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!

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.

Ties that bind: Liberals, conservatives and mental health

It’s not much of an exaggeration to say that there are some…umm, slight…differences between liberals and conservatives in America today. I continue to believe – perhaps naively – that the things which unite us are bigger than the things that divide us.

One of those things, without a doubt, is mental health.

First, speaking in generalities: Liberals tend to want government to do more, conservatives tend to want governments to do less. This is a very broad statement and there is a lot of room for nuance within it, but I think that’s pretty accurate. Looking at that from a mental health perspective, that tends to translate into liberals wanting government to do more (even if it means raising tax rates), conservatives want them to do less.

I have a theory: That’s not completely accurate, because conservative areas need as much help as liberal areas when it comes to this.

Let me approach this from a different perspective: Urban vs. rural. Again, broadly speaking, but urban areas tend to be more liberal, rural ones more conservative. But – and this is important – rural areas really, really struggle when it comes to mental health. Suicide rates are higher in rural areas than urban areas. This is for any reasons, including an increased prevalence of firearms and a lack of access to health care practitioners.

At the same time, urban areas – which have high levels of poverty and minorities – also really struggle in these areas. Urban areas with high levels of poverty have significantly higher rates of mental illness. Unfortunately, poverty makes mental illness worse, and the mentally ill are more likely to be pushed into poverty and lose access to health insurance and care – thus creating a viscous cycle.

Here’s my theory: These can be united. While I represent an urban area, I don’t want anyone to suffer or struggle, no matter what they look like or where they live, and I am sure that the vast majority of conservatives feel the same. We all care about the people we represent, and I’m hoping that, over the next couple of years, I can find more people to work with in order to bridge the gap between liberals and conservatives/urban and rural areas. I’m hoping that we can use mental health to do that, and in so doing, help all of the people we represent.

 

 

 

A strange gender gap: Men, women and writing about depression

As part of my marketing efforts for Redemption, I’ve been reaching out to other author’s in similar book categories, which means other Young Adult books which deal with mental health, depression and anxiety. These efforts are how you’ve seen some of the other Six Question entries.

The other day, I noticed something strange:

Let me give some backup here to that tweet: I just went back through my notes on other authors. I identified 115 authors who also had books in this category. Of those 115, only 18 were men; 89 were female, and another 8 either had names that could have been either gender or used initials (which often than not, means they are a woman – see J.K. Rowling, who went with her initials because her publishers were trying to disguise the fact that she’s a woman).

Anyway, that difference is massive: 115 authors, and a mere 16% are men!

What the hell is going on here?

This is just a hunch, but I think what I’ve found is a microcosm of society as a whole: Women are much more willing to discuss mental illness and emotions than men. According to research, both men and women are more likely to be viewed more negatively when they suffer from “gender atypical” mental health disorders. Additionally, according to a 2015 study, men are more likely to have negative attitudes towards health seeking, which results in a less significant uptake in using mental health services.

This blows me away. I mean, it shouldn’t – none of this is surprising, and intuitively, I think most of us recognize that women are more comfortable seeking help and discussing emotional topics than men.

There are so, so many issues facing women today. I’m so glad that, as a member of the human race, we are doing a better job at discussing vitally important issues like women’s equality and safety. But I think one of the things we don’t do a good enough job of – and my above observation would seem to back up this assertion – is discussing how these gender stereotypes also hurt men.

Please, please do not misunderstand me here – I am not saying, “Boohoo, but what about the white man, life is so hard for us, we are so discriminated against!” That simply isn’t true, and it is abundantly clear that other minorities and women have much, much tougher obstacles to overcomes than any white man does. It is also apparent that we, as a society, must do a better job at creating a more level playing field and changing our culture as it pertains to women and minorities.

But, I think it’s important to note that men can also be the victims of gender stereotyping and expectations – and clearly, this is one such example. What I would hope this observation would make us realize is that we must do a better job of working towards true equality in society – and men have many, many ways to benefit from achieving that ideal as well.

TMS Update: Is this what feeling better feels like?

So, it’s been about six weeks since I started Transcranial Magnetic Stimulation. As I type this, I’ve had about 26 sessions, with another ten or so to go.

How am I feeling? Is it working? Better. And yes. It is working. And I feel reasonably convinced at this point that it’s not just the placebo effect.

Let me discuss the second part of that question first, because I think it’s almost the most important. Why do I think it’s not a placebo effect? Because life is NOT perfect. I think – I don’t know, but I think – that if this was a mere placebo effect, I’d be sitting here, flying through the sky. Life would feel perfect. There would be birds and sunshine and candy everywhere and all that crap. Then, eventually, the effect would wear away, and I’d crash hard.

Simply put, that isn’t true. Everything doesn’t feel perfect. I’ve still gotten depressed about things, upset. Most of the time, it’s been normal life events. On a couple of days I’ve still woken up really down, but that feeling fades easier than it did before treatment. Simply put, things aren’t magical.

So then, let me tackle the question in the title: Is this what feeling better feels like? Maybe? I can’t answer that question definitively yet, because I don’t know . Look, I’ve been on anti-depressants and in treatment, as needed, since I was 18. I’m 35. Half my life. So I’m not quite sure what “normal” is.

Here’s what I do know. Since I started TMS and began to feel it’s positive impacts:

  • I’ve been enjoying things more. A lot more. A couple of examples:
    • As I’ve long since established I am a big computer game nerd. I play these games more, and I just like them more. I’ve had more fun playing them.
    • I was with my wife and my kids at a local food fair. I’m sitting there, eating this big ole Taco Salad. My son is leaning on me, eating Mac & Cheese. He’s snuggling in. I’ve got my little boy, good food, happy environment, great music. I felt good. I felt lucky. My phone was firmly in my pocket. I felt like I was in the moment. That didn’t happen before.
  • I wake up in the morning without this impending sense of dread. Without feeling like there’s a ceiling over my head, pressing down. It just feels like the world has less pressure. I still feel stressed, still feel overwhelmed. But the world doesn’t feel like it is filled with nearly as much darkness.
  • I’ve been less snappy. Less grouchy.
  • I’ve had an easier time concentrating and getting things done. My motivation is higher.
  • You know that myth about the depressed writer? Bull. Depression does help give you insight and experience for writing, but if it’s too severe, you ain’t writing. And I’ve had a much, much easier time writing lately.

Arguably the most important observation since this started has been from my wife. She was skeptical when TMS first started. She told me last week that she didn’t think it would work, and part of her almost wishes she didn’t know I was doing it so she wouldn’t risk being fooled by a placebo effect as well.

Why? Because she noticed the difference too. She told me the other day, unprompted, that she sees it’s working. She sees that I am happier. And my wife is smarter than me! So if she is noticing this, it makes me more convinced that this thing really is working.

Are things perfect? Hell no. They never will be.

But they are unquestionably better.

DISCLAIMER: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences. However – and again, this is just me writing – I’ve had my TMS from the TMS Center of the Lehigh Valley. I am grateful for their skills, professionalism and willingness to work with my rather insane schedule. I highly, highly recommend them if you are local to the area.

When discussing suicide: Sharing stories of hope and recovery

I talked a lot last week about the CDC Technical Packet I read on suicide, and I have one more item in it that I want to discuss.

There’s a section in the packet (“Lessen Harms and Prevent Future Risk”) which applies to anyone who has ever walked down the dark path of suicidal ideation – or even suicide attempts – and come back. Under the approaches subheading, the report says:

Safe reporting and messaging about suicide. The manner in which information on a recent suicide is communicated to the public (e.g., school assemblies, mass media, social media) can heighten the risk of suicide among vulnerable individuals and can inadvertently contribute to suicide contagion. Reports that are inclusive of suicide prevention messages, stories of hope and resilience [italics added by me], risk and protective factors, and links to helping resources (e.g., hotline), and that avoid sensationalizing events or reducing suicide to one cause, can help reduce the likelihood of suicide contagion.

Later, in the evidence section, the report notes:

Finally, research suggests that not only does reporting on suicide in a negative way (e.g., reporting on suicide myths and repetition) have harmful effects on suicide, but reporting on positive coping skills in the face of adversity can also demonstrate protective effects against suicide. Reports of individual suicidal ideation (not accompanied by reports of suicide or suicide attempts) along with reports describing a “mastery” of a crisis situation where adversities were overcome [italics added by me] was associated with significant decreases in suicide rates in the time period immediately following such reports

So, let’s talk about that for a second, because this is important. Many have discussed suicide, and whenever there is a high profile suicide in the media, reports often discuss specific methods and details. That’s bad.  As the report above clearly demonstrates, the way in which suicide is discussed in society can have an extremely positive or negative affect on impact rates.

And here’s the part which specifically touches all of us who have been there: There’s something potentially life saving about sharing your story.

Describe it. Tell people about your darkness. Tell them how suicide was something you considered. Maybe even attempted. Tell them the truth – be open and honest with your experiences. But don’t just emphasize the sadness. Talk about how you found your way back. Talk about how you fought your demons, and thanks to X, Y and Z, are now in recovery. You don’t have to pretend that everything is perfect – in that, that likely won’t ring true. But what I think people can and should say is that they no longer want to end their lives – that they want to live, to fight on, and to lead a good life. This is what I tried to do when I shared my specific story of suicidal ideation in the aftermath of the Anthony Bourdian and Kate Spade suicides.

If you can, I’d encourage you to tell your story, and do so as noted above. I truly believe that doing so can save lives.