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Symptoms of depression in others

I’ve written a lot about how to deal with depression if you’re the one suffering, but there’s one topic that I realized I haven’t touched on a ton: How can you recognize when someone you know or love is depressed? That can be a challenge: The symptoms may be subtle, or they may be screamingly obvious. But recognizing that someone is suffering is the first step towards getting them the help that they may need.

So, what are the signs of depression in someone else? There’s the obvious: They seem down. They express negative emotions or feelings about themselves. But spotting depression isn’t always that easy, sadly. Here’s a few thoughts on how you can keep an eye out for when someone is down:

  • Lack of energy: The person you know or love just doesn’t seem to want to do anything anymore.
  • Social withdrawal: They don’t want to spend time with their friends, go to work or do anything other than lie in bed/stay at home and watch TV.
  • Changes in appetite: This can go either way – someone suddenly stops eating or is eating all the time.
  • Tired and/or lacking energy: Okay, yeah, we’re all busy and constantly sleepy, but if someone is complaining to you about wanting to do nothing but sleep – or not being able to get any sleep – that’s a problem.
  • Reckless behavior: People with depression will often do anything to escape their own heads. This may involve behavior which unnecessarily puts them in some sort of risk. That may involve increased use of alcohol or drugs or other dangerous activities.
  • Attention problems: People with depression may have a hard time focusing on work or school. If you see your friend having a bigger problem than usual paying attention, that may be a sign that they are in trouble.

Two additional things about the symptoms noted above. First, there has to be a baseline. Someone may seem like they are withdrawing from the world when the truth is that they are just a homebody – you have to have something to judge their behavior against, and it has to represent a change from the norm.

Second, these changes can be subtle. People with depression are often good – too good – at hiding their symptoms (trust me). This is for a variety of reasons – they don’t want to be a burden, they think it’s just “all in their head,” etc. As a friend or a loved one, this can make your life difficult, but it requires you to keep an eye out for behavior. This is particularly important when someone you know has been depressed in the past, or is likely to slip into a depressive spell again. My poor wife has a series of symptoms which she is constantly on the lookout for, and if you have someone you love who has suffered, you know exactly what I am talking about.

As always, I welcome your thoughts and comments! Anything I missed here? Please let us know in the comments below!

Suicide rates are on the rise

Bad news, per a press release from the American Foundation for Suicide Prevention. The CDC has released it’s 2017 mortality report on suicide and found that 47,173 Americans killed themselves – an increase of 3.7% over the 44,965 Americans who killed themselves in 2016.

The suicide rate is at a 50 year peak, an astonishingly high number, and one which is actually contributing to a decrease in the life expectancy of the average American. Suicide is the currently 10th leading cause of death in America.

The American Foundation for Suicide Prevention says that five things need to change in order to comprehensively address suicide reduction:

  1. Cultural attitudes about help seeking and overall awareness about mental health conditions.
  2. Access to affordable mental health care.
  3. Training for primary care physicians to screen for mental health and suicide risks.
  4. Reducing access to lethal means of suicide.
  5. Better data collection.

I’d add this, based on other research that I’d seen: We need a stronger social safety net. This means that we need a more activist government that can provide a social and financial backstop for people who are in need of it. Studies have shown that suicide rates are lower in areas where there is a stronger social safety net, but that connection seems to be particularly strong when there is good access to health care and housing assistance.

This is a harder one to advocate for, to be honest, and I think there are two reasons behind that.

First, the concept of a “stronger social safety net” is broader and more abstract. The five points noted above are relatively clear-cut, and the connection between them and suicide reduction is clear. I think that connection is weaker when it comes to improving the social safety net, but it doesn’t mean that the two aren’t connected.

Second – and maybe this is just in my head – is a political concern: A stronger social safety net requires more government intervention and funding. That, of course, is a much broader and more political statement, one which slants more towards the progressive end of the ideological spectrum. And that gets difficult for non-partisan organizations which typically fight for stronger mental health services.

I think that’s a long term challenge for the mental health community. Again, I’m a Democrat and pretty progressive, so I’m biased, but I do think that the research bears this out: A more progressive political orientation is better for individuals with mental health challenges and to reduce the scourge of suicide.

That is NOT to say that Republicans or conservatives don’t care about mental health or suicide reduction – nothing could be further from the truth, and I have very proudly worked with Republicans and conservatives on mental health and suicide reduction legislation. But, it is a challenge. The simple truth is that making improvements in these areas requires more government intervention.

Anyway, as always, I’m curious to hear your thoughts – do you agree or disagree with me? Let us know in the comments below!

An in-depth look at worldwide suicide

The Economist has an absolutely fascinating and thought provoking look at suicide trends across the world. The most interesting item in the article is the graph above, which shows two things. First, suicide worldwide is declining. Second, the United States is the exception – we’re the only place in the western world where suicide is increasing, which is terribly upsetting.

The article is well worth reading, but it is a long one. I’ll try to summarize some of the trends it notes.

First, and most importantly: Suicide rates are down 38% from 1994. That’s fantastic news. But, of course, those decreases haven’t occurred evenly across all subgroups.

In China and India, significantly less women are killing themselves. This is attributed to public policy changes – and changes in culture – which have given women more freedom and independence. As gender norms have changed, women have gained more control over their lives, thus leading to lowered suicide rates. In other words, gender equality can save lives.

Increased urbanization is helping with this as well, as rural suicide rates are higher than urban ones – a trend which seems to be relatively constant across the word.

In Russia, cultural and political changes contributed to massive spike in suicides among middle aged men. That number, though still high when compared to the rest of the world, is now at half of its peak in the 1990s. This is attributable to a few things. First, the article notes that men have learned how to live in Russia’s new society and economy, having more success at getting a job and earning a living. Unemployment and economic upheaval leads to suicide, so as more men get jobs, they are less likely to kill themselves, and this is a constant across the world, in all cultures.

Additionally, studies have noted that suicide rates are tied with health care access. In countries where the unemployed still had access to health care, suicide rates did not increase during recessions – something that was not true in countries where health care was harder to come by.

Alcohol is also linked to suicide – alcohol consumption and suicide rates move together, though the article was unclear about whether or not one caused the other or a third factor moved both.

Suicide rates are higher among the elderly than they are the young or middle-aged population. As health care and poverty improves among this group, suicide rates fall.

The article also notes that means reduction – be it with guns, poison or gas – can have a major effect on suicides. The impulse to kill oneself is often fleeting, and reducing access to deadly weapons can absolutely reduce suicides.

What are the broad, global conclusions of this article? The one thing that I get out of it – more than anything else – is that public policy can have a major, major impact on suicide. Efforts to enhance economic security, increase access to health care, spread economic freedom and enhance gender equality plays a big role in reducing suicides. These are important factors which must be taken into account for any mental health conversation.

Does social media cause depression?

Despite being a complete social media addict (sigh), I’ve written repeatedly about the negative impacts that social media can have on your mental health. However, one of the key, unanswered questions has always been this: Is the relationship casual? That is, does social media use cause loneliness, does loneliness cause an increase in social media use, or is a third item related to both?

New research indicates that the relationship IS casual: Social media use does, in fact, make you more lonely.

This comes from a new study, courtesy of Melissa Hunt, the associate director of clinical training at the University of Pennsylvania’s Psychology Department.

In her study, Hunt took two groups of college students. In the first, students were asked to use social media as they usually did (about an hour a day). The second group was asked to limit it’s social media use to ten minutes per site.

The results, per Hunt: “The main finding of the paper is that limiting your use of Facebook, Snapchat and Instagram to 30 minutes total or less per day results in reductions in depression and loneliness, especially for people who were moderately depressed to start with.”

Yikes.

Yikes yikes yikes.

This is the first study, to my knowledge, which directly shows that social media is a CAUSE of depression, not just correlated with it. However, I can’t say I’m particularly surprised by this. We know that excessive use of social media can create a variety of negative impacts on someone’s life, including cyberbullying, negative body image and more. However, this is the first time that there has been a direct casual link established between depression and social media.

What do we do? Well, that’s easy: Use social media less. Seriously. It’s good for you to do that anyway, even if this study isn’t accurate (though I intuitively think it is).

More research is needed, but I firmly believe that this study will be the first of many, many which show the devastating impacts which social media is having on our society and our culture. And it’s hard for me to say: Like many of you, I find myself completely addicted to social media. But it’s an addiction which needs to break.

 

The danger of Benzodiazepians

If you’ve suffered from any sort of mental health disorder, odds are good you are familiar with Benzodiazepians (aka Benzos). Benzos are a class of drugs which are used to treat anxiety and a slew of other conditions, including insomnia, seizures and more. In the short-term, they can be very helpful in getting people through panic attacks. Personally, I’ve used them in the past for rip-roaring anxiety attacks, and they can be helpful in getting through the worst of these condition. When taken in conjunction with therapy or other long-term medication strategies, they are a useful tool in treating mental illness.

Use of benzos has dramatically increased. From 1996-2013, the amount of adults prescribed benzos increased 67%, going from 8.1 million to 13.5 million. Those increases are also seen among individuals who have been prescribed opioids – and that has led to overdose issues.

According to government research, over 30% of opioid overdoses also involve benzos:

Line graph showing causes of death from opioids, benzodiazepines and opioids, and opioids without benzodiazepines between 1999 and 2015

 

Meanwhile, overdose deaths from Benzos have shown frightening increases of late:

Number of Deaths Involving Benzodiazepines

There is also evidence of late that shows that Benzo prescriptions for those with PTSD may increase suicide risk, and that use of Benzos may be tied to an increased risk of Alzheimer’s.

So, am I telling you to throw away your Benzos? No, no, and hell no. When used under a doctors care, and responsibly, Benzo medication can be an important part of any therapeutic regimen. Candidly, when my anxiety was at it’s peak, I walked around with tranquilizers as a “just in case.” Knowing I had those to fall back on gave me the confidence to continue my daily routine in terms of my school, work and social life. If I hadn’t had those, I would have had major difficulties functioning. Eventually, modifications to my regular medication and therapy helped me address my anxiety issues, ones which (thankfully) have not come back.

Benzos can be helpful – you just need to be careful in how you use them!

PS: GO VOTE TOMORROW!

How to stay hopeful in a world filled with darkness

This week:

I spent most of Saturday crying on and off. It’s almost impossible not to. You keep reading and hearing how the world is coming apart at the seems, how things are getting so much worse, how toxic the political environment is.

Everything does seem hopeless. I get that. But it isn’t. While world events are overwhelming, and the darkness does often seem to be closing in, now, more than ever, those of us who are capable of having and expressing hope have an obligation to do so.

If world events seem overwhelming to you, here are a few ways you can try and draw some hope.

First: Concentrate on the good in the world, not the evil.

As it happened, the day of the Pittsburgh shootings, my family and I were going to an open house at a local Mosque. I did this Facebook live video while I was there:

The conclusion is this: Evil is loud. Good is soft. But there is still more good than evil. In the aftermath of the Pittsburgh shootings, hundreds rallied for peace. Pittsburgh blood banks put out a call for help after the shootings and were overwhelmed with donors. First responders did their job that day, heroically running into the Temple, and likely saving lives while doing so, even while four of their own were injured.

The world may seem broken, but that’s because evil screams and gets more attention. Don’t concentrate on that. There is so much good in this place. You don’t even have to look very hard.

Second: Find what you can control, and do something about it.

One of the hardest lessons for me in government and politics has been learning the limits of governmental power. And no, I don’t mean that in the sense of wanting government to be able to do more. I mean acknowledging that there are simply some things beyond our control. You get into government and politics because you want to help people, and then you realize that you can’t save everyone.

What all of us can do, however, is make a difference in certain areas, and that’s what I am referring to. What are you good at? What are you passionate about? Concentrate on that, not on all the evil in the world. Find where you can make a positive, tangible difference in someone’s life. For me, that’s been mental health and other areas of government and pubic policy I am passionate about. For you, that will almost certainly be something different, but find what it is and go for it.

Don’t give into the hopelessness. Find where you can make a difference, and make it.

Third: It’s okay to unplug and take care of yourself.

You can’t do good without taking care of yourself. Unplug for a few hours or a day or two. It’s okay. Don’t feel guilty. And if that guilt becomes overwhelming, remember: You’re no good to anyone if you burn out.

Fourth: Draw solace from the fact that there are millions of others like you.

I’ll refer you back to the blog entry I wrote a few weeks ago: Millions upon millions of Americans are deeply worried about the world in which we live. That doesn’t change the world, no. But it does create a base of people who agree with you – that things are scary, and that we have to work to make the world a better place.

Finally: Remember the arc of history.

Despite it all, humanity has made more progress in more areas than any of us could have ever dreamed. Progress is not inevitable. It zigs and zags. But, with the concentrated effort of a dedicated world, it does come. Concentrate on that, focus your efforts on the forward momentum of humanity, and we will be okay.

Using Facebook to diagnosis depression

I came across this article in Medical News Today, which reviews a study done in the medical journal Proceedings of the National Academy of Sciences. To make a long story short, the study reviews Facebook data and medical records, analyzing information posted by the more than 100 people who had been diagnosed with depression.

While there is ample evidence that social media can be a cause of depression (I have written about the topic before), this is the first time that I have ever seen published information which notes that social media can be used as a diagnosis tool for depression. That has some pretty interesting implications.

First, the study itself. Here’s one of the most important parts:

The scientists fed the information into an algorithm. In total, Eichstaedt [author of teh study] and colleagues analyzed 524,292 Facebook status updates from both people who had a history of depression and from those who did not.

By modeling conversations on 200 topics, the researchers determined a range of so-called depression-associated language markers, which depicted emotional and cognitive cues, including “sadness, loneliness, hostility, rumination, and increased self-reference” — that is an increased use of first-person pronouns, such as “I” or “me.”

The researchers found that the linguistic markers could predict depression with “significant” accuracy up to 3 months before the person receives a formal diagnosis.

Here’s a look at what words can be used to predict depression (none of this will be a surprise):

F4.large

Also notable is that more self-referential language is found more often in people with depression. That’s not really a surprise, as depression and narcissism are often linked.

To be perfectly honest, none of the above should be very surprising. Extended use of terms that indicate pain, distress or rumination would obviously indicate someone who is in a crisis. What is interesting, however, is that you can actually use these terms on social media to predictably and reliably diagnosis depression. That, to me, is fascinating. It is yet another tool in the toolbox for diagnosis depression, and as numerous studies have shown, depression remains massively under diagnosed, with some estimates showing that up to 2/3 of all individuals with depression are undiagnosed.

Empirical data confirms it: “Trump Anxiety Disorder” is real

Let me add a disclaimer here: This one is going to be difficult, because I’d like to approach the subject below as a legitimate mental health issue, not a political one.

I’ve written about this before, but a new Politico article, along with some of the data in it, has pushed this topic back to the surface.

From the article:

 The American Psychiatric Association in a May survey found that 39 percent of people said their anxiety level had risen over the previous year—and 56 percent were either “extremely anxious” or “somewhat anxious about “the impact of politics on daily life.” A 2017 study found two-thirds of Americans’ see the nation’s future as a “very or somewhat significant source of stress.”

All of this has led to the creation of – and I can’t believe I’m typing these words – “Trump Anxiety Disorder.” According to Dr. Jennifer Panning, that disorder is defined by, “increased worry, obsessive thought patterns, muscle tension and obsessive preoccupation with the news.”

Additional research has shown that the election resulted in people having a more difficult time having “open and honest” conversations and damaged relationships.

On a personal level, this jives with not only my experience, but conversations I’ve had with others. Years ago, I remember speaking with my therapist about how I was very stressed by the state of world affairs, and I commented that I knew how ridiculous that sounded. He looked at me as if I had three heads. “That’s not ridiculous at all. Almost all of my patients have said that.”

I was so, so relieved. And as I have relayed this story to others, they are relieved as well – it’s not just them! At all!

So, what is there to do about this? Yeah, on that one, I have very little. Unplugging and setting boundaries is important, but the best way I have been able to keep my focus in the age of Trump is this: Concentrate on where you can make a difference. Focusing on the non-stop news cycle (CNN/MSNBC/FoxNews are the worst things on the planet) will drive you nuts, no matter who you are. Concentrate on the areas where you can make a positive difference, and go from there.

That’s the best advice I can give. If you have anything better, please leave it in the comments below!

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

A mental health hero: Jason Kander

Last week, a brave politician made national news by dropping out of a high profile Mayoral race. That man is Jason Kander, and he’s someone worthy of our attention and praise.

Kander is the former Missouri Secretary of State. In 2016, he ran for the U.S. Senate as a Democrat, and in a tough year for Democrats, he came within three points of defeating incumbent Senator Roy Blunt. Kander ran an amazing campaign and aired one of the best ads of 2016, in which he talked about his army background and support for universal background checks while assembling a gun…blindfolded.

Kander’s military story is equally impressive: He volunteered for the Missouri and volunteered for a tour in Afghanistan in 2005, serving as an intellegence officer.

Kander’s political star was on the rise, and until last week, Kander was a candidate for Mayor in Kansas City. That changed with this heartbreaking note, in which Kander discussed his battle with depression, PTSD and suicidal ideation:

About four months ago, I contacted the VA to get help. It had been about 11 years since I left Afghanistan as an Army Intelligence Officer, and my tour over there still impacted me every day. So many men and women who served our country did so much more than me and were in so much more danger than I was on my four-month tour. I can’t have PTSD, I told myself, because I didn’t earn it.

But, on some level, I knew something was deeply wrong, and that it hadn’t felt that way before my deployment. After 11 years of this, I finally took a step toward dealing with it, but I didn’t step far enough.

I went online and filled out the VA forms, but I left boxes unchecked — too scared to acknowledge my true symptoms. I knew I needed help and yet I still stopped short. I was afraid of the stigma. I was thinking about what it could mean for my political future if someone found out.

Kander dropped out of the race and has since been silent on social media. I assume – and sincerely hope – he is getting the care he needs and deserves.

Broadly speaking, the stats on veterans, mental health and suicide are horrifying:

  • According to a 2014 report by the Department of Defense, there were 1,080 suicide attempts (245 suicides) among active-duty service members for all armed services in calendar year 2013.

  • A recent study of 52,780 active-duty members of the U.S. Air Force found that 3 percent of male participants and 5.2 percent of female participants reported suicidal ideation in the previous year. Of the participants that reported suicidal ideation, 8.7 percent also reported a recent suicide attempt.

  • Veterans who screened positive for PTSD were 4 times more likely to report suicidal ideation than veterans who did not, and the likelihood of suicidalideation was 5.7 times greater in veterans who screened positive for PTSD and two or more comorbid disorders.

Those who take care of us – our first responders and military veterans – deserve better. And I sincerely hope that Kander’s story helps to push this issue.

It takes people like Kander – national political rock stars – discuss their pain, to destigmatize an issue, and to help more people get help. I can only imagine how many veterans are looking at Kander and thinking, “Me, too,” and then hopefully getting the help they need. Kander’s words will have a larger impact than I think most of us could ever hope to have.

Most importantly, best wishes to Kander. I cannot imagine what demons he faces – what pain he took on – in the name of protecting America. He, and countless other veterans and first responders – deserve our love, and our resources, to heal. I am so grateful to all of them for their bravery.