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I'd like to share with you an excerpt from the introduction to my next book, Brain Rules for Baby: How to Raise a Smart and Happy Child from Zero to Five (October 12, 2010). Stay tuned for more information on the book and Fall book tour.

Every time I lectured to a group of parents-to-be about baby brain development, I made a mistake.

The parents, I thought, had come for a tasty helping of science about the brain in utero—a little neural crest biology here, a little axonal migration there. But in the Q&A session after each lecture, the questions were always the same. The first, delivered by a very pregnant woman one rainy night in Seattle, was “What can my baby learn while she is still in my womb?” Another woman asked, “What’s going to happen to my marriage after we bring our baby home?” A dad delivered the third question, with some authority: “How do I get my kid into Harvard?” An anxious mom asked the fourth question: “How can I make sure my little girl is going to be happy?” And the fifth belonged to a downright noble grandmother. “How do I make my grandchild good?” she asked. She had taken over parenting responsibilities from a drug-addicted daughter. She did not want the same thing to happen again.

No matter how many times I tried to steer the conversation toward the esoteric world of neural differentiation, parents asked variations on these same five questions—over and over again. Finally, I realized my mistake. I was giving parents Ivory Tower when they needed Ivory Soap. So, this book will not be concerned with the nature of gene regulation in the developing rhombencephalon. Brain Rules for Baby instead will be guided by the practical questions my audiences keep asking. “Brain Rules” are the name I give what we know for sure about how the early-childhood brain works. Each one is quarried from the much larger seams of behavioral psychology, cellular biology, and molecular biology. Each was selected for its ability to assist newly minted moms and dads in the daunting task of caring for a helpless little human.

I certainly understand the need for answers. Having a first child is like swallowing an intoxicating drink made of equal parts joy and terror, chased with a bucketful of transitions nobody ever tells you about. I know firsthand: I have two boys, both of whom came with bewildering questions, behavioral issues, and no instructions.

I soon learned that’s not all they came with. They possessed a gravitational pull that could wrest from me a ferocious love and a tenacious loyalty. They also were magnetic; I could not help staring at their perfect fingernails, clear eyes, dramatic shocks of hair. By the time my second child was born, I understood that it is possible to split up love ad infinitum and not decrease any single portion of it. With parenting, it is truly possible to multiply by dividing. My wife and I still marvel at how different our sons are from us, and yet how similar. Having kids is like mailing yourself a letter from the most delightful, meaningful future you can imagine.

My children also amplified the meaning of my work as a scientist. Watching a baby’s brain develop is like having a front-row seat to the Big Bang. It starts out as a single cell in the womb, quiet as a secret. Within a few weeks, it is pumping out nerve cells at the astonishing rate of 8,000 per second. Within a few months, it is on its way to becoming the world’s finest thinking machine. These mysteries fueled not only wonder and love but, as a rookie parent, I remember, anxiety and questions.

Too many myths

Parents need facts, not just advice, about raising their children. Unfortunately, those facts are difficult to find in the ever-growing mountain of parenting books. And blogs. And message boards, and podcasts, and mother-in-laws, and every relative who’s ever had a child. There’s plenty of information out there. It’s just hard for parents to tell what to believe.

The great thing about science is that it takes no sides—and no prisoners. Once you know which research to trust, the big picture emerges and myths fade away. To gain my trust, research must pass my “grumpfactor.” To make it into this book, studies must first have been published in the refereed literature and then successfully replicated. Some have been confirmed dozens of times. Where I make an exception for cutting-edge research, reliable but not yet fully vetted by the passage of time, I will note it.

To me, parenting is about brain development. That’s not surprising, given what I do for a living. I am a developmental molecular biologist, with strong interests in the genetics of psychiatric disorders. My research life has been spent mostly as a private consultant, a for-hire troubleshooter, to industries and public research institutions in need of a geneticist with mental-health expertise. I also founded the Talaris Institute, located in Seattle next to the University of Washington, whose original mission involved studying how infants process information at the molecular, cellular, and behavioral levels. That is how I came to talk to groups of parents from time to time, like on that rainy Seattle night.

Scientists certainly don’t know everything about the brain. But what we do know gives us our best chance at raising smart, happy children. And it is relevant whether you just discovered you are pregnant, already have a toddler, or find yourself needing to raise grandchildren. So it will be my pleasure in this book to answer the big questions parents have asked me—and debunk their big myths, too. Here are some of my favorites:

Myth: Playing Mozart to your womb will improve your baby’s future math scores.

Truth: Your baby will simply remember Mozart after birth—along with many other thingsshe hears, smells, and tastes in the womb. If you want her to do well in mathin her later years, the greatest thing you can do is to teach her impulse control in her early years.


Myth: Exposing your infant or toddler to language DVDs will boost his vocabulary.

Truth: Some DVDs can actually reduce a toddler’s vocabulary. It is true that thenumber and variety of words you use when talking to your baby boost both his vocabulary and his IQ. But the words have to come from you—a real, live human being.


Myth: To boost their brain power, children need French lessons by age 3 and a room piledwith “brain-friendly” toys and a library of educational DVDs.

Truth: The greatest pediatric brain-boosting technology in the world is probably a plain cardboard box, a fresh box of crayons, and two hours. The worst is probably your new flat-screen TV.


Myth: Telling your children they are smart will boost their confidence.

Truth: They’ll become less willing to work on challenging problems. If you want to get your baby into Harvard, praise her effort instead.


Myth: Children somehow find their own happiness.

Truth: The greatest predictor of happiness is having friends. How do you make and keep friends? By being good at deciphering nonverbal communication. Learning a musical instrument boosts this ability by 50 percent. Text messaging may destroy it.

Research like this is continually published in respected scientific journals. But unless you have a subscription to the Journal of Experimental Child Psychology, this rich procession of findings may pass you by. This book is meant to let you know what scientists know—without having a Ph.D. to understand it.

Benzodiazepine withdrawal

June 21, 2010  |  Posted by Dr. Madhavan | No Comments

Benzodiazepines are a class of medication used to treat anxiety and insomnia.  These medications have been around since the late 1950s and their role in treatment has changed over the years.  Initially benzodiazepines were a staple treatment for people suffering from “nervous conditions” (now called anxiety disorders).  Over the past 20 years, these medications have given ground to Serotonin Specific Reuptake Inhibitors (SSRIs) in the treatment of anxiety.  Despite this, they remain effective tools in treating anxiety due to their rapid and predictable clinical effect and good tolerability.

After prolonged use or use of high doses, a person’s brain develops a tolerance to benzodiazepines.  This tolerance is not just for the specific medication, but for the entire class of medications.  If a person were to miss several doses of the medication in succession or were to dramatically decrease their dose quickly, that person might experience benzodiazepine withdrawal.  This is a syndrome characterized by an increase in anxiety, irritability, nausea, insomnia, and head and body aches among other symptoms.  In most cases, this is a miserable period of days or weeks that will gradually abate.  However, in some cases this can lead to a life-threatening situation requiring hospitalization.

Generally, the treatment of benzodiazepine withdrawal involves replacement of the missing medication and then gradual tapering of the medication.  People taking a benzodiazepine should consult with their medication prescriber before deciding to reduce or stop one of these medications.

A person’s recovery from facial cosmetic surgery has several unique aspects that are relevant to psychiatry.  In this article I will talk about some of the unique challenges to recovery and discuss some of the ways that these issues can be addressed.

Expectations for a surgical procedure determine how the outcome of that surgery is interpreted by a patient.  Full recovery from a facial cosmetic surgery can take weeks to months.  Pain levels can exceed what was expected.  When the pace of recovery, pain levels or the surgical outcome are not what a patient had anticipated, a sense of frustration is common.

Every surgical procedure contains an element of unpredictability and because of this, anxiety is often seen during recovery.  Facial cosmetic surgery procedures are no different.  Two common postoperative variables are the time it takes for swelling to reduce and the time for bruising to resolve.  Swelling and bruising are inherent to any surgical procedure.  In an abdominal procedure, these can be masked with clothes.  With a facial procedure it is difficult to disguise swelling or bruising.  This can raise self-consciousness and make social interactions uncomfortable.

Up to 55% of patients undergoing facial cosmetic surgery develop some degree of anxiety or depression in the postoperative period.  Many of these patients will experience a gradual reduction in these symptoms over time without the intervention of a psychiatrist.  A smaller percentage of patients will continue to struggle with anxiety and unmet expectations, and in some cases these concerns may escalate.  For these patients, reassurance from the surgical team does not provide any relief.  In these cases, treatment by a psychiatrist can be helpful in reducing anxiety and coming to terms with the surgical outcome.  Treatment can consist of medication, psychotherapy or both. Specific recommendations are based on current and past symptoms and patient preference.

Psychotropic drugs are big business: in 2009, roughly 300,000,000 prescriptions were written for these agents.

A New Treatment Option for Major Depression

May 18, 2010  |  Posted by Psychiatric Times | No Comments
Transcranial magnetic stimulation (TMS) is noninvasive focused brain stimulation that uses pulsed magnetic fields. The underlying mechanism depends on the principle of electromagnetic induction, the process (discovered by Faraday in 1839) by which electrical energy is converted into a magnetic field and vice versa.1