Depression and Anxiety
Written and researched by Bob Murray, PhD
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One in Six "Considers Suicide"
March 25, 2002
According to researchers, as many as 4% had considered taking their own life in the past year. The survey, conducted by the Office of National Statistics, found that such suicidal thoughts were more likely among women and younger adults. Tony Blair's government has set a target of reducing suicides by 5% by 2010. Last year, however, the rate actually increased by 1%.
The ONS survey also revealed that suicidal thoughts were more common in divorced people, lone parents, and people who rented rather than owned their homes.
Increased rates of suicidal thinking were also found among those with mental disorders, who were dependent on alcohol or drugs, or who had experienced several stressful life events.
A total of more than 8,000 people were questioned for the survey. They were asked whether they had ever thought that life was not worth living, or whether =hey felt they would be better off dead. The sample was also asked whether they had ever attempted suicide, or if they had deliberately harmed themselves in any way but not with the intention of committing suicide.
Just over 4% of people questioned said they had attempted suicide -- about half a percent in the past year. Some 2% of those taking part had deliberately tried to harm themselves -- but without suicidal intent. Of those currently suffering depression, a quarter had at one time attempted suicide compared with 2% of those with no current mental disorder.
Psychosis was the factor which had the highest relevance to the likelihood of suicidal thoughts, followed by the number of stressful life events endured by the person. Schizophrenia is one illness which can lead to psychotic episodes -- as can Alzheimer's Disease or manic depression.
Richard Brook, chief executive of the mental health charity Mind, said: "Revelations that as many as 15% of adults have at one time or another considered suicide come as no surprise to Mind. We would hope that highlighting the fact that someone they know well could be affected by suicidal thoughts will help tackle the stigma of mental health problems, and make people more sympathetic to those experiencing problems."
Read more in BBC News
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New Research Throws Doubt on St John's Wort
March 25, 2002
Gerlie De Los Reyes and colleagues at the University of Southern California draw attention to research suggesting that hyperforin, rather than hypericin, may be the active component of the medication.
"Hypericins isolated from the extract have been shown to be virtually inactive as psychotropic agents in animal models," say the researchers.
The team looked at eight commercial brands of St John's Wort and found wide variations in the amount of hyperforin that they contained. Only two of the products tested contained enough to be clinically therapeutic, they concluded. And although recent literature suggests that hyperforin is an active antidepressant, it is not routinely used to standardize St John's Wort products because it degrades under ambient conditions.
Gerlie De Los Reyes said, "It's essential that manufacturers standardize and list the content of hyperforin on St John's Wort labels. Consumers must have this information to make informed decisions about the medications they are taking."
Read more in American Journal of Health-System Pharmacy
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New Report on Women and Depression
March 25, 2002
These findings are among those summarized in a new report, "Summit on Women and Depression: Proceedings and Recommendations," just published by the American Psychological Association, and reflecting the research reviewed by 35 internationally renowned experts from a variety of disciplines who contributed papers to the Summit.
Major depression can impair a person's social and physical functioning even more severely than serious medical conditions such as hypertension, diabetes or arthritis, and can result in disability and significant loss of income, according to the research cited in the report. Furthermore, a World Health Organization Report examining "The Global Burden of Disease" found that "depression presents the greatest disease burden for women when compared with other diseases."
Among the major causes of depression in women the report singled life stress and trauma. Case-control and community-based studies have shown that more than 80 percent of major depression cases were preceded by a serious adverse life event. Traumatic events, such as childhood sexual abuse, adult sexual assault, male partner violence and physical illness also can lead to depression. Initial research has suggested that early trauma has a greater impact on risk for depression than later occurring trauma. Research has also indicated that women may be more likely than men to experience depression in response to a stressful event.
The report also outlined current research that has demonstrated that relationships are more paramount to women's self-concept than for men's. It also stated that women are more likely to experience stress in response to adverse events occurring in the lives of others and place their needs secondary to those of others. These interpersonal orientations illustrate major psychological differences between men and women that may help account for differences in vulnerability to depression.
Once again it is gratifying to have our long-held beliefs authenticated. BM
Read a summary of the report on the APA website
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Depression Leads to Overeating for Women, But Not Men
March 25, 2002
That is according to University of Minnesota psychologist Robert Jeffery. His year-long study of 1,800 obese men and women looked at gender differences in the eating behavior of overweight adults. "Moods don't seem to be driving men's eating, but depression is a key driver for women," said Jeffrey, speaking at the American Psychosomatic Society meeting in Barcelona.
At the start, everyone rated how difficult they found it to resist food in varied situations -- at parties, when watching TV, etc. -- or while experiencing certain emotions. Participants also took a depression test and were asked about their medical histories. Women were nearly twice as likely as men to have a history of depression. "Body weight is not a big issue for men," Jeffery says, "but a lot of these women might be depressed because they're overweight, and the social consequences of this for women are much greater."
Women's depression around weight apparently prompts even more weight gain. For women, depression was strongly tied to trouble controlling eating behavior. Depression correlated with the women's inability to resist foods even more than their body weight did. For men, the heavier they were, the less confident they felt about controlling their weight; depression had no bearing on that confidence.
But could men just be denying that food is a crutch for them? Jeffery thinks not, because the relatively lighter men voiced more confidence about resisting food, and the heavier men said they had more trouble.
A year later, after receiving counselling in a weight-loss program, women who weren't depressed lost more than twice as many pounds as the depressed women who said they had trouble resisting food. For men, neither mental health nor confidence about controlling eating predicted weight loss.
Men usually have to be much more overweight than women before they'll enter weight-loss programs, Jeffery says. Women dominate group programs, "and programs with a lot of women ought to be addressing depression." Men, he says, "tend to be a lot more naive than women" about what puts on the pounds. "Eating is kind of a knee-jerk thing for them." An informational approach might work best for men, he says.
Read more inAmerican Psychological Association and USA Today
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Psychiatrists Admit Down Side of Antidepressants
March 25, 2002
The Royal College of Psychiatrists, which represents around 10,000 psychiatrists, has withdrawn previous advice that said "six or seven in every 10 depressed people will get better on antidepressants." Based on the most recent research, new draft advice says that between only 50% and 65% "will be much improved" if they take antidepressants.
For the first time, the new advice also concedes that herbal remedies made from the flower St Johns Wort are "about as effective as antidepressants in milder depression."
The college's old advice said that antidepressants are not addictive. "There is no evidence that antidepressant drugs caused dependence syndromes," it said. The new study acknowledges that there is a debate on the subject and points out that "up to a third of people experience withdrawal." It says withdrawal "seems to be greatest" with Seroxat, the biggest selling antidepressant in the UK which, like Prozac, works by boosting the levels of the brain chemical serotonin.
Withdrawal symptoms included nausea, flu-like symptoms, anxiety and sweating. In the last few years, prescriptions for antidepressants have more than doubled in England, from 9m in 1991 to 22m in 2000, due largely to the increase of drugs such as Seroxat and Prozac, known technically as selective serotonin reuptake inhibitors, or SSRIs. One of the reasons for this sharp increase was the view that SSRI were effective and relatively problem free, a view brought into question by the RCP's new advice.
The study comes after a report by Health Which?, published by the UK Consumers Association, claiming that official advice on antidepressants was misleading. Health Which? also pointed out that recent research suggests a link between suicide and SSRIs. The draft RCP guidelines claim that "suicidal thoughts will pass once the depression starts to lift."
Separately, scientists are finding interesting interactions between SSRIs (selective serotonin re-uptake inhibitors) such as Prozac and Paxil and certain form of cancer.
John Gordon, professor of immunology at Birmingham University, writing in the journal Blood has found that these drugs may stimulate the growth of brain tumours by blocking the body's natural ability to kill cancer cells. Gordon and his colleagues found evidence to suggest cancer cells can be killed by "positive thinking," which could be blocked when people take Prozac.
The study, to be published in the journal Blood next week, examined the effects of Prozac and other antidepressants on a group of tumor cells growing in a test tube. The researchers found that the drug prevented the cancer cells from committing "suicide," thereby leading to a more vigorous growth of the tumours. Although an increased risk of cancer has not so far been detected in Prozac patients, the latest findings could lead to a global re-evaluation of the drug's long-term safety.
On the other hand Prof Gordon's work has also shown that SSRIs may also provide some protection against other forms of cancer: "An exciting property of serotonin is that it can tell some cells to self-destruct. We have found that serotonin can get inside the lymphoma cells and instruct them to commit suicide, thereby providing the potential for an effective therapy," Professor Gordon said.
In newspaper stories the professor was also quoted as saying that people should not suddenly stop taking SSRIs on the basis of his findings.
Persistent studies have also tied Prozac to suicide. The main problem with antidepressants is that they do not deal with the underlying relationship causes of depression which researchers are coming to see as the main factor in the disease. BM
Read more in The Guardian
Read more in Health Which?
Read more in the journal Blood
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Absence Makes the Spouse "Grow Sadder"
March 11, 2002
Frequent business trips abroad could leave the "home alone" spouse with more than an aching heart, research suggests. A study by the American-based World Bank indicates that spouses left at home are much more likely to come down with mental health problems than those whose partners do not travel. In fact their level of stress-related and psychological problems was three times as high.
The researchers say their findings reveal just how delicate the home/life balance has become -- with frequent travel demands affecting both worker and spouse.
Researchers looked at the medical insurance claims made by spouses of World Bank employees over a 12-month period. They found that 16% more claims came from those whose spouses frequently travelled abroad. Twice as many people whose spouses spent time away cited psychological problems as those whose partners stayed at home. When the business trips overseas reached four or more, the number of claims made by spouses for psychological stress and related disorders tripled.
Women outnumbered men in terms of numbers of claims made by two to one -- but more business travellers were men.
The authors suggest repeated, intermittent trips away seemed to have a worse effect on people than longer but more infrequent separations. This is because short frequent absences were more likely to disrupt family life and destroy the chance to establish routines.
One of the authors, Dr Lennart Dimberg, said: "It is beginning to be understood that the boundary between the workplace and the home is permeable." It's when partners are separated that anxiety grows and relationships can start to break down He said earlier research showed business travellers themselves suffered increased rates of mental health problems.
Elaine Douglas, a chartered psychologist who works on the Isle of Man, said the strain on spouses is down to the lack of control. She said: "It's not as if the spouse can say 'I don't want you to go,' because it is their partner's job. The person on the business trip can get the buzz of going off somewhere -- there's no frisson of excitement in doing the mundane things at home. Keeping in touch by telephone or e-mail is not the same, the spouse is left to make all the day-to-day decisions by themselves."
Of course the absent spouse may be absent because his/her partner has failed to say, in concrete terms, that they have a need that the absent one not be absent. Many people do not believe that they have the right to articulate such a need, or they put it in such a way as it can be brushed aside (e.g. the way the need is put is too general), or they have not thought through what consequence they might bring to bear if the absent one insists on being absent despite the deserted one's need being given. If, for example, you feel physically safer if your spouse is around, then it is no wonder that you will get stressed or depressed if he/she is absent. Physical safety is the strongest of all the four basic relationship needs (the others are emotional security, attention and importance. (For more relationship tools see Alicia's article "The 3 Essentials for Successful Relationships", our audio-workbook "Transform Your Life and Your Relationships", or come to our Uplift Program) BM
Read more in Occupational Health and Medicine
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Spiritual Beliefs Ward Off Depression
February 25, 2002
So concludes a new study carried out by the Economic and Social Research Council based at Loughborough University in the UK. Their research, which explores the lives of recently bereaved older people, found that those who had a strong sense of belief and personal meaning also experienced more wellbeing. The research found that other people, similarly bereaved, but whose beliefs were weaker, were much more likely to reveal depression symptoms. A considerable number of these people also gave indications of similarly low scores on both personal meaning and existential transcendence (rising above the failures of living).
The sample of 28 recently bereaved people's experiences were analyzed as individual case studies. The participants were drawn from three areas in the south of England. They took part in three in-depth personal interviews conducted by a counselor, which were scheduled for the first anniversary of the spouse's death, six months later and after the second anniversary. Evidence was taken on:
- the person's adjustment to bereavement
- the role of belief systems in that adjustment
- the support for those belief systems.
Out of the 28, nine indicated low or weak spiritual beliefs, 11 moderate levels of beliefs and eight had strong beliefs. The researchers were particularly interested in those whose score was moderate and in how spiritual help might be made most relevant to these people.
Eight of the 11 people with moderate beliefs thought that their lives had lost meaning and purpose and several showed depressive symptoms during the second year after losing their spouse.
The remaining three in the 11 moderate belief category were equally interesting, however, in showing in different ways the value of spiritual belief. One woman had major difficulties in adjusting to bereavement and these were related to her doubts about her spiritual beliefs. But these beliefs seem to have been strong enough to have helped her in eventually recovering and went towards explaining her strong sense of personal meaning.
The research identified evidence on the importance of early experience and particularly faith as handed down by parents (the participants had various denominational backgrounds within a Christian setting). "It is possible to conceptualize the development of religious belief as in part an attachment process whereby trust in parents is extended to a higher power," says Professor Peter Coleman, psychologist, University of Southampton.
The decline in the practice of religion, which has been apparent among older people as well as the rest of the population in the last 20 years, does not mean that spiritual beliefs have declined, says the report. A large part of the population still believes in some sort of transcendent power or in God. What has happened is the loss of respect for the authority of the Christian churches. More freedom, however, has to be set against isolation and lack of support provided by organized structures, says the report.
We've been saying for a long time that one's belief in a higher power is often enabled by trust in parents, particularly the dominant parent. In a hunter-gather band belief in the elders was easily converted into belief in pantheistic gods. AF
Read more about the Economic & Social Research Council report
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Depression May Cause Diabetes
February 10, 2002
According to a paper published in the Psychiatric Times, depression and diabetes are intimately linked. In fact patients with diabetes are twice as likely to experience depression as those without diabetes. The odds of depression are similar in type 1 and type 2 diabetes and are significantly higher in women than in men.
The course of depression in diabetes tends to be severe, with recurrences being the norm and not the exception. Following successful treatment, fewer than 10% of patients remain depression-free over the ensuing five years.
Just why diabetes sufferers are so prone to depression is unknown. It probably involves a complex dance of psychological and genetic factors as well as the strain of coping with a very difficult disease. However there is a growing body of evidence showing that depression may, in fact, cause the illness.
A number of recent studies have shown increased insulin resistance in depressed patients without diabetes and recent studies that controlled for conventional risk factors (e.g., age, obesity, body mass index) found that depression was associated with a twofold increased risk of type 2 diabetes.
One of the main problems has been that despite all the evidence linking diabetes and depression, doctors have rather stubbornly ignored the mood disorder in treating the disease. This situation has been blamed on a variety of factors, including the presumption by clinicians that depression is merely a secondary reaction to the medical illness, the view (often shared by patients and family members) that the diagnosis conveys an additional burden, and the stigma attached to having a mental illness.
Primary care physicians may also lack sufficient training and face financial disincentives to perform psychodiagnostic testing. The fact that the average physician-patient interaction in the United States is currently about eight minutes long also contributes to poor depression recognition.
I wonder if hypoglycemia and depression are linked in the same way as diabetes and depression are? My guess is that they are. BM
Read more in Psychiatric Times
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Post Traumatic Stress Disorder (PTSD) and Depression Affect Memory
February 10, 2002
A study reported in the British Medical Journal suggests that those given the task of sorting out genuine asylum seekers from mere economic refugees may have their work cut out for them.
The authors highlight evidence that shows that people who have been through terrifying, life-threatening, experiences may develop faulty memories. What's more these memories become even less reliable with repeated interviews.
Yet it is discrepancies between accounts of an event that are often used to judge the credibility of asylum seekers.
The study found that the variations in the stories of those suffering from PTSD increased with length of time between interviews. More discrepancies occurred in details peripheral to the account than in details that were central to the account.
Under the terms of the 1951 United Nations convention on the status of refugees, a refugee is someone with a well founded fear of persecution on arbitrary grounds such as ethnicity or political opinion who cannot achieve protection in their home country. When they escape to a new country, their application for asylum is considered in the light of the information they can supply and any facts known about their country. There will often be little documentary evidence about the asylum seeker, and a legal decision on status by the authorities in the country of reception may rest on their credibility as a witness. Asylum seekers sometimes give accounts of persecution that differ with each telling.
Generally, the more detail a memory has, the more believable and convincing the account is. The gist of an autobiographical memory (central details) can be reconstructed from general (historical or schematic) knowledge, whereas details of a specific event (peripheral details) cannot. Recall of peripheral details is thus seen as a good way of distinguishing between "accurate recollection and plausible reconstruction." This is presumably the principle that, in part, guides state authorities' reliance on consistent details as an indication of credibility.
However, this view has been challenged in research on witnesses' evidence. Laboratory and field studies have shown that people recall more details that are central when an event has a high level of emotional impact, such as armed robbery, than when an event is emotionally neutral. Their recall of central details is, however, at the expense of their recall of peripheral.
Depression and anxiety, two sides of the same coin, are often associated with PTSD. Refugees often suffer from these states and both affect attention and memory. Clinically anxious people tend to focus on aspects of their environment that seem threatening rather than those that don't. Depressed people are biassed towards recalling negative personal memories in favor of positive ones. Patients with depression and with Post Traumatic Stress Disorder can have difficulties in retrieving specific autobiographical memories.
The researchers, who studied the effect of questioning on a group of Bosnians who had already been granted refugee status in the UK. They found that PTSD has a significant effect on the recall of peripheral events. Discrepancies (including the provision of new information) exist between autobiographical accounts of refugees given by the same individual on two occasions up to seven months apart. These findings cannot be explained on the grounds of intent to deceive. For refugees with high post-traumatic stress disorder, more discrepancies were found with longer times between interviews. (In the asylum process, there may be months or years between the original interview and an appeal hearing.) In addition, more discrepancies are found in details rated by participants as peripheral, compared with recollection of the central gist of the event. Discrepancies therefore cannot be taken as automatically implying fabrication.
Read more in the British Medical Journal
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Depression Lowers Disease Immunity
February 10, 2002
A US-based study found that depressed people, especially among the over 60s, are not producing enough white blood cells to fight off infection. Depression is estimated to affect up to 57% of older adults for some period of their lives.
The study suggests that earlier detection of even mild depression is crucial if the knock-on effect of lowering a person's immune system is to be combatted.
During the study, reported in the Journal of Abnormal Psychology, researchers looked at a group of 78 adults with an average age of 72.5. It compared 22 patients suffering from chronic depression with 56 non-sufferers, on their ability to generate enough white blood cells to fight off infection.
The results showed that those with chronic mild depression had low T cell response to laboratory-produced infection when they were re-assessed 18 months later. T cells and their performance are the most reliable gauge of a person's ability to fight off foreign bodies such as viruses and bacteria. The older the person, the poorer the immune response was found to be.
The information, together with previous research, showed depressive symptoms could increase the typical immune system decline which accompanies ageing.
Lead researcher Lynanne McGuire of the John Hopkins School of Medicine said: "In this study, it seems that it is the length of time of the depression, not the severity, that is affecting a person's immunity." She said changes in immunity have been associated with both depression and ageing, particularly in those over 60.
A lack of social support was highlighted as a risk factor for depression in the report.
It had long been argued which comes first, people with long-term illnesses becoming depressed or their immune system being affected by the depression. It would now seem to be clear that it is depression which lowers the immune system and paves the way for disease.
The researchers suggest the effect of mild depression on the immune system is linked to the increased risk and severity of infections and cancer found in older adults. Spotting and treating even mild depression in this age group may be essential to achieving better health in older people, they add.
There is increasing evidence that depression is a causal factor in many diseases from osteoporosis to heart disease and certain forms of cancer. The process by which the symptoms of depression become "physical" is called somatization. In our
Fortinberry Murray Professional Training program we teach practitioners to look for the underlying clues to somatized depression in their patients/clients. We also explain more about this phenomenon in Creating Optimism: A Proven, 7-Step Program for Overcoming Depression. BM
Read more in the Journal of Abnormal Psychology
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
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