Falling: Faces of Depression and Anxiety (by Clara Lieu)

Clara Lieu is an artist at Rhode Island School of Design.

She has this amazing gift of observation. For example, she has this series on her website (claralieu.com) called Waiting. Here is how she describes it.

I am interested in the contradictions found in waiting figures: even though these figures stand in very close physical proximity to each other, it seems apparent that there is a significant emotional distance between them. Each figure seems locked within their own existence, unaware and unresponsive to the other figures surrounding them. Yet simultaneously, waiting in a line creates a situation where the gesture of one figure leads directly to the next, creating a fluidity between all of the figures. I am engaged by the individual and group anxiety that seems to permeate such silent and still scenes.

So true. My first iPhone line was like that.



She also completed a very impressive series of drawings and sculptures called Falling. This series, unlike her others, are very personal, based on her own experience with depression.

She emailed My Three Shrinks to let us know about her work. I was so impressed that I asked her more about herself and the motivation to show such an intimate view of her anguish.

I developed depression and anxiety at a young age, and lived with the condition for most of my life before being diagnosed and treated just a few years ago. It was startling to see myself clearly for the first time, free from the disease. Only at that point did I have the emotional distance that allowed me to to be in position to address this subject artistically. I knew at that point that I felt an uncontrollable drive and compulsion to make the work.

"Falling" was an unusual project me for in that it was told from a very personal, intimate perspective unlike my previous projects, which approached the subject matter with an emotional distance. Depression is something that happens privately, behind closed doors; it's a secret that most people keep hidden and never talk about in public. Unfortunately here's still a social stigma associated with depression that causes people with depression to conceal their true emotions from others. On a broader level, I'm looking to open a dialogue about a topic that is rarely discussed openly by exposing my own personal experience. 

She goes on to describe this body of work:

"Falling" is a visualization of personal experience with depression and anxiety. The condition brought on frequent episodes where I felt emotionally and physically out of control. Unable to “release” myself from these episodes, I waited for the physical limitations of my body to end them. Recounting the affected years, I realize how accustomed I became to depression’s influence; many emotions and feelings belonged to it and not my own personality. After an extended, untreated struggle, a diagnosis brought relief, and the process of unearthing myself from the disease began. 

Her work can be found at claralieu.com.




Note: October 11 is National Depression Screening Day.       Get screened.

Podcast #68: Supermax, Health Exchanges, Statins, and e-Novels

Here's what we talk about:

• Clink talks about the burning issues in corrections, including a class action suit against a federal control unit prison in Colorado, filed by a civil rights organization.  Allegations include the idea that correctional officers were abusive and that mental health services were inadequate.  You can read more about this in Clink's article here.

Clink provides the following links:

1. For the lawsuit at: http://www.scribd.com/doc/97561358/Bacote-et-al-v-Federal-Bureau-of-Prisons on June 29, 2012.

2. For an article from The Atlantic:  http://www.theatlantic.com/national/archive/2012/06/an-american-gulag-descending-into-madness-at-supermax/258323/ on June 29, 2012.

• Roy talks about the Supreme Court decision to uphold the Affordable Care Act (aka ObamaCare) and talks about the Mental Health Parity Act and the delay in getting this clarified.  Roy believes there will be increased access to mental health care.   
  

•  Roy talks about Network adequacy and whether providers are actually available.  Here is his link to his article on Health Information Exchanges. 

•  Dinah talks about statins and depression and and reads from Emily Dean's blog on Evolutionary Psychiatry where she discuss statins and depression and violence and cholesterol.  The guinea pig pictured above has a fine lipid profile.

• Dinah  talks about her new novel : Home Inspection.                

        

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post.

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

WhatsMyM3?

NBC-4 News Clip from Doreen Gentzler (May 16, 2012)

What’s your mental health number?

This is the question that the Bipolar Collaborative is asking, using its WhatsMyM3 screening tool [PubMed]. “Many other illnesses have a 'number' that one can track – cholesterol, high blood pressure, diabetes. What’s the number for mental health?” asks Michael Byer, president of M3 Information, based in Bethesda, Md.

~from Clinical Psychiatry News

Today's USA Today newspaper ran a story titled, "Screening for mental illness? Yes, there's an app for that," by Michelle Healy.


WhatsMyM3 is a validated, 3-minute tool that screens for symptoms of depression, bipolar disorder, PTSD, and anxiety, and can be used to monitor changes in symptom severity over time.

One of the developers, Michael Byer, approached me about a year ago for my opinions on development and use of the screening tool. Disclosure: After reviewing the research and seeing how useful it is, I have become more involved in the organization, becoming an adviser to the group that was started nearly ten years ago by past NIMH chief, Robert Post MD. (listen to podcast #63)

It differs from other mental health screening tools, such as the PHQ-9 and the MDQ, in that these are all unidimensional -- they only measure one domain of symptoms. The M3 is multidimensional, measuring four areas of symptoms. Furthermore, when compared to results from the standardized interview tool, the Mini International Neuropsychiatric Interview (the MINI measures for 15 different mental illness diagnoses), WhatsMyM3 provides a total mental health score that is 83% sensitive in finding true positives and 76% specific in finding true negatives. In addition to the total score, there are four subscores, one each for depression, bipolar, PTSD, and anxiety.

Put another way, the negative predictive value of the total score is 89%, meaning that if you score under the threshold, there is an 89% chance that you do not have any mental health diagnosis by the MINI. As with most screening tests, you want the negative predictive value to be high so that you don't have to subject the "negatives" to more specific testing. The positive predictive value, or PPV, is generally lower for screening tests. It is 65% for WhatsMyM3, meaning that if you score positive (total score >= 33 and positive for functional impairment), the odds of you having a diagnosis is almost two-thirds. A clinical evaluation can then help to determine if you do have a diagnosis. (Note: this tool cannot give you a diagnosis; it can only describe your relative risk of having, or not, a diagnosis.)

What people have found to be most helpful is using WhatsMyM3 to monitor their symptoms over time once they do have a diagnosis. This can be done for free on the website, or for $2.99 using the iPad or iPhone apps, or the Android app. For mental health clinicians, they can download the free M3Clinician iPad app and then screen their own patients. For about a dollar per screen, they can register their patients who want to track their symptoms over time and share their scores with the clinician. Primary care providers also purchase screens, and can even obtain insurance reimbursement by billing for an annual health risk assessment. The patient reports can be viewed by logging into m3clinician.com.

A sample report for a fake patient can be viewed here.

I think this sort of tool, or app, is exactly the sort of mHealth thing that empowers consumers to better manage and become engaged in their health care needs. This is happening in other areas, like diabetes, heart disease, and obesity. Mental health is also making great strides in mHealth.

---

I should also point out here that the folks at M3 Information were the only ones to take us up on our offer of a free "advertisement" on Shrink Rap in return for donating at least $200 to our NAMIWalk for Mental Health Month (we don't typically accept display ads). A logo ad will be running soon on Shrink Rap soon for two weeks in recognition of their charitable donations. It will look like this and link to the iPhone and Droid apps. [We received no money ourselves from M3 nor from NAMI. We've never accepted any money from Pharma companies, nor does M3.]

Ketamine, Special K, and Depression

I just wrote a post over on Clinical Psychiatry News about the experimental use of ketamine (aka, rave drug "Special K") for instant relief of depression and suicidal ideation.

Please go over there to read it (link above), and feel free to comment there (sorry, registration is required but it's free) or here. I'd like to hear about providers who have used ketamine for their patients and from people who themselves have used it for depression.

Edit: find a list of clinical trials using ketamine for depression on clinicaltrials.gov.

NYT: When Lobotomy Was Seen as Advanced

This is an eye-opening essay about how lobotomies were used back in the day.
[posted via email]
From The New York Times:
ESSAY: When Lobotomy Was Seen as Advanced
New research indicating that Eva Perón was lobotomized not long before her death is a reminder of how enthusiastically this operation was once embraced.
http://nyti.ms/tRibGb

Would You Like Prozac With Your Latte?

The Guardian recently published this story about a longitudinal Harvard study of 51,000 female coffee drinkers followed over ten years. They found that there was a 20% lower risk of clinical depression in the women who drank four or more cups of coffee a day compared to non-drinkers. This is consistent with a previous study of 86,000 female nurses followed over ten years, where they found that the relative risk of suicide was reduced even for moderate to low coffee drinkers, defined as drinking two or three cups per day.

This is good news for me since I usually start my day with a half a pot before I get to work. (Yes, that much, really. No wonder Dinah sent me a link to this story and said, "You've gotta blog about this.")

The trick is, there may be a ceiling effect to all this: once you get to eight or more cups a day this risk of suicide starts to increase again according to one study.

Somewhat gratuitously, the Guardian article threw in reference to our "druggy society" and faulted the researchers for not considering other factors like social supports, involvement in religious groups or community activities, and even whether the women were drinking coffee alone or with friends:

"As the scientists will also tell you, neurotransmitters respond to everything: hugs, kisses, conversation, books, pictures, gardening, hunger, worry, rows, war – all raise or lower chemical levels."

Ah yes, clinical depression and suicide must be the result of not getting enough hugs or the fact that you haven't taken up gardening. Cringe-worthy health reporting, at its best. The reporter concludes:

"...supposedly scientific comments of this sort serve little purpose except to coax women into a state the doctors can then medicate."

Amazing. A simple study about caffeine and depression has somehow been morphed into another nefarous plot by evil Dr. Pillshrink.

Is This Depression?

Over on KevinMD, an anonymous doctor has post up called the Absence of Joy about his own problems with depression.  He writes:


For ten years I fought against the feeling that for long periods of time I was abnormally unimpressionable.  Not all the time, but certainly for moments. I was neither incredibly happy nor depressingly sad.  I put all this down to the stresses of making ends meet by moonlighting in ER’s, working impossible hours, studying for interminable exams, followed by the stresses of looming loan repayments, cash flow crises, parenting and marriage demands as my practice struggled to find its feet.

During moments of reflection I would question my condition, briefly consider depression as a factor, and then disregard it completely.  I was sleeping well.  I was not miserable.  Just stressed, like many of my colleagues.  Burn out was the diagnosis I chose for myself, and there seemed to be no easy option to deal with that.

But as the joy withdrew from my life, I was unable to identify the cause within.  I looked for other causes.  If the reason was not internal, it had to be external.  I found subtle fault with everyone around me, my wife, my kids, my career, my patients, my staff.  I considered changing my situation, leaving all of these, building another life, because this one did not appear to make me happy.
My wife saved me from myself.  Some ultimatums later, I was presented with a diagnosis of subclinical depression and began taking an SSRI.

He goes on to talk about how much better he feels and how much less labile his moods are.  He mentions things rolling off him like they'd roll off a duck's back, and of course we Shrink Rappers are big into ducks. 

So why am I writing about this blog post?  I think because I wasn't so sure I would have offered this patient medications.  Of course it's only a snapshot, and sometimes a recounting of symptoms on paper does not match the distress that a live person can convey, but the writer does not describe clinical major depression, what we think of as an illness.  He does a great job of describing existential angst, and makes no mention of whether he's had psychotherapy.  Perhaps he describes dysthymia (a low grade chronic depression that depletes the patient) but I wasn't totally sure.  I almost had the sense while reading that he's taking a happy pill that moves him to complacency. But the writer describes a huge relief, satisfaction with his outcome, and who am I to second guess? 

Just thought it might make for some good conversation here on Shrink Rap.  Do check out the whole post over on KevinMD by clicking here.

Video Report: Deep Brain Stimulation for Psychiatric Disorders? : Clinical Psychiatry News

Look, it's our friend, Ben Greenberg!
Hi, Ben.
Ben is an expert on Deep Brain Stimulation. We like him.

Suicide, Brains, and Football

In yesterday's New York Times, Alan Schwarz wrote about the tragic suicide of football player Dave Duerson this past week. Schwarz notes that prior to shooting himself, Duerson texted family members that he wanted his brain examined for Chronic Traumatic Encephalopathy, a condition we've discussed before in our post Brains, Behavior, and Football.

Schwarz writes:

Doctors, N.F.L. officials and even many players denied or discredited the links between football and such brain damage for months or even years. The roughly 20 cases of C.T.E. that have been identified by groups at Boston University and West Virginia University were almost always men who had died — most with significant emotional or cognitive problems — with no knowledge of the disease. Now, for the first time he knows of, Stern said, a former player has killed himself with the specific request that his brain be examined.

I'm left to wonder, did this former football player have this problem? Sometimes depression alone causes memory problems and sometimes people with depression worry that they have Alzheimer's disease, or any number of other illnesses for that matter. Treating the depression may help the memory problems, and may alleviate the fears of other illnesses. And we don't know much about the Chronic Traumatic Encephelopathy induced by repeated head injuries: is the course of the dementia altered by early intervention with medications? Does the depression respond to the usual treatments for mood disorders? Could Mr. Duerson have been saved, at least for a while?

Here's an article on the treatment of chronic brain injury with hyperbaric oxygen in animal models:
http://www.hbot.com/first-successful-treatment-of-chronic-traumatic-brain-injury

And here's an emedicine article on treatments for repetitive brain injuries (not necessarily specific to CTE) with medicine recommendations, but no mention of antidepressants or medicines to slow the course of dementia:
http://emedicine.medscape.com/article/92189-treatment

Here's a medscape article on CTE and dementia:
http://www.alzheimersreadingroom.com/2010/08/causes-of-dementia-chronic-traumatic.html

And, finally, here's a shout out to my friend and med school classmate Robert Morrison, M.D., Ph.D. whose paper for our public health class was published in JAMA back in 1986 as a state of the art review of boxing and brain injury: http://jama.ama-assn.org/content/255/18/2475.short

Is it worth it in the name of sports?

Could I ask a huge favor of the next football player who considers suicide? Instead of completing the act, could you have your depression treated and then write about the results? It would be an enormous contribution. Sure, it would be an anecdote, and not a controlled trial, but perhaps it would add something to the field. And we'd be happy to publish your story here on Shrink Rap.

My heart goes out to the family of Dave Duerson.

Very Little Very Sad People

I thought I'd give you a heads up that The New York Times Magazine will be featuring an article on Preschooler Depression this weekend. I am working on my ability to see into the future, and it's going well.

Pamela Paul will write:

Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know. “How many times have you heard, ‘They’ll grow out of it’ or ‘That’s just how he is’?” says Melissa Nishawala, a child psychiatrist at the New York University Child Study Center.

And some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York. Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.”

It's long. Just say, "I saw it at Shrink Rap first."

Is Your Job a Downer?

1. 

Katina writes to us from onlinecolleges to let us know about a post on which jobs are the top ten most depressing:

Check it out here: 10 Professions with the highest levels of depression.

What I found to be interesting is that the assumption is that the jobs cause the depression.
For example:

1. Social Workers: If you had to deal with abused children, unkind foster parents and less than stellar family dynamics all day, you might be depressed too. Those working in this field are three times more likely to be depressed than the general population, and many are so focused on helping others they don't get the help that they need themselves.

There's nothing in the post that addresses the chicken-or-egg? question. Maybe people with depression are drawn to certain fields. Artists are listed, with the statement that those who chose to work in the field "found it depressing." And everyone kind of gets it: doctors, nurses, social workers, lawyers, artists, janitors, food service people, finance, nursing home and childcare workers. What's left? What's the depression rate among bloggers?

Please Pass The Chocolate

This is for Victor, who sent us the link to a CNN article looking at mood and chocolate consumption: Chocolate and Depression Go Hand and Hand by Denise Mann. So here's the scoop, people eat more chocolate when they are depressed. Mann writes:

Although gorging on chocolate and sweets to beat the blues has become a cliché thanks to sitcoms and romantic comedies, there's been "little prior scientific literature linking chocolate and depression," says the lead author of the study, Dr. Beatrice Golomb, a professor of medicine at the University of California at San Diego School of Medicine. The study, she says, provides evidence to support "the popular perception that when people need a pick-me-up, they pick up chocolate."

It's unclear, however, whether depressed people eat more chocolate simply because they crave it, or whether chocolate consumption itself somehow contributes to a depressed mood.

In the study, Golomb and her colleagues surveyed more than 900 people about their weekly chocolate consumption and their overall diet. They also gauged the moods of the participants using a standard questionnaire used to screen for depression. (People who were taking antidepressants were excluded from the study.)

It's not really clear from the article if the article is talking about people with transient sadness or people with clinical depression, but if there's any link between chocolate and emotional states, then we're happy to link to it on Shrink Rap.

Victor: may your salsa win the contest this weekend. And I don't want to hurt your feelings but I've never been able to eat that chocolate bacon bar you gave me.

Why Can't We Be Sad?

Today's New York Times Magazine has a really interesting article by Jonah Lehrer called "Depression's Upside." Mr. Lehrer talks about a possible evolutionary purpose for Major Depression.

Mr. Lehrer writes:

The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

So I didn't like the article at the beginning; it relied on anecdotes--the woman who felt so much better with antidepressants that she'd grown complacent in a bad marriage, for example. It doesn't capture all the patients I see, and any way you dice it, if you end up dead from suicide, your productivity comes to a halt. It seems to me that there are some people who suffer in ways that these anecdotes don't explain. I suppose, however, even if we assume that depression is an unproductive, tormenting state, when it ends, is there something to be gained from having gone through it. Lehrer tells us, "Wisdom isn't cheap, and we pay for it with pain." I, personally, think there remains a differentiation between pain and major depression, and that perhaps one can grow through all sorts of suffering, and I'm all in favor of finding my own personal path to wisdom in ways that might not entail so much suffering. Just a thought.

But I ultimately, I liked the article because Lehrer, while clearly a proponent of the "don't mess with evolution, less drugs, please," school of thought, presents a balanced view. He gives Peter Kramer (Listening to Prozac) a voice, and talks about the objections to the viewpoint he puts forth. He describes a theory that depression is evolutionarily helpful because of the ruminative nature of the illness. He also cues us in that this is just one explanatory theory which remains unproven, and there are others. Lehrer continues:

Other scientists, including Randolph Nesse at the University of Michigan, say that complex psychiatric disorders like depression rarely have simple evolutionary explanations. In fact, the analytic-rumination hypothesis is merely the latest attempt to explain the prevalence of depression. There is, for example, the “plea for help” theory, which suggests that depression is a way of eliciting assistance from loved ones. There’s also the “signal of defeat” hypothesis, which argues that feelings of despair after a loss in social status help prevent unnecessary attacks; we’re too busy sulking to fight back. And then there’s “depressive realism”: several studies have found that people with depression have a more accurate view of reality and are better at predicting future outcomes. While each of these speculations has scientific support, none are sufficient to explain an illness that afflicts so many people. The moral, Nesse says, is that sadness, like happiness, has many functions.

The article finishes off with the idea that people in depressive states are better thinkers, they notice more, they work better. He talks about a study that shows that on gloomy days with dismal music playing, shoppers notice more trinkets by the cash register. Gloomy weather and oppressive music might set a low mood tone, but this seems a far cry from an episode of major depression, and not something that is generalizable to anything more than clouds and music and trinkets. There's a second study mentioned of undergrads doing an abstract reasoning test that shows people with a "negative mood" perform or focus better; again, it falls short of being a comparison for major depression. The shrinks among us find it hard to imagine that 'negative moods' and Major Depression are all that linked. Everyone has negative moods. Not everyone has major depression.

What about the studies that link mood disorders and creative tendencies? This does seem likely, and we're left to wonder (my own thoughts, not the article) if the intense experience of an episode of mood disturbance either fuels creativity by feeding it material or requiring a release, or if the genetics are wired such that mood disorders and artistic talents might be coded near one another.

You thoughts?

Depressed And Staying That Way

From the LA Times Blog: "Depression Treatment Lacking For Many People"
The post refers to a study in the Archives of General Psychiatry and notes:

Treatment for major depression is abysmal, according to a study published today in the Archives of General Psychiatry. In a national survey of 15,762 people, it found that only half of all people with depression received treatment. And among those who did receive treatment, only 21% were getting care that is consistent with American Psychiatric Assn. guidelines.

Researchers at UCLA and Wayne State University found that nearly 45% of individuals with depression received psychotherapy with no medication. Only 34% received antidepressants. African Americans and Mexican Americans were prescribed antidepressants a third less often than whites.

Oh, I'd like to read the full article in the hard copy, but my journals have so far not reached my new office.

The LA Times piece goes on to talk about how more psychiatrists are using antidepressants in combination with second generation antipsychotics, and is critical of this practice. Seems like an entirely separate issue to me:
In another study, also in the Archives of General Psychiatry, researchers found that a growing number of Americans are being prescribed combinations of antidepressants and antipsychotic medications even though there are few studies that support the benefits of such combinations.
The study examined prescribing data from 13,079 psychiatry office visits between 1996 and 2006. Researchers found a growing trend in the use of more than one psychotropic medication, such as combinations of antidepressants and sedatives, antidepressants and antipsychotics or two different antidepressants.

----
On a separate note: Happy Birthday, Ross!

Assessing Teenagers

Teenagers. They should be considered their own species (--note, no one asked me).

Perri Klass, M.D. has a nice piece in the New York Times about assessing teens for depression and suicide, "18 and Under--Asking the Hard Questions." It's mental health from the perspective of a pediatrician, and I like that she's thoughtful about the issues.

Here's an excerpt:

And before you get to the S’s, there is the E for emotion, which, Dr. Ginsburg said, should be much more than screening for depression. “If you start by asking boys if they’re depressed or sad, most boys will deny that,” he told me. “If you start by saying, ‘So, are you stressed out?’ — every boy, no matter how big and strong, every girl, no matter how much she wants to portray herself as being in control, will admit to stress.”

Markers for depression may help identify adults at risk for suicide, but they are not a reliable way to screen adolescents. “Only about half of kids who kill themselves are depressed in the way that we think about depression — sad, not taking care of themselves, not sleeping or sleeping too much, not eating or eating too much,” Dr. Ginsburg said. The other half may be impulsive, angry, disappointed, trying to get even.

Dr. Shain said adolescents often changed their ideas and their plans. So an assessment has to go beyond the feelings of the moment to include thoughts they have had, dangerous ways they have behaved and the important questions of intent and ambivalence.

“Sometimes you’ll get an ‘I don’t know’ answer,” he explained, “which might be ominous, might mean they don’t know or might mean they don’t want to tell you.”

If a teenager does acknowledge thinking about suicide, there are many more questions to be asked. Dr. Lydia A. Shrier, director of clinic-based research on adolescent and young-adult medicine at Children’s Hospital Boston, said some young people chronically struggled with these issues.

Don't Smile (...at least not on Facebook)

A Canadian woman lost her disability benefits because her insurer found her smiling, and vacationing, face up on her Facebook page. See details Here.

The article notes:

"In the moment I'm happy, but before and after I have the same problems" as before, she said.

B--- said that on her doctor's advice, she tried to have fun, including nights out at her local bar with friends and short getaways to sun destinations, as a way to forget her problems.

She also doesn’t understand how Manulife accessed her photos because her Facebook profile is locked and only people she approves can look at what she posts.

It kind of reminds me of Roy's post: Wipe that smile off your face. Thanks to Meg for the link!

Rethinking Antidepressants

Thanks to Henry for sending this link.

On cnet news, Elizabeth Armstrong Moore writes about research presented at this month's Neuroscience conference in Chicago:

Depression researcher Eva Redei presented research at the Neuroscience 2009 conference in Chicago this week that calls into question two tenets of depression science: that stressful life events are a major cause of depression, and that an imbalance in neurotransmitters triggers depressive symptoms.

Armstrong goes on to report that the research looks at the overlap of genes in RATS (not peeps) and notes that antidepressants work better for stress then depression and the genetic overlap between the two is minimal (--oh, why isn't Roy writing this, he's so much more eloquent than I am about the genetic stuff).
Armstrong goes on to say:

To test the long-held belief that stress is a major cause of depression, Redei looked for similarities between these two sets of genes. Out of more than 30,000 genes on the microarray, 254 were related to stress and 1,275 to depression. Only 5 were found in both samples.

"This finding is clear evidence that at least in an animal model, chronic stress does not cause the same molecular changes that depression does," Redei says. She is now looking at the genes that differ in the depressed rats so that she can narrow down targets for drug development.

Antidepressants are also often ineffective, Redei says, because they aim to boost the neurotransmitters serotonin, norepinephrine, and dopamine, whose reduced levels have been associated with depression. But this strategy is now also being called into question.

It's sort of news to me that we thought stress "causes" depression. I guess I thought extreme stressors (as opposed to general 'stress') can precipitate depression in those inclined to become depressed. Many people suffer extreme distress without getting major depression and many people with histories of major depression weather severe storms without a recurrence. What is nice about this research is that it challenges us to think in new ways, and I think sometimes research gets hooked around theories that aren't definitely proven and creativity gets stifled. Anything that nudges that can't be bad....

Women Around the World are in a Funk

Victor sent me this. This and cinnamon buns. What more could I ask for?

So in "Blue is the New Black" New York Times columnist Maureen Dowd tells us women have become more unhappy.

According to the General Social Survey, which has tracked Americans’ mood since 1972, and five other major studies around the world, women are getting gloomier and men are getting happier.

Before the ’70s, there was a gender gap in America in which women felt greater well-being. Now there’s a gender gap in which men feel better about their lives.

Did they give everyone Beck Depression Inventories? I'm assuming this isn't an increased incidence of major depressive disorder, but increasing rates of dysphoria, disappointment, disenchantment, and disillusionment, to name just a few dis-able affective states. And according to renown mood authority Arianna Huffington: "Women around the world are in a funk." Apparently women get sadder as they get older and, "They tend to attach to other people more strongly, beat themselves up more when they lose attachments, take things more personally at work and pop far more antidepressants."

The Weather Outside is Frightful: Depression & Cloudy Days

Yesterday's issue of Environmental Health has an open access article by Shia T. Kent, et al, entitled "Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study."

They looked at sunlight exposure for nearly 17,000 subjects from another depression study to determine if cognitive function was affected by gloomy days.

People with major depression were 2-1/2 times more likely to have impaired cognitive function during periods of reduced sunlight than were people without depression, independent of other factors.

I saw this first on Health Day.

Wipe That Smile Off Your Face!

"You may not smile in Arkansas, Indiana, Nevada, or Virginia." At least, not if you are getting your driver's license photo taken.

Apparently, they use photo detection software to compare faces for identity fraud purposes. And smiling thwarts the computer.

Is it even legal (or constitutional) to require drivers to not smile? Can they frown? Stick out their tongues? Look cross-eyed? (Interesting face research where you can combine 2 faces; and a blog on pics of faces in places; and make your own Flash face like Mr Potato Head).

I supposed DMV would prefer folks who are depressed when they get their photo taken, to keep the computers happy. One man's downer is another machine's Prozac.

Just bizarre.