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.

Text messaging can help save your life, too.

There has been no end of bad press for the scourge of text messaging. You can hardly listen to the news or read a newspaper without stumbling upon some other negative consequence of texting. There are clearly some issues with text messaging, from the danger while driving to the inordinate amount of time some people spend doing it. So, finally, texting has found a little bit of positive news in a pair of studies out recently. Text messaging helps smokers break the habit:

"Text messaging may be an ideal delivery mechanism for tailored interventions because it is low-cost, most people already possess the existing hardware and the messages can be delivered near-instantaneously into real world situations," said the study, which is scheduled to appear this week in Health Psychology, the journal of the American Psychological Association.

There is so much value in getting therapy out of the office and this study highlights why it is key. Behavior change needs to occur in your context, not in the context of a therapy room. We like immediate gratification and if there's some way to help with that immediacy, treatment is going to be much more likely to be successful.

More disheartening treatment utilization news

The NIMH reports on a recent study released in Archives of General Psychiatry:

About 3 percent of U.S. adolescents are affected by an eating disorder, but most do not receive treatment for their specific eating condition, according to an NIMH-funded study published online ahead of print March 7, 2011, in the Archives of General Psychiatry.

While the data on the success of treatment for an eating disorder in adolescence is unclear, the fact that most of anyone suffering from a major mental disorder isn't getting treatment is quite disturbing. Given the extremely powerful reinforcement contingencies in place for an eating disorder, earlier intervention is needed.

Bipolar disorder vastly undertreated

Reuters reports on an issue that has been troubling me for some time: the under-treatment of serious mental health conditions. Along with schizophrenia, bipolar disorder is responsible for a phenomenon called downward social drift that we see occur as a result of major mental illness.

Bipolar disorder is responsible for the loss of more disability-adjusted life-years than all forms of cancer or major neurologic conditions such as epilepsy and Alzheimer's disease, primarily because of its early onset and chronicity across the life span," Kathleen Merikangas of the National Institute of Mental Health and colleagues wrote in the Archives of General Psychiatry.

I think the Affordable Care Act will help in this respect since we may be able to see a time when one's health insurance isn't tied to being employed at a place that offers benefits. It would be very difficult for someone with a condition like bipolar disorder or schizophrenia left under/untreated to hold a full-time job long enough to get benefits. It happens far too frequently and with the mental illness untreated, the likelihood of holding a job with benefits decreased. It's an awful cycle and one that does not end well for anyone - the sufferer or society at large.

Where has all the psychotherapy gone?

In "Where has all the psychotherapy gone?", the APA Monitor asks:

"Don’t you love ‘If your antidepressant isn’t working … try Abilify!’? How about: ‘If your antidepressant isn’t working, try psychotherapy!’"

The author highlights disturbing trends in spending by drug companies and how insurance companies are encouraging the use of medication over psychotherapy. I believe this to be to the long-term detriment of patients and the insurance companies themselves. After all, we all already know how to take pills. It's the skills we need to actually make real changes in our lives. Medication is an extremely useful adjunct to therapy, but it should not be a replacement for it.

Forbes.com: The Forgotten Patients

Forbes magazine has a lengthy article on suicidality and its treatment. The magazine reports:

Wixom spent the next year in group and individual sessions learning practical skills to manage her emotions so that they didn't spiral out of control. They included distress tolerance techniques like plunging her head into ice water, devising ways to distract herself when bad thoughts arose and learning not to leap to the conclusion that one bad day implies a life of misery. She has not been hospitalized since. "DBT is the best thing in the world. It changed my life," says Wixom, who got married halfway through therapy and is raising two daughters, ages 10 months and 2 years.

The article discusses the difficulty in finding support for the treatment of suicidality but does highlight the importance of not ignoring the issue. Related to the purpose of our practice, however, is the prominence of DBT in the treatment of chronic suicidality. There is help, you just have to know where to find it.