Posted by: jedwardswright | April 10, 2012

Sleep Disorders and Depression

Most people with depression will not be surprised to hear that there is a relationship between sleep disorders and depression. Insomnia or hypersomnia (excessive daytime sleepiness) are often listed as symptoms of Major Depressive Disorder (MDD).

Generally the inference is that depression causes sleep problems. While this is true, because the connection between the two is complicated, it is also possible that sleep disorders contribute to depression. In fact, evidence suggests that people with insomnia are ten times more likely to suffer from depression.[i]

Other sleep disorders associated with depression are Restless Legs Syndrome (RLS), narcolepsy and Obstructive Sleep Apnea (OSA).[ii] A recent study from the Centers for Disease Control and Prevention found an association between OSA and major depression, regardless of weight, sex, age or race.[iii]

‘”Snorting, gasping or stopping breathing while asleep was associated with nearly all depressive symptoms,”’ according to Anne G. Wheaton, lead author on the study.

Proper medication has a good track record of treating Restless Legs Syndrome. OSA can usually be successfully treated. While sedating medications are only recommended for short-term use in the treatment of insomnia, tricyclic antidepressants may be helpful in relieving sleeplessness for some patients. In the case of OSA, however, sedating antidepressants could worsen the condition, so it is important to have an accurate diagnosis of the particular sleep disorder involved.[iv] Instead a CPAP (Continuous Positive Airway Pressure) which uses a steady mild airflow through a facemask is usually recommended for OSA.

If you suspect that a sleep disorder could be contributing to your depression, speak to your family physician about the possibility of having a sleep study done. It is a simple, non-invasive test that only requires one night out of your schedule, and it could benefit your health immensely.


[i] “Depression and Sleep,” National Sleep Foundation. http://www.sleepfoundation.org/article/sleep-topics/depression-and-sleep

[ii] “Depression and Sleep,” National Sleep Foundation. http://www.sleepfoundation.org/article/sleep-topics/depression-and-sleep

[iii] American Academy of Sleep Medicine. “Survey Finds Association Between Symptoms Of Obstructive Sleep Apnea And Depression.” Medical News Today. MediLexicon, Intl., 1 Apr. 2012. Web.

10 Apr. 2012. http://www.medicalnewstoday.com/releases/243572.php

[iv] “Depression and Sleep,” National Sleep Foundation. http://www.sleepfoundation.org/article/sleep-topics/depression-and-sleep

 

Posted by: jedwardswright | March 27, 2012

Decision-Making and Depression

In a study published by PLos Computational Biology, by researchers at University College London, participants (all without clinical depression) were asked to make a series of decisions involving a maze and money. Choosing certain pathways penalized the players at the beginning of the game, but led to greater rewards later on.

It was found that the players who avoided the initially negative pathways despite the possibility of future gain reported a greater number of depressive symptoms than the players who took the risks and got the bigger pay-off.

The researchers called this decision-making process “pruning.” When faced with hundreds of options, one method of determining which choice to make is to rule out the possibilities that involve initial discomfort.

For instance, a person might choose to buy a car because it is cheaper initially, even though the vehicle has a reputation for needing more repairs over time. Even though this is a poorer choice in the long term, a person who is pruning based on the avoidance of short-term loss to may at first think that it was the better decision.

There are two obvious conclusions that could be reached from this study. One is to conclude that the tendency of depressed people to make bad choices contributes to depression. Another is that when people are depressed they are so conditioned to avoid pain that they automatically rule out difficult choices despite any long-term benefit.

I originally favored the second interpretation, knowing how sensitive those of us with Major Depressive Disorder are to enduring further pain, but on considering the matter further I now think that this is a “chicken and egg” situation.

I believe that depressed people get into a cycle of avoiding difficult choices with immediate pain but long-term gain because their burden of pain is already so heavy to bear. Eventually, when they realize that they have made bad decisions and missed opportunities their regret adds to their misery.

Our avoidance of uncomfortable situations or painful effort is costing us – big time. The major question then is how do we get ourselves past our initial difficulties to reap greater rewards?

Whether it is going through the rigors of exercise in order to reap the benefits of a healthier body or getting past a fear of flying to reunite with family members, what difficult decision is keeping you from experiencing long-term rewards?

References

Grace Rattue. “Depression And Bad Choices Linked To Bias In Decision-Making.” Medical News Today. MediLexicon, Intl., 8 Mar. 2012. Web.

27 Mar. 2012. http://www.medicalnewstoday.com/articles/242676.php

Public Library of Science. “Decision-Making, Poor Choices And Depression.” Medical News Today. MediLexicon, Intl., 11 Mar. 2012. Web.

27 Mar. 2012. http://www.medicalnewstoday.com/releases/242697.php

 

Posted by: jedwardswright | March 21, 2012

Social Anxiety Disorder

Everyone experiences anxiety to some degree, but some people avoid certain social situations to the extent that it interferes with their daily lives. People with Social Anxiety Disorder live in such fear of everyday activities like speaking in public, starting conversations with strangers, or using a public restroom that panic sets in at the thought of carrying out those activities.

This distress is expressed by symptoms like trembling, blushing, crying, even nausea or diarrhea. Once these reactions begin the individual’s horror at the likelihood that they are being judged escalates even further, and a full-blown panic attack may set in, embarrassing the person even further.

A person with Social Anxiety Disorder realizes that this extreme fear is irrational, but that knowledge does not help. The terror becomes obsessive, and thoughts like “They are all looking at me,” “I am going to make a fool out of myself,” or “What if I fail?” spiral endlessly through that person’s mind.

While it may be possible to escape anxiety-producing circumstances for a while, and thus avoid the onset of symptoms, inevitably an unexpected situation will arise and then the fear reaction will be worse than ever. For this reason it is best to seek treatment for Social Anxiety Disorder rather than continue to dodge uncomfortable situations endlessly.

Treatments for Social Anxiety Disorder fall into two categories: psychotherapy and medication. Most experts recommend both. Cognitive Behavioral Therapy (CBT) focuses on changing your pattern of thinking about stressful circumstances. The medication most often suggested is some type of selective serotonin reuptake inhibitors (SSRIs). These drugs are non-addictive and very effective in the treatment of social phobia.

Please check the following resources for more information.

Resources on Social Anxiety Disorder

Mayo Clinic Social Anxiety Disorder: Symptoms

examiner.com What is social anxiety? by Gregory Pacana

WebMD Just Shy or Social Anxiety Disorder? by Gina Shaw

WebMD What is Social Anxiety Disorder?

SP/SAA Social Phobia/Social Anxiety Association

Posted by: jedwardswright | March 14, 2012

Inflammation, Immunity and Depression

Our brains interact with every function of our bodies, which is why it is often difficult to isolate particular relationships. Recently, however, some researchers and physicians are noticing a relationship between one of our bodies’ defense mechanisms and depression.

According to several studies, hormones released by the immune system and markers related to inflammation “were positively correlated with depression.”  Simply put, the more depression we experience, the more inflammation will accompany it.[i]

Most of us with depression are well aware that aches and pains accompany our brain illness, and so will easily see the link between inflammation and depression, but but we may not be aware that depression often co-exists (or is “co-morbid”) with many other inflammation/immune disorders such as heart disease, diabetes, Chrone’s disease, autoimmune diseases, cancers, HIV, and Multiple Sclerosis.[ii]

A proposal published online in the journal Molecular Psychiatry even suggests that depression is a by-product of an evolutionary development intended to fight off infection, since inflammation is like an over-reaction by the immune system. Even when people with depression aren’t fighting an infection, their levels of inflammation are higher than normal.[iii]

Since stress can activate the immune system, it makes sense that depression is linked to the immune system response called inflammation. Some research actually suggests that by decreasing inflammation, depression can be reduced.[iv]

This evidence that depression and the immune system may be linked could lead to new approaches in the fight against depression.

Posted by: jedwardswright | February 28, 2012

Fathers with Depression

Women have sudden and serious hormonal changes after childbirth, so it makes sense that many suffer from post-partum depression. Throw in the major life-changing circumstances that new mothers experience—being on maternity leave, loss of sleep, isolation—and it becomes clear that both physical and circumstantial factors would create a very stressful time in the first few years of motherhood.

Do new fathers experience a form of post-partum depression too?

Obviously we can rule out the hormonal issues that women face, but new dads also face new challenges and fairly drastic lifestyle changes as well. Their partners are suddenly absorbed in taking care of a newborn, and fathers traditionally consider the financial well-being of the family to be primarily their responsibility. Fathers may also face sleep disruption, and increasingly modern dads are more involved in the day-to-day care of their children.

In fact, research has shown that depression is more likely in fathers (as well as mothers) during their child’s first year of life,[i]  and particularly during the three month to six month stage.[ii]

In an article published in February in the online edition of Maternal and Child Health Journal, a team led by Micheal Weitzman, M.D, professor of medicine at the New York University School of Medicine found that of the factors they studied, paternal unemployment was the greatest predictor of depression in new fathers, followed by maternal depression.[iii]

It is predictable then that new dads without jobs or trying to cope with their partners’ post-partum depression will be prone to depression. (I would suggest that under-employment would be a likely risk factor as well.) This is valuable information for family doctors or pediatricians to keep in mind when interacting with new parents.

While the previous study was primarily concerned with the predictably negative impact of fathers’ depression on children, it seems to me that we should be concerned about paternal depression anyway, not only for its impact on the family but also because depressed fathers deserve to have their mental health considered as important too.


[iii] Grace Rattue. “Fathers With Depression – Who Might Benefit From Screening?.” Medical News Today. MediLexicon, Intl., 28 Feb. 2012. Web.

28 Feb. 2012. <http://www.medicalnewstoday.com/articles/242245.php&gt;

Posted by: jedwardswright | February 22, 2012

What If There Was a Blood Test for Depression?

If you have depression, then it is likely somewhere along the way you have met someone in the medical profession who cast doubt on that diagnosis. You almost certainly have been told by friends, family or even acquaintances that if you would look on the bright side or try harder you would be just fine.

What if there was a reliable, scientific test that could indicate the presence of depression, not unlike getting your blood sugar checked?

Recently, the journal Molecular Psychiatry published an article that indicates such a test may become available before too long. A team of researchers concluded “that a test analyzing levels of nine biomarkers accurately distinguished patients diagnosed with depression from control participants without significant false-positive results.”[i]

How accurate were their results? Researchers were able to identify the blood samples of depressed patients from those of control groups with a sensitivity of 90 percent.

So far only a small study has been done, so larger clinical trials are still required to further assess the practicality of using the test in a larger population, but the results are very encouraging.

This test is different because it uses a formula to take nine separate biomarkers, including some associated with stress and inflammation, to calculate a score measuring from one to ten, whereas previously tests had tried to measure only one biomarker at a time. It is the combination of these factors that makes the test more accurate.

Imagine being able to go to your doctor or medical lab, having blood withdrawn and a short while later having measurable proof that there was something wrong with you!  Patients with depression would be diagnosed sooner, the doubters could be proven wrong and we would have the satisfaction of having tangible scientific data to support our claims that we feel terrible.

It may still take a while for the test to reach a doctor’s office near you, but isn’t it nice to know that a test for depression is more than a theoretical possibility? The next generation may never know the added stress of being grilled over whether or not their symptoms are real, and the stigma surrounding depression would hopefully be decreased.

I look forward to that day.


[i] Massachusetts General Hospital. “Depressed Patients Accurately Distinguished From Healthy Controls By Blood Test.” Medical News Today. MediLexicon, Intl., 3 Feb. 2012. Web.

21 Feb. 2012. <http://www.medicalnewstoday.com/releases/241100.php&gt;

Posted by: jedwardswright | February 15, 2012

Bullying and Depression

Every so often a study comes along that seems to prove what I knew all along. I’m betting that you knew it from experience too.

A recent study published in Child Development[i] found that adolescents with depression are more likely to be bullied by their peers because they have trouble establishing friendships. This study’s relevance comes from their conclusion that maybe after all kids aren’t depressed because they are bullied, but bullied because they are depressed

This conclusion was reached after no less than 20 years of data obtained by surveying 4th to 6th graders, their parents and teachers. Children who were depressed in 4th grade were being ostracized by fellow students as early as Grade 5 and had a hard time “fitting in” in Grade 6. This was even truer of girls than boys.

You and I can probably fill the researchers in on what happens in subsequent grades, if they don’t already know. Depressed children entering the teen years become loners, pushed more and more into the outer circle of high school society. The more depressed a teen is the more likely that he or she will become an outcast or scapegoat.

I have observed as a teacher that, particularly in the 7th to 10th grade, students reminded me of a wolf pack as they turned against the weak and defenseless among them, even sometimes literally circling or cornering a trapped victim, then verbally, or even physically, delivering blow after blow.

Adult society has enough difficulty accommodating people with differences. With the overwhelming pressure to conform that exists in teen culture, is it really that surprising that nonconformity is punished even more severely in middle and high school?

Depressed children and teens are the walking wounded, so not only are they likely to attract bullying, they also suffer intensely when insulted or browbeaten. What I would like to tell the authors of this study is this isn’t an either/or question that they are posing.

Yes, initially children attract bullies when they are depressed, but they also become more depressed because they are being bullied. This is not just a cause and effect situation; this is a cycle which develops into a downward spiral.


[i] Christine Kearney. “Depression Linked To Adolescent Bullying.” Medical News Today. MediLexicon, Intl., 11 Feb. 2012. Web.

15 Feb. 2012. <http://www.medicalnewstoday.com/articles/241531.php&gt;

Posted by: jedwardswright | February 9, 2012

Does Spanking Contribute to Depression?

My mother spanked me when I was a child. I spanked my own children at times when they misbehaved.

I never considered that admission to be particularly controversial. Certainly later as a teacher I learned many non-physical methods of discipline that I wished that I had known about when my own kids were small, especially preventative measures. Definitely if I had to do it over again I would spank less, and perhaps not at all.

However, I didn’t think that being spanked had a significant bearing on my becoming depressed, nor did I believe that a little corporal punishment along the way was detrimental to my children’s healthy development.

Now along comes a research study that has me questioning all that.

In a recent article in the Canadian Medical Association Journal (CMAJ) reports that research over the past 20 years overwhelmingly indicates that physical punishment of children not only makes them behave more aggressively and show more antisocial behaviors, but also lead to mental health problems, including depression and anxiety.[i]

According to the article’s authors, Dr. Joan Durrant of the Department of Family Social Sciences, University of Manitoba, and Ron Ensom of the Children’s Hospital of Eastern Ontario, when parents in 500 families were taught to use non-physical methods of discipline, their children’s negative behaviors decreased.

My first thought is that physical punishment can encompass many things, from being slapped across the face to a gentle paddling on the bottom. Let’s assume for the sake of argument that the parental behavior being targeted was in fact spanking a child with the hand. This would indicate that not only have generations of parents gotten it wrong, but that generations of children may have suffered from mental illness as a result.

I do remember being spanked as a traumatic experience that sometimes left me sobbing hysterically well after the paddling was over. Quite honestly, I had associated my distress with the humiliation of my mom’s insistence on spanking me on my bare bottom. Maybe there was more to it than that.

While I remain convinced that genetics plays a major role in determining whether or not we have depression, I do think that our childhood experiences and trauma as adults can be a large contributing factor to mental illness.

What do you think? Are you of the “It never did me no harm” school of thought, or do you genuinely feel that being spanked (or not) contributed to whether you became depressed?


[i] Canadian Medical Association Journal. “A Child’s Long-Term Development May Be Harmed By Physical Punishment.” Medical News Today. MediLexicon, Intl., 7 Feb. 2012. Web.

9 Feb. 2012. <http://www.medicalnewstoday.com/releases/241245.php&gt;

Posted by: jedwardswright | February 2, 2012

Anxiety and Me

For me, anxiety and depression go hand in hand. They are soul mates who are rarely found apart.

 Doubt and despair have so much in common. Where doubt produces fear, despair extinguishes hope. Self-doubt paves the way to depression with whispers: “You knew you couldn’t do it,” “You’ll never amount to anything” and “You’re a failure, you know.”

My faith is a counterbalance to the negatives going on in my head, and without it I might easily succumb.

Still, I need strategies to fight back against the darkness. Usually these amount to replacing the negative thoughts with positive, and reminding myself what God says that challenges the statements rolling around in my head.

Recently, I tried something new which might seem to contradict this approach. Rather than fight my anxiety straight on, I let it have it’s say and exposed it to the light of day.

Here is what I did.

I wrote at the top of a page in a notebook, “Things I am anxious about today,” then began a point form list of my worries and fears. Filling the page was easy. Afterwards, I sat back and looked at my assembled terrors and found that they looked less threatening. I felt a little lighter for the experience.

One of the things I discovered was that a number of my anxieties were contradictory. For instance, I wrote both “I am afraid that we won’t sell the house,” and “I’m afraid that we will sell the house.” I had myself covered either way. No matter what happened, I would be anxious about it!

By revealing the absurdity of my fears, I felt better able to deal with them. It all seems less serious somehow.

I thought at the time I might write in my “Anxiety Notebook” every day, or every week perhaps, but so far I haven’t felt the need to go back, and it has been about seven days or so. I imagine that I will feel the need to uncover my fears again before long though, so I am keeping that notebook handy.

Maybe something like that would help you too.

Posted by: jedwardswright | January 24, 2012

Autism and Depression

Simply because someone is diagnosed with one condition does not mean that he or she does not have other identifiable disorders. Autism is difficult enough, but when combined with depression the impact is greater still. Obviously, it is more challenging to detect or treat depression in people with communication difficulties.

Depression is considered to be more prevalent among people with autism than people in the general population[i] and in fact depression is thought to be the most common psychiatric illness of persons with autism. [ii]Whether that is more because of the stress of living with autism or a genetic predisposition towards depression is still hard to determine, but it has been demonstrated that, like most of us with depression, autistic individuals with depression are more likely to have depression in their families.[iii]

Circumstances which may contribute towards depression in people with autism include the knowledge that they are different from others, difficulties with social interaction, loneliness, feelings of failure, and extreme anxiety.  Sexual frustration may also be a factor in teenagers and adults.[iv]

In addition to the usual symptoms of depression (e.g. sleep problems, increased or decreased appetite, tearfulness or social withdrawal), a person with autism may exhibit an increase in behaviors such as hand flapping,  echolalia, or rocking, or displays of inappropriate emotions.[v] They may be more susceptible to catatonia, which typically is expressed as slower movement and a decrease in self-care, or show greater obsessive-compulsive behaviors. Increases in aggression may also be symptomatic of depression[vi] and so can a decrease in interest in usual preoccupations.[vii]

Depression is thought to be more likely with age, so during adolescence it may become more prevalent. In the case of persons with Asperger’s Syndrome or other high-functioning autism the change to high school or college may be a particularly stressful time when depression can appear.[viii]

Some evidence suggests that the higher functioning a person with autism is the greater the odds of being affected by depression, but this is still speculation at this point. It is known that higher functioning people with autism are more prone to low self-worth, which would fit with this theory.[ix]

As for treatment, “most studies advocate the use of a structured form of psychotherapy, along with appropriate behavioral and educational interventions. In more able and older persons with autism, cognitive-behavioral strategies may help to cope with anger and depression, although these are seldom successful in isolation.” While medication is increasingly being prescribed for the treatment of persons with both autism and depression, this appears to be as a result of the known benefits for others with depression rather than any research on their effect on people with autism in particular.

While treatment for depression is not intended to treat autistic symptoms, it is likely to provide a better quality of life for both the person with autism and depression and reduces the level of support required from the family and community.[x]


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