As the cortex loses neurons, it stops modulating the panic, grief, rage and fear that the subcortical systems still fire, so new mood and anxiety symptoms can be part of the process. Explain that process to patients and families instead of just naming depression or anxiety, and in the nursing home or ICU, controlling the sleep-wake cycle may get much of the effect with fewer problems.
What it does to mood
The subcortical systems keep firing just fine: panic, grief, separation distress, stress, rage, fear. As the cortex recedes and loses neurons, it no longer modulates that affect the way it did across the rest of life.
“your subcortical systems are firing just fine. So the panic, grief, the separation, the stress signal, the rage, fear, all those things that have been firing across your life and you've got the brain to handle it, it's As your cortex is receding and losing neurons, you are no longer modulating that affect properly”
14:51Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026Guest episode
Sleep and agitation
In the nursing home or ICU patient, controlling the sleep-wake cycle with something like trazodone, mirtazapine, melatonin or ramelteon may give a lot of the same effect without the same problems.
“if you control the sleep wake cycle, In the ICU or nursing home patient using something else like a trazodone, mirtazapine, or even a melatonin or ramelteon, you may get a lot of the same effect without the same problems”
1:00:35Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
Talking to patients
Slow down and explain the process that is going on, rather than saying "you have depression" or "you have anxiety, that's why you feel bad now." It helps patients and it helps families understand.
“really slowing down and explaining what's going on and why it's not, oh, you have depression, that's why you feel bad now. You have anxiety. That's why you feel bad now. But this is what's the process that's going on. It helps patients. It helps families understand better”
15:31Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026Guest episode There is enough evidence to at least mention that lithium seems to help prevent dementia, especially in bipolar disorder.
“I do think there's enough evidence so far to at least mention that this seems to be something that is a positive effect of lithium in preventing dementia. Especially in bipolar disorders”
37:06Mood Stabilizers for Bipolar Disorder: Lithium, Lamotrigine, Depakote & MoreJul 2026
It also comes up on
From these episodes
- Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026 · 2 points
- Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 · 1 point
- Mood Stabilizers for Bipolar Disorder: Lithium, Lamotrigine, Depakote & MoreJul 2026 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.