The Brain, The Mood, The Music.

The brain, the mood, the music. Part I. Joachim Uys, Ph.D.

Whenever I give lectures on psychiatric disorders, I tell my audience that we fall in one of two categories. We either have a psychiatric disorder or we know personally of someone who has one, this can be a family member, friend or acquaintance. It is therefore not surprising that an estimated 9.7% of U.S. adults had a mood disorder in the past year. Furthermore, the past year prevalence of any mood disorder among adults was higher for females (11.6%) than for males (7.7%), while 21.4% of U.S. adults experience any mood disorder at some time in their lives 1 compared to 25% for Europeans 2. These are not trivial percentages, but a burning question I always had was what about the link between creativity and mood disorders? In fact, history and anecdotal evidence have shown us that there is a fine line between creativity and “madness”. In this article, I will discuss the correlation between artistic creativity and mood disorders. In addition, the potential for music as an adjunct therapy for mood disorders will also be briefly discussed.A follow up article (part II), will focus on the neurological structures involved in music and rhythm. For the purpose of this article, mood disorders include depression, bipolar disorder and seasonal affective disorder.

One of the earliest studies to examine the role between creativity and mood disorders was done in 1974, which longitudinally examine a cohort of 15 writers from the University of Iowa Writer’s workshop and compared them with age-, gender- and educational-matched controls 3.The results showed that 80% of the writers had some type of mood disorder and more specifically, 30% had either bipolar I or bipolar II disorder. More recent studies have also found interesting results. A large population-based study in Sweden amongst almost 4.5 million people, using the public registry, tested the associations between a tertiary education in an artistic filed and hospital admission for schizophrenia, bipolar disorder or unipolar depression. Compared with the general population, there was an increased risk in developing all of the above mentioned disorders, even after adjusting for IQ and other confounding factors 4. Another recent study examined the relationship between creativity and the risk for future manic episodes among individuals with a clinical risk for bipolar disorder and a history of depressive disorder 5. Bipolar-at-risk (BAR) individuals scored higher on the Barron-Welsh Art Scale (BWAS) than the non-BAR group, suggesting a higher level of creativity in the BAR group. Furthermore, individuals with euphoric mood swings had higher BWAS scores than those without mood swings. This is just a small sample of the studies that show similar results and it is clear that there is a relationship between mood disorders and creativity, but what about using music as a therapeutic tool?

Studies have shown that music alleviated depression symptoms and increased quality of life in patients undergoing hemodialysis 6. They received music therapy twice per week for 75 minutes. Interestingly, another study found that music therapy can even affect drug dosages 7. This study by Stefani et al., showed that patients who received music therapy could decrease their neuroleptic drug dosages compared to controls. In addition, with regards to antidepressants, the control group had to increase their dosages over time, while the dosage in the music therapy group remained unchanged. A recent study examined the role of music during psychedelic therapy in patients with treatment-resistant depression 8.Patients received the hallucinogen, psilocybin, during two therapy sessions. During the first session they received 10mg followed by the second session one week later where they received 25mg psilocybin. The most appreciated musical genre’s were ethnic-, vocal-, and neo-classical music. The patients left the session approximately 7 hours later. While the study had no placebo condition, patients described the music as having a substantial influence on the therapeutic sessions, including mystical experiences and insightfulness.These are not the only studies which show the advantages of music therapy. There is an extensive systematic review of numerous studies about music therapy for depression from the Cochrane Library 9, which corroborates the positive treatment effects on mood disorders.

In conclusion, while the data show that there is a higher prevalence of mood disorders in creative persons, there is no data to support that creative people with mood disorders are more creative than those without mood disorders. With regards to music as a therapeutic tool, the evidence suggests that music therapy can play a valuable role in the treatment of mood disorders. However, currently it is not known if different music genres, for example techno compared to trance, have different efficacy in treating mood disorders.

References:
1. Harvard Medical School. National Comorbidity Survey (NCS). August 21, 2007.
2.Alonso J, Angermeyer MC, Bernert S, et al. “Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project”. Acta Psychiatr Scand Suppl. 109 (420): 21–7, 2004.
3. Andreasen NJ, Canter A. The creative writer: psychiatric symptoms and family history. Compr Psychiatry. 15(2):123-131, 1974.
4. MacCabe JH, Sariaslan A, Almqvist C, Lichtenstein P, Larsson H, Kyaga S. Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedishpopulation-based case-control study and sib-pair analysis. Br J Psychiatry. 212(6):370-376, 2018.
5. Burkhardt E, Pfenning A, Breitling G, Pfeiffer S, Sauer C, Bechdolf A, Correll CU, Bauer M and Leopold K. Early Interv Psychiatry. Creativity in persons at-risk for bipolar disorder-A pilot study. Oct 10. doi: 10.1111/eip.12748, 2018.
6. Hagemann PMS, Martin LC and Neme CMB. The effect of music therapy on hemodialysis patients’ quality of life and depression symptoms.J Bras Nefrol., http://dx.doi.org/10.1590/2175-8239-jbn-2018-0023. 2018.
7. Stefani MD and Biasutti M. Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study. Front Psychol. 7:1518. eCollection 2016.
8. Kaelen M, Giribaldi B, Raine J, Evans L, Timmerman C, Rodriguez N, et al. The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology (Berl).235(2):505-519, 2018.
9. Music Therapy for depression. Cochrane Database Syst Rev. 11:CD004517. doi: 10.1002/14651858.CD004517.pub3, 2017.

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