linked to a shortage of a neurotransmitter called serotonin and vitamin B6 shortage can cause too little of this to be produced in the body. Research in Birmingham (England) has found that the substance from which serotonin is made fails to rise after birth in some women who later become depressed.

Tiredness and sheer exhaustion are often cited as causes of postnatal blues but there is almost certainly more going on than this. Undoubtedly, physical and mental exhaustion are a part of the baby blues in some women but they are unlikely to be a major factor in true post-natal depression.

*5/72/5*