Category Archives: Depression

Men and Depression

11 Wednesday Sep 2019

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In my years f doing groups I have on occasion facilitated men only groups. One issue that comes up is depression. We all have bouts of sadness now and than and when those bouts of sadness interfere with our daily lives than we need to take a step in the direction of change. Below is a handout I often use, particularly with dual diagnosed men.

Symptoms of Depression

Not everyone who is depressed or manic experiences every symptom. Some people experience only a few; some people suffer many. The severity of symptoms varies among individuals and also over time.

· Persistent sad, anxious, or “empty” mood.

· Feelings of hopelessness or pessimism.

· Feelings of guilt, worthlessness, or helplessness.

· Loss of interest or pleasure in hobbies and activities that were once enjoyable

· Decreased energy, fatigue; feeling “slowed down.”

· Difficulty concentrating, remembering, or making decisions.

· Trouble sleeping, early-morning awakening, or oversleeping.

· Changes in appetite and/or weight.

· Thoughts of death or suicide, or suicide attempts.

· Restlessness or irritability.

· Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.


Co-Occurrence of Depression with Other Illnesses

Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated. Research has shown that anxiety disorders which include post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder commonly accompany depression.

Substance use disorders (abuse or dependence) also frequently co-occur with depressive disorders. Research has revealed that people with drug and/or alcohol addiction are almost twice as likely to experience depression.

Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s.

Causes of Depression

Very often, a combination of cognitive, genetic, and environmental factors is involved in the onset of depression. Modern brain-imaging technologies reveal that, in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly.

In some families, depressive disorders seem to occur generation after generation; however, they can also occur in people with no family history of these illnesses. Genetics research indicates that risk for depression results from the influence of specific multiple genes acting together with non-genetic factors.

Environmental factors such as trauma, loss of a loved one, a difficult relationship, financial problem, or any stressful change in life patterns, whether the change is unwelcome or desired, can trigger a depressive episode in vulnerable individuals. Once someone experiences a bout of depression later episodes of depression may occur without an obvious cause.

Men and Depression

Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression in men or a co-occurring condition that more commonly develops in men. Nevertheless, substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends. Other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm’s way.

How to Help Yourself if You Are Depressed

Depressive disorders can make one feel exhausted, worthless, helpless, and hopeless. It is important to realize that these negative views are part of the depression and do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Engage in mild exercise. Go to a movie, a ballgame, or participate in religious, social, AA/NA meetings or other healthy activities.
  • Set realistic goals and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Expect your mood to improve gradually, not immediately.
  • Feeling better takes time. Often during treatment of depression, sleep and appetite will begin to improve before depressed mood lifts.
  • Postpone important decisions. Before deciding to make a significant transition–change jobs, get married or divorced–discuss it with others who know you well and have a more objective view of your situation.
  • Do not expect to ‘snap out of’ a depression. But do expect to feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking as your depression responds to treatment.
  • Let your family and friends help you.

Self-Care for Depression 2

20 Tuesday Aug 2019

Posted by in Depression, Self-Care

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Everyone gets the blues from time to time. In fact, according to the National Institute of Mental Health, major depressive disorder (also known as depression) affects 7 percent of adult Americans every year, and chronic, mild depression affects 2 percent.

The good news is you may not have to turn to drugs to combat the blues. Of course, if bouts of depression continue for weeks at a time, you need to see a health-care professional and work out a treatment plan. But for occasional down days, adopting some simple lifestyle and diet changes and making them part of your daily routine can naturally boost your mood.

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A regular dose of exercise may be just what you need to ease the first signs of depression or anxiety. A study by a team of researchers including Michael Babyak, professor of medical psychology at the Duke University Medical Center, showed that engaging in mild aerobic exercise three times a week was as effective as undergoing a standard treatment with antidepressant medications. While researchers aren’t sure why exercise helps, some speculate being active may affect brain chemicals or improve blood flow to the brain. Babyak says you don’t necessarily have to do extremely vigorous activity — even fast walking (try for 30 minutes at least three times a week) may help improve your mood.

 The foods you choose can also affect your mood. “Low levels or actual deficiency of such nutrients as omega-3 fatty acids, zinc, selenium, chromium, vitamin D, and the B vitamins folic acid and B12 are all associated with human depressive symptoms,” says Alan C. Logan, naturopathic physician and author of The Brain Diet (Cumberland House, 2007). However, Ronald Pies, M.D., clinical professor of psychiatry at Tufts University School of Medicine and professor of psychiatry at SUNY Upstate Medical University, Syracuse, adds that there’s no solid evidence to date that specific foods or nutrients can boost a person’s mood under normal circumstances. The key, he notes, is moderation. “A nutritious, well-balanced diet is very important for maintaining a normal mood.”

 Omega-3 fatty acids, found in fish, fish oils, and flaxseed, are being studied for their mood-boosting properties. Specifically, research suggests that eicosapentaenoic acid (EPA), an omega-3 found in oily fish, may be especially effective against depression. Though the jury is still out on all of the potential benefits of omega-3s, many experts say it’s worth giving them a try. “Consider adding more omega-3 fatty acids to your diet, if not to boost mood, then to improve your overall cardiovascular fitness,” says Ronald Pies, M.D., clinical professor of psychiatry at Tufts University School of Medicine and professor of psychiatry at SUNY Upstate Medical University, Syracuse. “This can be easily done by increasing your dietary consumption of certain fish, such as salmon or herring.” You can also get fish oil in supplement form.

When your body relaxes, it can help you see the world from a rosier perspective. One way to achieve effective relaxation is through the increasingly popular practice of yoga. Studies by India’s National Institute of Mental Health and Neurosciences have shown that certain yoga-linked breathing exercises can lower levels of cortisol, an adrenal hormone linked to stress. Another study found that immediately after a one-hour session, yoga practitioners had a healthy boost in levels of the mood-related neurotransmitter gamma-aminobutyric acid (GABA). Low brain levels of GABA have been associated with anxiety and depression. Yoga has many other health benefits as well.

Some people report that taking the herbal supplement St. John’s wort helps their depressive symptoms, while others find no benefit. Naturopathic physician and author Alan C. Logan says research has shown that it’s worth trying St. John’s wort if you have mild to moderate depression. He warns, however, that this herb shouldn’t be used if you’re already taking antidepressant medications. In addition, St. John’s wort can interact with many other prescription drugs, such as birth control pills, making them less effective. As a general rule, it’s always advisable to consult a health-care practitioner before using any nutritional supplement.

Getting your feelings out, be it in a letter or journal entry, or through creative writing, can provide insight into your feelings and give you perspective on how to let go of destructive emotions. James W. Pennebaker, Ph.D., professor and chair of the department of psychology at the University of Texas, says that although research about the value of expressive writing is still preliminary, regularly recording your emotional upheavals can improve both your physical and mental health. He recommends a writing session that lasts for a minimum of 15 minutes a day, on paper or the computer, for at least three or four consecutive days. Try to write continuously without worrying about spelling or grammar.

Research shows that a lack of sunlight during the dark winter months can cause a verifiable condition called seasonal affective disorder (SAD), or the winter blues. Alan C. Logan, naturopathic physician and author, says that even adults who don’t have SAD often report a decline in mood during this time. Greater exposure to natural sunlight can help combat this problem, as can the regular use of a full-spectrum light box. “The value of a light box has also been demonstrated even in healthy adults without SAD,” says Logan. Using the light box early in the morning (7 a.m. or earlier) may be most effective, he adds.

A massage by a skilled practitioner is not only rejuvenating for your muscles, it can also be a great stress and anxiety buster. A 2005 review of many research studies showed that massage therapy consistently lowered levels of the stress hormone cortisol in patients with various physical and psychological conditions. At the same time, it increased the activity of pleasure-related chemicals in the brain. Even if it’s not for therapeutic purposes, a massage can be enjoyable and decrease muscle and mental tension.mindembodiedorang.png

Trying to think positively, even during down times, can also affect your mood. Start by making a list of all the things in your life that you appreciate — the results may surprise you. Alan C. Logan, naturopathic physician and author, adds that being mindful (staying in the moment) can also help. He suggests you can do this by paying attention to your thoughts, emotions, and bodily sensations. “Taking stock of these mental events in a nonjudgmental way allows for the identification of negative patterns that can lead to depressive symptoms,” he says. “Research suggests that mindfulness may lead to resilience against stress and positively alter brain activity in the areas governing emotions.”

 Though your tendency may be to avoid people when you’re feeling down, often this can just add to feelings of isolation and depression. Reaching out to people, whether you discuss how you’re feeling or not, can help. Studies show that positive social ties can significantly protect a person’s health and well-being. So try to strengthen your relationships with people around you: Propose social dates, keep in touch with friends, explore volunteer opportunities, or take a new class. If your depression makes it too difficult to do these things, you should begin by reaching out to a doctor or therapist for some help.

Self-Care and #Depression

13 Tuesday Aug 2019

Posted by in Depression, Self-Care, Uncategorized

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As a clinical psychologist, Mary Pipher, PhD, designed “healing packages” for her patients: activities, resources, and comforts to help them recover from trauma. Then, after Dr. Pipher’s book Reviving Ophelia became a runaway best-seller, she herself suffered from an episode of major depression and designed a healing package of her own. “The essence of my personal healing package,” she describes in her book Seeking Peace, “was to keep my life as simple and quiet as possible and to allow myself sensual and small pleasures.” She created a mini-retreat center in her home and modified the ancient ways of calming troubled nerves to fit her lifestyle. Pipher’s healing package looked like this:

She accessed the healing power of water by walking at Holmes Lake Dam, swimming at the university’s indoor pool, and reading The New Yorker magazine in the bathtub every morning.loneliness1.jpg

She cooked familiar foods, dishes that reminded her of home: jaternice, sweetbreads, and perch; and cornbread and pinto beans with ham hocks.

She unpacked her childhood teacup collection and displayed it near her computer desk to remind her of happy times and of people who loved her.

She reconnected with the natural world by walking many miles every week on the frozen prairie, watching the yellow aconites blossom in February and the daffodils and jonquils in March, following the cycles of the moon, and witnessing sunrises and sunsets.

She read biographies of heroes like Abe Lincoln, and read the poetry of Billy Collins, Robert Frost, Mary Oliver, and Ted Kooser.

She found role models for coping with adversity.

She limited her encounters with people and gave herself permission to skip holiday gatherings and postpone social obligations. She erased calendar engagements until she had three months of “white space” in her future.

She embraced her body through yoga and massage. She started to pay attention to tension in her neck and other cues from her body and let those signals teach her about herself.

msclip-030.jpgShe meditated every day.

These activities were exactly what she needed to emerge from the other side of depression. She writes:

After taking care of my body for several months, it began to take good care of me. My blood pressure improved and my heart problems disappeared. After a few months of my simple, relatively stress-free life and my healing package of activities, I felt my depression lifting. I enjoyed the return of positive emotions: contentment, joy, calmness and new sparks of curiosity and energy. I again felt a great tenderness toward others.

 

Psychiatrist James Gordon, MD, discusses similar healing packages in his best-selling book Unstuck. At the end of his first meetings with all of his patients, he will write out a “prescription of self-care,” which includes instructions on changing diet, advice about specific recommended meditations or exercises, and a list of supplements and herbs. “Among my recommendations, there are always actions, techniques, approaches, and attitudes that each person has told me — which she already knows — are helpful,” he explains. At the end of his introduction, he suggests each reader take some time to write out his or her own prescription. He supplies a form and everything.

Each person’s healing package is unique. Many people have benefited from more meditation and mindfulness exercises, psychotherapy sessions, and therapies like Eye Movement Desensitization and Reprocessing (EMDR) that help unclog the brain of painful memories. Some people do better with more physical exercise and nutritional changes. While mindfulness and meditation have certainly helped many become aware of my rumination patterns, the most profound changes in others recovery  have come from the bags of dark, green leafy vegetables, yoga, and breathing exercises.

It’s empowering to know that we don’t need a doctor or any mental health professional to design a healing package for us. We are perfectly capable of writing this prescription ourselves. Sometimes (not always), all it takes are a few simple tweaks to our lifestyle over a period of time to pull us out of a crippling depression or unrelenting anxiety.

Serotonin deficiency may not be linked to depression

19 Friday Jul 2019

Posted by in brain, Depression, mental health, Neuroscience, Uncategorized

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Depression strikes some 35 million people worldwide, according to the World Health Organization, contributing to lowered quality of life as well as an increased risk of heart disease and suicide. Treatments typically include psychotherapy, support groups and education as well as psychiatric medications. SSRIs, or selective serotonin reuptake inhibitors, currently are the most commonly prescribed category of antidepressant drugs in the U.S., and have become a household name in treating depression.feelings-54.jpg

The action of these compounds is fairly familiar. SSRIs increase available levels of serotonin, sometimes referred to as the feel-good neurotransmitter, in our brains. Neurons communicate via neurotransmitters, chemicals which pass from one nerve cell to another. A transporter molecule recycles unused transmitter and carries it back to the pre-synaptic cell. For serotonin, that shuttle is called SERT (short for “serotonin transporter”). An SSRI binds to SERT and blocks its activity, allowing more serotonin to remain in the spaces between neurons. Yet, exactly how this biochemistry then works against depression remains a scientific mystery.

In fact, SSRIs fail to work for mild cases of depression, suggesting that regulating serotonin might be an indirect treatment only. “There’s really no evidence that depression is a serotonin-deficiency syndrome,” says Alan Gelenberg, a depression and psychiatric researcher at The Pennsylvania State University. “It’s like saying that a headache is an aspirin-deficiency syndrome.” SSRIs work insofar as they reduce the symptoms of depression, but “they’re pretty nonspecific,” he adds.

Now, research headed up by neuroscientists David Gurwitz and Noam Shomron of Tel Aviv University in Israel supports recent thinking that rather than a shortage of serotonin, a lack of synaptogenesis (the growth of new synapses, or nerve contacts) and neurogenesis (the generation and migration of new neurons) could cause depression. In this model lower serotonin levels would merely result when cells stopped making new connections among neurons or the brain stopped making new neurons. So, directly treating the cause of this diminished neuronal activity could prove to be a more effective therapy for depression than simply relying on drugs to increase serotonin levels.

Evidence for this line of thought came when their team found that cells in culture exposed to a 21-day course of the common SSRI paroxetine (Paxil is one of the brand names) expressed significantly more of the gene for an integrin protein called ITGB3 (integrin beta-3). Integrins are known to play a role in cell adhesion and connectivity and therefore are essential for synaptogenesis. The scientists think SSRIs might promote synaptogenesis and neurogenesis by turning on genes that make ITGB3 as well as other proteins that are involved in these processes. A microarray, which can house an entire genome on one laboratory slide, was used to pinpoint the involved genes. Of the 14 genes that showed increased activity in the paroxetine-treated cells, the gene that expresses ITGB3 showed the greatest increase in activity. That gene,ITGB3, is also crucial for the activity of SERT. Intriguingly, none of the 14 genes are related to serotonin signaling or metabolism, and, ITGB3 has never before been implicated in depression or an SSRI mode of action.

These results, published October 15 2013 in Translational Psychiatry, suggest that SSRIs do indeed work by blocking SERT. But, the bigger picture lies in the fact that in order to make up for the lull in SERT, more ITGB3 is produced, which then goes to work in bolstering synaptogenesis and neurogenesis, the true culprits behind depression. “There are many studies proposing that antidepressants act by promoting synaptogenesis and neurogenesis,” Gurwitz says. “Our work takes one big step on the road for validating such suggestions.”

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The research is weakened by its reliance on observations of cells in culture rather than in actual patients. The SSRI dose typically delivered to a patient’s brain is actually a fraction of what is swallowed in a pill. “Obvious next steps are showing that what we found here is indeed viewed in patients as well,” Shomron says.

The study turned up additional drug targets for treating depression—two microRNA molecules, miR-221 and miR-222. Essentially, microRNAs are small molecules that can turn a gene off by binding to it. The microarray results showed a significant decrease in the expression of miR-221 and miR-222, both of which are predicted to target ITGB3, when cells were exposed to paroxetine. So, a drug that could prevent those molecules from inhibiting the production of the ITGB3 protein would arguably enable the growth of more new neurons and synapses. And, if the neurogenesis and synaptogenesis hypothesis holds, a drug that specifically targeted miR-221 or miR-222 could bring sunnier days to those suffering from depression.

Depression and the inflammatory process

27 Wednesday Mar 2019

Posted by in Depression, mental health, research, Uncategorized

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Most people feel down, tired and inactive when they’re injured or ill. This “sickness behavior” is caused by the activation of the body’s immune response. It’s the brain’s way of conserving energy so the body can heal.

This immune response can also occur in people with depression. This has prompted some researchers and clinicians to hypothesise that depression is actually a side effect of the inflammatory process.

But while there may be a connection between inflammation and depression, one doesn’t necessarily lead to the other. So it’s too simplistic to say depression is a physical, rather than a psychiatric, illness.

The inflammation hypothesis

University of California clinical psychologist and researcher George Slavich is one of the key recent proponents of depression as a physical illness. He hypothesises that social threats and adversity trigger the production of pro-inflammatory “cytokines”. These are messenger molecules of the immune system that play a critical role in orchestrating the host’s response to injury and infection.

This inflammatory process, Slavich argues, can initiate profound behavioral changes, including the induction of depression.5241352878_f53a343088.jpg

The idea that the activation of the immune response may trigger depression in some people is by no means a new one. Early descriptions of post-influenza depression appeared in the 19th century in the writings of English physician Daniel Tuke.

But it was not until the 1988 seminal paper, published by veterinarian Benjamin Hart, that the phenomenon of acute “sickness behavior” caught the interest of the scientific community.

Hart described his detailed observations of the “behavior of sick animals”. During acute infection, and in response to fever, the animals sought sleep, lost their appetite, showed a reduction in activity, grooming and social interactions, as well as showing signs of “depression”.

Just like the immune response itself, these changes reflect an evolved survival strategy that shifts priorities toward energy conservation and recovery.

Putting the theory into practice

Cytokine-induced sickness behavior has subsequently been studied as an example of communication between the immune system and the brain.

The behavioral changes during sickness resemble those associated with depression, so it didn’t take long for researchers to make a connection between the phenomenon of sickness behavior and mental disorders.

Such speculation was strengthened by research showing that depressive states can be experimentally induced by administering cytokines and other immunogenic agents (such as vaccines) that cause an inflammatory response.

Depression is frequently associated with inflammatory illnesses such as heart disease and rheumatoid arthritis. It’s also a side effect of treatment with cytokines to enhance the immune system.

Over recent decades, researchers have made progress in understanding how inflammation may impact on the activity of signalling pathways to and from the brain, as well as on the functioning of key neural systems involved in mood regulation.

But there’s not always a link

From the available evidence it’s clear, however, that not everyone who suffers from depression has evidence of inflammation. And not all people with high levels of inflammation develop depression.

brain-anatomy-colored.jpgTrajectories of depression depend on a complex interplay of a spectrum of additional risk and resilience factors, which may be present to varying degrees and in a different combination in any individual at different times. These factors include the person’s:

  • genetic vulnerabilities affecting the intensity of our inflammatory response
  • other medical conditions
  • acquired hyper-vigilance in the stress response systems due to early life trauma, current adversities, or physical stressors
  • coping strategies, including social support
  • health behaviors, such as sleep, diet and exercise.

Implications for treatment

In line with the notion that inflammation drives depression, some researchers have already trialled the effectiveness of anti-inflammatory therapy as a treatment for depression.

While some recipients (such as those with high levels of inflammation) showed benefit from the treatment, others without increased inflammation did not. This supports the general hypothesis.

However, in our desire to find more effective treatments for depression, we should not forget that the immune response, including inflammation, has a specific purpose. It protects us from infection, disease and injury.

Cytokines act at many different levels, and often in subtle ways, to fulfill their numerous roles in the orchestration of the immune response. Undermining their vital role could have negative consequences.

Mind versus body

The recent enthusiasm to embrace inflammation as the major culprit in psychiatric conditions ignores the reality that “depression” is not a single condition. Some depressive states, such as melancholia, are diseases; some are reactions to the environment; some are existential; and some normal.

Such separate states have differing contributions of biological, social and psychological causes. So any attempt to invoke a single all-explanatory “cause” should be rejected. Where living organisms are concerned it is almost never that simple.

In the end, we cannot escape the reality that changes must occur at the level of the brain, in regions responsible for mood regulation, for “depression” to be experienced.