Tag: depression

Six medically backed treatments for depression – which make absolutely zero sense (part one!)

Depression is, without a doubt, one of the most miserable and common illnesses currently coursing it’s way through the world. And if I have to tell you this, you’re probably one of the lucky ones who has never felt a smothering blanket of pain and sadness squish the life out of you. If that’s the case, congratulations! You are not one of the nearly one in five Americans who are actively suffering from some sort of mental illness.

Depression is widespread and terrible. What’s being done to deal with it? On that front, there’s good news and bad news. With proper treatment, depression can be managed and cured. So, if you are one of the unlucky Americans who suffer from depression, there’s plenty of reason to hope: Therapy and medication can help you recover.

So, does that mean that these are the only options for treatment? Absolutely not.

A friendly reminder: I am a long-time depression sufferer, blogger and writer. So, should you make any changes to your treatment regiment based on the words that you read here? Absolutely not. Hopefully, this article can help you become more aware of a variety of treatments out there. However, do not, under any circumstances, change your medical treatment based on these words. You should never make any treatment changes without talking with a medical professional first. Traditional approaches – such as medication and therapy – unquestionably work – and I know because I take my medication every day.

That being said, there are a lot of ways which can help you fight depression, get healthier and feel better. They may not make sense. They may be counterintuitive. They may make you scratch your head and ask, “What in the world is fish oil?” (See item #2). But, every item mentioned below has serious, medically-backed research which shows that even the most depressed people can find some sort of hope in their own personal hell.

So….

Sunshine

Do you remember being down at some point in your life and someone screaming at you, “Get out of bed and go outside, you’ll feel better!”

They were right.

Depression rates go up in the winter. This is thanks to Seasonal Affective Disorder, which strikes people as a result of a lack of sunlight. It’s also more common as you go further north, as a result of colder temperatures and less sun. Your body’s natural circadian rhythm – your natural clock – gets disrupted when there’s less sun. This makes perfect sense, of course: You see sun, you wake up. You see dark, you sleep. And when that rhythm gets nuked, it can play havoc with your body and your mind.

Additionally, the lack of sun can cause your body’s production of serotonin and melatonin – two chemicals which are linked to a variety of mood disorders, including depression – to go haywire.

But, even if you don’t have SAD (which, not for nothing, is the most perfect acronym of all time), sunshine can help you fight depression. For everything said above about how darkness can cause depression, the inverse is also true: Sunlight can help fight it. Not only does it reset your body’s natural clock back on track and help produce serotonin and melatonin, but it helps stimulate your body’s production of Vitamin D – this, in turn, helps fight depression.

Don’t have the time to go outside? Live in an area made of dark, sad clouds (way to go, Connecticut)? That’s okay: Artificial light can help too. Light boxes (big, shiny boxes which produce a certain type of light) have been shown to be effective in fighting depression.

Fish Oil

Let’s answer this question first: What on Earth is fish oil? Because it sounds…well, it just sounds terrible.

Fish oil can be ingested in two ways: By eating fish, or by taking supplements. The reason it’s so good for you is because it contains Omega-3 fatty acids, and two in particular: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

For years, fish oil has been known to be effective in fighting a variety of ailments, including lowering your blood pressure and cholesterol, increasing heart health and reducing joint pain. But, one of the newly discovered benefits of fish oil? It helps fight depression. There’s no set explanation for how it works, but one theory is that taking fish oil – which is rich in the aforementioned Omega-3s – make it easier for serotonin to get into your cells, thus helping to combat depression.

However it works, there are studies out there which show that it does. A 2008 paper reviewed a series of metanalysis on fish oil and noted that it had a “significant depression effect”, while a 2017 paper found that multiple studies indicated that fish oil is effective in fighting depression.

Like everything in science, more study is needed. But this is real. Numerous papers show that fish oil can help you fight off depression. Of course, it’s not the only effective and goofy thing out there. This leads us to….

Anti Inflammatory Drugs

When you are depressed, your brain gets swollen. You read that right.

In this sense, your brain is like the rest of your body. When you are injured, the injury usually swells up. This is because white blood cells rush to an area to heal it and guard against infection, causing the wound to get bigger.

Depression works in a similar way. According to a study which appeared in JAMA Psychiatry, which found that severe depression can swell your brain by as much as 30%. Now, if this is something which occurs as a symptom of depression, that’s one thing. But the more important question is this: Can inflammation of the brain cause depression?

Yep.

Other studies have found that treatments which increase brain inflammation can cause depressive symptoms like a “loss of appetite, sleep disturbance, loss of pleasure” and more.

So, does that mean that anti-inflammatories can be used to treat depression? Again: Yes. According to a 2016 review of 20 studies, anti-inflammatories improved symptoms of depression. This doesn’t mean that you should run home and start popping Advils, but it does mean that if you’re struggling with depression, you should have a conversation with a medical professional about drugs which reduce inflammation.

But what if fighting depression could be even more simple? As simple as getting warmer?

New postpartum drug highlights continuing divide between the rich and the poor

Let’s start with the good news: For the first time ever, the FDA has approved a drug specifically designed to deal with postpartum depression (PPD). The drug is called Zulresso, and it is produced by Sage Therapeutics.

We know that PPD can be absolutely devastating. According to the article linked above, as many as one in nine women are hit by PPD. So the availability of a clinically successful drug designed specifically for PPD can be a godsend.

Now for the bad news: The cost and time period associated with Zulresso may put it far out of reach of many.

First, the cost: A whopping $34,000. That number might be slightly out of range for…you know, everyone not made of money.

As for it’s method of delivery? That’s another challenge: It has to be administered intravenously, over a 2.5 day period, in a certified clinic. That’s 2.5 days where a woman cannot work, cannot care for her baby (or the rest of her family). And let’s keep in mind, many women simply cannot afford to take 2.5 days off from work, and this is particularly true for hourly workers or those who are economically insecure.

Tragically – and unsurprisingly – women who need this help the most are also most likely to have this drug and its potential benefits out of reach. There are some women who are more likely to experience PPD, and unsurprisingly, in many cases, these are women who are more economically or socially vulnerable. These factors include job loss and a lack of other emotional, familial or financial support.

Simply put, this may mean that this new drug it is not an option for many. We know that tougher economic times – and tougher economic circumstances – lead to an increase in PPD cases. This treatment – both its costs and length of treatment – may be out of reach for many poorer women and their families.

To be clear, I’m not trying to poo-poo the potential success for Zulresso. I am trying to make a broader point though: Many areas of mental health treatment are, sadly, out of reach for the poorest among us. Hopefully, medical advances will continue to improve and make Zulresso’s life-saving benefits available for all women and families in society, regardless of their economic station in life.

Video games can help fight depression

When it comes to mental illness, video games often get a bad rap. There is a ton of talk in the media about how video games cause violent behavior (it’s not that simple) and how video game addiction is a real thing (it is, but not as big of a problem as some may lead you to believe).

Don’t get me wrong – video games can be very bad for your mental health, particularly if you overdo it and become withdrawn, ignore your real life obligations or substitute games for real world interaction. That being said, there is also ample evidence which demonstrates that video games can be really good for depression.

This Geek & Sundry article lays the case out nicely. It notes that different games can have different, positive purposes (MMORPGs can help people become more social, puzzles can help reduce outside distractions and deal with trauma, etc).

Additional useful information is in this Slate article, which discusses what happens to someone’s brain when they play video games:

In the past few years, multiple fMRI studies, including a seminal one conducted at Stanford University, have peered into the brains of gamers. Their results show that when we play video games, two regions of the brain are continually hyperstimulated: the region most associated with motivation and goal-orientation (often referred to as “the reward pathways”) and the region most associated with learning and memory (the hippocampus).

BUT, the article also notes:

These two regions of the brain, the reward pathways and the hippocampus, are the same two regions that get chronicallyunderstimulated, and that even shrink over time, when we’re clinically depressed.

In other words: Video game play is literally the neurological opposite of depression.

The key, according to this article, is to “play games with a purpose” – in other words, a positive goal. Doing so will alter your brain and encourage you to see the world in a whole new light. This, in turn, help rewire your brain so that you can better cope with depression.

There is also ample evidence that video games can help you fight depression. One 2018 study found that action games can help reduce depression. And a 2012 study found that a fantasy game designed specifically to fight depression could be more effective than visiting a counselor.

And all of this, of course, says nothing about the very positive ways which certain games show depression – and show people fighting back. And, after all, I’m a big fan of using media to show how to conquer depression!

On a personal level? I’ve found video games to be a very pleasant distraction at the moments where I am down. They can, however briefly, take me away from my troubles and give my brain space to breathe and recover. I get the temptation to drown yourself in a video game when you are down, but the truth is that this accomplishes nothing. If you use video games as a way to reorient yourself to the real world, it can help get you to where you need to be. Maybe that’s why I tend to like open world games that provide a big escape – games like Skyrim or Grand Theft Auto 5…err, I mean, Mario Kart. Let’s go with that.

As always, I welcome your thoughts below. Have these experiences been yours? What video games do you play when you are down? Let us know in the comments!

Postpartum depression in…Dads?

I caught this article in Healthline and it made me want to further explore this topic: There is ample research which shows that Dad’s can suffer from Postpartum Depression, too.

First, a disclaimer. This is not an attempt to minimize the pain or severity of Postpartum Depression in Moms. This is not a #NotAllMen related entry, and please don’t take it that way. The evidence is clear – Postpartum Depression in women problem is real (with as many as one in seven women suffering), it is large and it is significantly more widespread than postpartum depression in men. Indeed, in my legislative career, I’ve worked on legislation which would help low income women be screened and treated for Postpartum Depression.

That being said, Postpartum does apparently hit Dads too, and I think its an issue worth exploring.

The Healthline article reviewed a variety of research on Postpartum in new fathers, which analyzed a variety of internet postings in blogs and chat rooms (yeah…not sure about that) and showed that many men suffered from symptoms about Postpartum and weren’t sure what to do or where to find information.

However, there is ample research – of a more rigorous, academic type – which shows that Postpartum does truly exist in men, so much so that it has a name: Paternal Postpartum Depression (PPD). This issue is widespread enough that there is an entire website dedicated to it. Postpartummen.com accurately notes that there are many symptoms of depression, but men often experience and express it differently, including through anger and alcohol. For what its worth, this is also something which I blogged about a couple of weeks ago.

How widespread is this issue? According to a study published in the Journal of American Medical Research, high – as many as one in ten men. The study also noted that the rates were slightly higher during the 3-6 month period, and PPD correlated moderately with maternal depression. Hormones are a big cause of maternal postpartum depression, but that’s also the case for men: Men experiencing PPD also have testosterone drops.

The good news is that treating PPD is just like treating any other disorder – as long as you are able to seek and find help, you’ll get there. As best I can tell, relying on therapists and support groups are widely accepted options to deal with PPD.

As always, I conclude by asking you for your opinion! Do you have experience with dealing or treating PPD? I’d love to hear your thoughts in the comments below!

 

A new nasal spray for depression

There’s a new anti-depressant treatment now available: Spravato. It’s related to Ketamine, and if it sounds familiar, there’s good reason for it: It’s biologically related to the party drug “Special K.”

Obviously there are major differences. This drug is a nasal spray and actually given in doctors offices – in other words, you won’t be taking this one home and having it in the morning like a standard anti-depressant. That is because, per this Vox article:

….because it can sedate patients and bring on out-of-body experiences, the FDA is only making it available through certified clinics, where patients are to be monitored for at least two hours after taking the drug.

This drug is meant for “treatment-resistant depression” – meaning those who have tried at least two other major depressant treatments and not had their depression ameliorated.

Operators of these clinics – no surprise – were overwhelmingly supportive of the FDA approval. From a USA Today article:

“This is an enormous deal in terms of access to care,” Levine said. “And the degree of advancement can’t be overstated. This is truly the best new option in over 60 years. And more will be coming down the pike.”

Treatment doesn’t work like standard medication. The same USA Today article told the story of Jonathan Herbst, who credited the drug with saving his life:

A financial services manager in Philadelphia, he began ketamine treatments in August – five or six treatments in the first two weeks, then one maintenance treatment every three or four weeks.

Are there side effects? You bet, and they sounds like a very fun time! They include: feeling disconnected from mind and body, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk. Additionally:

The FDA warned that esketamine distribution will be tightly controlled due to the potential for abuse, suicidal thoughts and sedation along with possible problems with attention, judgment and thinking.

It’s also worth noting that this drug’s approval did not come without real controversy over its effectiveness. This drug was approved after four clinical trials – three of which lasted only four weeks – and two of those short-term studies “did not meet the pre-specified statistical tests for demonstrating effectiveness.”

What do I think? I honestly have no idea. As usual: I’m not a Doctor. Go talk to your Doctor if you are interested. All I’m trying to do here is update my readers about this new drug. If you have treatment-resistant depression (high five, fellow sad people!), it is certainly worth exploring this option. Just be aware, however, that it’s still a relatively new drug with real side effects and some questions about its effectiveness. At the same time, however, there is clearly enough evidence to warrant its approval by the FDA, and there are absolutely people who credit this drug with making major improvements to their life.

And, as always: If you’ve had any experience with ketamine (good or bad!) or any thoughts to share, please write them in the comments below!

Gender differences in depression

This isn’t exactly a revolutionary statement, but men and women experience depression differently. Gender differences and the topic of “toxic masculinity” have received quite a bit of press lately, and this is an area I think is absolutely worth exploring. Do men experience depression differently then women? Do they then show those differently Because of the way we socialize the genders, are men more likely to experience and express depression differently and in ways which we would consider to be more stereotypical?

According to the available research, yes, absolutely.

An October 2013 study found that men experience depression in a manner which is “different than what is included in the current diagnostic criteria.” The results of the study found that men are more likely to experience anger, aggression, substance abuse and risk taking when depressed. These symptoms are not used when diagnosing depression, but are outside of currently accepted diagnostic criteria.

Even more interestingly: When alternative (but accepted) measures are used to diagnose depression, the study found that men and women experience depression in relatively equal proportions.

Other reviews have come to similar conclusions. In this article in VeryWellMind, it was noted that women express depression by becoming more visibly emotional, while men become “more rigid” and less emotional. An article in University Health News noted that symptoms of depression experienced by men often involve “having symptoms that are not usually considered in the diagnosis of depression.”

What does this tell us? Men and women are obviously socialized differently and express emotions in different ways. What I would love to know is the role of this socialization and how it affects depression expression – what men are more likely to experience and express depression in different ways? What women are more likely to express depression in ways which are more similar to men? That would be an interesting study.

But, the conclusions here are pretty clear. Men experience depression different then women, and that means that we have to be more aware of the gender differences between the two in order to ensure that men get the same treatment as women. I’d also argue that it means we have to ensure that we raise men differently. Men need to know it’s okay to experience and express emotions in ways which aren’t stereotypically male. Things seem to be changing in that regards, but that one is on all of us who are parents to ensure that men know there’s nothing wrong with being sad and saying as much.

What is ASMR, and can it help with depression and anxiety?

If you’ve been on the internet long enough, odds are good you’ve heard of or seen ASMR videos. I’ve found them to be a nice, relaxing break, one capable of helping you unwind at the end of the day, similar to relaxing meditation. But, can they help with depression or anxiety? It certainly appears that way.

First, for the uninitiated, let me answer this question: What is ASMR? It stands for “autonomous sensory meridian response.” Per the Google definition, which is pretty accurate as far as I am concerned:

a feeling of well-being combined with a tingling sensation in the scalp and down the back of the neck, as experienced by some people in response to a specific gentle stimulus, often a particular sound.

ASMR recently was seen by hundreds of millions of Americans with this Super Bowl commercial from Michelob:

ASMR can be triggered by a variety of things. For some people, there is nothing that works (like my wife, who wants to throw my iPad out the window when I watch these videos). For others, ASMR triggers include gentle sounds (like tapping or whispering) or demonstrations.

There are a ton of channels and videos on YouTube which are designed to “trigger” ASMR. It’s become an incredibly popular internet trend, one that thousands (if not millions) use to relax and unwind.

From a mental health perspective, here’s a more interesting question: Can ASMR be used to help fight off depression and anxiety?

Well, yeah. Maybe.

ASMR as a formal, intentional genre of videos is relatively new, having only been around since the early 2010s. However, there has been some research done on the subject, and the answer, so far, is yes. According to a study published in 2015, 80% of participants who viewed ASMR said that the viewing had a positive effect on their mood, while another 69% found that their depression symptoms had been improved. Another study showed that ASMR videos can reduce heart-rate and increase skin conductivity, signs of physical and mental relaxation. There are also a slew of internet reports, like this one, of people who have used ASMR to fight depression.

Just to be insanely clear here: ASMR is not a substitution for therapy or medication. Personally, I think it’s a nice distraction, a good way to unwind and temporarily ease the painful symptoms of depression or anxiety. That being said, it’s not a permanent, formal treatment. But, if you’re stressed and looking to relax a bit, ASMR can be helpful. And, even if you’re not – go enjoy it! Millions of people across the world have found themselves finding relaxation and joy with ASMR. Go search for videos and see if there’s anything there you like.

American Teenagers: Depression is our biggest problem

This Pew study. Wow.

PSDT_02.20.19_teens-00-00

According to a new study by the Pew Research Center, a whopping 96% of teens view depression and anxiety as a major or minor problem among their peers, far outpacing literally every other societal problem, including bullying, alcohol, poverty, teen pregnancy and more. And the numbers aren’t even close.

Per the story, it’s even worse than just the graph above:

  • Teens feel this way regardless of whether or not they personally suffer from depression – this means that they are hugely aware of the problem in others, which obviously shows it has a high degree of preeminence.
  • The trend is specific to all teenagers, regardless of “gender, racial and socio-economic lines, with roughly equal shares of teens across demographic groups saying it is a significant issue in their community.”

This makes perfect sense, sadly. As we know from empirical data, rates of mental illness are increasing across the board, but the trend is most visible among American teenagers.

If teenagers across the board are seeing increases in mental illness, what doe that tell us?

I’d argue a broader point, using the graph above: The rise in the first line is a direct result of the rise in every other line.

Again, we know that mental illness is increasing. We also know that mental health isn’t like some contagious virus – you don’t “catch” depression the way you catch a common cold. So, what is it? What is leading to the massive spikes we are seeing in mental illness? My argument is this: It’s not just one thing, but many things. As the graph above and corresponding story makes clear, American teenagers are facing major societal challenges. They are scared, worried and anxious, as a result of a variety of factors, including a more complex society, increasing reliance on technology (at the expense of regular relationships) and the pressures of a rapidly changing and interconnected world.

A problem like this cannot simply be addressed at an individual level. It goes without saying that access to mental health care is incredibly important, and fighting mental health stigma (my favorite issue!) is vital, but we aren’t going to really get at a reduction in mental illness unless we address the societal and cultural problems which have resulted in its increase.

What does that look like? I don’t know all of the answers. But, if you’ve read this blog before, none of what I’m going to say is particularly new. Teenagers – well, hell, and the rest of us – are too addicted to technology. They are spending more times with their phones and less time with each other. This has devastating psychological impacts. The answer is not that simple, of course. But we know that teenagers are spending less time with each other in a variety of ways – less time at parties and social gathers, less time away from adults and less time simply interacting with one another. At the same time, world events and pressures are more available and accessible than they ever have been – thanks, in part, to our lovely phones.

What’s the end result? A generation that is more depressed, more brittle and less resilient.

This isn’t an effort to place blame, but it’s something all of us are responsible for addressing. Teenagers become adults…and, as someone who has suffered from depression and anxiety for my entire life, I don’t want an entire generation of teenagers and young adults to feel that pain. We have to deal with this. Now.

Five ways YOU – yes, you – can help beat mental health stigma

One of the things I am most passionate about when it comes to mental health is trying to beat the stigma surrounding it. I was asked a very interesting question yesterday: What does that look like? What is a stigma free world?

The best answer I have for that very valid question is this: We treat and view physical and mental illness in the same light. And we don’t view mental illness as being anything other than what it is: A serious, dehabilitating and potentially deadly category of diseases which require time, resources and care to heal.

Unfortunately, we don’t live in a society where that is currently the case. We know that nearly one out of five American adults have some sort of mental illness, but only 30-40% seek treatment.  Stigma continues to play a role in this disconnect and in people’s assumptions of what it’s like to live with a mental illness.

So, rather than asking a broader question about what we can do, as a society, let me put the question to you in a more direct, personal terms: What can you do to help end mental health stigma?

Here are five suggestions. They are all relatively simple. You may have thought about them already. But I think it’s important that all of us realize we have a role to play in terms of ending mental health stigma.

1) You have to talk about it: One of the most difficult things which people can do in terms of mental health is also one of the simplest: You have to talk about it. If you are depressed, say it. If you are anxious, say it. According to research, anti-stigma campaigns which are most effective are those which feature real, “normal,” identifiable people discussing their mental illness. This means that the most effective person to attack mental health stigma is…well, you.
2) Encourage people to seek help: If you are one of the lucky ones who has avoided mental illness, that’s wonderful. You still have an important role to play: If someone you know is in pain and needs help, encourage them to get it. Be supportive and non-judgmental, but help them get the help that they need and deserve.
3) Encourage an equal perspective between physical & mental illness: I might be off here, but I believe ending stigma means that we take mental illness the same way we take physical illness. That, I believe, is important, because most people aren’t going to look at a broken arm and think, “Gee, I can just tough it out!” When someone gets physically sick, we usually don’t think twice about helping them get the help they need. I think this is a good model for breaking mental health stigma.
4) Watch your language: Here’s one that I must confess I sometimes violate, and I need to stop. Expressions like, “I’m crazy” or “You’re nuts” don’t help anything. All that does is reinforce a negative stigma about mental health. There has been an awesome campaign in the past couple of decades to eliminate use of the word “retard” as a negative description, and it’s fantastic. The campaign operates on the principle that we are a better society if we are more inclusive. This has to extend to how we discuss mental health as well.
5) Don’t just talk about failures and pain – talk about successes and joy. I think part of the problem with the way we discuss mental health is we discuss it. We talk about failures, about challenges, about struggles. When you discuss mental health, don’t just concentrate on the negatives. Talk about joys and victories. Talk about beating struggles, about thriving. Mental illness can, of course, be extraordinarily painful, but that makes our victories sweeter. Talk about thriving, not just the pain.
As always, I’d love to hear from you! Anything you want to add? Let us know in the comments below!

Teens, marijuana and depression

A friend of mine was kind enough to flag this article for me, and it brings up some points that I really think are worth exploring.

As a debate over legalizing marijuana continues across the country – and in Pennsylvania – a new study draws a connection (not a casualtional one, however) between teen marijuana use and depression.

From the NBC report on the study:

Researchers found that cannabis use during the teenage years was associated with a nearly 40 percent bump in the risk of depression and a 50 percent increase in the risk of suicidal thoughts in adulthood, according to the study, published Wednesday in JAMA Psychiatry.

The report does note that this isn’t to say marijuana causes depression (though that may, in fact, be the case). It’s possible that the depression encourages marijuana use, or that a third factor (such as economics, anxiety, stress, etc) cause both the depression and marijuana use.

Still. The study does show a clear connection between marijuana and depression. There’s an irony to that: Some research shows that medical marijuana may actually help alleviate symptoms of depression. This may be a secondary benefit of medical marijuana, which has been shown to relieve pain and stress – two factors which, of course, may lead to someone becoming depressed.

Can these seemingly contradictory findings be reconciled? Sure. It’s possible that the drugs act in such a way which helps those who are already depressed, but affects other aspects of someone’s brain chemistry in those who are not depressed, thus making them so. It’s also important to note that there are major differences in terms of the chemical composition, and effects, of medical and recreational marijuana, thus potentially resulting in different effects.

The causes and effects of marijuana use are not always clear or linear. More research is needed.

Personally, I believe that marijuana needs to be examined and researched like any other drug. I’ll also note a flaming hypocrisy within our current medical and judicial systems: Numerous legal drugs (such as Oxycontin) are obtainable from reputable medical professionals, despite the fact that Oxycontin is more potent and addictive than marijuana.

Our drug policy in America makes no sense. But – and this is a big “but” – we cannot sit here and pretend that legalizing marijuana is the solution to many of our woes. Legalizing marijuana may be preferable to the alternative of prohibition, but that’s not to say that there won’t be significant negative side effects, and this may very well be depression in young people. Marijuana legalization – it’s pros and cons – need real, comprehensive study and thought. It could have major benefits and harm to the mental illness space.