Links for Keyword: Depression

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Exercise 'no help for depression', research suggests

By Branwen Jeffreys Health correspondent, BBC News Combining exercise with conventional treatments for depression does not improve recovery, research suggests. In the NHS-funded study - published in the British Medical Journal - some patients were given help to boost their activity levels in addition to receiving therapy or anti-depressants. After a year all 361 patients had fewer signs of depression, but there was no difference between the two groups. Current guidelines suggest sufferers do up to three exercise sessions a week. The National Institute for Health and Clinical Excellence (Nice) drew up that advice in 2004. At the time it said that on the basis of the research available, increased physical activity could help those with mild depression. The latest study, carried out by teams from the Universities of Bristol and Exeter, looked at how that might actually work in a real clinical setting. All 361 people taking part were given conventional treatments appropriate to their level of depression. But for eight months some in a randomly allocated group were also given up advice on up to 13 separate occasions on how to increase their level of activity. BBC © 2012

Related chapters from BP6e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 11: Motor Control and Plasticity
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 5: The Sensorimotor System
Link ID: 16877 - Posted: 06.06.2012

Talk therapy on phone improves depression

Talking to a psychologist on the phone as therapy for depression may work as well as meeting face-to-face, according to a new study. Depression is common in the general population and psychotherapy is considered an effective treatment that some patients prefer to antidepressant medications. The convenience of phones could make psychotherapy more readily available.The convenience of phones could make psychotherapy more readily available. (Charles Rex Arbogast/Associated Press) But about 75 per cent of patients with depression in previous studies said barriers like time constraints, lack of available and accessible services, transportation problems and cost stop them from going for treatment. In Wednesday's issue of the Journal of the American Medical Association, researchers compared treatments by randomly assigning 325 patients at community clinics in Chicago to face-to-face therapy or telephone therapy for 18 weeks. "Our study found psychotherapy conveniently provided by telephone to patients wherever they are is effective and reduces dropout," the study's lead author, David Mohr, a professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, said in a release. The results showed 20.9 per cent of the people who had therapy over the phone dropped out compared with 32.7 per cent for face-to-face therapy. But those in the telephone group scored three points higher on a depression scale than those who met in person. © CBC 2012

Related chapters from BP6e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 16876 - Posted: 06.06.2012

Why Some People Blame Themselves for Everything

Content provided by Stephanie Pappas, LiveScience People prone to depression may struggle to organize information about guilt and blame in the brain, new neuroimaging research suggests. Crushing guilt is a common symptom of depression, an observation that dates back to Sigmund Freud. Now, a new study finds a communication breakdown between two guilt-associated brain regions in people who have had depression. This so-called "decoupling" of the regions may be why depressed people take small faux pas as evidence that they are complete failures. "If brain areas don't communicate well, that would explain why you have the tendency to blame yourself for everything and not be able to tie that into specifics," study researcher Roland Zahn, a neruoscientist at the University of Manchester in the United Kingdom, told LiveScience. Zahn and his colleagues focused their research on the subgenual cingulated cortex and its adjacent septal region, a region deep in the brain that has been linked to feelings of guilt. Previous studies have found abnormalities in this region, dubbed the SCSR, in people with depression. The SCSR is known to communicate with another brain region, the anterior temporal lobe, which is situated under the side of the skull. The anterior temporal lobe is active during thoughts about morals, including guilt and indignation. © 2012 Discovery Communications, LLC.

Stress and antidepressants: by their powers combined

By Scicurious They are Captain Planet! Ok, not quite. But, strangely, antidepressants on top of stress hormones may be stronger than they are alone. Why is this? And what’s going on? Well, we’re not quite sure. The most commonly prescribed antidepressant (and antianxiety) medications out there are the SSRI, selective serotonin reuptake inhibitors. These include drugs like fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft). How these drugs work, however, is still up for debate. At first, everyone thought that, because these drugs increase levels of the neurotransmitter serotonin in the brain, that depression must be caused by low levels of serotonin, and the increase would make you feel better. We have since learned that this is not the case. Headaches don’t result from lack of aspirin, and depression doesn’t result from lack of serotonin. The next theory for how depression, and antidepressants, might work was the neurogenesis theory. We used to believe that you were born with all the neurons you’d ever have, but we now know that neurogenesis, the birth of new neurons, occurs throughout life in areas of the brain like the hippocampus, an area usually associated with learning and memory. Antidepressants can increase neurogenesis, on a time course which matches the clinical efficacy of antidepressants. © 2012 Scientific American

Related chapters from BP6e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 16851 - Posted: 05.29.2012

Trials highlight worrying flaws in psychiatry 'bible'

by Peter Aldhous HOW reliable is reliable enough? When it comes to diagnosing mental illness, most people would want the bar set pretty high, which is why the latest revision of psychiatry's diagnostic manual has become mired in controversy - again. Last week, at its annual meeting in Philadelphia, Pennsylvania, the American Psychiatric Association revealed results from "field trials" of diagnoses proposed for the next edition of the APA's Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. Essentially, the trials asked whether doctors would come to the same conclusions when assessing the same patients using the new diagnostic criteria. While for some diagnoses reliability was good, others yielded scores little better than chance. Already, the results have led to two proposed disorders being relegated to the volume's appendix, which lists conditions that require further study. Critics argue that more might have joined them had the APA not adopted a low threshold for what is considered an acceptable score for reliability. The conditions with questionable reliability include subtly altered descriptions of two of the most common diagnoses in psychiatry: major depressive disorder and generalised anxiety disorder. That has opened a can of worms, leaving some mental health professionals wondering about the reliability of even established psychiatric diagnoses. © Copyright Reed Business Information Ltd.

Why Are There No Biological Tests in Psychiatry?

By Allen Frances* When the third edition of psychiatry’s manual of mental illness, the DSM-III, was published 30 years ago, there was great optimism it would soon be the willing victim of its own success, achieving a kind of planned obsolescence. Surely, the combining of a reasonably reliable system of descriptive diagnosis with the revolutionary new tools of neuroscience would quickly yield a deep and broad understanding of psychopathology. And just as surely this would translate into standardized biological tests that would replace the cookbook listing of subjective symptoms and subjectively evaluated behaviors that comprised the DSM-III criteria sets. Sadly, progress has been much slower than anyone expected, with many exciting findings turning out to be no more than dead ends. The vast research funding has indeed provided a basic science revolution, but so far its discoveries have had no impact whatever on clinical diagnosis. Even the most promising candidates—biological tests for the accurate diagnosis of dementia—are several years away. And, for the rest of psychiatry, there is no immediate prospect that our rich basic science knowledge base and powerful investigative tools will contribute to clinical practice any time soon. We have learned a great deal in the past 30 years, but perhaps the most important lesson is that the brain is ineluctably complex and reveals its secrets only slowly and in very small packages. There has been no low hanging fruit. The expectation that there would be simple gene or neurotransmitter or circuitry explanations for schizophrenia or bipolar or obsessive-compulsive disorder has turned out to be naïve and illusory. © 2012 Scientific American

Psychiatry Manual Drafters Back Down on Diagnoses

By BENEDICT CAREY In a rare step, doctors on a panel revising psychiatry’s influential diagnostic manual have backed away from two controversial proposals that would have expanded the number of people identified as having psychotic or depressive disorders. The doctors dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems. They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would not be mistaken for a mental disorder. But the panel, appointed by the American Psychiatric Association to complete the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., did not retreat from another widely criticized proposal, to streamline the definition of autism. Predictions by some experts that the new definition will sharply reduce the number of people given a diagnosis are off base, panel members said, citing evidence from a newly completed study. Both the study and the newly announced reversals are being debated this week at the psychiatric association’s annual meeting in Philadelphia, where dozens of sessions were devoted to the D.S.M., the standard reference for mental disorders, which drives research, treatment and insurance decisions. © 2012 The New York Times Company

Parents’ Depression Linked to Problems in Children 18 and Under

By PERRI KLASS, M.D. Like many other primary care doctors, I sometimes sense the shadow of depression hovering at the edges of the exam room. I am haunted by one mother with severe postnatal depression. Years ago, I took proper care of the baby, but I missed the mother’s distress, as did everyone else. Nowadays it’s increasingly clear that pediatricians, obstetrician-gynecologists and internists must be more alert. Research into postnatal depression in particular has underscored the importance of checking up on parents’ mental health in the first months of a baby’s life. But a parent’s depression, it turns out, can be linked to all kinds of problems, even in the lives of older children. “Depression is an illness that feeds upon itself,” said Dr. William Beardslee, professor of child psychiatry at Harvard Medical School, who has spent his career studying depression in children and developing family interventions. “Very often people who are depressed don’t seek the care they need.” In 2009, the Institute of Medicine and the National Research Council issued a report, “Depression in Parents, Parenting, and Children,” that summarized a large and growing body of research on the ways that parental depression can affect how people take care of their children, and how those children fare. Copyright 2012 The New York Times Company

Related chapters from BP6e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 16764 - Posted: 05.08.2012

High fat diets and depression: a look in mice

By Scicurious Only a few weeks ago I looked at a study on fast food consumption and depression, and only a few days ago I talked about a brand new study looking at high fat diets and protection from heart attack damage. And today, we’ve got another study on high fat diet, this time in mice, and depressive-like behavior. What is the effect of a high fat diet? Well, it appears to be getting more complicated with each new study. But it this study, at least, it looks like diet-induced obesity might produce depressive-like effects in mice. But how the diet is doing that is not so well defined. Several studies in humans have found a correlation between obesity and the development of depression. But it’s important to keep in mind that correlation is not causation. Many people who become obese also have other things going on (socioeconomic status, family history, comorbid disorders) which can influence the development of depression. In order to determine if obesity itself is causing depression, you first have to deliberately cause obesity in a controlled population. And this is where mice come in. Using a specialty high fat and high sugar diet, Sharma and Fulton fed up a set of mice for 12 weeks, until they were significantly fatter than control mice. They then looked at behavioral tests for anxiety and depression. © 2012 Scientific American

Brain not required for antidepressant to act

By Laura Sanders Brewer’s yeast cells don’t have the brain chemical serotonin — or brains, for that matter — but that doesn’t stop the single-celled fungus from responding to an antidepressant in unexpected ways. A new study finds that the antidepressant piles up in yeast cells, distorting normally curved membranes and triggering the cells to start eating themselves. These single cells are far removed from the vastly more complex human brain. But studying how drugs affect yeast might help scientists better understand how antidepressants work, says study coauthor and evolutionary pharmacologist Ethan Perlstein of Princeton University. Perlstein and his colleagues focused on sertraline, sold as Zoloft, part of a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These drugs are thought to boost mood by increasing the levels of serotonin floating around between nerve cells. Sertraline latches on to a molecule called the serotonin transporter, part of which sits on the outside of nerve cells and slurps up serotonin. By gumming up the serotonin transporter, sertraline leaves more free serotonin. Yeast have none of this. “A molecule like Zoloft should be completely innocuous to a yeast cell, in the way that an antibiotic would be innocuous to a viral infection,” Perlstein says. © Society for Science & the Public 2000 - 2012

Post-Prozac Nation

By SIDDHARTHA MUKHERJEE Few medicines, in the history of pharmaceuticals, have been greeted with as much exultation as a green-and-white pill containing 20 milligrams of fluoxetine hydrochloride — the chemical we know as Prozac. In her 1994 book “Prozac Nation,” Elizabeth Wurtzel wrote of a nearly transcendental experience on the drug. Before she began treatment with antidepressants, she was living in “a computer program of total negativity . . . an absence of affect, absence of feeling, absence of response, absence of interest.” She floated from one “suicidal reverie” to the next. Yet, just a few weeks after starting Prozac, her life was transformed. “One morning I woke up and really did want to live. . . . It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on. Was it the Prozac? No doubt.” Like Wurtzel, millions of Americans embraced antidepressants. In 1988, a year after the Food and Drug Administration approved Prozac, 2,469,000 prescriptions for it were dispensed in America. By 2002, that number had risen to 33,320,000. By 2008, antidepressants were the third-most-common prescription drug taken in America. Fast forward to 2012 and the same antidepressants that inspired such enthusiasm have become the new villains of modern psychopharmacology — overhyped, overprescribed chemicals, symptomatic of a pill-happy culture searching for quick fixes for complex mental problems. In “The Emperor’s New Drugs,” the psychologist Irving Kirsch asserted that antidepressants work no better than sugar pills and that the clinical effectiveness of the drugs is, largely, a myth. If the lodestone book of the 1990s was Peter Kramer’s near-ecstatic testimonial, “Listening to Prozac,” then the book of the 2000s is David Healy’s “Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression.” © 2012 The New York Times Company

Computer game effective in treating adolescent depression

CBC News A special computer game is as effective for treating adolescent depression as one-on-one counselling with trained clinicians, Australian researchers report in the British Medical Journal. Researchers at the University of Auckland in New Zealand observed 187 young people12 to 19 years old who showed mild to moderate depressive symptoms. Roughly half played SPARX, a 3D fantasy game that has users work through a series of seven levels dealing with a range of topics, including: Emotions. Finding hope. Recognizing unhelpful thoughts. Over four to seven weeks, players must restore balance in a world dominated by GNATs, or gloomy negative automatic thoughts. Another group underwent face-to-face treatment by trained counsellors and psychologists. According to the researchers, SPARX was as effective in reducing symptoms of depression. Moreover, 44 per cent of those who played at least four levels completely recovered compared to 26 per cent in usual care. The results were based on several depression rating scales. © CBC 2012

Depression in Teens Could Be Diagnosed with Blood Test

By Jennifer Welsh and LiveScience Can a psychiatric disorder be diagnosed with a blood test? That may be the future if two recent studies pan out. Researchers are figuring out how to differentiate the blood of a depressed person from that of someone without depression. In the latest study, published today (April 17) in the journal Translational Psychiatry, researchers identified 11 new markers, or chemicals in the blood, for early-onset depression. These markers were found in different levels in teens with depression compared with their levels in teens who didn't have the condition. Currently, depression is diagnosed by a subjective test, dependent upon a person's own explanation of their symptoms, and a psychiatrist's interpretation of them. These blood tests aren't meant to replace a psychiatrist, but could make the diagnosis process easier. If a worried parent could have a family physician run a blood test, it might ease the diagnosis process during the already tough time of adolescence, said Eva Redei, a professor at Northwestern University in Evanston, Ill., who was involved in the study of the teen-depression blood test. If they hold up to further testing, blood tests could help young adults, who often go untreated because they aren't aware of their disease, get treated. The biological basis of a blood test could also help to reduce that stigma, researchers suggest. © 2012 Scientific American

Antidepressants Can Raise Blood Pressure During Pregnancy

By ANAHAD O'CONNOR, Reporter Taking antidepressants during pregnancy raises the risk of high blood pressure in expectant mothers, a new study shows. Antidepressants are one of the most commonly used medications in pregnancy, and hypertension can cause problems for both mother and child. About one in five women suffer from depression during pregnancy, and up to 14 percent of those women end up using an antidepressant medication to treat it. Though the drugs are commonly prescribed to pregnant women, there has not been much research on the effect they can have on a mother’s health. The new study, published in The British Journal of Clinical Pharmacology, looked at more than 13,000 pregnant women, 1,200 of whom had pregnancy-induced hypertension with no history of the condition before they became pregnant. The researchers found that women taking antidepressants of any kind had a 53 percent greater risk of high blood pressure. Those who were taking Paxil, which belongs to the most commonly prescribed class of antidepressants, known as selective serotonin reuptake inhibitors, saw their risk rise even higher, by 81 percent. Though those numbers sound high, it’s important to note that the absolute risk from taking these drugs remained low. Antidepressants raised a woman’s absolute risk of hypertension from 2 percent to 3.2 percent, and Paxil raised it from 2 percent to 3.6 percent. © 2012 The New York Times Company

Aging makes people more vulnerable to depression, but the problem can be treated

By Carolyn Butler, My beautiful, fiercely independent grandmother Audrey has always been one of the most positive forces in my life, even as she has endured the death of my grandfather and most of her friends. At the same time, she has faced such mounting challenges as the gradual loss of her hearing and, more lately, the affront of having to walk with a cane. But now, on the eve of her 94th birthday, her vision has deteriorated to the point that she’s having trouble reading her beloved newspaper every morning. For the first time, she seems sort of depressed. Watching Grams struggle to keep up with the family-dinner chitchat on a recent trip home, I couldn’t help but wonder whether the particular trials of growing older — from the death of loved ones to gradual declines in health, self-sufficiency and control — inevitably lead to this unhappy outcome. The short answer is that aging does seem to make us more vulnerable to depression, but it’s not a foregone conclusion. “Even though so many things happen as we get older — lots of losses and physical changes — most people weather those by adapting, and adapting without becoming depressed,” says Susan Lehmann, director of the Geriatric Psychiatry Day Hospital at the Johns Hopkins Hospital. There’s a difference, she adds, between feeling profoundly lonely or blue and true clinical depression, which is a mood state involving physical and behavioral manifestations that does not shift easily. © 1996-2012 The Washington Post

Insight Into a Shocking Therapy for Depression

by Elizabeth Norton Since the 1930s, doctors have been jolting the brains of depressed patients with electricity to relieve their symptoms. The treatment, known as electroconvulsive therapy (ECT), works, but it can cause memory loss and confusion and lead to difficulty forming new memories. Today, physicians generally limit it to patients who are severely ill, including those at risk for suicide. Now, a brain-imaging study highlights the part of the brain most affected, perhaps pointing to safer, less-invasive ways to achieve the same results. Depression may be caused by an overactive brain, says physicist and neuroscientist Christian Schwarzbauer of the University of Aberdeen in the United Kingdom. "There may be so much internal communication that the brain becomes preoccupied with itself, less able to process information coming in from the outside world," he says, noting that studies have found that people with depression have heightened connectivity among brain networks involved in paying attention, monitoring internal and external cues, remembering the past, and controlling emotions. In a 2010 study, psychiatrist Yvette Sheline and colleagues at Washington University School of Medicine in St. Louis, Missouri, found that these overactive networks converged on a common point in a region called the dorsal medial prefrontal cortex. This common point, dubbed the dorsal nexus, may "hot wire" the brain networks together in a way that leads to depression, the authors hypothesized. © 2010 American Association for the Advancement of Science.

How Depressed Is That Mouse?

By Robin Marantz Henig In “Lifting the Black Cloud,” Robin Henig surveys the search for new, improved antidepressants. Much research in the area involves laboratory mice and rats. Here, Henig explains how scientists determine whether a rodent is depressed. It’s hard to develop an animal model for depression. As Michael Kaplitt of Cornell Medical College puts it, “A mouse can’t tell you how it’s feeling.” Scientists have had to come up with proxy behaviors, actions that they interpret as “depressionlike,” to measure whether particular drugs or therapies are having an effect. To identify depression in laboratory animals, investigators rely on the following: Forced swimming test. The rat or mouse is placed into a cylinder partially filled with water from which escape is difficult. The longer it swims, the more actively it is trying to escape; if it stops swimming, this cessation is interpreted as depressionlike behavior, a kind of animal fatalism. Tail suspension test. A mouse (it does not work in rats) is hung upside down from its tail, and the sooner it stops wiggling, the greater its depressionlike behavior is said to be. Administering an antidepressant usually increases the length of time that a mouse will struggle when suspended by the tail. © 2012 Scientific American,

Faster-Acting Experimental Antidepressants Show Promise

By Ricki Rusting Antidepressants restore well-being to many people, but sometimes at the cost of such side effects as weight gain or loss of interest in sex. And these side effects can be just part of the frustration. As Robin Marantz Henig wrote in "Lifting the Black Cloud," in the March issue of Scientific American, the drugs that have long dominated the market—the selective serotonin reuptake inhibitors (SSRIs) and the serotonin and norepinephrine reuptake inhibitors (SNRIs)—"do not help everyone and eventually fail in more than a third of users. A pill that seems to be working today might well stop helping tomorrow. And the drugs can take several weeks to start having a marked effect." Equally disturbing, some major pharmaceutical houses, such as GlaxoSmithKline, are pulling back from developing psychiatric medicines. But not everyone is abandoning the effort, she noted. Researchers in government and small biotech firms are trying to pick up some of the slack and are searching for agents that work in new ways. For instance, some investigators, such as Ronald Duman of Yale University, are focusing on finding compounds that will kick in more quickly in our bodies. Duman and his colleagues are trying to learn lessons from ketamine, an anesthetic and painkiller that is also sold illicitly under the name "Special K." The group has shown in rats that ketamine rapidly causes neurons to make new contacts with one another and, apparently by so doing, produces antidepressant effects. Based on an understanding of the molecular basis of those changes, the researchers are now looking for safer agents that operate in a similar way. © 2012 Scientific American

Mental Health: Use of Statins May Lower Depression Risk

By NICHOLAS BAKALAR The use of statin drugs to lower cholesterol in people with stable coronary artery disease is associated with a significantly reduced risk for depression, a new study reports. It has been well established in many studies that coronary artery disease increases the risk for symptoms of major depression — feelings of hopelessness and despair so severe that they interfere with daily routines and activities. Researchers recruited 965 people with stable coronary artery disease at outpatient clinics in the San Francisco Bay Area, tracking their statin use and depressive symptoms over six years. The study was published online Feb. 21 in The Journal of Clinical Psychiatry. Statin users had fewer symptoms of depression at the start of the study. And among the 776 people free of depression at the beginning, those who took statins were significantly less likely than those who did not to develop depression over the course of the study. Even after adjusting for age, sex, smoking, education, income, social support, baseline depression symptoms, medication use and other factors, statin use was associated with a decrease of 38 percent in the odds of developing depressive symptoms during the follow-up period. “We’re not sure that this association is causal,” said Dr. Mary A. Whooley, the senior author and a professor of medicine at the San Francisco Veterans Affairs Medical Center. “This is an observational study and not a randomized trial.” Still, she said, “the findings are very intriguing.” © 2012 The New York Times Company

Postpartum Depression: Bringing in the Baby

by Claudia M Gold I recently had the privilege of being appointed to the Massachusetts Commission on Postpartum Depression (PPD). Lately I have been writing a lot about love, and this new role brings me again to this subject. When we support caregivers (I use this word rather than mother, as while the primary caregiver is usually the mother, it may be the father or another relative) who are struggling with postpartum depression, we are dealing with disruptions in passionate love relationships. Depression is, in fact, only one potential cause of such disruption. Perhaps our conversation should focus on relationships from the beginning. Education material about PPD does address the impact of PPD on child development, but the language is often focused on the caregiver, rather than the caregiver-child relationship. Across the ocean in Scotland my friend and colleague Suzanne Zeedyk has had a good deal of success in calling attention to the need to support early parent-child relationships. The departments of education, health care, finance and even law enforcement are on board in recognizing this need. On her website under "what I do" she writes: Science is helping us to better understand how relationships shape the development of human brains and human communities. I make this knowledge understandable for parents, professionals and policymakers Suzanne has created a beautiful DVD, The Connected Baby. There is a live streaming of the film today March 1st on the blog Mothering.com. One segment entitled "The Dance of the Nappy" films a mother changing her baby's diaper, interspersing commentary. In this simple and elegant way she shows the exquisite attunement between mother and baby that goes on in countless minute to minute interactions throughout the day. It is in this relationship that a baby's brain grows and develops. It is how he develops a sense of himself. © 2012 NY Times Co.

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