There's a full moon behind those clouds

Weatherwise, we've settled into a dark, chilly, rainy stretch, but that kind of weather doesn't have to take us hostage. Overall, most aspects of my life continue to improve.

I attended a technical writing conference a couple of weeks ago and a seminar on patents and trademarks last week. Both were exciting, not only for the content, but, more particularly, for reconnecting with some dear friends and former colleagues. I did experience a couple of off days after the conference, a result of getting too far out in front of myself, I suspect. The seminar, as I mentioned, was very good and we followed it up with a visit with my wife's cousin in upstate New York. (I tangentially wrote about the trip in this blog post.)

During this stretch, I passed a couple of milestones, including a birthday, which were noted quietly. I've tried to participate in activites, some new, some not, that get me outside of the house and outside of myself.
In a couple of weeks, I plan to attend a high school reunion. I'm really looking forward to seeing a few people. (There are also a few folks I wouldn't mind not seeing. I skipped the reunion 10 years ago. One guy from my high school, and one with whom I share a birthday, ran into Mike and said that if I missed this reunion, he'd kick my ass. That's not the reason I'm going and is almost the reason that I'd decide not to go.)

I'm nervous about it because I don't always do well in crowds and because it may not be easy to explain what I'm doing and why. Folks who coach us in job searches encourage us to develop an elevator statement - Imagine that you meet a hiring manager in an elevator. What would you say about yourself in the small number of minutes that you're in the elevator with that person. So far, here's what I have for the reunion:

I've taken early retirement for medical reasons. I'll then go on to talk about my marriage, children, grandchildren, parents and in-laws, and some of my other activities, such as Joseph's Project.

My sleep is still irregular. I have an appointment with my primary care physician next week and will ask him about a referral to a sleep specialist. My psychiatrist and I agree that we've done about all that we can with medications at this point, so it's worth looking at other angles.

While walking, I usually listen to music. This line from Bob Dylan has stayed with me: "Gonna forget about myself for a while, gonna go out and see what others need."

Depression expert: Finns should use more medications

A British professor says that, while antidepressant use in Finland has increased ninefold in the past 20 years, it's still not enough.

What's here already

We're still twiddling the knobs on meds and other factors that might be affecting my sleep. My spirit remains good overall, although several days of bad sleep will leave me cranky and discouraged. It's a good time to practice gratitude, not only redirecting my thoughts away from the sources of unhappiness, but also finding joy in each instance. When out shopping, for example, I don't have to feel that that woman left her shopping cart in my way just to annoy me. Instead, I can say, "Oh, look. There's a two-for-one deal on oatmeal."
Unlike times past, I do have enough strength to have some control over how I feel. That, in itself, is a source of gratitude and relief.
Perhaps the biggest change is that I'm getting outside of the house, outside of my routine and comfortable patterns. I'm taking a course through a local college's continuing education program for seniors. I may have a regular, though unpaid, blogging gig for realworcester.com. We went to Matt's and Mike's football games (in the rain), attended Lily's birthday party, and had dinner at Mike and Lynn's last night. Next month, I'll attend a seminar on patent research in Albany, a program suggested by an attorney friend for whom I may do some contract work.
There still isn't anything that I could describe as an ordinary day. I could and sometimes do get discouraged, but it's better for me to refocus on how far I've come and how much support I have around me. Good parents know how to redirect the attention of an upset or misbehaving child, a technique that I can use even when the recalcitrant child is me.

Licenc(s)e to pry before licenc(se) to drive

Service Nova Scotia now requires people renewing their licences to indicate on an application form if they’ve had a "psychiatric or psychological condition."

People who indicate yes — even if it was something such as a bout of depression — are asked to provide more specific details and then must have a doctor complete a medical, sharing what’s usually confidential information with the government.

From Critics: Don’t tie driver’s licence renewal to psychiatric history
via TTWS -Baby You Can't Drive My Car

What is this sleep thing of which you speak?

I am continuing to improve. I have more good days than not. The troubled days are rare and rarely severe. The troubles usually come unannounced. I can take me until mid-morning to be able to say, "Oh, that's what's happening." At that point, I set down whatever breakable objects I might be carrying and find a chair.
My BDI scores occasionally show numbers that are typical of what you'd expect from someone who's listened to too many Leonard Cohen tunes. I'm tolerating the meds well and some of the side effects are starting to recede.
Nevertheless, sleep remains a mystery. We started keeping track of the times that I ate and took the meds in the evening, thinking that we might be able to determine why I fall like a brick some nights, only to wake in a few hours, unable to re-doze. The last two nights, I've not been able to get to sleep until well after 1 and then, as evidenced by the timestamp on this note, wake a short while later.
My spirits, for the most part, remain good, hopeful, and my days are productive. A few months ago, two nights of bad sleep would have been devastating. Today, i have more tools and experience to deal with such nights and days.
I should note (and I don't mean to be submissive to any suggestions, hoping that I'm not sounding like "I've tried everything and nothing works for me.") that I practice lots of different techniques to help with sleep: meditation, breathing exercises, relaxation response, sleep hygiene habits, little or no caffeine after noon, 'n such.
A number of years ago, I went to an acupuncturist. After several sessions that led to little relief, the acupuncturist remarked that my soul was wandering. He meant it as a statement of resignation (his treatment hadn't worked) and apprehension. Me? I think of it as a Yoda-like figure, traveling through the woods and across open spaces. There will be nights for good sleep. This wasn't one of them.

[Update: here's a summary of The 11 Kinds of Insomnia.]

Powered by ScribeFire.

Finding the Right Way To Disclose a Disability

I've been in touch with friends and former managers to talk about the possibility of returning to work. One of the key topics is how I address the time that I've not been working. There is still a lot of prejudice and misunderstanding regarding any kind of medical disability, let alone depression. I will be honest, but also cautious.
The Wall Street Journal provides some helpful tips when talking with current or future employers regarding your disability: Finding the Right Way To Disclose a Disability

A year later

This time last year I was in the hospital, 8-East at UMass. I can't really tell if that's a long time ago or not. If we measure it by the amount of change (new psychiatrist, new meds, overall improvements), then it seems like a lot. As we get older, however, a year passes quickly, no matter what the circumstances might be.
The hospital stay was an important part of my recovery. It brought a new focus to my treatment, notably by first having a team at the hospital that instituted a new treatment regimen, which led to a change of psychiatrists and a new anti-depressant. (The anti-depressant, Emsam, is an old class of medication delivered in a new way.) With continued counseling and bouyed by the amazing support of Sandra, the rest of my family, and friends, I've been able to make good progress. I can now think about the future; this time last year, I could barely think about what I'd be doing after lunch.
I first heard the phrase, "It takes a village to raise a child," at a church conference in Bridgeport, Connecticut in 1990 or so. It made sense then and it makes sense now, whether we're talking about a child or about any person in any kind of need. I live in a good village.

It's a good day, even if the piano is silent.

A. chastised me a bit because I posted a link such as this when I hadn't written anything here for nearly a month. Point well-taken.
In sum, I'm doing well, better for a longer stretch than any time in more than a couple of years. A. will usually ask me, "Out of seven days, how many days are good days?" For the last month, it's been six or seven good days in a week. The tough days (which aren't so very tough when compared to any days, say, this time last year) are most often triggered by bad sleep. We still don't know the combination of psychological, chemical, and environmental factors that can predictably lead to good sleep.
The current meds, combined with the cumulative effects of previous treatments (ECT, CBT, M-o-u-s-e), let me say, without a wild tangle of equivocation, that I'm doing pretty well.

A guy is in his hospital bed after surgery. The doctor comes in, reviews the charts, and says, "Very good."
"Will I be able to play the piano when I get out of here, Doc?" the patient asks.
"Certainly," says the doctor. "I see no reason why you shouldn't be able to do that."
"Great. I never could before."

So, let's enjoy these better days. There's plenty to do, even if playing the piano isn't on the list for today.

Thoughts for your next walk

The news tells us that exercise is helpful,even for treatment-resistant depression. The news also tells us that exercise doesn't affect depression or mood much at all. Or,maybe it does. “Exercise may still be beneficial for patients being treated for an anxiety or depressive disorder,” said the researcher in the latter study.
While it's easy to be flippant about these conflicting reports, it's also good to note that there is a lot of research focused on finding out which treatments will work for which people. It seems that not only may we be genetically predisposed to certain illnesses, we may also be predisposed to certain treatments. Matching the treatment with the genetic profile of the patient will be the next big breakthrough in medicine.
Until then, there's no shortage of advice on what to do or not do, what to take or not take.

Spirituality Tied to Higher Depression, Anxiety Rates

A researcher finds that people with a religious affiliation tend to have lower rates of depression and anxiety. If, however, you are seeking a higher meaning for life, as the researcher characterizes spirituality, you're more likely to have symptoms of depression and anxiety. So, go to church, but think about the meal planning for the next church supper rather than pondering the meaning of the pastor's sermon.

Spirituality was significantly linked with higher lifetime odds of having depression, manic episodes, and social phobia. Spirituality was also coupled with higher lifetime odds of having panic disorder, although this connection was not statistically significant.

Spirituality Tied to Higher Depression, Anxiety Rates -- Arehart-Treichel 41 (21): 26 -- Psychiatric News

How Prozac sent the science of depression in the wrong direction - The Boston Globe

A little late in posting this. From last Sunday's Boston Globe: How Prozac sent the science of depression in the wrong direction.

In sum, Prozac and its SSRI cousins purportedly treated depression by increasing the level of serotonin in the patient. Well, it turns out that it's not quite so. Raising or lowering serotonin, by itself, seems to have little direct effect on depression.

"The scientists showed that fluoxetine gave brain cells the ability to take on new roles and form new connections, which erased the symptoms of the disorder."

So, Prozac can help, but not in the way that we thought it did.

Sleep as art, science, or what?

Sunday nights are often not a good night for sleep for me. It's as though I've forgotten how to sleep. Last night was typical. I fell asleep around 9:30, woke an hour later, stayed awake for maybe a couple more hours, and then got up somewhat early (4:30). Even though my mood is pretty good today, I also know that I'm not at my best.
I've been through the stress reduction program and can practice lots of different meditation techniques while waiting for sleep to come. Sometimes I listen to the radio, sometimes not. Last night, I got up and read through the Sunday papers until I felt drowsy.
I used to get mad at my inability not to sleep some nights, but not so much anymore. Getting mad, of course, doesn't do any good.
It might be easier to understand if my sleeplessness came as the result of something interesting - perhaps I'm excited about something, past or future, for example. My head is pretty empty as best as I can tell.
Ah, well, tonight's another night.

It's been a quiet week ...

It's a good week when there isn't much to report about depression. I met with an endocrinologist on Monday to see if we can figure out some of my recent lab results, including an elevated parathyroid (PTH) level. I had a follow-on 24-hour calcium test to help determine if this is primary hyperparathyroidism or secondary. Hyperparathyroidism can mimic or exacerbate depression symptoms. Stay tuned.
The endocrinologist also said that she'd never seen glasses as thick as mine.
My sleep has been uneven, although the last couple of nights have been ok. Yesterday, I got frustrated because I wasn't able to solve a problem with one of our websites; a task that should have taken 15 minutes wound up taking maybe three hours. I know that I can't think as clearly as I would like to (or as clearly as I used to), so it's important to be careful about the tasks that I take on.
Still, it's been a pretty good week. I remember two years ago at this time, I had, in addition to deepening symptoms of depression, double pneumonia and malignant melanoma Both of the latter two conditions have been treated successfully.

If at first you don't succeed, you're typical

This article, Johns Hopkins: Depression|Anxiety on switching antidepressants, is a reminder of why people with depression get confused, scared, and angry about their treatment plans. "If the first one doesn't work, try another or maybe try two at a time or maybe a third or ...." Yeesh.

I have a mental illness

There. Do I feel better for having written that? Um, not really. It's still a hat that I don't feel completely comfortable wearing. (I don't, as usual, wear a hat anyways.) Nevertheless, it's important to get this out on the table.

I looked through this blog and discovered that I'd not said that I had a mental illness. I have certainly said that I deal with depression. (I am also careful not to say that I suffer from depression. Suffering is a difficult word to use.) To say that I have a mental illness adds a class of images and innuendos that aren't easy to handle. Nevertheless, that's what it is. Depression is a mental illness in the sense that it affects the brain and the mind. It can be argued that all illnesses are physical because they are represented by some pathology in the body, in this case, the brain.

The liberation movements have shown us how people can embrace their pejorative names as a way of defusing the words' power: queer, nigger, and alcoholic come to mind. Using the description of mentally ill helps to take back control. It doesn't define the whole of me, but it's an important part.

[In the too-weird-for-words dept., while writing this, I had iTunes set to shuffle through my library. Just up is Crazy by Gnarls Barkley.]

Where do we go from here? Pretty much the same track - keep on keeping on. [Next up on iTunes? U2 - I Still Havent Found What Im Looking For.]

A picture you don't particularly need to see in a magazine in your therapist's waiting room.

Keith Richards in a Louis Vuitton ad in The New Yorker:

If you're wandering around the middle, are you going backwards or forwards?

The last couple of weeks have had more tough days than easy ones, mostly tied to erratic sleep. Some days, I need to sleep 12 or more hours; others, I wake early in the morning and get through the day with the limited rest.

Because of that, I've pulled back and set limited goals for each day. Usually, the three-things-a-day guideline works pretty well, even if I lump a bunch of small tasks into one goal. For example, I had a half dozen errands to complete in town (hardware store, gas station, library, town hall, M&L's, bank, grocery store) which I count as one task. The other two for today are to get some exercise (Marley and I went for a walk.) and to go to an appointment with my psychiatrist this afternoon. Anything beyond that is a bonus.

It's difficult, however, to get a sense of progress when I have setbacks. Are they temporary interruptions or indicators that a new depressive episode is starting? For the past six or so months, the difficult times have been just temporary disruptions; I come out of them and, sometimes, even improve. Today's been better than the past four days. It's hard to plot a trend with just one day.

I'm looking forward to my appointment this afternoon. I have the test results that my neurologist had ordered. Some of the tests may have implications for treatment of depression as well as treatment of the muscle pain that I've experienced. My psychiatrist doesn't limit himself to topics related to the brain and mood alone; the whole body is in play. That's good.

Again, why I turn to the Internet for all of my answers.

His and Hers Depression Blog: Can Texting Help With Depression?.......by Susan

Texting is a great way to stay in touch with family and friends because it's so fast. You can quickly share an interesting idea or picture.

mobile phones and depression

are you addicted to texting?... Mobile phone addiction: Clinic treats children

Black dogs to help you with your black dog

Dr. Deb: Psychiatric Service Dogs

I think that this dog is helping.

Slipping gears

For several days this week, I was so tired that I could barely pry myself loose by noon. My mood was ok, given that I couldn't get much done beyond the basics - getting dressed, preparing meals, 'n stuff.

On Wednesday afternoon, I called my primary care physician to see if the elevated PTH levels that had shown up in my blood work from a couple of weeks ago might be causing this tiredness. He said that it wasn't likely, given that my calcium levels were within proper range.

What the tests didn't show was that I'd started taking some calcium supplements this past weekend. The idea was that boosting my vitamin D levels might help. There have been news reports lately that tie low vitamin D levels with depression. What may have happened, however, is that by boosting my calcium levels, I may have triggered a problem with the PTH.

So, I've stopped the calcium supplements and do feel better today. Stay tuned. We're a complex mess o' chemicals, ain't we?

Another fine learning experience

A friend once told me that I'd look forward to the hard times for what they had to teach me. Then, as now, I haven't been able to look forward in joy, but,with some work, I have been able to become grateful. This article, Your Wandering Mind on Depression: Being Thankful for depression, goes along the same lines - the things that I need to do to get through and beyond the period of depression can become good and permanent changes in my life after the depressive episode is past.

Of course, it's important to remember that, in order to make any kind of changes, you/I need a certain take-off velocity. The strength to get often has to come from outside agents - meds, therapy, ECT. Without that extra strength, you/I will generally go deeper, rather than climb higher.

With that strength comes enough hope to get the engines running.

Finding happiness or letting happiness find you

This has been a pretty good stretch - a lot of fun, good energy, and clear thinking. The last couple of days, since my muscle biopsy, have been less so, but, even with the tiredness and discomfort, I'm confident that I'll be back on the right path soon. A year ago, even six months ago, I couldn't have been that confident. It's clear that I'm doing better.

So, what worked? All of it: the ECT treatments last year, the current meds, counseling, loving support from family and friends, time. I needed it all and, with the possible exception of more ECT treatments, I'll continue to need it all. It's easy to get all wrapped around the axle with the dialectic of whether it's mind or medicine that we need. Maybe some folks can get better with one treatment method, but that's not been true for me. It makes it difficult, when there are a lot of variables, to determine which one to tweak when things start going bad again. But, no one said that this was going to be easy.

A few quick notes re the PBS show on Depression

Last night's show, DEPRESSION: Out of the Shadows . PBS, was pretty good. Most of it focused on the suffering that patients feel and how depression can affect the whole family. The most telling part, for me, was when one of the subjects showed all of the prescription medications that he takes daily - anti-depressants, adjunct meds, meds to counteract the side effects of other meds. There's interesting research coming out regarding Area 25, a central part of the brain that appears to affect mood, pleasure, energy, and mental focus.

The follow-on discussion host by Jane Pauley was also good. Of particular note is how anti-depressants alone can have devastating consequences for people, such as Pauley, who have biopolar disorder. Anti-depressants in those cases can trigger even wider mood swings and suicidality.

In all, it was worth watching.

Depression as a conversation stopper

It shouldn't come as a surprise that the topic of depression often leads to a silent, dead end. In the past few months, I've been in touch with some friends and former co-workers. In several cases, when I've explained that I'm out of work due to depression, I've received no response.

As I said, it's not really surprising. The topic of depression breaks a conversation train on a couple of levels. First, it's such an amorphous illness with no tidy set of causes or definitive course of treatment. Sometimes, we're trying to treat the core illness while, at other times, we're trying to ameliorate the symptoms (such as insomnia or myalgia). CBT, ECT, m-o-u-s-e.

Second, when depression is at its ripest, there isn't much else going on. I've worked hard to keep current on a range of topics - technical stuff, politics, world events - but, some days, I've got nothin'. I've been out of work for almost two years and so the technical stuff that I've learned is pretty much in the abstract. I haven't had to create and deliver products with any of that knowledge.

I'm not feeling sorry for myself on this. It is what it is. It's part of the reinvention process - how do I develop new interests and new topics for conversation. I'll let you know how it works out.

‘Mad Pride’ Fights a Stigma - New York Times

This article, ‘Mad Pride’ Fights a Stigma - New York Times, from this past Sunday's paper, is getting a lot of attention among the mental health bloggers. In brief, the article describes a movement among people with mental illness - notably schizophrenia and bipolar disorder - to embrace the word 'mad' as a way doing battle with the stigma associated with their illnesses. This is done, in part, because there's a perception that people with schizophrenia and bipolar disorder are scary. (People with depression, by comparison, are seen as harmless and helpless, if they're seen at all.)

A by-product of the rebellion against the stigma of mental illness is that some folks are moving away from any treatment, medication or therapy, regarding those treatments as an effort by society and medical establishment to tame or tranquilize patients, rendering them, well, harmless and helpless. I've got to say that, while many people have had bad results in their dealings with mental health professionals, I've also seen the absolute disasters and even death that comes to people who can't or won't be treated.

In all, though, it's good to mix it up. Even people whose mental capacities are diminished need to have a voice in their treatment .

Brains of People with Depression Different - Psych Central News

In addition to the key findings of this report, Brains of People with Depression Different - Psych Central News, that people with depression have fewer of the receptors that regulate happiness, there's an interesting note at the end of the article. The researchers are looking for people who are depressed but who are also not taking medication. This is a key problem in many types of medical research - establishing a control group against whom varying treatments can be tested.

Having been through a brief time last fall when I needed to get off of one antidepressant before starting a new one, I can attest that untreated depression is still quite miserable. As interested as I am in the science, I know that I couldn't stand an extended time without treatment.

Antidepressants Do Work In Depression While Evidence For Cognitive Behavioural Therapy Is Poorer Say Experts

For the past few months, there's been a lot of brouhaha about the lack of effectiveness of antidepressants in the treatment of mild to moderate depression. So, not surprisingly, along comes another report that claims that cognitive-behavioral therapy (CBT) is no more effective than other forms of psychological support. (Apparently, in the UK, CBT is commonly prescribed as a first-line treatment for depression.)

AlphaGalileo.Org: Antidepressants Do Work In Depression While Evidence For Cognitive Behavioural Therapy Is Poorer Say Experts

The conclusion is that treatments should be more nuanced - psychotherapy, medications, or other - based on the specifics of a patient's history and condition rather than on the enumeration of symptoms according to standardized questionnaires.

Religious Orientation and Depression « Biotikos

Once again, we're caught in that vexatious spot of confusing causation with correlation. This article summarizes research that tries a) defines two types of religious orientation and b) correlates those orientations to a prevalence of depressive symptoms.

Religious Orientation and Depression « Biotikos: "if people seek future growth and have more personal attachments to their religion, they are less likely to have depression. The results from both studies show that an intrinsic view of religion is related to lower depressive symptoms."

If we're more outwardly focused (confusingly defined as intrinsic), we're less like to have depressive symptoms. If we're inwardly focused in our religious practices (extrinsic), our depressive symptoms are likely to increase. The study doesn't address the possibility that that the religious orientation is caused by, rather than causing, changes in our depressive symptoms.

Sometimes, the pain of depression comes from healing karma

Buddhist Teachings > Lama Zopa Rinpoche > Transforming Depression

... when you wash a dirty piece of cloth, the water becomes black with dirt. You don't see the black dirt as a negative thing since it means the cloth is getting clean. In the same way, when you practice dharma negative karmas can ripen causing you to get sick because you're purifying so much negative karma by practising dharma. So you should rejoice when you get depressed!

Would I be reading this if I wasn't sick?

This page, Depression Cures, provides a list of various homeopathic treatments for depression. I pretty much stopped reading at the one that had me drinking my own urine in a cold shower, but toe-wiggling does sound a bit like one of the meditation techniques that I've used with some success.

My opinion on homeopathy, indeed on a lot of topics, is that finding something that works for you is the most important thing. I am cautious, however, and tend to look for treatment that have a fair bit of peer-reviewed (not peerer-reviewed) science behind them. There are tangential treatments, such as the efficacy of cartoons on mood, that can be safely practiced and are likely to bring relief from symptoms with minimal side-effects. Anything that I might ingest, be it apple-cider vinegar or the aforementioned urine-for-a-treat, ought to have some good science behind it. Combining some homeopathic treatments with other medications can be deadly.

Jolting the brain fights deep depression - CNN.com

Reports about this study are showing up in lots of places recently. Deep-brain stimulation (DBS) is in a place similar to ECT (shock) treatments - very effective in many cases and still quite creepy for all but the most experienced observer.

Jolting the brain fights deep depression - CNN.com: "'Depression is> a physiological disorder, and basically we are regulating the abnormal signals to brain causing the depression,' says Dr. Ali Rezai, director of the Center for Neurological Restoration at the Cleveland Clinic in Ohio."

Sometimes, a cold is just a cold. Sometimes, it has something special.

So, for a week now, I've been laid low with a cold or something more. I've had bronchitis and pneumonia in the past and this feels a bit like those, but not enough for me to call the doctor. I've slept a lot during the day and, generally, at night, too.

The risk comes at the beginning and end of such an illness when we start to think that we can get back to normal (using whatever we consider to be normal these days). The day can start out with good energy and then drop out quickly. While the energy is dropping, I'm still thinking that I can get done the many little things that I've laid out for myself. If I'm not careful, I can start to spiral downward in the frustration. So far, it hasn't been bad. I've felt lousy physically, but my mood has stayed intact. These are the signs of progress that we can celebrate.

Buoy for Perinatal Blues & Beyond: PBS Airing Depression: Out of the Shadows

PBS will be running a series on depression and related issues starting on May 21: Buoy for Perinatal Blues & Beyond: PBS Airing Depression: Out of the Shadows. Folks in the Boston area can watch the show on WGBH. Check your local listings for time and channel.

Antidepressant Overload in 'Comfortably Numb' : NPR

Article by and interview with Charles Barber, author of the new book Comfortably Numb: How Psychiatry Is Medicating a Nation. Another in the wave of critical assessments of current treatments for mental illness. Particularly, he raises the caution flag at the overprescription of antidepressants for mild-to-moderate depression: Antidepressant Overload in 'Comfortably Numb' : NPR

A couple of points:

• Again, Barber makes the distinction between mild and severe depression, that meds can save the lives of people who are severely depressed.
• He's critical of the practice of having primary care physicians prescribe meds. He's right, in the sense that just prescribing meds is often lazy medicine that makes big pharma rich.
  I should note that my primary care physician was the first to prescribe antidepressants for me when I was 16, back in the 60s. In that case, it was revolutionary that a general practice doctor would be able to diagnose and treat depression in a teenager.
  

About blog depression

This nonist public service pamphlet brings a smile and, then, upon closer reading, a strong urge to walk away from the keyboard and go stack firewood or sumptin'.

(About the other depression, well, most of the time I can accept the fact that not getting better doesn't equate to getting worse. The past few days, however, it's been easy to get discouraged. I keep doing what I believe I need to do, including the aforementioned walking away from the keyboard.)

Antidepressants enhance neuronal plasticity in the visual system

When I was a kid, I had a lazy eye. Eventually, it was corrected with surgery. During my younger years, I had to wear a patch over my good eye to strengthen the lazy one. Most often, I'd wear the patch while watching television, giving me a good excuse to sit in front of the tube for a long time. ("I'm strengthening my eye.")

New research shows that fluoxetine (Prozac) augments the eye-patch regimen. "Gimme my pills and patch, Ma. I gotta fix my eye."

Prescriptions in the Twilight Zone

Two-and-a-half weeks ago, I brought a prescription to our local *cough* Rite-Aid *cough* pharmacy. They told me that the insurance company was requiring prior authorization before they'd approve the prescription. The pharmacy contacted my doctor and arranged for the authorization, which was approved last Thursday. I stopped by the pharmacy today and learned that they had no record of the prescription.

None. Nothing.

The pharmacist asked if I was sure that I had brought the prescription to this pharmacy. I assured her that I had and that I had talked with her last Friday about it.

They're gonna call my doctor and request a new prescription. Why am I getting the feeling that we might have to go through the prior authorization rock-climb again?

A day at a time works best when you know what day it is.

About 3:30 this morning, I figured out why I wasn't able to sleep. On Saturday evening, I took Sunday night's pills by mistake. As a result, at bedtime on Sunday, I looked in the pill container, saw that Sunday's slot was empty, and figured that I'd taken my pills but forgotten that I'd done so.

And so, though tired, I went to bed at 9PM and, except for a few snoozes here and there, couldn't sleep. I got up at 2:30, read some of the newspaper, had an early breakfast, and then realized what had happened.

So now, as my mother used to say after one of her sleepless nights, we'll pretend that we're traveling today. I have an appointment with my psychologist this afternoon and several other errands to tend to. It's supposed to be a nice day, so Marley and I will go for a walk.

We used to tease my father because he'd put an X on the calendar to cross off each day. We're finding that a lot of his quirky ideas made sense.

Which sounds worse: major depression or leaky gut?

The results demonstrate that intestinal mucosal dysfunction marked by an elevated translocation of gram-negative bacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Researchers are suggesting that IgM and IgA panels be used to screen people who suffer from depression for leaky gut.

Progression with Depression « balancefromwithin

Oh, snap - Early history of depression linked to Alzheimer’s later in life

“History of depression, and particularly an early onset, but not presence of depressive symptoms increased the risk for Alzheimer disease. This risk was not mediated by smaller hippocampal or amygdalar volumes.”: iTWire - Early history of depression linked to Alzheimer’s later in life

In other words, there's a correlation, but they don't know the cause yet.

Moving forward, sideways

I've been quiet here because, for the most part, things are going pretty well and I've been busy doing other stuff. This morning, however, I had an appointment with my GP to talk about my elevated CK levels (over 800 in the last round) along with pain in a lot of different muscles. We're suspecting that the Seroquel may be causing it. My level has been elevated since August of 2006. I don't remember when I started Seroquel, but it could have been around that time. I will talk with my psychiatrist to find out if he's encountered any correlation. If so, then we're not in any better position, because the Seroquel has been an important part of my medication regimen. If not, then my GP will have to dig deeper, perhaps literally, with a muscle biopsy. Ick.

Prior Authorization redux

I met with my psychiatrist last week. I reported that the Sonata wasn't helping much and that I'd probably do just as well on the Lunesta. So, he wrote a new prescription for Lunesta which I dropped off at the local pharmacy.

When I returned to the pharmacy, the pharmacist told me that the medication required prior authorization. This is a medication that, except for one month, I've taken for about a year and half. The pharmacist faxed the necessary form to the doctor's office.

Today, I called the pharmacy and learned that the prescription hadn't been approved. I called the insurance company and learned that the medication required two prior authorization - one for the medication itself and one for the quantity. The insurance company had approved the request for the med, but hadn't done anything about the quantity. If I hadn't called, no one at the insurance company would have told us that we needed this second approval. The kicker is that I'd had a prior prior authorization on the quantity, but that authorization expired in February. So, the person on the phone took down all of the information and said that she would contact the doctor. Why do I have a feeling that I've been to this movie before?

BTW, it's not only patients who struggle with the mishegas that is the prior authorization process. Doctors get frustrated as well, as indicated in this article, Prior Authorization: The Bane of Doctors - World of Psychology.

On insurance parity for mental illness

An interesting review of the discussing around parity for coverage of mental illness:
The Murky Politics of Mind-Body: "Depression Is a Brain Disease" 101

Jimi Hendrix - Voodoo chile berkeley 1970

YouTube - Voodoo chile berkeley 1970

The first year

Next week marks the end of my year out of work. There's no doubt that I'm much better than I was. As I review the year's numbers, I also get the feeling that I underestimated how out of it I was. Now, as I have several good days in a row, I can see that I'm a long way away from being able to do the kind of work that I used to do.

Along those lines, I received a note from the Social Security Administration regarding a program called Ticket to Work. Briefly, the program offers an array of services to help disabled people find a path to work. It could be full- or part-time doing what you did before something new. I called the local agency, Mass. Rehab., to get the process underway. They have a six-month waiting period for new services, but at least I'm in the queue.

I have an appointment with my psychiatrist this afternoon, mostly to review meds. After all the trouble we had getting the prescription for Sonata, I haven't been impressed by what it's done for me. We'll twiddle the dials, but, overall, I'm doing ok.

Black pups face doggie discrimination - Pet health- msnbc.com

Black pups face doggie discrimination - Pet health- msnbc.com

For varying values of spring

Although the vernal equinox doesn't take place until next week, March is often classified as a spring month. We're finding, however, that someone forgot to tell Mother Nature. We had a brief burst of snow this morning, enough to cover the ground. The temperature has risen enough to melt most of it, but there's another storm in the forecast for the weekend.

After all the hoopla regarding medications, I think we've found a mix that works pretty well:

• Sonata, for sleep. (This was the one that took several weeks of preapproval brouhaha.)
• Seroquel, a mood stablizer that also helps with sleep.
• Emsam, the MAOI patch.

I'm sleeping through the night most of the time. Well, I do wake up, but have been able to get back to sleep until a reasonable hour. I still need a nap most days, but my mood, energy, and cognition have all improved. My BDI numbers this week put me in the moderate depression category, the best that I've had this year.

Next Monday, I'm going to meet with a new therapist. Although I like my current therapist, I'm not feeling as though we're getting anywhere new. I'll see how I like the new guy, a pastoral counselor with a D. Min., before I make any permanent changes.

If something to turn - holiday is necessary you!!!

I used a few web-based tool to bring in news regarding depression. You can set up automated searches with Google to keep track of news and blogs that have the word 'depression' in them. Sometimes, you'll get information about economic depression or Depression glass, but, for the most part, Google provides good and interesting information several times a day.

Of course, there are a lot of folks peddling a lot of ideas regarding the treatment and/or cure of depression. For example:


















It reminds me of the web classic All Your Base Are Belong To Us, but now for psychiatry.

Finding someone who accepts responsibility

The update on my saga wrt the new medication. Yesterday I met with my doctor. He gave me a copy of a letter that the insurance company had sent him on the 14th, indicating that the prior authorization request was approved. I brought the letter to the pharmacy. The pharmacist was on the phone with the insurance company for 45 minutes and still couldn't get the request released.

I called today. The first person said that everything was approved and that pharmacy should just call the insurance company's help line if they're having difficulty. I explained that it seemed that there were two authorization requests in play here, one for the med itself, the other for the quantity. It appeared that the quantity had been approved, but not the med. (Imagine the tortured soul who came up with that rule.) The agent forwarded my call to the prior authorization line, which turned out to be an automated system that told me what I already knew, that one request had been approved.

I called back and eventually got to a supervisor who threaded his way through the events and explained that the approval had been for an increased quantity of a class of drugs, not for the drug itself. We still needed approval for the drug. But, mirabile dictu, he realized that I am a patient waiting for a medication. He arranged to have the pharmacy give me a five-day supply while he and my doctor worked things out. I thanked him for taking responsibility and helping me in a very direct way.

Now, this evening, we'll find out if the medication makes a difference.

This week's depression links - 2/28/08

• Antidepressants Only Benefit The Severely Depressed, Study

  the difference in effect between drug and placebo was only clinically significant in those patients who were very severely depressed at the start of their treatment and this effect was more likely due to a weaker response to the placebo than a stronger re

• Ask your dentist: dental health, inflammation, and depression :: Rebuild from Depression Blog

  There are schools of thought that “inflammation” is the underlying cause or at least common bond between heart disease, diabetes, and depression.

• Bout of depression good for soul

  This reminds me of the old story about a person ingesting a small amount of arsenic every day in order to build an immunity to it. I don't know if the story is true and I am less certain that it's a good idea.

• Depression the great excuse of our times | NEWS.com.au

  Depression has become the great excuse of our times and what is a genuine condition has been corrupted into a nifty carry-all excuse.

• Modafinil augmentation of SSRI therapy in patients...[CNS Spectr. 2006] - PubMed Result

  CONCLUSION: Twelve weeks of modafinil augmentation relieved excessive sleepiness, reduced fatigue, and improved patients' overall clinical condition, including mood.

• PLoS Medicine - Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

  Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decr

• Psychologist Seeks Stone Age Solutions to Depression

  What the author doesn't mention is that the life span of our stone age ancestors was probably in the mid-30s.

• Psychology Today: Lose Some, Win Some

  Apparently, skipping a night's sleep can alleviate symptoms in severely depressed patients. It doesn't work and even has a negative effect on mild-moderate depression patients.

• Researchers Explore The Antidepressant Effects Of Ketamine

  Ketamine, a drug used in general medicine as an anesthetic, has recently been shown to produce improvements in depressed patients within hours of administration.

• The Medicated Americans: Antidepressant Prescriptions on the Rise: Scientific American

  A study of antidepressant use in private health insurance plans by the New England Research Institute found that 43 percent of those who had been prescribed antidepressants had no psychiatric diagnosis or any mental health care beyond the prescription of

• The gut-brain barrier in major depression: Intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression – Source: Neuro Endocrinology L

  It is suggested that patients with MDD should be checked for leaky gut by means of the IgM and IgA panel used in the present study and accordingly should be treated for leaky gut.

• What the media misses about antidepressants

  A different view of the recent news that antidepressants are often no more effective than a placebo. In this writer's view, because patients respond uniquely to each medication, it's worth trying SSRIs on the chance that it might just save a life.

• Your Wandering Mind on Depression: A History of Depression (Part One)

  If you experience depression in early adulthood your risk for future depressive episodes increases with the number, severity and length of each depressive episode.

• » Blog Archive » Mindfulness with Jon Kabat-Zinn

• Delicious Links Builder by InternetDuctTape.com

  This list was created using Delicious Links Builder

  • 

I was looking for an argument, but I keep getting Hit on the Head lessons*

So, nearly three weeks ago, my doctor wrote a new prescription for me. I brought the prescription slip to our local pharmacy. When I returned an hour later to pick up the medication, the pharmacist said that the insurance company needed prior authorization (the doctor must say that I really need this specific medication at this dosage.) Thus started an egregious violation of the Strange Sketch Act:

• I've spoken with my doctor's office at least four times. In addition, the pharmacy has spoken with the doctor's office two or three times. The folks at my doctor's office have sent the prior authorization forms to the insurance company.
• I've received one phone call from the insurance company that says that my request was approved. I've kept the message on my answering machine.
• I've spoken with the insurance company at least a half dozen times. One time they said that the quantity of the medication was approved, but not the medication itself. Last Wednesday, I submitted an online query, detailing it all in four-part harmony. The email response that's promised within 48 hours has yet to arrive.
  
• s been approved, and c) the pharmacy won't be able to place the order.
• The insurance company's web site reports the following:
  
  
  
• I've spoken with the pharmacy in person and on the phone at least 10 times. They've not been able to place the order because the insurance company hasn't approved the request. Today, the pharmacist called the insurance company who, in turn, told the pharmacist that they haven't received any information from my doctor regarding the prior authorization.
• The pharmacist called my doctor's office. My doctor won't be in until this afternoon. I'll call everyone again later today and I'll bet you a nickel that a) my doctor's office will report that they've submitted the request, b) that the insurance company will either claim that they haven't received the request or that it'

* Bowing with reverence to the Monty Python argument sketch (in video) and in text.

Depression links - 2/20/08

• Johns Hopkins: Depression|Anxiety on acceptance commitment therapy ( Wednesday, Feb 20 at 10:30 PM )

  ACT therapy suggests that, rather than attempting to challenge and change negative thoughts and beliefs (as cognitive therapy advocates), we should accept and feel our negative thoughts and feelings (in effect, embrace our pain) in an attempt to defuse th

• Does psychotherapy help older people with depression? ( Tuesday, Feb 19 at 09:21 AM )

  Despite stronger evidence of psychotherapy helping younger people, "all of these complications make it hard to say whether psychotherapy could be beneficial among older people," Wilson said.

• Something in the way he moves ( Tuesday, Feb 19 at 08:24 AM )

  Depressed people experience longer resting periods more frequently and shorter ones less frequently than healthy people do.

• » Closing the Circuit: Helen Mayberg's research could revolutionize depression treatment « Brain Fitness Revolution at SharpBrains ( Tuesday, Feb 19 at 08:19 AM )

  If we knew that a particular brain pattern indicated what type of treatment a patient would best respond to, it could save them years of unsuccessful treatment," says Mayberg. It could also eliminate the need for drug treatment for some patients, and help

• Fighting the Darkness: My Secret Battle with Depression: The misunderstanding of depression continues ( Tuesday, Feb 19 at 08:06 AM )

  Back in ancient times, people believed that supernatural forces caused mental illness and some tried to rid sufferers from the illness by cutting holes into the afflicted person’s head in order to let the evil spirits out. The Greeks later explained men

• Is Mindfulness-based Cognitive Therapy Effective? - World of Psychology ( Tuesday, Feb 19 at 08:05 AM )

• C. E. Chaffin's Blog: Day 8, ECT #2; Roaches ( Tuesday, Feb 19 at 06:40 AM )

• Plumbing the Depths Of Depression - washingtonpost.com ( Tuesday, Feb 19 at 06:01 AM )

  break out the male Wistar rats and the injection needles

• As depression symptoms improve with antidepressants, hopelessness can linger ( Tuesday, Feb 19 at 04:26 AM )

  People taking medication for depression typically see a lot of improvements in their symptoms during the first few months, but lagging behind other areas is a sense of hopefulness, according to new research from the University of Michigan Health System.

• How to be depressed ( Saturday, Feb 16 at 06:25 AM )

  # Everything is pass/fail # I can read minds! # I can read the future, and see the whole world! # Let's apply a label! # If I feel bad, I am bad # I should do this, I should do that! # I'm responsible for everything # Bad things are worth extra points # G

• Atypical Depression Research -- Neurotransmitter.net ( Friday, Feb 15 at 05:37 AM )

  An overview of the research associated with atypical depression (AD), which is defined as mood reactivity and at least two of the following: weight gain, hypersomnia, leaden paralysis and interpersonal rejection sensitivity

• Mindfulness-Based Cognitive Therapy for Depression ( Thursday, Feb 14 at 08:42 PM )

  The liberation in realising that we are not our thoughts is one shared by cognitive therapists and Buddhists alike.

• Psychiatric Rating Scales for Depression -- Neurotransmitter.net ( Thursday, Feb 14 at 06:40 PM )

  Several evaluation tools to help with the assessment of symptoms of depression

• Dr Shock MD PhD: Magnetic Seizure Therapy less cognitive side-effects compared to ECT ( Thursday, Feb 14 at 05:09 AM )

  This research showed that chronic treatment with high-dose MST resulted in less cognitive impairment than ECT and that high-dose MST did not significantly differ from the effects of anesthesia alone.

Michael Moore is a rose-colored-glasses optimist

So I go to the doctor on Thursday and explain what's been going on, that I've been sleeping very poorly, waking at 2 or 3 in the morning and then trying to make do for the rest of the day. The doctor prescribes a medication that might help. It's fast-acting and short-lived so that I can take it at 2 or 3 and still wake at a decent hour.

I bring the prescription to the pharmacy. They say that it'll be ready in a half hour. I come back a half hour. They tell me that the insurance company needs pre-authorization, meaning that the doctor has to explain why I need this medication and why the others that we've used haven't worked.

That was Thursday night. I called the doctor's office on Friday. They said that they'd received the fax from the pharmacy and would send out the information to the insurance company.

It's now Tuesday afternoon, nearly five days later. The doctor's office claims to have sent the material to the insurance company. The insurance company is, like, nuh-uh. The pharmacy says that they'll sell the medication to me for $420 if I wanted to go without the insurance.

Oh, did I mention that it took four days to get a refill on another medication?

This week's depression links - 2/7/08

• ScienceDirect - Pain : Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population ( Thursday, Feb 07 at 10:51 PM )

  The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of

• depression linked to an autoimmune thyroid condition may have poor prognosis ( Thursday, Feb 07 at 04:31 AM )

  Research published in BMC Psychiatry this week suggests that some patients with depression may be suffering from a subtle autoimmune thyroid condition, which could hinder their recovery.

• Depression linked to earlier death: study ( Wednesday, Feb 06 at 04:10 AM )

  "The study lacked information on causes of death, and it is not clear why patients with a history of depression had a higher mortality rate, the researchers note."

• Metapsychology Online Reviews - Philosophy - Review - Shyness ( Wednesday, Feb 06 at 04:08 AM )

  that his main concern is that the new DSM metamorphosed normal behaviors into sicknesses, that shyness is a good example of this phenomenon and that this is a bad thing.

• Happiness: Enough Already | Print Article | Newsweek.com ( Tuesday, Feb 05 at 07:25 PM )

  Another in the theme of the pursuit of happiness as a false goal: "once a moderate level of happiness is achieved, further increases can sometimes be detrimental" to income, career success, education and political participation ...

• Insomnia patients often denied sleep treatment when they have mental health conditions ( Tuesday, Feb 05 at 03:18 AM )

  “Insomnia can cause you to have anxiety and depression, and depression and anxiety can cause you to have insomnia. It’s a chicken-and-egg type of story. But research has shown that if one of the conditions is left untreated it can exacerbate the other

• Relax Like A Pro: 5 Steps to Hacking Your Sleep | The Blog of Author Tim Ferriss ( Tuesday, Feb 05 at 03:14 AM )

  2. Use ice baths to provoke sleep....The result: it’s like getting hit with an elephant tranquilizer. Don’t expect it to be pleasant at first.

• New antidote to depression « No turning back ( Monday, Feb 04 at 03:48 AM )

  Doctor Xanthe prescribes this to counter depressants. She guarantees this game makes one euphoric.

• C. E. Chaffin's Blog: At Rope's End ( Sunday, Feb 03 at 02:18 AM )

  In California we'd rather let the mentally ill be shot by the police on the street than force them into treatment. Protecting the victim's right to be crazy is much more important than intervening for their welfare.

• Why Serotonin Can Cause Depression And Anxiety ( Saturday, Feb 02 at 10:47 PM )

• Achieve a Deep, Uninterrupted Sleep: Nighttime Habits | Health | Reader's Digest ( Friday, Feb 01 at 09:09 PM )

  Some helpful tips on sleep, but if I tried to remember 24 things before going to bed, I'd not sleep a bit.

• Factors Associated with Alexithymia in Patients Suffering from Depression ( Friday, Feb 01 at 09:03 PM )

  Alexithymia is very common among patients with depressive disorder.

• Dr Shock MD PhD: DSM V citeria for Depression for Dummies ( Friday, Feb 01 at 08:53 PM )

• RCPsych: Cognitive behavioural therapy website versus information website for depression ( Friday, Feb 01 at 08:21 PM )

  After 6 months, the effects of both interventions had declined, but the benefits of the CBT intervention remained significant, whilst those of the information website did not. After 12 months, the pattern of decline was maintained.

• How To Really Talk To Your Therapist: Four Collaborative Steps ( Friday, Feb 01 at 07:44 PM )

  - Take ownership of your therapy - Plan out what to say in advance - Keep your wits about you - Enlist a third party to consult with you and your therapist

• Psychiatry24x7.com - Data on circadian rhythms discussed by researchers at Northwestern University ( Friday, Feb 01 at 07:17 PM )

  there are two general ways in which disrupted circadian rhythms could lead to depression: (i) disorganization within the circadian system could itself lead to neurobiological dysfunction and (ii) a circadian disturbance of the normal sleep-wake cycle coul

• Acupuncture for Treating Depression ( Thursday, Jan 31 at 10:48 PM )

  Two randomized, controlled, clinical trials suggest that electroacupuncture may reduce symptoms of depression as effectively as amitryptiline, a tricyclic antidepressant medication.

• Write Out Of Depression ( Thursday, Jan 31 at 10:25 PM )

  "After you've written about your dream and your impressions about it, write for five more minutes about whether there are any ideas about your waking life that you'd like to take away from this exercise -- maybe even insights about handling your depressio

• Furious Seasons ( Thursday, Jan 31 at 10:16 PM )

  Depression has four different elements; physical, mental, emotional, and spiritua

On numbers

My psychiatrist and psychologist conferred last week and, among other things, recommend that I use the Beck Depression Inventory to assess my symptoms. For the past year, and recording the numbers since April, we've used a 1-7 scale to assess my mood, energy, and cognitive abilities. The scale is based on a similar scale used to assess pain - 1 is great; 7 is incapacitated.

It's a puzzle that they haven't recommended the BDI before. They've probably used it as part of interviews; I suspect that the hospital and Social Security folks used BDI or something similar in their evaluations. Nevertheless, I've been carefully recording and reporting our numbers for all this time and it seems strange that they're only now introducing the BDI as a tool for regular use.

I had an appointment with my psychologist yesterday and will see my psychiatrist on Thursday. The major issue of late, as I've mentioned before, has been my bad sleep and the toll that it takes on my resilience.

In spite of the tiredness and the nearby troubles, I've been able to get stuff done on a daily basis, something that wouldn't have happened even two or three months ago. Some of the tasks are as simple as being able to throw something away. Others involve more analysis and skill, such as setting up a home network for our two computers. I've been using Remember The Milk as a way to plan and track completion of tasks. There's a Firefox extension that integrates RTM with GMail, making it handy to look at the day's business in a single page. It's just nerdly enough to be fun.

A Love Letter to ECT - World of Psychology

A Love Letter to ECT - World of Psychology: "We have a lot of respect for James Potash, a well-known researcher from Johns Hopkins who has made his career by studying the genetic basis of mood disorders and schizophrenia and possible overlaps.

So we were a little saddened to see him write this love letter to ECT, over at ABC News."

Sleep and mood

For the last few weeks, I've had lousy sleep. Often, I'll wake at 2, 3, or 4 in the morning. Generally, I'll have a nap sometimes during the day to give me a bit more energy. If I don't get the nap, I stumble through the day and there's still no guarantee that I will sleep better that night.

We've tweaked the meds, increasing the Seroquel, but without much effect. Most of my tough days (3.5 or worse) come after a bad night of sleep. I also have some days that are ok and even good.

I have an appointment with my psychiatrist next week. This will be the main topic.

This week's depression links - 1/29/08

• Clinical Psychology and Psychiatry: A Closer Look: The Serotonin Monster Strikes Again ( Wednesday, Jan 30 at 02:43 AM )

  Continued reporting on whether there really is a chemical imbalance associated with depression or is it just a catch-phrase used by Big Pharma to persuade us to buy and use meds.

• The age of depression: 44 marks the start of that mid-life crisis - and scientists say it lasts years | the Daily Mail ( Wednesday, Jan 30 at 02:12 AM )

  "... while most of us enjoy a happy start and end to life, there is a trough in the middle, with 44 the year when depression peaks."

• Depression and dualism | Technovia ( Wednesday, Jan 30 at 12:46 AM )

  ... our best option is probably to look at environmental factors, the history of the experiences of the patient, and so on. In other words, psychiatry.

• Naturally and Surely Cure Depression and Neurosis ( Wednesday, Jan 30 at 12:43 AM )

  "Depression and neurosis can easily be cured through dream interpretation using the method discovered by Carl Jung in 1920, which I simplified in 1988." Today, these problems exist only for those who insist on suffering…

• Top 8 Tips for Living with Depression - Christianforums.com Forums ( Wednesday, Jan 30 at 12:41 AM )

  Grab a bucket and mop ....

• Don't Worry, Be Moderately Happy, Research Suggests ( Monday, Jan 28 at 07:09 PM )

  The people in our study who are the most successful in terms of things like income are mildly happy most of the time

• The new black: Mourning, Melancholia and Depression by Darian Leader review | Non-fiction book reviews - Times Online ( Sunday, Jan 27 at 07:45 PM )

  It’s nothing like as incoherent as the life we have to deal with while it happens.

• Bad science: Depression - the facts and the fables | Comment is free | The Guardian ( Sunday, Jan 27 at 07:44 PM )

  The serotonin hypothesis will always be a winner in popular culture, even when it has flailed in academia, because it speaks to us of a simple, abrogating explanation, and plays into our notions of a crudely dualistic world where there can only be weak pe

• Book - HOW SADNESS SURVIVED ( Friday, Jan 25 at 02:14 AM )

  "Do most types of depression represent an adaptation – an evolved mechanism which improved the survival and reproductive value of humans in our ancestral environment? Has depression been selected?" From http://www.geneticsandhealth.com/2008/01/23/dep

• Depression: How You Label Determines How You Feel | The Blog of Author Tim Ferriss ( Friday, Jan 25 at 01:59 AM )

  "Gratitude training can be used pre- or mid-depressive symptoms to moderate the extremes and speed the transition." Making a gratitude list is one of the quickest way to ground onself - you may hurt, but there are plenty people and ideas to hold on to.

• Getting out of depression (learned helplessness) by learning to be optimistic « Living an intentional Christian life ( Friday, Jan 25 at 12:02 AM )

  Start with your hair. Then your clothes. Then try avoiding hurtful people. Then go to a church where you feel loved. Then go to counselling and learn new skills. Then… then… then…

• Genetic Test To Predict Antidepressant Response ( Thursday, Jan 24 at 11:34 PM )

  "To our knowledge, our results provide for the first time evidence that genetic variants in the [gene for P-gp] account for differences in the clinical efficacy of antidepressants, most likely by influencing their access to the brain," they wrote.

• That Sinking Feeling: Depression Saps Workers, Employers | workforce.com ( Thursday, Jan 24 at 10:26 PM )

  That’s because while workers with behavioral health problems—a phrase that encompasses substance abuse and mental health problems—are a small percentage of the overall workforce, they are responsible for a large percentage of overall health expendit

• Black Dog Institute - Home - Black Dog Institute ( Thursday, Jan 24 at 07:54 PM )

• Neuropsychopharmacology - Abstract of article: Erythropoietin Improves Mood and Modulates the Cognitive and Neural Processing of Emotion 3 Days Post Administration ( Thursday, Jan 24 at 07:54 PM )

  Erythropoietin (Epo) has neuroprotective and neurotrophic effects and is a promising candidate for treatment of neurodegenerative and psychiatric disorder.

• ScienceDirect - Trends in Immunology : Cytokines sing the blues: inflammation and the pathogenesis of depression ( Wednesday, Jan 23 at 06:04 PM )

  Increasing amounts of data suggest that inflammatory responses have an important role in the pathophysiology of depression. Depressed patients have been found to have higher levels of proinflammatory cytokines, acute phase proteins, chemokines and cellula...

Using Music to Lift Depressions Veil

Using Music to Lift Depressions Veil - Well - Tara Parker-Pope - Health - New York Times Blog: “I think we can be reasonably confident that music therapy has an effect,'’ Ms. Maratos said. “Music therapy is often used where more conventional therapies are not as likely to be as accepted or tolerated.”

At the end of the article is a link to a podcast that provides some additional information about the findings.

See also.

Depression links - 1/22/08

• Health and Quality of Life Outcomes | Abstract | 1477-7525-6-4 | Emotional and rational disease acceptance in patients with depression and alcohol addiction ( Tuesday, Jan 22 at 09:07 AM )

  "Disease acceptance should not be regarded as a coping style with an attitude of fatalistic resignation, but as a complex and active process of dealing with a chronic disease. One may assume that an emotional acceptance of disease will result in a therape

• Today Is the Most Depressing Day of the Year, Google Says No ( Monday, Jan 21 at 07:42 PM )

  The original article claims that January 21 is the most depressing day of the year. This story - http://www.msnbc.msn.com/id/6847012/ - says that it's January 24.

• » Pet Depression FAQ’s » Blog Archive » MicroNutra Articles ( Monday, Jan 21 at 06:32 PM )

  If your pet has symptoms of depression, try the natural product Anivive to stabilize their mood.

• Brainsway Home ( Monday, Jan 21 at 06:30 PM )

  " Brainsway Inc. is dedicated to the development and marketing of Deep TMS (Transcranial Magnetic Stimluation) systems, a novel, non-invasive medical device for treatment of a wide range of neurological and psychopathological disorders. In principle

• People not always needed to alleviate loneliness « Biosingularity ( Sunday, Jan 20 at 03:02 AM )

  "... anthropomorphizing pets or God may actually confer many of the same psychological and physical benefits that come from connections with other people."

• Vicarious Therapy: Early Medical Intervention For Major Depression ( Saturday, Jan 19 at 10:17 PM )

  I often wonder, had I received help at 18 or 19, instead of 36, would I be better today? Would I be struggling so hard to find something to help me?

• 3quarksdaily ( Saturday, Jan 19 at 06:05 PM )

  Why is the experience of antidepressants so variable? Medical anthropologists have known for a long time that medicines are not just taken by bodies; they are incorporated into cultures, that is to say into preexisting cosmologies that permit certain rep

• MHA Response To New England Journal Of Medicine Study, "Selective Publication Of Antidepressant Trials And Its Influence On Apparent Efficacy" ( Saturday, Jan 19 at 12:53 AM )

  "Historically, papers that get published have been those with positive results. This study highlights what is known as the "waste basket" problem in which studies with positive outcomes are more likely to be published than those with neutral or negative o

• Depression Is Not A Chemical Imbalance & Antidepressants Are Not Effective : Elaine Vigneault ( Friday, Jan 18 at 05:33 AM )

• Dr Shock MD PhD: ECT and Election Time ( Friday, Jan 18 at 05:26 AM )

  Senator Thomas Francis Eagleton of Missouri was the running mate for George McGovern, the Democratic candidate for the election for the Presidency of the United States in 1972. He had to step back because of his disclosure having had ECT in the mid 60's.

• Selegiline patch doesn't alter sexual function ( Friday, Jan 18 at 04:54 AM )

• Student and his family open up on toll of depression, risk of suicide - The Boston Globe ( Thursday, Jan 17 at 07:19 PM )

  "It's extremely difficult for parents to acknowledge it, because there's a lot of pain with acknowledging it, and also it's a hard thing to identify..."

• CeNeRx BioPharma Announces Successful Completion Of Phase L Clinical Program For Novel Antidepressant Agent Tyrima(TM) ( Thursday, Jan 17 at 07:17 PM )

  the unique selectivity and reversibility of CeNeRx's Tyrima should enable patients to benefit from the efficacy advantages of the class while avoiding the food- associated cardiovascular side effects of older MAOIs.

• Depression is over-diagnosed, psychiatrist claims | Special reports | Guardian Unlimited ( Thursday, Jan 17 at 06:47 PM )

  More importantly, it appears that antidepressants are over-prescribed, given for what we could better characterize as fairly normal unhappiness.

• Shrink Rap: This is Why You Need A Psychiatrist ( Thursday, Jan 17 at 06:21 PM )

  More about the recent news reports showing that negative reports on the efficacy of antidepressants are often not published.

• Women and Men Doctors Have Divergent Views on Women and Depression | Medical Health Articles ( Thursday, Jan 17 at 04:27 AM )

  “The beliefs of female and male doctors about women and depression are pretty consistent,” said Jo Parrish, vice president of communications for the Society, “but our survey does reveal a few areas where female doctors may be more in tune with the c

• Depression: It's Spiritually Incorrect ( Wednesday, Jan 16 at 09:36 PM )

  Somehow Christians and God-fearers of all religions are programmed to believe they are "above" mental illness and depression. Faith conquers all.

• Method for Treating Apathy Syndrome ( Wednesday, Jan 16 at 09:31 PM )

  Did you know that there was such a thing as an apathy syndrome? We learn, however, that apathy is not depression. See http://neuro.psychiatryonline.org/cgi/content/abstract/10/3/314

• Is Complete Remission Realistic? - World of Psychology ( Wednesday, Jan 16 at 09:26 PM )

  The reality today is that few treatment plans filled out by clinicians with their clients say, “Goal: Complete remission of depression.” Instead, they are far more likely to say, “Goal: Reduce daily depressive feelings by 10% as measured by self-rep

• How to Naturally and Surely Cure Depression and Neurosis - Associated Content ( Wednesday, Jan 16 at 09:05 PM )

  Curing depression with Jung and the interpretation of dreams

• On Depression and Coping « Tarakuanyin ( Wednesday, Jan 16 at 09:03 PM )

  One family's story about depression and other diseases and how each member of the family finds a pathway through.

• Nature and nurture are both to blame for depression, study says ( Wednesday, Jan 16 at 03:27 AM )

• Vagus Nerve Stimulation for Depression - Out of the Black Hole ( Tuesday, Jan 15 at 08:44 PM )

  this is the first book to be published about winning the battle with a medical implant procedure called VNS Therapy.

• Treating Depression in Older Adults: Challenges to Implementing the Recommendations of an Expert Panel ( Tuesday, Jan 15 at 05:58 PM )

  via Hospice and Caregiving Blog

• Re-occuring depression . . . an attack of tachyphylaxis « The Sidewalk Psychiatrist ( Tuesday, Jan 15 at 05:57 PM )

  Tachyphylaxis is the fancy term used to describe the waning of benefit that some people experience from antidepressants or other medication.

Giving your day the three-fingered salute

When all that’s left is to re-boot your day: "When you feel all is going wrong with your day, stop what you are doing and sit down. Take a deep breath and then close your eyes for a fifteen minute nap. The nap is the re-booting of your “internal operating system” (as the doc liked to compare it). Then when you open your eyes again, the re-boot is complete and you must now pretend that it is a new day."

Anti-Antidepressant Videos

YMMV - Antidepressant Videos : Elaine Vigneault

Does It Help To Continue Antidepressant Drug Treatment For Preventing Recurrence In Depression?

Does It Help To Continue Antidepressant Drug Treatment For Preventing Recurrence In Depression?

Are we too happy?

In Praise of Melancholy - ChronicleReview.com: "My fears grow out of my suspicion that the predominant form of American happiness breeds blandness. This kind of happiness appears to disregard the value of sadness."

The author is careful in making the distinction between melancholia and depression. The former is a praise-worthy state of awareness of the true nature of our being; the latter is an often crippling illness. "Melancholia, far from a mere disease or weakness of will, is an almost miraculous invitation to transcend the banal status quo and imagine the untapped possibilities for existence."

Thanks, but I think I'll sit this one out. It reminds me of my childhood friend, Dave, who lit a match so he could see if there was gasoline in the carburetor of his car.

We don't receive news about unsuccessful antidepressant studies

The New England Journal of Medicine has published a review of antidepressant trials and has noted that nearly a third of the studies that showed an unfavorable result were not published. This, according to a follow-up story in the Wall Street Journal, "inflated the reported effectiveness of all 12 of the antidepressants studied, which were approved between 1987 and 2004."

Further, reports the New York Times, it's a reminder that finding an effective antidepressant is still very much a trial-and-error process. The Times quotes Dr. Erick Turner, a psychiatrist and former F.D.A. reviewer who now works at Oregon Health and Sciences University and the Portland Veterans Affairs Medical Center. "The bottom line for people considering an antidepressant, I think, is that they should be more circumspect about taking it,” he said, “and not be so shocked if it doesn’t work the first time and think something’s wrong with them.”

Things we shouldn't need to be told

There are quite a few serious warnings associated with EMSAM, the MAO inhibitor that I have been taking:
Emsam in particular and the MAOI class of antidepressants in general have a lot of warnings regarding interactions with foods and other medications. So far, the restrictions haven't been burdensome. It's not a bad idea to avoid cheeses, given the risks of high cholesterol. (Jennie did comment, however, "What's Christmas without cheeses?")

The warnings that come with medication differ slightly from the warnings that are printed by the pharmacy, which, in turn, differ slightly from the warnings shown at the web site of the company that provides our medication insurance. Two out of three say that hot dogs aren't safe. One says that raspberries and raisins pose a moderate risk.

Yesterday, I was at the dentist and needed to receive a topical antibiotic. I was able to use my Blackberry to check on the safety of the antibiotic wrt Emsam (no problem).

So, the principles of common sense and moderation prevail. I won't eat a pint of raspberries in a sitting. The good news of this effort is that the medication seems to be working well. I have had a few nights when I haven't slept well (waking early) and that has the potential of causing trouble. Nevertheless, I continue to have more good days than bad and the good days have been among the best that I've had in a long time.

Depression Links - 1/15/2008

Here are this week's links on the topic of depression.

• Coming Out Of The Dark
  • 
    
• Depression beneficiaries double in five years - New Zealand news on Stuff.co.nz
  • The number of people receiving the sickness benefit due to depression has more than doubled in the past five years.
• Depression really is in your head
  • 
    
• Dr Shock MD PhD: Risk Factors for Psychiatric Disorders
  • Twin studies suggest a heritability for depressive disorder of about 37%, which is much lower than the heritability for bipolar disorder and schizophrenia.
• Electroshock reborn as valid therapy
  • 
    
• Fighting the Darkness: My Secret Battle with Depression: The light at the end of the tunnel
  • 
    
• Getting stronger after depression - Case Studies, Health - Independent.ie
  • 
    
• God Will Restore Your Wasted Years! by David Wilkerson March 26, 1990
  • 
    
• Johns Hopkins: Depression|Anxiety on depression|neurogenesis
  • 
    
• Magic mushrooms could help depression, say scientists
  • Oh, this sounds like a great idea.
• Nature and nurture are both to blame for depression, study says
  • 
    
• Old in Massachusetts? Say Goodbye to Your Freedom - World of Psychology
  • 
    
• Psychiatry24x7.com
  • 
    
• Re-occuring depression . . . an attack of tachyphylaxis « The Sidewalk Psychiatrist
  • Tachyphylaxis is the fancy term used to describe the waning of benefit that some people experience from antidepressants or other medication.
• ScienceDirect - Journal of Affective Disorders : Gray matter reduction associated with psychopathology and cognitive dysfunction in unipolar depression: A voxel-based morphometry study
  • The volumetric results indicate that regional abnormalities in gray matter volume and concentration may be associated with both psychopathological changes and cognitive deficits in depression.
• The Wild Moods: Review of MBCT: Mindfulness Based Cognitive Therapy for Depression
  • 
    
• The monster strangled me and I never saw it coming - Times Online
  • 
    
• Treating Depression in Older Adults: Challenges to Implementing the Recommendations of an Expert Panel
  • via Hospice and Caregiving Blog
• Vagus Nerve Stimulation for Depression - Out of the Black Hole
  • this is the first book to be published about winning the battle with a medical implant procedure called VNS Therapy.
• dervala.net » Blog Archive » Against Depression
  • 
    
• sbc IMPACT! » Blog Archive » Depression: A Real Problem for Real People
  • The spirit of a man will sustain him in sickness, but who can bear a broken spirit? Proverbs 18:14.
• Delicious Links Builder by InternetDuctTape.com
  • This list was created using Delicious Links Builder