Churchill and the Stigma of Depression

This article is an interesting follow-up to the previous entry I made. I think that the author does an effective job teasing apart what works and for whom:​

In the case of depression, the core stigma is that depression is a weakness, a moral failing. That depressed people are soft, weak, pitiable. This attitude is specific to depression – not even bipolar disorder is seen in the same way, let alone the other diagnoses. They have their own stigmas. Depression’s is weakness.

Now this is why Churchill is a good counterexample. Not just because he’s famous or ‘great’, but because he was famously tough. He faced down Hitler. He was blood, sweat and tears. In the most famous photos of him (and they are famous, out of all his photos, because they correspond to the mental image) he is almost unsmiling – but never despairing. Just resolute.

I think the key here is the notion of Churchill being a counterexample ​and not just an example of someone with mental health difficulties being successful. It's the notion of opposite action in, ahem, action. By that, I mean that we have someone dealing with the syndrome of depression. Withdrawal, isolation, self-doubt are all part of this syndrome. What we see in someone like Churchill is that he's working to act opposite to those action urges. 

Perhaps what makes a good role model is to highlight someone doing behaviors that are specifically opposite to the action urges we're trying to deal with. Again, some research is needed here, but two articles to start the conversation.​

BBC: Do famous role models help or hinder?

​Apparently, last week was mental health awareness week in the UK. I didn't realize it at the time I bookmarked this article. 

Churchill might tell me something about the art of statecraft, or Fry about the pressures of fame and the joy of words, but someone closer to home, with a life more like mine and challenges more like mine, will tell me far more about a life with mental health difficulty and how best to live it.

I always wonder what one "should" do with respect to role models in mental health and I think it probably comes down to individual characteristics about what makes most sense in treatment. I'm sure there's a research study or two about this issue so I'll see if I can track one down and post about it in the near future.

Please see this post for a follow-up.​

You've to move it move it.

My son has a birthday card he got from his grandparents. It's one of those annoying singing birthday cards that have no audio fidelity at all but makes a 4 year-old crack up. The song is I like to move it. (by a band I've never heard of called "Reel 2 Real".) Whatever the band's name is or the degree of annoyance of the song, it's a catchy tune and an apt title for this post. The NYT reports:

Each volunteer exercised for four months, while continuing to take an antidepressant. At the end of that time, according to the study published recently in The Journal of Clinical Psychiatry, 29.5 percent had achieved remission, “which is a very robust result,” Dr. Trivedi said, equal to or better than the remission rates achieved using drugs as a back-up treatment. “I think that our results indicate that exercise is a very valid treatment option” for people whose depression hasn’t yielded to S.S.R.I.’s, he said.

I like to think of early depression treatment as targeting one or more of the areas affected by Major Depressive Disorder:

1. Cognitive
2. Somatic (physical/energy levels)
3. Sleep
4. Emotional
5. Motivational

There are others things that need to be targeted but the majority of patients in early treatment for depression have a lot of work to do one one or more of those areas and it's extremely relevant to their situation. It's nice to see something so clearly affected by depression, yet so incredibly simple to do, gets continued attention in the press and research literature.

Depression and physical activity

A while back, I bookmarked an interesting article (pdf link) that I've been meaning to write about. As I haven't had a chance to really digest the material and compose a longer entry, I thought I just get it up on the site for wider consumption. The gist of the research highlighted therein is that Tai Chi Chih seems to have a positive impact on geriatric depression. Given the relative reluctance some geriatric patients have to psychotherapy and the complicating factors of drug interactions, anything we can do to help that doesn't involve traditional medication management and/or psychotherapy is welcomed. The question remains what is the mechanism of change for this particular intervention. I suspect that it's a result of the increased ability to focus on an activity and the consequent ability to focus away from unwanted ruminations that helps, but that's just my slightly biased-towards-mindfulness explanation.

Depression isn't forever, but like an unwelcome houseguest, it finds its way back. Be ready.

As I was digging through the articles I've collected to read and post about, I came across this one with some research conducted by some local mental health professionals, amongst others. The study described in the article was a large multi-site data analysis in which adolescents with a Major Depressive Episode were followed-up over the course of several years after treatment. The researchers found that:

• recovery rates were good, with 96.4% of participants recovering during the follow-up period, with over two-thirds recovering during the first year of treatment.
• treatment modality was unrelated to recovery.[1]
• nearly half of those who recovered had a recurrence of symptoms within 5 years.

We've long known that a past major depressive episode predicts a future one. As a result, this finding is not surprising. What is interesting about the research here is that there is a predictive factor of both gender and co-occuring anxiety disorder.

As far as clinical implications go, this finding highlights the importance of skills acquistion for self-recovery after the completion of therapy by a trained professional. In addition, the should focus not just on the management of the depression symptoms but also of the anxiety features present. I'd like to see more follow-up on specific types of therapy and the longevity of their effects, but longitudinal study is hard and expensive, so we may never get to see that clinical application of these findings.

Depression isn't forever, but like an unwelcome houseguest, it finds its way back. Be ready.

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Footnotes: [1] This was not a study looking at the efficacy of various types of treatment, just a look at the efficacy of all treatments. The treatment options for participants in this study received either Cognitive Behavioral Therapy, fluoxetine (prozac), a combination or a placebo.

Talk is cheap (and effective)

MSNBC reports on suicide in the Native American Community:

"Let's say that all your emotions are in a glass of water. When somebody bullies you, dump out a little bit. When somebody offers you drugs and you take those drugs, and then somebody tears you down because you used drugs, pour out a little bit. Eventually that glass of water is going to be empty and that's kind of like your self-esteem. You're going to be empty, so you're going to try to commit suicide," said A.J. Hollom, a 14-year-old student.

The thing that's so sad about adolescents killing themselves is that it's so readily preventable. Teens experience the entire range of emotion but don't have the entire repertoire of coping skills needed to handle them. There are very effective treatments for suicidal adolescents and my method chosen method of treatment, Dialectical Behavior Therapy, is one of them.

For parents, therapists or concerned others, I recommend Dialectical Behavior Therapy for Suicidal Adolescents. I have spoken to the authors and listened to them give lectures and it's a great resource. The book is targeted at clinicians, but it's important for caregivers to be informed, too. If you've got other suggestions for books or resources, please mention them in the comments!

Prevention tips: exercise during leisure time

The BBC reports:

People who were not active in their leisure time were almost twice as likely to have symptoms of depression compared to the most active individuals, the study found.

This finding is hardly surprising, but the researchers point out two particular tidbits that may be new:

1. Exercise during leisure time is the important part, not just physical activity in general.
2. The intensity of the exercise appears to be unrelated to its protective effects.

That means it's time to get up and get moving, even if it's just a little while for a little bit.

Depression in pre-schoolers

It is probably really easy to scoff at the notion of depression in pre-schoolers and write off irritability (which can be a manifestation of sadness) as kids being difficult, but there is a qualitative difference between being crabby or sad and clinically depressed. The NY Times writes:

parents tend to feel responsible. Children of depressed parents are two to three times as likely to have major depression. Maternal depression in particular has been shown to have serious effects on development.

Keep in mind that these are just probabilities and stats and don't mean that every child of a depressed parent will be depressed. The Times continues:

But it’s easy to overstate the role of maternal depression. “Most kids of depressed parents don’t get depressed,” says Arnold Sameroff, a developmental psychologist at University of Michigan’s Center for Human Growth and Development, who has studied children of parents with mental problems.

The bottom line with this issue is that you need to trust your parental intuition. If you suspect your child isn't just being a 3 year-old, ask a professional.

PSA for Paxil CR users

The New York Times reports:

Some of the antidepressant Paxil CR produced at the plant was ineffective because a layer of active ingredient split from a layer of a barrier chemical during manufacturing, the government said, and some lots contained only the barrier chemical.

This is obviously quite concerning for some of the readers of this site. The good news is that the drugs were all manufactured between 5 and 9 years ago, so you probably don't have any more of it. Please read the press release for more information.