Alper Evrensel

The Gut-Brain Axis: The Missing Link in Depression

The gut microbiota is essential to human health and the immune system and plays a major role in the bidirectional communication between the gut and the brain. Based on evidence, the gut microbiota is associated with metabolic disorders such as obesity, diabetes mellitus and neuropsychiatric disorders such as schizophrenia, autistic disorders, anxiety disorders and major depressive disorders. In the past few years, neuroscientific research has shown the importance of the microbiota in the development of brain systems. Recent studies showed that the microbiota could activate the immune and central nervous systems, including commensal and pathogenic microorganisms in the gastrointestinal tract. Gut microorganisms are capable of producing and delivering neuroactive substances such as serotonin and gamma-aminobutyric acid, which act on the gut-brain axis. Preclinical research in rodents suggested that certain probiotics have antidepressant and anxiolytic activities. Effects may be mediated via the immune system or neuroendocrine systems. Herein, we present the latest literature examining the effects of the gut microbiota on depression.

Fecal Microbiota Transplantation and Its Usage in Neuropsychiatric Disorders

Fecal microbiota transplantation has a 1700-year history. This forgotten treatment method has been put into use again during the last 50 years. The interest in microbiota-gut-brain axis and fecal microbiota transplantation is rapidly increasing. New evidence is obtained in the etiopathogenesis of neuropsychiatric disorders. There is a large number of experimental and clinical researches in the field of gut-brain axis. There is limited information on fecal microbiota transplantation. Despite this, initial results are promising. It is commonly used in the treatment of gastrointestinal diseases such as Clostridium difficile infection, Crohn’s disease, ulcerative colitis. It is also experimentally used in the treatment of metabolic and autoimmune diseases. There are case reports that it is effective in the treatment of autism, Parkinson’s disease, multiple sclerosis, chronic fatigue syndrome and irritable bowel syndrome. Its implementation is easy, and it is a cheap and reliable treatment method. However, the long-term risks are unknown. Additionally, standard application protocols have not yet been established. There are a lot of questions to be answered. A university in Turkey has got official permission this year, and started to apply fecal microbiota transplantation. In this review, neuropsychiatric areas of use of fecal microbiota transplantation have been discussed in the light of the current information.

Neural synchronization as a hypothetical explanation of the psychoanalytic unconscious

Cognitive scientists have tried to explain the neural mechanisms of unconscious mental states such as coma, epileptic seizures, and anesthesia-induced unconsciousness. However these types of unconscious states are different from the psychoanalytic unconscious. In this review, we aim to present our hypothesis about the neural correlates underlying psychoanalytic unconscious. To fulfill this aim, we firstly review the previous explanations about the neural correlates of conscious and unconscious mental states, such as brain oscillations, synchronicity of neural networks, and cognitive binding. By doing so, we hope to lay a neuroscientific ground for our hypothesis about neural correlates of psychoanalytic unconscious; parallel but unsynchronized neural networks between different layers of consciousness and unconsciousness. Next, we propose a neuroscientific mechanism about how the repressed mental events reach the conscious awareness; the lock of neural synchronization between two mental layers of conscious and unconscious. At the last section, we will discuss the data about schizophrenia as a clinical example of our proposed hypothesis.

Psychiatric Symptoms in Rapid-onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation Syndrome and its Treatment: A Case Report

To the Editor: Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare disease. It is diagnosed in childhood (usually at 3–4 years of age). It affects endocrine, respiratory, and autonomic nervous systems. It shows different symptoms at different ages. Rapid weight gain, obesity, alveolar hypoventilation, hypernatremia, cardiopulmonary arrest, hyperprolactinemia, diabetes insipidus, excessive sweating, increase pain perception, obstructive sleep apnea, cold hands/feet, and digestive dysmotility can be seen. Alveolar hypoventilation is essential for the diagnosis.[1] Behavioral problems, mental retardation, personality changes, and mood disorders may accompany. There is no any special diagnostic test. Its treatment is symptomatic.[2] This study is intended to inform clinicians about psychiatric symptoms of a girl with ROHHAD syndrome.

Episodic headache due to ruptured intracranial dermoid cyst.

A 24-year-man presented to the neurology department with sudden onset headache. No neurological deficits, signs of raised intracranial tension or meningeal irritation were found. Also, no medication was started prior to the headache. The patient had experienced similar episodes of headaches for the past 3 years, which were not relieved with analgaesics. The headaches started suddenly from the cervico-occipital region, spreading bilaterally to anterior regions. The attacks were characterised by a dull aching and were episodic, with variable duration between 1 and 2 weeks; they were causing the patient severe disability. A cranial MRI showed a well-defined, ellipsoid, extra-axial 30×18×11 mm mass in the anterior neighbour of left MCA, predominantly hyperintense with hypointense …

The Soul, as an Uninhibited Mental Activity, is Reduced into Consciousness by Rules of Quantum Physics

This paper is an effort to describe, in neuroscientific terms, one of the most ambiguous concepts of the universe—the soul. Previous efforts to understand what the soul is and where it may exist have accepted the soul as a subjective and individual entity. We will make two additions to this view: (1) The soul is a result of uninhibited mental activity and lacks spatial and temporal information; (2) The soul is an undivided whole and, to become divided, the soul has to be reduced into unconscious and conscious mental events. This reduction process parallels the maturation of the frontal cortex and GABA becoming the main inhibitory neurotransmitter. As examples of uninhibited mental activity, we will discuss the perceptual differences of a newborn, individuals undergoing dissociation, and individuals induced by psychedelic drugs. Then, we will explain the similarities between the structure of the universe and the structure of the brain, and we propose that consideration of the rules of quantum physics is necessary to understand how the soul is reduced into consciousness.

Venlafaxine induced akathisia: a case report

Venlafaxine – a serotonin, noradrenaline and dopamine reuptake inhibitor1 – is a new generation antidepressant. The drug has been rarely reported to be associated with the development of akathisia.2 A review of the literature in PubMed revealed only four cases reported to date. Different from previous cases in which patients developed akathisia at a dose of 150 mg/day, we present the case of a 35-year-old male patient who developed akathisia with venlafaxine 75 mg/day. Our patient had been receiving psychiatric treatment for obsessive-compulsive disorder and avoidant personality disorder for the last 10 years. He was started on sertraline 50 mg/day and shifted to venlafaxine 75 mg/day with cross-tapering. He was not on any other psychotropic or non-psychotropic drugs. Akathisia started on the third week of venlafaxine treatment. The patient could not fall asleep at night because of agitation: need to move his feet constantly, inability to sit for a long time, and need to rock his feet during daytime if he had to remain seated. As venlafaxine provided a marked improvement in compulsions, we continued the treatment and added propranolol 40 mg/day for akathisia. Although propranolol relieved the patient’s akathisia, symptoms did not disappear until we added clonazepam 1 mg/day to the treatment as well. The patient complained about the sleepiness caused by clonazepam, so we withdrew this medication from the treatment. Even though he was taking propranolol, akathisia symptoms became more intense than before, leading us to gradually discontinue venlafaxine. Akathisia symptoms continued until 1 week after complete venlafaxine withdrawal. Meanwhile, compulsions significantly increased after venlafaxine discontinuation, and the patient was started on paroxetine 20 mg/day, with no signs of akathisia. The patient’s mother had a diagnosis of bipolar disorder for which she had used tricyclic antidepressants and classical neuroleptic drugs for a long time, without any akathisia symptoms. Four cases of venlafaxine induced akathisia have been reported in the literature. Three of those cases experienced akathisia at the dosage of 150 mg/day, and one at 225 mg/day.2 In our case, the patient developed akathisia at the dosage of 75 mg/day. Also, all the cases previously reported used other drugs and had comorbid diseases,2 whereas our patient did not have any comorbid disease and was not using any other medication that might lead to drug interactions. Finally, the patient’s mother had taken psychotropic drugs for a long time, without any extrapyramidal side effects (EPS), which helped us rule out any genetic inheritance for EPS. Therefore, our conclusion is that even low doses of venlafaxine, such as 75 mg/day, may cause akathisia.

Tolosa-Hunt syndrome and comorbidity of obsessive compulsive disorder and aortic aneurysm

A 59-year-old man with obsessive compulsive disorder (OCD) was on antidepressant treatment for years. Six months ago, he got a severe headache on the left side of his head, reported pain behind his left eye, diplopia and ptosis displayed on his left eyelid. The patient had mild migraine attacks occasionally. However, his previous headache was very intense when compared with earlier ones. By cranial MRI, a lesion (22×7 mm horizontally, 13×8 mm vertically) adjacent to carotid segment 4 (C4) of the left internal carotid artery was found. The lesion showed a hyperintense signal in contrast-enhanced T2-weighted images, which was the result of enhanced abnormal soft tissue extending through the orbital fissure and into the orbital apex. This did not cause compression on the optic nerve and there was slight bulging into the left cavernous sinus (figure 1). The patients blood and cerebrospinal fluid biochemical parameters were within …

Inappropriate sexual behaviour due to frontal dementia

Three years ago, a 55-year-old man, a teacher, was involuntarily brought to our outpatient psychiatry clinic by his wife. He had agreed to be examined because of his wifes divorce request. He had no symptoms and no insight about his condition during the examination. According to his wife, he had started to spend more time on the computer using social media (Facebook, etc) to chat with women whom he did not know before and was staying up all night. He had an increased demand for sexual intercourse from his wife and had started to watch pornography. Their frequency …

Gut-Microbiota-Brain Axis and Depression

Contrary to the general belief, a fetus is not sterile. Gut microbiota becomes colonized to the fetus in the intrauterine period. Microorganisms play a very significant role in the development of the immune system and the brain of the fetus. There is a bidirectional symbiotic relationship between gut microbiota and the body. This interaction is determinant on human health. Gut microbiota has fundamental effects on neurodevelopmental processes such as blood-brain barrier formation, myelination, and neurogenesis. There is a relationship between dysbiosis of microbiota and neuropsychological disorders, particularly depression. Colonization of pathogen bacteria in the gut and their metabolites (endotoxins) leads to immune response. Microorganisms affect the brain via the immune system, neuroendocrine system, and nervus vagus. Nutrition, stress, and medication lead to dysbiosis by changing the microbiota composition. It is also possible to purposefully manipulate the gut microbiota. Dysbiosis may be restored by changing gut bacteria composition with probiotics and fecal microbiota transplantation (FMT). Probiotic bacteria have a potential to be used in depression treatment. FMT may be a sign of hope in treatment-resistant depression in the future. The door to the mysterious world of gut-brain relationship seems to have just been opened.