Smartphones are Redefining how Depression is Managed

We live in a world where smartphones are seamlessly woven into our lives while continually constructing a digital version of ourselves. Unlike their cell phone predecessors, smartphones (e.g., iPhones and Androids) are embedded with sophisticated tools, such as GPS trackers, accelerometers, and voice and ambient light detectors, which can analyze spatial and social dimensions of everyday life.

The role of Smartphones in the monitoring and management of mood disorders, such as depression, is steadily increasing.

Smartphones have given us the ability to customize and organize our days based on our preferences, and gather data which reflect our connections, opinions, habits and behaviors. Since people tend to identify with and trust their own devices, a smartphone provides a healthy platform to express and record thoughts privately. They have thus far enhanced human individuality. In some ways, your smartphone is an interesting diary of your life.

It’s fascinating to note that there is now more computing power in the palm of one’s hand than all of NASA had when the first humans landed on the moon! [1] This may seem inconceivable, but it underscores the rapid technological advances made in recent years. The possibilities for this goldmine of untapped processing power are vast, particularly given the ubiquitous nature of smartphones.

HealthRhythms, the brainchild of Dr. David Kupfer, Dr. Ellen Frank and Dr. Tanzeem Choudhury, is a startup company founded on the evidence-based notion that our mental health is inextricably linked to our everyday life. By leveraging passively collected data from smartphones, HealthRhythms seeks to provide a fluid and clinically grounded understanding of mental health risks associated with daily routines, or “behavioral rhythms.”
Measure (HealthRhythms Inc.) is an app designed to monitor the behavioral rhythms of people with major depressive disorder (MDD). This includes tracking cycles throughout the day and night, such as physical activity, sociability and sleep. Depression is associated with sleep problems, fatigue, loss of interest in social activities and anhedonia (inability to feel pleasure), among other symptoms [2]. Passive tracking of depression symptoms by smartphone sensors requires little to no effort from the individual, is minimally intrusive, and can potentially provide a more reliable picture of depression symptoms rather than depending on individual feedback alone in clinical settings weeks later, which can be prone to recall bias. The app can also collect data via customizable self-report questions prompted at regular time intervals. In sum, Measure is a valuable tool for ecological momentary assessment (EMA)—that is, moment-to-moment assessment of an individual’s behaviors and experiences in real-time and in their natural environments [3].

Because mood and emotional state can frequently change throughout the day, EMA gathers a continuous and more complete picture of individual’s state. An ongoing pilot feasibility study by CAN-BIND researchers hopes to establish Measure as a usable and acceptable tool for tracking depressive symptoms of patients with MDD.
Identifying symptom improvements can proactively reinforce positive behavioral change, and identifying the worsening of symptoms at the right time allows for early and effective intervention and can prevent immense suffering. Smartphone apps may not be the panacea for monitoring depression but are certainly a leap-forward from traditional methods.

[1] C. Shelley, “Do-it Yourself podcast: Rocket Evolution” National Aeronautics and Space Administration. NASA Education. 13 July 2009. Web. 1 Aug 2017.
[2] American Psychiatric Association. “Diagnostic and statistical manual of mental disorders: DSM-5.” Washington, D.C: American Psychiatric Association. 2013.
[3] M. Rot, H. Koen, R. Schoevers. “Mood disorders in everyday life: a systematic review of experience sampling and ecological momentary assessment studies.” Clin Psychol Rev. 2012 Aug;32(6):510-23

Author: Yashvi Asher, Summer Student.

Editors: Aleksandra Lalovic, PhD and Janice Pong, MSc


CAN-BIND at Science Rendezvous- bringing brain science to the streets

This year, the Canadian Biomarker Integration Network in Depression (CAN-BIND) program participated in the 10th Science Rendezvous. This is Canada’s largest science festival, spanning 30 cities with thousands of fun and creative science activities brought to city streets.

Our exhibit was located at the University of Toronto (St. George Campus) where community members and families came out to learn about science through colourful posters, interactive demonstrations and live experiments. There were also opportunities to meet and talk to the researchers and scientists behind the goggles and the laboratory doors.

The CAN-BIND exhibit highlighted a range of exciting research topics!

Zebrafish research models. Photo credit: Dr. Brock Schuman.

Our MYTH BUSTERS activity boasted a fun “facts or fiction” game to test and increase the knowledge of visitors on topics of depression and research techniques. Dr. Brock Schuman is a postdoctoral fellow at the Zebrafish Centre for Advanced Drug Discovery at the Keenan Research Centre for Biomedical Science, St. Michael’s Hospital. He was available to answer questions about zebrafish research models that are helping us to understand the role of genes and proteins in mood disorders. Find out more about zebrafish models here.

Did you know that technology can help further our understanding of depression? Our GOING MOBILE FOR MENTAL HEALTH display shared how data collected from your smartphone can be used to manage your mental health and wellness. CAN-BIND is currently conducting multiple studies that are using and testing mobile apps that can track and share data that could be beneficial in managing depression.

MRI image of the human brain. Depression can affect different areas of the brain such as the hippocampus (highlighted in blue). The hippocampus is involved in memory function and concentration.

Our BRAIN STRUCTURES AND MOOD display navigated through different parts of the brain that are affected in people with depression. Areas such as the amygdala (regulation of emotions) and hippocampus (important in memory function and concentration) were shown in brain images. These images were obtained using magnetic resonance imaging (MRI) by CAN-BIND investigators at the McMaster University/ St. Joseph’s Hamilton clinical research site (pictured, right).

Did you know researchers can measure the volume of your hippocampus from brain scans? These changes in volumes and/ or activity level could serve as biological markers or ‘biomarkers’ for early diagnosis and prevention of depression. They could also be used to predict response to various treatments of depression, and to predict relapse. Understanding these changes could contribute to improved health and wellness and intervention strategies in the future. CAN-BIND researchers are actively analyzing rich datasets to find such biomarkers.

MUSIC activates the reward pathway in our brain, like food, drugs and money,” says Dr. Thenille Braun Janzen, postdoctoral fellow and music therapy project co-lead with CAN-BIND. Dr Braun Janzen spoke about how music and rhythmic sensory stimulation can be used as therapies for depression. You can learn more about different music based approaches commonly used in research and therapy to promote health by reading our recent blog post here.

WELLNESS & COGNITION: Cognition is known as the act of thinking, perceiving and understanding. In depression, cognition is affected. “Changes in cognition in those with depression can be very subtle, so people don’t often consider it as a major problem,” says Dr. Shane McInerney, CAN-BIND study psychiatrist. “Mental sharpness is affected, as is concentration and the ability to process information quickly. These deficits in functioning can affect a person’s social functioning and wellness.”

Canada 150 themed CAN-BIND maple wellness tree at this years Science Rendezvous (May, 2017).

The exhibit brought together interactive information about cognition, wellness and the Cognitive Distortions Scale (CDS), a common scale used by clinicians and researchers to help identify thinking errors before, during and after treatment of depression.

To bring together the diversity of research and to raise mental health awareness, we encouraged volunteers, visitors and passersby to share wellness tips on maple leaves and add them to our Canadian wellness tree in recognition of Canada 150!

The CAN-BIND team enjoyed the opportunity to share research projects and brain health knowledge in a fun and interactive way with Science Rendezvous attendees. Thank you to everyone who visited! We look forward to seeing you at other CAN-BIND education and outreach events.

CAN-BIND researchers, students and staff gather to volunteer at the 10th annual Science Rendezvous event. Photo credit: Keith Ho.

To learn more about out CAN-BIND’s various outreach initiatives, click here.

Editors: Shane McInerney, MD, MB, MSc, MRCPsych, Janice Pong, MSc, Amanda Centini, MSc.


Me, My Depression and the CAN-BIND-1 Study

Imagine for a moment, that during the rainy days of spring, you feel unusually tired, have disrupted sleep and feel low in mood. Your motivation declines and you find little joy in your favourite activities for weeks, months or even years. These can be some of the common symptoms of depression.

Approximately 1 in 10 people worldwide suffer from depression. A 12-month survey showed that 4.7% of the Canadian population aged 15+ years reported symptoms that met the criteria for a major depressive episode.

The Canadian Biomarker Integration Network in Depression antidepressant medication study (CAN-BIND-1) aims to help predict response to treatment for depression. The research study involved persons living with depression and healthy participants who underwent a series of investigations such as brain imaging, blood tests and questionnaires.

Participants received antidepressant treatment and were assessed biweekly using a range of clinical and biological investigations over 16 weeks to monitor how they responded to the medication. -Dr. Shane McInerney, Study Psychiatrist

As the CAN-BIND-1 study comes to an end, we interviewed participant, Makyla Jabour, a 26-year-old Toronto resident about her personal journey of living with depression and participating in the study.


Makyla Jabour, Executive Project Specialist, Investments Inc., CAN-BIND-1 study participant

Q: Often people will feel reluctant to reach out for help. What encouraged you to seek treatment for depression?

A: Because of my depression, I lost my appetite. For months at a time, I was unable to eat or sleep and couldn’t focus on anything. I couldn’t even bring myself to wear anything besides a hoodie and sweats.

I was really down and unwell. One day, I came home and my new puppy, James, had destroyed my pair of TOMs® shoes. Generally speaking, I wouldn’t really care but instead, I threw a shoe across the room and starting crying my eyes out. It was at that point my partner and I started looking for help. 

Q: Do you think there are certain triggers that cause you to become depressed?money-jar

A: Finance is definitely one of my triggers. If I have to take a month off for whatever reason, mental or physical health, I’m not going to get a paycheque. How do you cope with that? It’s a vicious cycle: you feel depressed because you have no money and you have no money because you’re depressed and can’t function the way a healthy person would.

But overall, it could be a number of different things. I don’t know if it’s truly an imbalance of my brain chemistry or if there are small things that happen that build up to it.

Q: What encouraged you to take part in the CAN-BIND-1 study?CAN-BIND MAJ QUOTE

A: I’d lie in bed for hours on end and have suicidal thoughts- that was my tipping point. When I told them (the CAN-BIND staff) what was happening with me, I got into the study immediately. It was a study where people are like-minded and understand what you’re going through.

Q: The study involved a series of investigations such as brain imaging, blood tests, and questionnaires. How did you find this process over the 16 weeks of the study?CAN-BIND assessments-image

A: Daunting. Because I was severely depressed, getting out of bed was difficult; then going for blood work and having Franca (the study coordinator) walk me through all the different tasks was daunting. 

The electroencephalography (EEG) was my favourite! I liked them putting the gel on my head- that was my highlight. However, the first time I did the brain scan I had a little panic attack so they had to stop.

It got easier once I was on the medication and I was doing the regime properly. I was exercising (I’m terrible at exercising.) After a while, I saw the change in myself.

It was daunting but it was progressive and worth it. It went by so quickly. There was such a large difference from where I started to where I was at the end- it was almost inspiring. 

Q: What were your thoughts on taking antidepressant medication in the study? How did the treatment affect you?

A:  The antidepressant helped tremendously. But it was also very difficult adjusting to being on medication.

As a person, I think if you find the right medication for you, it feels as though you’re not really taking medication. Which in itself is a problem as well because a lot of people with depression will just stop taking their medication and this is how it (the illness) cycles and continues.

Q: How would you describe your journey in living with depression?

A: Have you ever been to Wonderland? You know the Behemoth? The big roller coaster? That’s what my life is like. It’s very difficult to deal with something when you don’t have the coping mechanisms to deal with it straightaway.

It’s not just difficult for me; it’s difficult for everybody around me. I’m quite fine being depressed and staying in my room for days- I can lock the world out. But it’s not logical. It’s not conducive with my life.

There are days I could wake up and I just don’t feel like getting out of bed. Thankfully, my work is very good with mental health – I mean I would never call them and say ‘hey, I just don’t feel like coming into work today’ obviously, but there are a lot of fields of work where you can’t just stop.

Q: Stigma refers to negative attitudes (prejudice) and negative behaviour (discrimination) toward people with mental health problems. How did this affect you?

A: If it’s one thing I’ve had to deal with, it’s the stigma of mental health.

People don’t realize that it’s insulting sometimes when they say ‘oh, but you just need to smile and sit up’ or ‘just perk up’- it’s not like that. If I could just perk up I would obviously just perk up. And no problem, I can put on a smile.

But it’s not about just smiling. It’s much more than that; it’s much deeper than that. It’s about figuring out how to deal with those emotions and gathering as many tools as you need to combat different parts of your life.

Q: What advice would you give to help someone who may be at a difficult point in their life?

A: Go out and get help. Do what’s best for you; don’t just do what’s best for other people.

A therapist once said something to me: depression is like having a friend from childhood that you don’t really like but have to keep around. They come over, sleep on your couch for days at a time, never clean up after themselves and just suck everything out of you.

And that’s what depression is to me. So find that one mantra that you can say to yourself – this is not me, this is a part of me. And go get help. You will feel so much better when you’re around people who’ve dealt with it or can appreciate what you’re going through.

Q: Finally, what inspired you to share your story?

A: I like talking about it. I like people understanding and knowing that people with depression aren’t people who are mopey all the time. People with depression are often people like me who are outgoing and social, the ones who are always up for a good time.


For more information on CAN-BIND’s current research studies, click here.

Editors: Shane McInerney, MD, MB, MSc, MRCPsych, Andrew Kcomt, BScPhm.



What Can Music Do For Your Depression?

It has never been easier to listen to music. The distribution of music via Internet through smartphone apps or streaming services has dramatically changed the way people interact with music on a daily basis. Whether in the car, at work, at the gym, or while doing chores, people in general spend a lot of time listening to music.  New consumer research has shown that on average 68% of smartphone owners stream and listen to music for at least 45 minutes each day. Another survey revealed that 2 in 3 people listen to music in the workplace with the intention to boost mood and creativity.

The use of music for self-regulation of mood and emotions has been known for centuries, and has been the subject of scientific investigation over the past decades. With a growing understanding of the benefits of music on physical, psychological and psychosocial health, research about the application of music as a therapeutic tool in the treatment or management of mental health disorders – such as depression – is still in its preliminary stages.

Here are 3 different approaches where music has been used in research and therapy to promote health:

Neurologic Music Therapy: a research based treatment system using music and music elements for rehabilitation of brain and behaviour function by focusing primarily on cognitive, speech-language, and sensorimotor disorders. This therapeutic approach is administered by an accredited music therapist with a certificate in neurologic music therapy. The interventions consist of research-based therapeutic exercises to facilitate functional non-musical outcomes, and to train and retrain abilities in cognition and psychosocial function, speech and language, motor control, emotional growth, and social skills.

Music Therapy: a form of therapy that uses music experiences and client-therapist relationships to promote, maintain, and restore health. A Music therapist is a qualified and accredited professional trained to promote musical experiences that can be broadly categorized into:

  • active experiences – this may involve singing, playing instruments, improvisation or the composition of music.
  • receptive experiences  this may involve an adjunctive activity performed while listening to live or recorded music, such as relaxing, meditating, practicing movement, drawing or reminiscing.

In general, music therapy interventions focus on facilitating well-being, social relationship building, self-awareness, self-expression, communication, and personal development.

Music Medicine: a term developed in the early 1990s and sometimes used to describe a variety of uses of music that does not include a therapeutic process and client-therapist relationship. Music medicine refers typically to music listening protocols for pain reduction, anxiety reduction, relaxation, mood induction, emotional well being, to induce sleep, and to boost alertness.

Music-related therapy can be offered in hospitals, educational facilities, long term care centres, and private clinics. To find more about music therapy services and for a list of accredited music therapists in Ontario, visit the Music Therapy Association of Ontario. To find more about Neurologic Music Therapy services in Ontario, visit the Academy of Neurologic Music Therapy (for clinical services click on ‘about us’ and ‘registry by location’).

The CAN-BIND program, in collaboration with the Music and Health Research Collaboratory, Faculty of Music, at the University of Toronto, is developing new research projects to better understand what music does for our health and more specifically, how we can use music in the treatment and management of depression.  For research updates and to find more about the research projects at CAN-BIND, click here.

Co-author: Thenille Braun Janzen, PhD.

Editors: Shane McInerney, MSc, MBBS, MRCPsych, Michael H. Thaut, PhD.


Does the Winter make you SAD?

Seasonal Affective Disorder (SAD) is a sub-type of depression associated with the shorter days during the fall and winter seasons.  SAD may affect up to 1 in 10 Canadians. Although several symptoms of SAD (such as low mood, fatigue, oversleeping, overeating, and a lack of motivation) are similar to the milder ‘Winter Blues’, SAD is a serious disorder that can severely affect an individual’s daily functioning. As we transition into winter, here are reliable sources to help you recognize and understand SAD this season:

  • In this overview on SAD, the Canadian Network for Mood and Anxiety Treatments (CANMAT) gives a brief introduction to the disorder and its treatment.
  • In this short video, Dr. Raymond Lam, a UBC- based psychiatrist from the CAN-BIND program, talks about how SAD differs from the ‘Winter Blues’ and the importance of continued treatment for this condition. Dr. Lam also provides useful information on SAD and light therapy.
  • The Mood Disorders Association of Ontario FAQ gives you the What, How, Who and Where on everything you need to know about SAD.
  • This Canadian Mental Health Association (CMHA) help guide, from the British Columbia division, gives tips on improving health and easing the symptoms of SAD. Province-specific guides are available.

If you have or think you may have SAD, consult your doctor who will be able to assess and guide you through the appropriate treatment. If you are concerned for a family member or friend, please encourage them to contact their doctor.

Editors: Shane McInerney, MSc, MBBS, MRCPsych, Raymond W. Lam, MD, FRCPC.


Let’s Talk About Suicide

As we join forces to express our ongoing support on World Suicide Prevention Day on September 10th, we asked three ambassadors of mental health and suicide awareness how they try to help and improve the lives of those touched by suicidality and mental illness through the work that they do in their field of expertise.

“Does anyone understand?” Individuals suffering from suicidal thoughts and ideation often find it difficult to seek help because of social stigma. Suicide was ranked the 9th leading cause of death in Canada from 2009- 2012 (Statistics Canada, 2015). Photo credit: Julia Fice.