Time to learn another three new things about mental health. This week we have:
- Further discussion on Antidepressant Effectiveness (vs. Placebos)
- Infographic on influential depression information sources
- Depression prognosis over 10 years
1. Antidepressants: Lifesavers—or Active Placebos?
Monday I discussed the rate at which people with depression respond to placebos (pills that do nothing). My point was not that antidepressants don’t work – far from it – it’s that some people do respond to sugar pills as if they were real medication.
Some people may have mistaken this for me suggesting that antidepressants aren’t effective, however. And it just so happens that the Psychiatric Times was considering this subject just as I was, so please check out Antidepressants: Lifesavers—or Active Placebos? for all the details on this subject.
To quote the article:
. . . the treatment of depression is an art that requires many tools—from family support, to CBT, to medication.
“We will not save lives by dismissing any of the tools we have today just because they are not effective for everyone,” he said. “But we should not be limited in the future by current treatments.”
2. Top 10 Online Influencers Making a Difference in Depression
This week ShareCare announced their list of the Top 10 Online Influencers Making a Difference in the World of Depression. ShareCare isn’t a site with which I’m overly familiar but among other things, they have subject matter experts that answer your questions on health topics.
Their top 10 depression influencers list is presented as an infographic and you can see it here. Yes, I’m at number two in a list of incredible people working for major organizations. I’m honored to have made their list.
3. Depression Prognosis Over 10 Years
I can tell you that about 75% of people respond successfully to appropriate depression treatment.* I can tell you that if you work with a doctor and a therapist you will likely experience meaningful symptom remission over time.
What I cannot tell you, however, is whether you will be depressed again in the future. It depends on a lot of variables but even knowing all of those, it’s still difficult to predict.
This study, though, followed people from the start of their treatment for major depression for 10 years. And here’s what they found:
- 77% of the follow-up months were spent non-depressed (euthymic)
- 16% of the follow-up months were spent in a sub-threshold depression (some depressive symptoms but not rising to the level of clinical depression)
- 7% in major depression
Unfortunately, I don’t have access to the full text, but the data, nonetheless, is interesting. I think knowing that you are statistically likely to spend three-quarters of your life symptom-free is a hopeful positive.
Thanks all. I’ll let you know when I learn more and do better.
* I was asked where this comes from. It is a widely-accepted number; you’ll note it’s used here.
Today we return to my 3 New Things series so I can touch on three new pieces of information I’ve found this week. This week I talk about:
- How to get a background check on a doctor
- The sorry portrayal of electroconvulsive therapy (ECT) in film
- The newly-proposed diagnostic criteria for personality disorders in the DSM-V
Keep up with mental health news. Three new things in mental health to learn this week:
- The more coffee (caffeine) your drink, the less likely you’ll be depressed
- Clinical records of real-life Sybil (part of the basis of “multiple personality disorder”) show likely falsehoods and unethical treatment
- Get your bipolar questions answered by a clinical psychologist
More Caffeine Decreases the Risk of Depression
This is one of the most marvellous pieces of mental illness information I have heard in a long time – caffeine (coffee) consumption is inversely related to depression. (More on effects of caffeine on mental illness.) In other words, the more coffee you drink the less likely you are to be depressed! Crazy, no?
Well, I guess no. According to a 10-year study of 50,739 women, the women who drank more caffeine were less likely to be depressed. Compared to depressed women who drink one or less cups of coffee per week:
- The relative risk of depression was 0.85 for women consuming 2-3 cups of coffee per day
- The relative risk of depression was 0.8 for women consuming 5 or more cups of coffee per day
- (No increase or decrease in risk was seen in those who drank decaffeinated coffee.)
Now, I’m not suggesting you buy a Starbucks or anything, but the data is quite incredible. I know one thing, I’m not skipping my morning coffee.
(According to their data, 2,607 cases of depression were identified. That number seems really low so they may have set their bar quite high for what qualifies as “depression” and thus this relationship may really exist between caffeine and severe depression, I’m not sure.)
Real Story Behind Sybil and Multiple Personality Disorder
One the more popular pieces on the Bipolar Burble written by a guest author was Everything You Know About Dissociative Identity Disorder is Wrong by Holly Gray. In this article, Holly exposes some of the myths about dissociative identity disorder – previously known as multiple personality disorder. And, of course, multiple personality disorder was made famous by the book (and movie) Sybil.
As Holly points out, there aren’t really “multiple personalities” or multiple people, inside one person with dissociative identity disorder, so the name was a misnomer and based on some very bad information – much of it from Sybil’s very public case. And A Girl Not Named Sybil in the New York Times aims to explore some of the problems with the story of Sybil, now known to actually be a woman named Shirley Mason.
Among other things, Mason’s therapist prescribes drugs in an unhealthy (addiction promoting) way and repeatedly administers sodium pentothal (truth serum as it has been commonly known). The article seems to suggest that Mason may have been making some things up and her therapist may not have been acting ethically, possibly making Mason actually worse. Do read the article. It goes to show you how one very loud, possibly untrue, case can overshadow reality.
Bipolar Question and Answer Session
Now, really, I’m your question and answer girl. You have questions, I have answers. But perhaps you’d prefer someone with a Phd to talk to. Well then you might try Dr. Rob (yes, I know). He’s hosting a live bipolar question and answer session on October 24th. You can submit confidential questions now or do so during the live session. If I can find the time I might just take a gander myself.
Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:
- Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
- Brain changes are noted in depressed females
- Why are some doctors anti-benzodiazepine?
1. Free rTMS in Manitoba (Canada)
RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.
- Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
- Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary
Cost of RTMS
Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.
And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.
Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.
2. Brain Changes Noted in Depressed Females
Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.
. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.
BDNF and GABA in Depressed Brains of Women
BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”
And work toward identifying the gene that contributes to depression:
. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.
I keep telling people: We’re getting closer to effective treatments and understanding every day.
3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos
I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.
My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.
I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.
Until next week all, when I shall learn more and do better.
This week I learned three new things about psychotherapy and depression.
I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.
With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:
- Psychotherapy is no better than placebo in treating depression?
- Which type of psychotherapy is better for depression?
- How does psychotherapy change the brain?
1. Is Psychotherapy Better Than a Placebo in Treating Depression?
When the study came out a couple of years ago alleging that antidepressants were no better at treating mild-to-moderate depression than a placebo, the antipsychiatry world went crazy (if you will). All their dire claims, it seems, had been proven true.
Well, the sky hasn’t fallen yet, but interestingly the same kind of analysis, when applied to psychotherapy, can also allege that psychotherapy is no better than a placebo too.
Of course, there is no such thing as a placebo in therapy. There is no “inert” counselling session. Scientific literature attempts to compare cognitive behavioural therapy (CBT), interpersonal therapy (IP) and others against wait-listed participants and those who have received therapy not containing the specific therapeutic technique being tested. Basically, they tell a therapist not to therapy. Which is a pretty tough thing to ask a human to do. And naturally, humans aren’t going to do it well.
Does Psychotherapy Work to Treat Depression?
I would say yes, therapy, various types, including cognitive behavioural, interpersonal and supportive therapy, all help treat depression. However, some suggest the jury is still out on how effective therapy really is in treating depression.
2. What Therapy is Best for Depression?
[push]Psychologist Gary Greenberg states CBT is more of an ideology and a “method of indoctrination into the pieties of American optimism.”[/push]
When selecting a therapy for depression one has many choices but the prevailing one in the scientific community right now is cognitive behavioural therapy (CBT). Everybody loves it. It’s the golden child. CBT is a highly intellectual and analytical therapy that is short-term and action-oriented so it’s no wonder that people like it.
In the same article as the one talking about therapy effectiveness in the treatment of depression, they also discuss which therapy is best for depression, and it kind of seems like none of the therapies are best. (This could be because, statistically, some people respond better to one treatment while others respond to other treatments and when you lump them all together, a similar percentage responds to each.)
3. What Does Psychotherapy Do to the Brain?
As I have mentioned several times, depression decreases brain volumes over time – ie, depression shrinks your brain. It does this through decreasing neurogenesis (the creation of new neurons); however, electroconvulsive therapy (ECT) and antidepressants have both been shown to increase neurogenesis and brain volume.
Interestingly, so does psychotherapy.
Until next week all. I’ll learn more and do better.
It’s a bit of a short week what with the holiday and all, but still, there is time for three new things about mental health. Today’s three new things are:
- A safety warning on the atypical antipsychotic drug asenapine maleate (Saphris)
- Saffron and depression
- Multi-drug (polypharmacy) treatment of mental illness
Serious Allergic Reactions Reported with Asenapine Maleate (Saphris)
Asenapine maleate (Saphris) is an atypical antipsychotic drug recently approved for use in the treatment of bipolar type 1 mania and mixed episodes (as well as schizophrenia).
In slightly less than two years of approval, about 87,000 people have been prescribed asenapine maleate. The FDA’s Adverse Event Reporting System (AERS) has had a significant number of serious allergic (hypersensitivity) reactions reported. These serious allergic reactions were reported in 52 cases and are considered Type 1 hypersensitivity. From the FDA:
“Signs and symptoms of Type I hypersensitivity reactions may include anaphylaxis (a life-threatening allergic reaction), angioedema (swelling of the deeper layers of the skin), low blood pressure, rapid heart rate, swollen tongue, difficulty breathing, wheezing, or rash . . . Several cases reported multiple hypersensitivity reactions occurring at the same time, with some of these reactions occurring after the first dose of Saphris.”
Any such reactions require immediate medical attention.
You can report serious allergic reactions to the FDA’s MedWatch program here.
FYI, asenapine maleate’s label has been changed and updated with this new information.
Saffron (crocus sativus) is the most expensive spice by weight and is integral in French bouillabaisse. And someone asked me this week, “Can saffron help with depression?” Initially, I did a search on the Alternative Medicine Index at the University of Maryland Medical Center and turned up nothing. This alternative index lists most everything so my immediate answer to “can saffron help with depression,” was no.
However, I may have spoken slightly too soon.
Upon closer inspection I did find one study that asserts, in treating mild-to-moderate depression:
“Saffron petal was significantly more effective than placebo and was found to be equally efficacious compared to fluoxetine and saffron stigma.”
Now, hold on a minute. This is not a good, particularly scientific, study. This is just a review of studies, some of which are very questionable in nature. The above statement is premature at best. All that can really be said (in my opinion) is that saffron deserves further study and that some formulation of it might work.
Good question. This is called polypharmacy and most doctors agree it’s a bad thing. The reason polypharmacy is bad is because it greatly increases the chance, and severity, of side effects. (There are other reasons too.) People who have been through rounds of polypharmacy will tell you this is true.
However, doctors continue to prescribe many drugs simultaneously for a condition. This article explores why polypharmacy is so common.
The article may make you take a look at your drug regimen and talk to your doctor about reducing some of your medication. This isn’t always possible, but a good idea if you can get away with it.
Note on Polypharmacy
It’s worth noting some conditions do warrant polypharmacy.
According to the Psychiatric Times article, the best indications for polypharmacy are few and well established:
- Bipolar depression
- Psychotic or agitated depression
- Co-morbid conditions that require independent medications (e.g., ADD and major depression)
- When partial response to the first medication requires adding another adjunctively
- When there is a combination of psychiatric and pain problems
OK all. Until next week when I will learn more and try to do better.
This week’s three new things include:
- A new supplement that may help brain health and mental illness: l-theanine
- A poor comparison between rapid cycling bipolar disorder and the financial markets
- A new discussion of antipsychiatry
1. New to Me: L-Theanine as an Antidepressant
Maurya, a commenter, asked if I knew anything about l-theanine. Well, I didn’t. Every once in a while even I run across something of which I haven’t heard.
So, for those of you in my boat, here’s a bit about l-theanine:
- L-theanine is derived from green tea although we’re not sure of the best way to extract it.
- L-theanine has been studied on mice and seems to exert antipsychotic- or even antidepressant-like qualities.
- L-theanine is a glutamate derivative and loyal readers will know that I think glutamate will be a big player in mental illness treatment in the next few years. (N-acetylcysteine (NAC) also works with glutamate.)
- There is very little conclusive research on l-theanine, we really just have ideas about what it does; it may possibly be a stress-reducer
- L-theanine may improve cognitive impairment (a human study)
As always, as this is a supplement it is not FDA-controlled and there is no guarantee as to what you will get in the bottle and you should never take any supplement without first checking with your doctor.
More studies on l-theanine can be found here.
I’m a writer so questionable metaphors irk me. And rapid cycling bipolar disorder as a metaphor for the financial marketplace? Really? That’s a whole new level of irk.
If you really want to make that comparison then the bulk of the article should be on the markets and not mental illness, and not the other way around like Lloyd I. Sederer M. D. did in Rapid Cycling Bipolar Disorder: In the Office and On ‘The Street.’
Comments of Mental Illness Stigma
All this poorly-written article did was confuse people and elicit a bunch of anti-bipolar comments like:
“The foundation of the Bi-Polar epidemic is based in suppressed biochemistry, outdated understanding of genetics and a complete misunderstanding of our true spiritual nature.”
“So how exactly is this different from saying some people dramatically over-react to external circumstances?
Sorry folks, but this one goes into the notebook for the next philosophical discussion of “medicalization” as a way of discussing deviance.”
Seems to me he just wanted to use mental illness as an eyeball-grabber, tricking readers onto a topic they would never otherwise read – with the extra bonus of eliciting remarks of stigma.
3. What I Find Interesting – New Discussion of Antipsychiatry
As you might know, I’m not a fan of antipsychiatry folks. I have written a lot on this topic and I’m sure I will write much more in times to come. But I can across this article, Getting It From Both Sides: Foundational and Antifoundational Critiques of Psychiatry which has an interesting discussion of antipsychiatry viewpoints.
Two Sides to Antipsychiatry
It astutely notes there are two sides of antipsychiatry – those who feel that nothing can be defined and thus no mental illness can be defined; and those who feel illness is rigidly defined and mental illness doesn’t meet that definition.
Both sides, as the author says,
“. . . have had the effect of discrediting and marginalizing psychiatry and of delegitimizing psychiatric diagnosis and nosology.”
It’s a very intelligent view of antipsychiatry criticism that is elevated far beyond what we normally see online. Check it out.
Until next week: Smarter and Better.
In today’s 3 New Things series I talk about:
- A great resource for alternative medicine information
- A new St. John’s Wort and depression study
- A new “fad” diagnosis up for consideration in the Diagnostic and Statistical Manual of Mental Disorders Version V (DSM-V)
1. What I Don’t Like – Fad Diagnoses in the DSM
Psychosis Risk Syndrome (AKA attenuated psychotic symptoms) and Temper Dysregulation (AKA disruptive mood dysregulation)
See, I’m not a scientist, and I honestly can’t tell you with any degree of certainty these conditions don’t exist or that they shouldn’t be specifically diagnosed. I just don’t think so, particularly as they may be pediatric diagnoses. The concern expressed in the article* is that these diagnoses have little scientific backing and will lead to yet a further increase in prescriptions of antipsychotics to children (and others) – and that I can tell you with certainty, that I am against.
There are many issues with the new version of the DSM, due out 2013, some positive, some negative, but honestly, if I started writing about them it would take until 2013 to finish. Best to take a millimetre at a time, I say
2. What I Do Like – Alternative Medicine Index from the University of Maryland
I’m not a huge fan of alternative medicine, mostly because it, as a rule, doesn’t work. However, if you’re going to wander down that path, you need a reliable source of information and I believe the Alternative Medicine Index from the University of Maryland is it. Now, keep in mind, when you do a search for something you’re going to come up with multiple documents, and some of them are going to conflict, but nevertheless, it’s the best place I’ve found to look up the real information on alternative / supplement / herbal treatments.
3. What I Could Have Told You – St. John’s Wort Doesn’t Work for Depression
OK, technically St. John’s Wort doesn’t work better than a placebo in mild depression and earlier it was shown St. John’s Wort doesn’t work better than a placebo in moderately severe depression either. (There could be reasons for this, such as formulation and strength, but it’s what we know for now.)
Until next week when I will learn more and try to do better.
* As always, the Psychiatric Times articles require a membership – but it’s free.
3 Things I’ve Learned About Mental Health This Week
In a continuation of the 3 New Things series, this week follows up on the British Psychological Society’s critique of the Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-V), talks about irritable mood in bipolar disorder and expresses my general disdain for people who can’t report about mental health accurately.
1. Do bipolars know when they’re irritable?
Irritability is a symptom for both depression and mania/hypomania in bipolar disorder. This seems to suggest people with bipolar disorder run around biting the heads off of everyone we meet, but this isn’t the case. While I may feel angry and irritable, I, for one, can cover this up as I know it’s a symptom of the illness and not really me.
The interesting thing is, some patients don’t even consider themselves irritable because they have the ability to hide it. Note the following interesting quote:
Patients may not understand what elevated, or euphoric, mood means, so it may be necessary to define these terms. Similarly, the meaning of “irritable” may be unclear to patients. Many patients do not regard themselves as irritable if they can refrain from expressing their easy propensity to anger. Therefore, it is critical to emphasize that although the anger may not be expressed outwardly, the emotion of simply feeling irritable is significant.
From: Psychiatric Times, Mixed States in Their Manifold Forms: Part I
Which begs the question – do you ever consider yourself in an irritable mood? How do you know?
2. The British Psychological Society’s Critique on the DSM-V
Last week I asked if the British Psychological Society (BPS) was reputable as I questioned the motives behind their critique of the DSM-V revisions. It’s not that they don’t have their points, it’s just the points they’re making are copied-and-pasted to virtually every diagnosis either new to the DSM or not. It turns out my suspicions may have been wrong. The BPS does seem to be a genuine, reputable organization.
I came across an article in Psychiatric Times that explained issues with the BPS’s DSM-V critique beautifully – by blindly applying the same “feedback” to virtually every part of the DSM, their feedback has no weight at all and smacks of an agenda.
Even if they say something people should be listening to, it gets lost in the din of all the noise caused by putting the feedback where it doesn’t belong (article).
3. Reporting on Mental Health Issues is Appalling
I am not a reporter. I try to be a true, honest, accurate writer of credibility, but a reporter I never claimed to be. For actual reporters though, I rather think they have a higher bar.
Like, to write things that are accurate. Exhibit A:
The treatment [rTMS] hinges on the idea that every cell in the body has an electromagnetic field, and when this field is out of alignment, problems develop. RTMS then uses the highly focused magnets to realign a depressed person’s brain, and get it functioning properly again.
For the record, that is incredibly wrong and rather stupid. rTMS has nothing to do with cells having “electromagnetic fields” and there is no such thing as “realignment.” That all sounds like new age mumbo-jumbo which, in this case, takes actual science and turns it into nonsense. All I can say is that if you read something in the media, you’d better check out the facts yourself because it sure seems like the reporter isn’t going to bother.
rTMS uses a very strong, magnetic field that rapidly changes polarity to create an electrical current. This current activates neurons in a specific part of the brain just like electroconvulsive therapy, but without the cognitive side effects (or likely, effecacy rate).
Perhaps it’s too much to ask that a reporter understand those two sentences. Sheesh. (And for an extra dose of outrage, check out the comments, which can only be inflamed by the misinformation in the article.)
Until next week when I will learn more and try to do better.
Sometimes writing for a living drives me bonkers. Basically, I have to be brilliant on-command. And seriously. That’s hard.
You. Write. Be brilliant. Now!
It’s a lot of work for me. My brilliance gets tired and bogged down in the bits of my job I don’t like doing.
However, then I’m reminded there are many wonderful things about my job. Specifically, I get to learn new things, every day, all the time. While others work at real jobs I spend all day looking up facts and studies and learning things I didn’t know when I woke up.
I love that stuff.
3 Things I’ve Learned About Mental Health
So, I’m creating a weekly feature by sincerely flattering Jane Friedman and stealing her idea. (Jane writes Three Happy Things about writing once a week. Go check her out.) I’m not sure they will be three happy things, exactly, but I will be sharing three new things about mental health I’ve learned each week.
This will give me a chance to share smaller details that don’t make it into a full blog post, pimp the resources I like and otherwise share my knowledge.
On board? Great!
Three New Things About Mental Health
Not surprisingly, I’m inundated with information about mental illness/psychiatry/psychology. I’m constantly researching, reading articles, checking sources and other such things. I come across things I like and things I don’t.
- What I don’t like – the British Psychological Society’s comments on the revisions proposed for the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The British Psychological Society appears to be a non-profit group dedicated to psychology/psychologists. Which is fine. I’m a fan of psychology/psychologists. But their remarks on the DSM-V revision sound like propaganda nonsense. Not only can they not get through a paragraph without cutting-and-pasting, they seem to have only one thing to say – we don’t like the idea of diagnosing mental illness; oh, and we’re better than you.
- What I do like – a Psychiatric Times article: The FDA Advisory Panel on the Reclassification of ECT Devices. I wrote about this issue for Breaking Bipolar to put it into smaller, more easily-digested chunks. (Why There Isn’t More Modern Data on ECT and Should the FDA Consider ECT Devices Less Dangerous.) But read the original article. It’s good and shines a light on yet another ECT issue that get’s people’s knickers all twisted.
- What I think is interesting – a journal article on methods of schizophrenia treatment. This article is interesting because it outlines non-North American treatment options as well as standard antipsychotic/medication options. The article’s goal is to define schizophrenia recovery and use evidenced-based methods to determine the best path to schizophrenia recovery. Do yourself a favor and educate yourself about schizophrenia.
I do admit, those may not be easy reading, but they are worthwhile reading (or skimming, anyway).
I’ll see you next week when will I learn more and try to do better.
PS: If anyone has any direct knowledge of the British Psychological Society I’d love to hear it. They seem quite legitimate but I have to question the motives of such an odd report.