Archive for the ‘depression’ Category

Facebook Help: How do I help someone who has posted suicidal content on the site?

If you have encountered a direct threat of suicide on Facebook, please immediately contact law enforcement.

You can submit reports of suicidal content to Facebook by clicking:

http://www.facebook.com/help/?search=suicidal#!/help/contact.php?show_form=suicidal_content

For reports in the United States, we also recommend that you contact the National Suicide Prevention Lifeline, a 24/7 hotline, at 1.800.273.TALK (8255). If possible, please encourage the user who posted the content to contact the Lifeline as well.  You can view a list of suicide prevention hotlines in other countries by visiting http://www.befrienders.org and choosing from the dropdown menu at the top of the page.

We encourage you to learn about how to identify and respond to warning signs of suicidal behavior online at the following address: http://www.suicidepreventionlifeline.org/GetHelp/WhatifSomeoneIKnowNeedsHelp.aspx

National Suicide Prevention Lifeline:

• Lifeline wants people to report to Facebook first, as Facebook has the ability to provide identifying information and the process is faster if they can report all info to the Lifeline at that time.
• Facebook works with the Lifeline once the content is reported.
• (If it is international, then Facebook works with the appropriate international organization.)
• Facebook receives the notification, then provides the Lifeline with all information about the user. Unfortunately, Lifeline cannot comment on the process from Facebook’s end but believes that given Facebook’s  sensitivity to suicide risk and knowing that their safety team works on the weekends, the Lifeline believes that the process is pretty quick and that it is the most efficient and quickest method for a user to receive help.

In 2005, the FDA issued a black box warning for antidepressants and suicidal thoughts and behavior in children and young adults.

• Many clinicians felt that this warning was inconsistent with their clinical experiences, and that it was not consistent with the data.

• In Wisconsin, the rate of prescribing these agents to children did not decrease after the black box warning was issued, and the rate of suicide did not change. In other states, where the rate of prescribing of antidepressants decreased, there was an observed increase in suicidality.

Researchers have now completed a study intended to determine the short-term safety of antidepressants by standard assessments of suicidal thoughts and behavior in youth, adult, and geriatric populations and the mediating effect of changes in depressive symptoms. They used data from intent-to-treat person-level longitudinal data of major depressive disorder from 12 adult, 4 geriatric, and 4 youth randomized controlled trials of fluoxetine hydrochloride and 21 adult trials of venlafaxine hydrochloride.

They extracted data from the suicide items of the Children’s Depression Rating Scale–Revised (CDRS-R)  and the Hamilton Depression Rating Scale  as well as adverse event reports of suicide attempts and suicide during active treatment. Data were analyzed from 9185 patients (fluoxetine: 2635 adults, 960 geriatric patients, 708 youths; venlafaxine: 2421 adults with immediate-release venlafaxine and 2461 adults with extended-release venlafaxine).

An analysis of the data showed that suicidal thoughts and behavior decreased over time for adult and geriatric patients randomized to fluoxetine or venlafaxine compared with placebo.  No differences in suicidality  were found for youths on fluoxetine or effexor compared to placebo. In adults, reduction in suicide ideation and attempts occurred through a reduction in depressive symptoms. In all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behavior.

Study authors concluded that

• Fluoxetine and venlafaxine decreased suicidal thoughts and behavior for adult and geriatric patients by decreasing depressive symptoms.
• In youths, depression responded to treatment, but no significant effects of treatment on suicidal thoughts and behavior were found.
• No evidence of increased suicide risk was observed in youths receiving active medication.
  

See the published article:

Suicidal Thoughts and Behavior With Antidepressant Treatment

Reanalysis of the Randomized Placebo-Controlled Studies of Fluoxetine and Venlafaxine

Robert D. Gibbons, PhD; C. Hendricks Brown, PhD; Kwan Hur, PhD; John M. Davis, MD; J. John Mann, MD

Arch Gen Psychiatry. Published online February 6, 2012. doi:10.1001/archgenpsychiatry.2011.2048

The Controversy

The media has continued to highlight the high-stakes battle that pharmaceutical companies have waged to make a profit by convincing doctors to prescribe antidepressants. Recent articles have focused more on the fact that pharmaceutical companies were not made to release studies that failed to demonstrate effectiveness of their products. Some articles have focused more on the failure of manufacturers to reveal potential adverse reactions or side effects.

This unbalanced media coverage has the potential to undermine effective treatment of psychiatric disorders. While the pharmaceutical companies stand to profit by convincing people that mental health conditions are medical conditions, the potential to profit does not necessarily mean that their facts are wrong.

Depression as medical illness

Depression is a medical condition. Studies of the brains and the biology of persons with depression have proven that there are real functional and physical changes that take place when a person is struggling with depression.  Depression, and 7 other mental health conditions, are identified by the World Health Organization as among the top 10 most disabling medical conditions worldwide.

Depression can be treated effectively. Studies have consistently shown that medications can treat depression. It is not a one-drug-suits-all approach. Treatment requires some trial and error. But the same is true for the treatment of hypertension. In addition, much like changes in one’s life circumstances can alter a person’s severity of hypertension, so, too can a change in one’s life circumstances make depression better–or worse! Some psychotherapeutic interventions, such as cognitive behavioral therapy or mindfulness based cognitive therapy have been shown to improve depression as well.

The controversy that exists about antidepressant medications is not about whether they are effective, but instead about whether the drive for profit has resulted in overarching assertions that these medications are THE ANSWER for EVERYONE.  While the controversy continues, people continue to experience depression at alarming rates, and many people seek help to minimize the impairment that their depression produces. It remains very difficult to analyze the data to determine whether antidepressants will for an individual patient.

So, what is the depressed person to do?

Find a provider that is willing to listen, to ask for details, and to take the time necessary to assess whether an individual patient is responding to the treatment efforts.

Find a provider who is willing to provide education and answers about their treatment decisions, and to include the patient’s preferences in their decision making.

Find a provider who can be flexible and adaptive  in their approach, willing to try something different if a patient is not responding, and who is willing to obtain consultations from other experts when necessary.

Many teens enjoy keeping in touch with their friends on social networking sites like Facebook and Twitter, but there are both risks and benefits to the use of these sites.  Overuse/Misuse of social media has been linked to mental health issues including depression and eating disorders.

Now, a  report from the American Academy of Pediatrics describes a new phenomenon called “Facebook depression,” in which children and teenagers spend an inordinate amount of time on social networking sites, then develop symptoms of depression.

Facebook depression is UNCOMMON–most children benefit from the use of facebook because they are able to maintain ties with friends and feel a connection with their community, according to Scott Campbell, an assistant professor of communication studies at the University of Michigan.

Heavy use of  Facebook can have serious consequences, so it’s important that parents are aware of their children’s media use, as well as remaining aware of their social lives away from the computer.

Dr. Michael Brody, Chair of the Media Committee for the American Academy of Child and Adolescent Psychiatry, and who was involved with the American Academy of Pediatrics report,  notes that relationships with peers become critical during adolescence, and that Facebook facilitates social engagement with friends.  “Kids become are very competitive, and kids want to be chosen,” said Dr. Brody.  Since facebook allows adolescents to see the number of friends their peers have, some youth may perceive that they are not as popular if they have fewer facebook “friends”. They may also perceive by reading the status updates of their facebook “friends” that they are not having as much fun as their peers. “I think the idea of envy and jealousy becomes very magnified through this medium,” says Brody.

Dr. Brody points out that causation is not suggested by the study.  The evidence does not suggest that Facebook leads to depression. It could be that certain adolescents who are already depressed are prone to spending too much time online, Brody said.

The study is consistent with previous findings of internet use–that depression and loneliness are associated with extremely heavy users of the internet–and also linked with a much lower rate of OFFLINE social connections.

Humans are social creatures, and studies have continued to demonstrate that having a healthy “social rhythm” is protective against mood disorders. It is important to engage with other people in real, offline, socially interactive ways.

Dr. Brody advises that parents encourage their children to engage in a variety of activities, and this can facilitate a healthy social rhythm:

I think kids who have a balanced life, who do schoolwork, who do after-school activities, who are in teams, who are in clubs, who do community service have a much lesser chance of becoming depressed

New research by scientists at the University of Cambridge suggests that the neurotransmitter serotonin, which acts as a chemical messenger between nerve cells, plays a critical role in regulating emotions such as aggression during social decision-making.

Serotonin has long been associated with social behavior, but its precise involvement in impulsive aggression has been controversial. Though many have hypothesised the link between serotonin and impulsivity, this is one of the first studies to show a causal link between the two. The research also provides insight into clinical disorders characterized by low serotonin levels, such as depression and obsessive compulsive disorder (OCD), and may help explain some of the social difficulties associated with these disorders.

These findings highlight why some of us may become combative or aggressive when we haven’t eaten.The only way to build serotonin in the brain is by consuming tryptophan in our diet, through foods such as poultry or chocolate. Serotonin levels are lower when a person has not eaten.  Since serotonin levels naturally decline when we don’t eat,  the researchers took advantage of this effect in designing their experiment.

• The researchers were able reduce brain serotonin levels in healthy volunteers for a short time by manipulating their diet.
• They used a situation known as the ‘Ultimatum Game’ to investigate how individuals with low serotonin react to what they perceive as unfair behaviour. In this game one player proposes a way to split a sum of money with a partner. If the partner accepts, both players are paid accordingly. But if he rejects the offer, neither player is paid.
• Normally, people tend to reject about half of all offers less than 20-30% of the total stake, despite the fact that this means they receive nothing – but rejection rates increased to more than 80% after serotonin reductions.
• Other measures showed that the volunteers with serotonin depletion were not simply depressed or hypersensitive to lost rewards.

These results suggest that serotonin plays a role in social decision making.

• Normally, serotonin keeps aggressive social responses in check.
• Changes in diet and stress cause fluctuations in serotonin levels, and this study suggests that the fluctuations in serotonin affect every day decision-making
• This study suggests that patients with depression and anxiety disorders may benefit from therapies that teach them strategies for regulating emotions during decision making, particularly in social scenarios.

This research was  funded by the Wellcome Trust and the Medical Research Council.

In contrast to years past, pop stars like Justin Bieber are far more in touch with their fans thanks to Facebook and Twitter. In social media, obsessive followers can cultivate a false, and often dangerous, sense of intimacy that has led to incidents of erratic behavior, like this week’s cyber death threats aimed at Bieber’s girlfriend. This is an issue that is serious, and should be taken seriously. 

 ”Where are the parents? Who is trying to g 

Parents must help their children use technology and media responsibly. Parents must remind children taht it is important to be kind and civil to other people–even if they are dating the teen idol the teen is in love with. Bieber is rumored to be dating Selena Gomez, and recent photos of the two of them together resulted in death threats sent to Gomez by Bieber fans on Twitter. 

The parents of the teen stars must also step up here; they need to balance the promotion and publicity of their children with the need for their children to have some privacy about their personal lives.  While it is fun for Bieber’s fans to receive ”tweets” from him, it can be difficult for a 10 year old to realize that the updates probably come from a PR team, and are not a personal, intimate communication between Bieber and the fan.  These “tweets” can produce a sense of intimacy and involvement in Bieber’s private life–such that they feel entitled to feel slighted by Gomez’ more special relationship. 

 The parents of these adoring fans that need to take notice. We need to guide our children in the appropriate use of media. We need to guide our children in how they communicate with others. we need to guide our children in relating to others in a way that is polite, appropriate, and even empathic–and not threatening. 

Celebrity obsession has been treated in children before; in fact, Dr. Ravitz had a patient who was obsessed with Bam Margera, famous skateboarder and ‘Jackass’ personality. After addressing the issue, it was clear the reason for the obsession was rooted in self-esteem issues and family relations 

Caregivers of youth who are really struggling in their relationships with teen idols must be alert to obsessions that go beyond healthy. It is developmentally normal to look for people outside of our family to idolize–to look to for values, and for how to dress, what to like. This is a part of separating from our parents, and trying to develop autonomy as individuals. But if a youth is struggling wtih feeling excluded, is struggling socially with peers, or is struggling with self-esteem, the normal interests in teen idols can become more intensely obsessive, and there may be underlying issues to address for the child that warrant mental health intervention. 

 Social media has only begun to dictate the way people communicate with each other. Although the issue is something to take notice of, the ugly language and death threats online shouldn’t be confused with the norm.

Most children with rapidly shifting moods and high energy have other mental disorders, not bipolar disorder, according to a NIMH-funded study published online ahead of print in the Journal of Clinical Psychiatry on October 5, 2010.

Background

Though some researchers feel that mania in children is exhibited when a child has rapid swings between emotions (usually anger, elation, and sadness) coupled with extremely high energy levels. But rapid mood swings and high energy are actually common in youth.

Overdiagnosis and misdiagnosis of bipolar disorder in youth seems to explain the increased numbers of children being diagnosed with and treated for bipolar disorder. In choosing proper treatment, it is important to know whether children with rapid mood swings and high energy have an early or mild form of bipolar disorder, or instead have a different mental disorder.

The Longitudinal Assessment of Manic Symptoms (LAMS) Study

• 707 children, ages 6-12, referred for mental health treatment.
• 621 participants were rated as having rapid swings between emotions and high energy levels, described as “elevated symptoms of mania” (ESM-positive).
• Parents of the other 86 children did not report rapid mood swings. These participants were deemed ESM-negative.

Study Results

• At baseline, all but 14 participants had at least one mental disorder, and many had two or more.
• Attention deficit hyperactivity disorder (ADHD) was the most frequent diagnosis, affecting roughly 76 percent in both the ESM-positive and ESM-negative groups. However, only 39 percent were receiving treatment with a stimulant, the most common medication treatment for ADHD, at the start of the study.
• Only 11 percent of those with rapid mood swings and high energy (69 out of 621) and 6 percent of those without these symptoms (5 out of 86) had bipolar disorder, meaning that only this small percentage had ever experienced a manic episode, as defined by the current diagnostic system.
• Of the children with rapid mood swings and high energy, another 12 percent (75 children) had a form of bipolar disorder that includes much shorter manic episodes.

Children with rapid mood swings and high energy:

• Reported more symptoms of depression, anxiety, manic symptoms, and symptoms of ADHD
• Had lower functioning at home, school, or with peers
• Were more likely to have a disruptive behavior disorder (oppositional defiant disorder and/or conduct disorder).

Important Points:

• 75 percent of ESM-positive youth did not meet the diagnostic criteria for any bipolar disorder.
• Thus, Bipolar disorder may not be common among children who experience rapid shifts in emotions and high energy levels.
• Children with rapid mood swings and high energy levels experience significant impairments due to mood and behavior problems.
• The researchers also noted that ESM-positive and ESM-negative youth were prescribed psychotropic medications—including antipsychotics—at similar rates. Further study may provide insight into how serious mental illnesses should be treated in children.

Study Follow up:

The study participants will be re-assessed every 6 months for up to 5 years, allowing the LAMS researchers to determine which children with rapid mood swings and high energy develop bipolar disorder later in life. This research may help identify predictors of the illness.

Findling RL, Youngstrom EA, Fristad MA, Birmaher B, Kowatch RA, Arnold E, Frazier TW, Axelson D, Ryan N, Demeter CA, Gill MK, Fields B, Depew J, Kennedy SM, Marsh L, Rowles BM, Horwitz SM. Characteristics of Children With Elevated Symptoms of Mania: The Longitudinal Assessment of Manic Symptoms (LAMS) Study. J Clin Psychiatr. Epub 2010 Oct 5.

Young men who attempt suicide before age 18 are much more likely as adults to be aggressive toward their girlfriends or wives, including hitting and injuring their partners.

The Study, published online in Psychological Medicine is based on data from 153 males from higher-crime neighborhoods who were assessed yearly from ages 10 to 32, and their romantic partners who participated when the men were ages 18 to 25.

This  new research highlights the need for intervention with suicidal teens: 58 percent of youth in that study group who attempted suicide went on to injure a partner, compared to 23 percent of young men who did not attempt suicide.

The study began when the men were kids, and before anyone had data to predict who would become violent. David Kerr of Oregon State University and Deborah Capaldi of the Eugene-based Oregon Social Learning Center, controlled for other problems suicidal youth can have which are also linked to violence to partner, such as aggression, depression, substance use, and family abuse history.

The researchers still found that young men who attempted suicide were more aggressive toward their partners.

The researchers had data from official domestic violence arrest records, women’s own reports of injury, and live observations of the couples.

In the past, domestic violence has been primarily attributed to cold, controlling and calculating individuals.

This study supports a growing body of research indicating that both men and women who are physically aggressive toward a partner have histories of aggressive and impulsive  behavior.

This study is important for prevention and treatment as well:

If a man is told that domestic violence is due to a need to coldness, a need to control, and systematic battering,  he may dismiss his difficulties, since this pattern doesn’t apply to him. If clinicians explain to men that their difficulties are related to the need to control anger and impulsive  reactions while under stress, they may be more aware that they are at risk, and better able to take responsibility for treatment.

A multicenter study led by UT Southwestern researchers, found that more than one-third of teenagers with treatment-resistant depression became symptom free six months after switching their medication, or combining a medication switch with cognitive behavioral therapy.

• Teens that had an improvement of symptoms after just three months into their new regimen were much more likely to show lasting improvements

• 2/3 of teens with depression continued to struggle with their symptoms after 6 months.
• Many of the patients in the study had been depressed for more than 2 years.
• All participants were less than 18 years old, with traits of moderate to severe major depression and thoughts of suicide. This is the population of individuals that typically have the worst treatment outcomes.
• Initially the teens failed to respond to treatment with the most common class of agents used to treat depression,  SSRIs(selective serotonin reuptake inhibitors) .
• Typically, 40 percent of teens will not respond to their first treatment.

Findings:

After 3 months,

• nearly 55 percent of the teens in the study improved when they both switched to a different antidepressant and participated in cognitive behavioral therapy,
• about 41 percent of participants showed improvement after just switching to either a different SSRI or to venlafaxine, a non-SSRI type of depression medication.

After 6 months,

39 percent of participants who completed six months of treatment no longer had symptoms of depression and were more likely to have had lower levels of depression, hopelessness and anxiety thaat the beginning of the study.

Other findings:

• Those who responded to the new regimen during the first three months were more likely to achieve remission, and many of those participants,  responded during the first six weeks of treatment.
• Current treatment guidelines suggest staying with a treatment for at least two to three months before trying another treatment.
• This study suggests we may need to revisit the guidelines, and be more proactive when treatment is not occurring withing the first 6 weeks.

The study was funded by the National Institute of Mental Health and the Advanced Center for Interventions & Services Research for Early-Onset Mood & Anxiety Disorders at the Western Psychiatric Institute in Pittsburgh.

Researchers at UC San Diego and UC Davis examined chocolate consumption and other dietary intake patterns:

• 931 males and female participants who were not using antidepressants
• participants were also given a depression screening test

Results:

• Those that screened positive for possible depression consumed an average of 8.4 servings of chocolate per month
• People that were not depressed consumed 5.4 servings per month
• The highest scorers on the mood tests, indicating possible major depression, consumed 11.8 servings per month
• Findings were similar among women and men
• After controlling for other dietary factors that could be linked to mood — such as caffeine, fat and carbohydrate intake, only chocolate consumption correlated with mood.

A serving of chocolate was defined as one ounce of chocolate candy

The relationship between chocolate and depression exists, but how the two are linked is unclear.

It could be that depression stimulates chocolate cravings as a form of self-treatment.

• Chocolate prompts the release of certain chemicals in the brain, such as dopamine, that produce feelings of pleasure.
• There is no evidence, however, that chocolate has a sustained benefit on improving mood.
• Like alcohol, chocolate may contribute a short-term boost in mood followed by a return to depression or a worsened mood.
• A study published in 2007 in the journal Appetite found that eating chocolate improved mood but only for about three minutes.

It’s also possible that depressed people seek chocolate to improve mood but that the trans fats in some chocolate counteract the effect of omega-3 fatty acids–thought to improve mood–in the body.

Another theory is that chocolate consumption contributes to depression or that some physiological mechanism, such as stress, drives both depression and chocolate cravings. It is possible that eating chocolate for comfort is a learned behavior; Chocolate is popular in North America and Britain, but in other cultures, different foods are considered pleasure-inducing pick-me-ups.