What if depression isn’t only a mood disorder? What if it’s rooted in something very fundamental – a speed disorder in the brain, treatable with innovative approaches such as a personalized musical prescription?
In an editorial published in the Journal of Psychiatry & Neuroscience, Dr. Georg Northoff, a professor at the University of Ottawa and senior scientist at The Royal, challenges long-held ideas of depression.
Northoff’s research in the area of "spatiotemporal psychiatry,” uniquely developed by him, holds promise for improving the lives of people who are struggling with one of the most common mental health conditions: depression.
Several observations over the years led Northoff to hypothesize that the core issue in depression may be a dysregulation of the brain's underlying temporal and dynamic processes. In other words, a question of speed.
In depression, perceptual, cognitive, motor, and emotional processes all show a striking lack of change in rhythms over time. This is in contrast to the non-depression brain, which exhibits a complex interplay of fast and slow rhythms with plenty of fluctuations.
“People who are diagnosed with depression often report having sluggish thoughts and being unable to change their thought contents and break from constant rumination,” says Northoff. “The same applies to emotions. Many people have moments of sadness, but many can fluctuate out of those moments to more happy mood states. Such change is more difficult in depressed people, who may remain stuck in a sad mood state for longer periods of time. Finally, the same observation applies to movement. People living with depression may show slower facial or other movements.”
To investigate the idea of depression as a speed disorder, Northoff and his research team are using advanced neuroimaging and computational techniques to measure the brain's speed across different regions and functions.
In mental health, current diagnostic approaches rely heavily on symptom checklists, which can be limiting. Northoff believes reframing depression using specific biological measurements could have profound implications for diagnosis and treatment.
Northoff and his team developed various “speed biomarkers” of the brain’s activity, which they now test in large-scale studies for their differential diagnostic specificity for depression.
By developing biomarkers based on the brain's temporal signatures, clinicians may also be able to more accurately distinguish depression from other mental health conditions, such as psychosis.
"Depression impacts millions of lives worldwide, yet our understanding of its complexities continues to evolve,” says Dr. Florence Dzierszinski, president of the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal and vice-president of research. “Dr. Northoff’s pioneering research is paving the way for innovative approaches that deepen our understanding and help bridge the gap between scientific discovery and compassionate care. Research IS Care."Even more importantly, understanding depression as a disorder that involves brain speed opens up new avenues for personalized interventions. Northoff's team is exploring "temporal tuning" techniques such as personalized playlists and breathing exercises tailored to an individual's optimal brain rhythms to nudge them back towards healthier patterns. Just as diabetes care is guided by precise glucose monitoring and treatment, Northoff is developing personalized mental health therapies based on an individual's unique brain spatio-temporal signatures.
Northoff shares two real-life examples of techniques that change the tempo of a brain that is out of step with the rhythm of the world around it.
- Client A is diagnosed with severe depression. In the mornings, she can barely move. To help her get going, she listens to her favourite techno beats. Upon closer examination, however, it is discovered that the music causes her to feel “aggressive and angry” instead of motivating her enough for her to get her day started. Northoff uses speed measures of both the client’s brain and her perception to find music that is a closer match to the unique timescales of her brain in the depressed state. Her new playlist pushes her into action but doesn’t alter her mood in a negative way.
- Client B is highly successful in her field, despite crippling social anxiety. She has been unable to overcome her feelings about public speaking, which she needs to do as part of her job. “We worked with her on personalized breathing protocols, finding the optimally slow breathing rate that diminishes and thus calms her anxiety. It has an immediate effect after just a few minutes of individual slow breathing,” describes Northoff. Now, before she gives a talk, she practices her slow breathing protocol for two or three minutes.
“When you give people more control, and when they know they have control, it further reduces anxiety or depression,” he says.
Northoff and his group, through their worldwide connections and collaborations, work on translating their research on speed in depression into clinical practice. For instance, they are currently conducting a worldwide study in 33 clinical centres aiming to test a questionnaire for time-space experience for the differential diagnosis of depression in about 2000 patients. Their approach represents a fundamental shift in how we conceptualize the brain's role in mental illness. By focusing on the brain's temporal dynamics, Northoff and his team are developing a more holistic understanding of the mind-brain relationship, which could transform mental health care, moving it towards a model that is better at matching treatments to each individual's uniquely preferred speed and rhythm.