Healthy Byte: Depression & Antidepressants

Sad

The sadness often descended like a curtain — heavy and dark.

But even when my depression threatened to cut me off completely from the world around me, I struggled with the decision to take antidepressants. It wasn’t just that I’d been taught to believe that “going on meds” was giving up. No, what really worried me was how I’d cope if the drugs didn’t work.

This is one of the biggest problems with our current methods of treating mental illness — it’s virtually impossible to know if drugs will help.

“Right now, [going on antidepressants] is very much trial and error,” Dr. Jeffrey Lieberman, the chair of the department of psychiatry at Columbia University, told Business Insider.

A group of Stanford researchers wants to change that. They’ve created a two-part test which they say could one day help predict — with striking accuracy — if someone with depression will respond to antidepressants. Their results were published in October in the journal Proceedings of the National Academy of Sciences.

At its essence, the test looks at two factors in someone with depression.

1. Specific patterns of brain function in one area of the brain that’s thought to play a key role in depression.

The researchers looked specifically at brain activity in the amygdala, a small structure deep in the center of the brain. The amygdala is part of our limbic system, a group of structures linked with emotions like anger, sadness, pleasure, and fear. People with depression tend to display higher activity in the amygdala, which can continue even after recovery.

To get a snapshot of what was going on in people’s amygdalas, the Stanford researchers showed their study participants images of emotional (angry and sad) faces while they sat in an MRI machine.

2. Exposure to stress in early life.

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People who are exposed to high levels of stress in childhood, either from experiencing a single traumatic event or as the result of being repeatedly abused or neglected, tend to be at higher risk for depression than people who are not.

As a result, the Stanford researchers included this factor in their diagnostic test by having patients fill out an early life questionnaire designed to assess their exposure to things like abuse, family conflict, illness, and natural disasters before they were 18 years old.

What the test showed

Based on someone’s “score” on the two measurements above — i.e. Did they show high patterns of brain activity when exposed to the emotional faces? Were they exposed to lots of early life stress? — the researchers were able to come up with a predictive snapshot of how well that person might respond to an antidepressant drug like Prozac or Zoloft.

The people who were the most likely to respond to antidepressants were those who’d experienced high levels of early life stress and were also highly reactive to specific emotional stimuli.

In other words, people with depression in the study who revealed that they’d been abused as a child and whose brain scans showed that they were highly reactive to the angry and sad faces were more likely to have a positive outcome on the drugs. Scientists believe that a stressful childhood experience like abuse can heighten our sensitivity to emotions, especially negative, potentially threatening ones. Eventually, this could make someone less sensitive to positive cues as well. The role of antidepressants in this scenario, then, would be to help normalize how our brain’s amygdala reacts to emotional stimulii, especially positive cues.

The same outcome was predicted for people who’d experienced low levels of early life stress and were also not very reactive to the faces. In these people, the role of the drugs would be to heighten their brain’s reactivity to emotional cues.

On the other hand, depressed people who said they’d experienced high levels of early life stress but did not react much to the faces (or people who experienced low levels of early life stress but were very reactive to the faces) tended to respond poorly to the drugs.

This jives with other research which suggests that exposure to early life stress, such as abuse or neglect, can change the structure and function of the amygdala, the structure linked with processing emotions. Scientists believe

‘Racing towards the same goal’

The test results are promising, not just because the test appeared to work, but because the researchers’ efforts are part of a bigger push towards transforming how we diagnose and treat mental illness.

For the vast majority of medical problems, there’s a diagnostic test that can tell you what course of treatment you should embark on. If you think you may have type 1 diabetes, for example, you take a blood test. If it’s positive, you’ll likely be prescribed insulin. If you think you may have a heart problem, you get an EEG. Depending on the outcome, you might be given several different kinds of drugs or told to start a specific exercise regimen. With mental illness, there are virtually no such diagnostic tests.

hug friend friendship couple love relationshipStrelka Institute for Media, Architecture and Design Follow/Flickr

The Stanford researchers aren’t the only ones who see this as a huge problem. They’re part of a growing number of scientists who are trying to create diagnostics for mental illness.

“This is one of many initiatives that are pointing towards how diagnostics will become a kind of standard of care,” said Lieberman. “Everybody is racing towards the same goal but they’re taking different paths.”

“I believe [this] is one very important way to transform how we manage depression,” Leanne M. Williams, a psychiatrist at Stanford University and one of the authors of the new paper, told Business Insider. “This could help close the gap between the insights we get from our research and the current devastating impact of depression.”

Here’s how it might work one day. Picture a scenario where someone with depression walks into a clinic, takes the test, and finds out she probably won’t respond well to antidepressants. Then, she has options: First, she could either go on the drugs anyway and see what happens (the test does not predict the future — depression is complicated and there’s still a chance that someone who performs one way on the test might have a different real life experience). Second, she might be encouraged to try a different route of treatment, such as talk therapy.

Like any new study, however, the present research has limitations.

For starters, the test has only been given to people with diagnosed depression in preliminary study settings so far. Researchers are still at the stage in their work where they’re deciphering how well it works and for whom. In other words, you aren’t going to see the test popping up at your doctor’s office tomorrow. Still, the scientists who designed the test told Business Insider that they plan to start deploying it in limited real-world settings at Stanford University in the next few months.

“Anything that would help identify such individuals or give doctors an idea of how they’d respond to treatment would be beneficial,” said Lieberman. “This is one piece of putting that bigger puzzle together. But it’s not the final piece.”

 

 

Originally Posted HERE

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Healthy Byte: Science’s Formula to Happiness

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Happiness can be fleeting under the best of circumstances. Even people who are basically happy have periods when they’re not, and for those who are prone to depression, it’s always a struggle. The core issue with depression (or one of them) is that it hijacks your urge to want to fix things, which obviously creates a vicious cycle. One strategy that helps with the hijack is to create a little routine that you stick to, and which can become a habit itself, and into which you build other habits (see below for more on this method). And according to science and psychologists, there are other things to do to improve your happiness level, whether you’re depressed or just dealing with “stuff” right now. Here’s what the science tells us we can do to make ourselves a little happier in an ongoing way.

(Note: Meds can be life-changing or life-saving for some people who are depressed, and it’s important to point that out. This article is about other strategies, which you can do with or without meds, and whether you’re depressed or just want to be happier overall.)

Exercise  

Unless you’re one of those people who likes to exercise, you won’t want to hear this, but exercise is well known to help with depression and improve well-being. “Cardiovascular exercise has been shown time and time again to be a wonder drug with regard to overall well-being,” says Ben Michaelis, psychologist and author of the book Your Next Big Thing. It’s actually similar to the efficacy of antidepressants for some types of depression, and this seems to be at least in part due to its neurogenic effects–that is, its capacity to “grow” new neurons in area of the brain known to be affected by depression (and dementia): the hippocampus. In fact, a study last week found that exercise helps release a compound in muscles, cathepsin B, which appears to migrate to the brain’s hippocampus and spark the development of new brain cells. So the exercise effect is not necessarily just about the endorphins from the “runner’s high,” as was once thought, but it’s about other types of changes that occur not only in the chemistry of the brain, but maybe even at a structural level, too.

The things you put in your body

“Avoiding processed sugars has been shown to reduce the likelihood for depression, which is another way of saying it promotes happiness,” says Michaelis. Studies have shown that Western diets in general are associated with prevalence of depression. Others have shown that sugar itself may be linked to depression–and while the mechanisms aren’t totally clear, researchers speculate that the oxidative stress that excess sugar can create may take a toll on the brain. There’s another body of evidence that’s lain out the addictive potential for sugar, which itself can contribute to depression, or at least to unstable mood and cycling ups and downs. And a fast-growing body of evidence has found that our gut microbes seem to affect our mental health in significant ways, and the foods we eat can select for or reduce certain strains of bacteria. More work needs to be done here, but eating a plant-based diet, low in sugar and processed foods may well help promote our mental health.

Make a schedule 

“Having a structured schedule that you set and follow is proven to help depression,” says psychologist Shannon Kolakowski, author of the book When Depression Hurts Your Relationship.“It’s the basis of behavioral activation for depression, an evidence-based treatment for depression.” She adds that creating a routine kills two birds with one stone. The structure of a daily routine that you can stick to is in itself comforting, even therapeutic, when you’re down or depressed. But it also makes getting in all the single elements that we know help depression more likely. “By planning activities that you do even when you don’t feel like it,” says Kolakowski, “it ensures you will get the exercise and social interactions, for example, that are so well known to help with depression.”

Social interaction

This one is fascinating because the research keeps showing that social connection is perhaps the single best thing we can do for our mental health. And it seems to occur at the level of the brain. (It may also be the single best thing we can do for our physical health, so it’s really a win-win.) “We know that a sense of community significantly adds to our happiness and overall mental health,” says Michaelis. We’re social creatures by nature, no matter how much you want time to yourself–there’s a thin line between being self-sufficient and being lonely.

And the catch-22 is that when we’re unhappy or depressed we tend to want to isolate; so forcing yourself to stay connected, especially during tough times, can be hard. Luckily, the effects are generally pretty immediate–most people have experienced that even a 10-minute conversation with someone can make a huge difference when you’re feeling really down. Or it can at least bring out of our heads enough to put things in perspective; and it reminds us that human interaction is a really powerful thing, even in small doses.

Marriage, says Kolakowski, is an extension of this one–at least, a good marriage. “Research shows that having a strong marriage can no doubt help depression,” she says. “But having a relationship that is struggling, unhealthy or lacking in support can unfortunately make depression worse in a cyclical fashion. So it’s important that your social relationships be good ones.”

Getting it out

A lot of people are familiar with the ongoing conversation in their heads (or monologue), which can exist whether you’re depressed or not. But it’s particularly loud when you’re depressed, and it creates a vicious cycle of over-thinking, internalization, and unhappiness (in fact, rumination is one of the hallmarks of depression). But directing those thoughts outward, by either talking to someone you trust or by writing it out in a journal, is a lot more therapeutic than just cycling it around in your head. There’s something about the act of telling that directs and releases it in a fundamentally different way from thinking it.

Therapy, of course, partially falls into this category, with the added benefit of feedback from someone who’s trained in problem-solving. More on this below.

Cognitive behavior therapy

This form of therapy is considered the gold standard for a number of different issues–anxiety, addiction and depression, to name a few. In CBT, the general idea is that you first learn to identify various thought processes as they arise, and just note them. Then for the negative ones (which are often fear-based, and kind of ridiculous–“I can’t do anything right”) you learn to replace them with more positive, and perhaps more logical, ones. Over time and with practice, this process becomes less clunky, and more natural and reflexive. Essentially you’re laying down new tracks of connections in your brain, which can be a lengthy process. But it’s very possible over time. Though CTB has been shown to have significant effects on depression, there are certainly others that can be just as valuable.

Meditation

This is a fascinating practice that, in various iterations, has been around for thousands of years, and the science is just starting to show how it changes the brain over time. Meditation wasn’t exactly developed to improve mental health, but this does seem to be one of its benefits. Studies have shown that eight weeks of meditation training seems to help improve a number of aspects of mental health: One study a couple of years ago from Johns Hopkins found that meditation addressed symptoms of depression and anxiety on the level of antidepressants. Another, out of University of Oxford, found that mindfulness-based cognitive therapy (MBCT) is as effective as antidepressants at preventing relapse in people with depression. One of the ways in which meditation seems to work for depression is that it reduces activity in the default mode network (DMN), the group of areas that are active when our minds are wandering, and generally associated with negative or stressful thoughts.

A central component of meditation is mindfulness, which is the act of paying attention without judgment to what’s going on at the present time–this trait itself has been linked to mental health. This is because just noting your present experience, rather than editorializing it, helps release some of the charge of those negative thoughts and feelings. Then they lose a little of their power. (You can see the natural overlaps between mindfulness meditation and CBT, which is why MBCT was developed.)

Be easier on yourself

This one is very hard to do without feeling self-indulgent, but self-compassion is actually a really important element to being happier. And it actually affects your connection to yourself and other areas of your life.

“This is a big one that’s counterintuitive when you’re depressed,” says Kolakowski. “Depression makes you beat up on yourself and feel down about three main components, what’s called the Cognitive Triad of Depression: your self, your future and others. Self-compassion helps you approach your self and your future with compassion as opposed to self-criticism. It also helps you to have compassion for others, which in turn helps you feel more connected and hopeful.”

Self-compassion has been shown to be an even better predictor of the severity of one’s symptoms of anxiety and depression (or lack thereof) than being mindful, which is a fairly good predictor in itself. And having compassion for yourself is actually an offshoot of mindfulness: If acceptance without judgment is a cornerstone of mindfulness, then not judging and being compassionate about you’re going through, and about yourself in general, is a stone’s throw away. In depression, or even in general down-ness or disillusionment, people tend to, at best, abandon themselves, and at worst, criticize themselves extensively and harshly. Here’s a nice rundown, if you need some ideas for how to be more compassionate with yourself.

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None of these is a cure for depression in itself or a key to well-being. But trying to remember and enlist some of them during difficult times may make a difference. And as always, these are practices–they take time. Doing a little each day, and being easy on yourself as you do, can make a big difference in our happiness over the long term.

Originally Posted HERE

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Healthy Byte: Depression Through the Lens

2015 10-8b

YOUR STORY ISN’T OVER YET

Photo: Laura Hospes

When Danish photographer and student Laura Hospes was hospitalized in a psychiatric hospital, she processed the experience one of the only ways she knew how — through her lens.

Now her photo series, “UCP-UMCG,” named after the psychiatric hospital in the Netherlands where she stayed, documents the 21-year-old student’s journey to rediscover herself through self-portraits. After a suicide attempt, she began treatment fordepression and an eating disorder, according to the Daily Mail.

Hospes was overwhelmed and confused when she first entered the hospital, she told the Mighty in an email.

“I couldn’t make contact with my own emotions and I felt like I was floating somewhere in the air with heavy stones tied on my whole body,” she told The Mighty. “After a month I slowly found myself back and the emotions screamed in my head. I was extremely sad or extremely angry. I felt so desolated in hospital, even if there were friend or family around me.”

The photo series won the photographer a spot on LensCulture’s list of 50 best emerging photographers for 2015 in the LensCulture Emerging Talent Awards.

“At first, I made this complete series for myself, to deal with the difficulties and express my feelings,” Hospes told The Mighty. “After that, I want to inspire people who are or have been in a psychiatric hospital. I want them to see my pictures and recognize themselves in it. I hope they feel taken seriously, less crazy and less alone.”

See her powerful self-portraits below:

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

Photo: Laura Hospes

To see more of Laura’s work, visit her website.

Clarification: Information has been added to this piece about the location of the hospital and the nature of her stay.

If you or someone you know needs help, please visit the National Suicide Prevention Lifeline. You can also reach the Crisis Text Line by texting “START” to 741-741. Head here for a list of crisis centers around the world.

Originally Posted HERE

For Additional Information on “Project Semicolon” click HERE

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Healthy Byte: Happiness is Contagious, Be a Carrier

2015 10-8a

Mongolian girl having a hearty laugh with her camel

Depression is not contagious, according to a new study published in the journalProceedings of the Royal Society B. Happiness, however, is more likely to spread between friends, and the results from the study may help remove some of the stigma surrounding depression.

The World Health Organization estimates that 350 million people worldwide are currently living with depression. Unfortunately, we haven’t made much progress in lowering that number, even though there are literally entire scientific journals devoted to the subject. Preliminary studies have now shown that social support and friendships may be a major factor in lifting you out of a diagnosed funk. Thanks to a detailed study, we have some of the first empirical evidence that happiness is contagious, and that those who befriend depressed people are not in danger of becoming depressed themselves.

Researchers examined data from over 2,000 teenagers who had reported their network of friendships and answered questions about their levels of happiness as part of an earlier research project. Based on the survey results, the scientists classified each student into either a “low mood” (depressed) category a or “healthy mood” (not depressed) category. Then, they mapped out friendships and ran computer simulations to determine whether happiness and sadness spread between friends like an infectious disease.

The result? Depression is not contagious. Meanwhile, happiness not only spreads—it may prevent (and even help people recover from) depression. The model suggests that teens with five or more happy friends have half the probability of suffering from depression over a six to 12-month period than teens without no “healthy mood” friends. And adolescents with 10 healthy friends have more than double the probability of recovering from depressive symptoms.

“This was a big effect that we have seen here,” said Thomas House, mathematics professor at the University of Manchester and coauthor on the study in a prepared statement. “It could be that having a stronger social network [the real-life version, not Facebook] is an effective way to treat depression.”

Since the study suggests teens are not at risk of “catching” depression from their friends, and having happy friends may prevent and even pull teens out of depression, House and his colleagues stress that it is important to promote any friendship between adolescents. Friendship is a win-win, the study says—it can’t hurt, but it may be both protective and curative.

“If we enable friendships to develop among adolescents (for example providing youth clubs) each adolescent is more likely to have enough friends with healthy mood to have a protective effect,” House said in a prepared statement. “This would reduce the prevalence of depression.”

Originally Posted HERE

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Healthy Byte: National Depression Screening Day

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October 8, 2015 is National Depression Screening Day in part to bring more public awareness in order to reduce the stigma often associated with mental illness.

Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide. Suicide results in an estimated 1 million deaths every year.

Although there are known, effective treatments for depression, fewer than half of those affected in the world (in some countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. Even in some high-income countries, people who are depressed are not always correctly diagnosed, and others who do not have the disorder are occasionally misdiagnosed and prescribed antidepressants.

Depression is the most common mental disorder and fortunately, depression is very treatable. A combination of therapy and antidepressant medication can help ensure recovery.

Key Facts:

  • Depression is a common mental disorder. Globally, more than 350 million people of all ages suffer from depression.
  • Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease.
  • More women are affected by depression than men.
  • At its worst, depression can lead to suicide.
  • There are effective treatments for depression.

Types and Symptoms

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.

A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.

Unipolar depression: in its typical depressive episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

Bipolar mood disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological factors. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes for the prevention of child abuse, or programmes to enhance cognitive, problem-solving and social skills of children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly are also effective in depression prevention.

Diagnosis and treatment

There are effective treatments for depression. Depression can be reliably diagnosed and treated by trained health workers delivering primary health care. Recommended treatment options for moderate-severe depression consist of basic psychosocial support combined with antidepressant medication or psychotherapy, such as cognitive behaviour therapy, interpersonal psychotherapy or problem-solving treatment. Psychosocial treatments are effective and should be the first line treatment for mild depression. Medicines and psychological treatments are effective in cases of moderate and severe depression.

Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

WHO response

Depression is one of the priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). The Programme aims to help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health. The programme asserts that with proper care, psychosocial assistance and medication, tens of millions of people with mental disorders, including depression, could begin to lead normal lives – even where resources are scarce.

Resources:

World Health Organization (WHO)

American Psychology Association (APA)