Grieving the loss of a friend, family or loved one may soon be considered a form of depression. While many doctors acknowledge that grief is a very normal part of losing someone close to us, they also acknowledge that it’s important to deal with that grief.

Speaking to the New York Times one doctor explains why turning grief into a depression diagnosis could end up hurting those people suffering from some for of grief. “This would pathologize them for behavior previously thought to be normal.” says one doctor.
Opponents to the diagnosis also say to could lead many people with short term grief receiving drug treatments that would normally be unnecessary outside of depression symptoms.

Supporters of the bill say it’s not about misdiagnosing patients but rather helping those people who’s grief has become debilitating. In those cases doctors argue that many grief stricken people don’t get help because they are told their extreme cases of grief are “normal” and therefore require no treatment.

Under the current definition/criteria for depress doctors have listed such cases as sleep loss, loss of concentration and other signs, however grieving was never included. If approved the new diagnosis would appears in the Diagnostic and Statistical Manual of Mental Disorders.

Also under consideration would be a tightening of the definition of Autism, a disorder many doctors now believe may be prescribed too often for children who are just socially awkward or still developing but at a slower pace then peers of the same age.

Do you think the act of grieving should be diagnosed as a form of depression or have doctors taken the definition too far outside of it’s original diagnosis?

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A clinical trial of ''magic mushroom therapy'' could take place in the UK within a year following two ground-breaking studies. Doctors plan to treat depressed patients who cannot be helped by modern drugs or behaviour-based psychotherapy with the active ingredient in hallucinogenic mushrooms. Psilocybin would slowly be infused into their bloodstreams while they receive a carefully tailored ''talking therapy''.

The controversial trial is planned by Professor David Nutt, from Imperial College London, who three years ago was sacked as the Government's chief drug adviser. Prof Nutt, former chairman of the Advisory Committee on the Misuse of Drugs (ACMD) clashed with then Home Secretary Alan Johnson after criticising the decision to toughen the law on cannabis.

The move to investigate psilocybin as a possible treatment for serious depression is linked to results from two far-reaching scientific studies. In one, volunteers were given psilocybin infusions while undergoing functional magnetic resonance imaging (fMRI) brain scans.

The findings, reported today in the journal Proceedings of the National Academy of Sciences, showed the drug disconnected two key ''hub'' regions of the brain with multiple connections to other areas. One of these regions, the medial prefrontal cortex (mPFC) is known to be hyperactive in people with depression. The other, the posterior cingulate cortex (PCC) at the back of the brain, is thought to play a role in consciousness and self-identity.

The second study, soon to be published in the British Journal of Psychiatry, found that the magic mushroom chemical enhanced memories associated with positive emotions. Scans showed that the memory experience was very ''real''. Activity was increased in brain regions that processed vision and other sensory information.

Speaking to journalists in London, Prof Nutt said the findings were ''a revelation''. ''Psychedelics are thought of as 'mind-expanding' drugs so it has commonly been assumed that they work by increasing brain activity, but surprisingly, we found that psilocybin actually caused activity to decrease in areas that have the densest connections with other areas. ''These hubs constrain our experience of the world and keep it orderly. We now know that deactivating these regions leads to a state in which the world is experienced as strange.''

It is the first time serious research has been carried out on the effects of ''psychedelic'' drugs for more than 50 years. In the 1950s and 1960s, scientists investigating drugs such as LSD and psilocybin carried out studies on around 40,000 patients and published 1,000 papers. Such work was brought to an abrupt halt when the drugs came to be seen as social evils and were made illegal.

''They got banned because they could be society changing,'' said Prof Nutt. ''There was great concern about that. Since then they've been virtually impossible to research.''He said finding support for the new studies had been ''damned difficult''. Neither the Medical Research Council (MRC) nor the Wellcome Trust, Britain's biggest research charity, had been willing to fund them. And both Nature and Science, the two most prestigious scientific journals, refused to publish the findings. Now the MRC is said to be showing interest in the planned clinical trial, which Prof Nutt believes could be undertaken this year with sufficient backing.

Twenty six patients with a history of serious depression which cannot be treated with drugs or cognitive behavioural therapy (CBT) are expected to take part. Half will be treated with psilocybin while trained psychotherapists prompt them to recollect happy memories and think positively. Findings from the earlier research suggest the positive effects of the drug might be long-lasting, or even permanent.

After the treatment, the patients' progress will be monitored for a year. Their responses will be compared with those of a ''placebo group'' of another 13 patients given infusions of a salt solution containing no psilocybin.

For safety reasons, both the PNAS and British Journal of Psychiatry studies involved healthy volunteers unaffected by mental problems. All had also taken hallucinogenic drugs in the past without reacting badly to them.

Thirty participants took part in the PNAS study and ten in the British Journal of Psychiatry study. Volunteers had a range of vivid and ''dreamlike'' experiences including seeing geometric patterns, an altered sense of time, and the ''Alice in Wonderland'' sensation of being either very big or very small.

They also underwent ''mystical'' transformations of the sort reported by Buddhist monks who practise deep meditation. This has been described as the ''ego dissolving'' and becoming ''one with the universe''.
One volunteer described the effect of psilocybin as being like ''kneeling before God''. Prof Nutt stressed that people should not be tempted to conduct their own experiments with magic mushrooms. ''This is a research tool which may give us insights into how to treat depression,'' he said. ''I would strongly resist people self-medicating.''

Dr Kevin Healy, who chairs the Royal College of Psychiatrists' Faculty of Medical Psychotherapy, described the British Journal of Psychiatry study as ''interesting'' but added: ''We are clearly nowhere near seeing psilocybin used regularly and widely in psychotherapy practice. ''Although this study found that psilocybin enhanced autobiographical recollection in 10 healthy volunteers, we have no evidence that it would enhance a therapeutic response in patients, where the experienced relationship between patient and therapist is central to the therapeutic work.''

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Patients with depression and type 2 diabetes showed more improvement when they received simultaneous treatment for both conditions, researchers report.

Their 12-week study of 180 patients found that nearly 61 percent of those who received integrated care combined with a brief program to help them adhere to their medication regimens achieved improved blood sugar test results, and almost 59 percent had a reduction in depression symptoms.

Among patients who received usual primary care for the two conditions, nearly 36 percent had improved blood sugar test results and about 31 percent had a reduction in depression symptoms, said the researchers at the Perelman School of Medicine at the University of Pennsylvania.

The study appears in the January/February issue of the journal Annals of Family Medicine.

There is a link between depression and diabetes, the researchers noted. Depression is a risk factor for diabetes, and diabetes also increases the risk of depression. Depression is common in diabetes patients and contributes to poor adherence to diabetes medication regimens, which can lead to poorer diabetes management.

In the integrated treatment group, care managers worked with participants to increase their adherence to both diabetes and depression medications, addressing barriers such as medicine costs and lack of social support.

“Though research demonstrates the link between depression and diabetes, few integrated programs is being implemented in practice,” study lead author Dr. Hillary Bogner, an assistant professor of Family Medicine and Community Health in the Perelman School of Medicine, said in a university news release.

“Our results demonstrate that integrated treatment for both conditions, combined with a brief program focused on adherence for primary care patients with type 2 diabetes and depression can result in a significant improvement in clinical outcomes. We hope the findings will encourage the adoption of adherence programs aimed at improving outcomes,” Bogner added.

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PEOPLE who battle severe depression should seek professional help to manage stress and prevent extreme acts such as suicide, said a leading clinical psychologist. It follows the suicide of Bahraini Badriya Ali, who died last week after pouring kerosene on her body and setting herself alight.

The 59-year-old was said to have been suffering from psychological problems. Such people need a strong support system at home to help them monitor their medication and manage daily life challenges to put them on the right road to recovery, said Al Dana Consultation Centre general manager and clinical psychologist Dr Banna Bu Zaboon.

She said lifestyle changes, stress and the breakdown of family unit can all contribute to the development of depression. However, it is important for those in stressful situations or jobs to take programmes that teach them how to manage and understand their stress to prevent becoming anxious.

It would also prevent people developing severe depression and related health problems. Dr Bu Zaboon, who conducts a five-day stress-related programme for institutions and companies, urged people to seek help from clinical psychologists to avoid depression and teach them self-reliance.

"Anyone can become depressed in their life and although they might not die they can lose interest in their life, family, health and job," said Dr Bu Zaboon. "We have a problem in our world, we don't recognise our feelings, so many patients feel restless and don't like to eat, but they don't realise they are having depression.

"We need people to identify how they are feeling. Some people think their problems are physical and will go to the doctor with back pain, restlessness, weight loss, unable to sleep and so on. "Some doctors will recognise that they are suffering from depression and refer them to a psychiatrist but some don't go.

"Depression can be hereditary and these people should take care. "If anyone feels they are becoming depressed they should seek medical attention quickly."According to the World Health Organisation (WHO) depression affects 121 million people worldwide and is among the leading causes of disability worldwide.

Severe depression affects five to 10 per cent of the global population, but almost all will experience feelings of depression at some point in their life. Dr Bu Zaboon said severe depression like other mental illnesses can lead to suicide if left untreated. She said medication combined with cognitive behavioural therapy was the best way to tackle severe depression.

Most people who commit suicide have not been taking their medication properly and are not receiving the care and support they need. "When you are very depressed you don't think properly and you can't control yourself and you think 'why live', someone like this is in severe pain, their coping system is zero and they can collapse in a minute," she explained.

"Anyone can feel for a moment that life is black but a normal person will quickly overcome these feelings, but a depressed person has a chemical imbalance in the brain and if they are not taking their medication properly and not going for psycho therapy it can be very dangerous for them. "Medication alone is not enough. They need cognitive behavioural therapy because it helps them think positively and to rely on themselves."

Dr Bu Zaboon said depressed people need a strong support system to regulate their medication to avoid a possible overdose. She said therapy might be necessary for the family of a depressed person as they were also affected by this condition.

"It's not easy to live with a severely depressed person, it affects the whole family because they become like a child and need to be looked after all the time," she said. "They need someone to take them to their appointments and make sure they take their medication and receive cognitive behavioural therapy.

"Families need to support patients who are severely depressed because they may try to end their lives, they can't feel happy, can't smile or taste their food."Following Ms Ali's suicide, Psychiatric Hospital chairman Dr Adel Al Offi said citizens and residents with psychological problems could receive free treatment at the Psychiatric Hospital in Salmaniya.

He said there was also a 24-hour Health Ministry hotline (39425525) for people suffering from psychological problems, but more needed to be done by civil societies, organisations and the ministry to support people with mental problems.

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A past suicide attempt is the best predictor of a future attempt, says psychiatrist and director of the Ottawa Psychopharmacology Clinic Dr. David Bakish. In addition, he says, "the risk of suicide is higher in someone who has a family history of suicide. Suicidologists from the 1900s on recognized that there was a familial tendency."

Bakish, who previously taught at the University of Ottawa and worked at the Royal Ottawa Hospital, notes that when profiling patients in the emergency room, "we would look at those with that weight towards suicide very carefully before discharging them. And in my clinical practice now, we treat patients who have had a previous suicide attempt and have someone in the family who had a suicide attempt much more aggressively."

Gene screening indicates that people with "suicidal ideation seem to have a bigger number of a specific serotonin receptors. So there definitely seems to be a linkage with serotonin."He adds that the genetic connection becomes more complex with time.

For example, he says, negative events in childhood could change serotonin sensitivity and could result in an individual being prone to overreact in some situations, "sometimes by a cry for help through suicidal gestures."

"There are many other reasons for suicidal thoughts," says Bakish. "You can have the person who is perfectly well, then blows the family fortune and jumps out of a window. There is also a whole body of literature on drugs that may or may not induce suicide."

However, the biggest problem of all, he says, is that "people don't see depression as an illness. They see it as a failure of their psyche and are embarrassed because there is a stigma and people - particularly males - come for help too late. People should accept that depression is an illness, that treatment and medication can help and that suicidal ideation is a danger sign."Almost all suicides are preventable, he says. "The easiest way to decrease the suicide rate is to get the patients who have depression treated."

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Marcus Trescothick, the former England cricketer, and Jonny Wilkinson, England’s 2003 Rugby World Cup winner, are supporting the campaign to get more people to talk openly about mental health problems. The Department of Health has provided £16 million for the Time to Change campaign, aimed at children in schools and youth clubs and via social networking websites.

Nick Clegg, the Deputy Prime Minister, said: “This is particularly important as young people suffering with a mental illness are particularly vulnerable to the stigma surrounding it. They can be bullied, marginalised, left to suffer alone, too afraid to talk about what they are going through. This is a tragedy.” Government figures suggest one in four people will experience mental health problems during their lives. Trescothick, who has spoken about his own battle with depression, urged more people to “speak out about their mental illness, just like I did”. In a blog for the campaign, Wilkinson has described his “obsessiveness” and “dark” thoughts that led him to self-harm.

It comes a year after the Coalition launched its mental health strategy, which was designed to improve access to psychological therapies. More than 500,000 people have entered treatment for mental illnesses between July 2010 and September 2011, while 24,000 were able to move off sick pay and benefits after receiving therapy for their problems, the Government said.

A salesman who lost his job after telling his boss he was depressed yesterday won the backing of MPs and business groups after posting his letter of dismissal on Twitter. Roy Ward tweeted: “Dear Twitter, I just opened up to my boss about my depression and she’s indicated she might have to fire me. Erm, help?” Within a few hours thousands of users began contacting him to offer their support and advice, including Louise Mensch, the Tory MP, Alastair Campbell, Tony Blair’s former spin doctor, and the Chartered Institute of Personnel and Development.

 

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Does depression have an upside? Is there some sort of evolutionary advantage for a person to become depressed, for instance, to re-evaluate their lives or perhaps a choice they made that led to their current depression?

Most people who are depressed certainly wouldn’t think so. (I don’t either.) But it doesn’t stop evolutionary psychologists and other researchers from positing that there may indeed be some sort of evolutionary reason for it. Richard Friedman, MD, writing in the New York Times today, explores the issue.

Other researchers have found that sad subjects were better judges of deception than happy ones. Evolutionary psychologists suggest that perhaps the rumination of people who have depression is an adaptive strategy to solve a painful problem.

But research on this issue is nearly always done on college students, and not even depressed ones at that. That certainly limits the generalizeability of their results, and doesn’t necessarily translate into a better understanding of depression as experienced by people who are actually clinically depressed.

It’s a conclusion Dr. Friedman eventually comes to as well. Even if there’s some “point” to depression, it no longer seems to serve the evolutionary advantage it might have once did.

Regardless of its evolutionary purpose, depression remains a serious but eminently treatable mental disorder. Our minds try to justify life problems in a million different ways. However, none of it helps for us to actually treat the problem in the here and now of people’s personal lives.

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Individuals treated for both depression and Type 2 diabetes have better medication compliance and experience significant improvements in depression and blood sugar levels compared to those receiving typical  treatments, according to a new study out of the University of Pennsylvania.

Over 60 percent of patients who received both treatments along with a short period of intervention to encourage adherence to prescribed medication regimens experienced improved blood sugar levels and 58 percent had fewer depression symptoms, compared to only 36 percent and 31 percent, respectively, of patients who received regular care.

Depression is a known risk factor for diabetes, and diabetes also increases the risk for the development of depression. Depression is frequently found in patients with diabetes, and it tends to contribute to poor adherence to medication routines, which hinders diabetes management.

“Though research demonstrates the link between depression and diabetes, few integrated programs are being implemented in practice,” said lead author Hillary Bogner, MD, MSCE, an assistant professor in the Perelman School of Medicine at the University of Pennsylvania.

“Our results demonstrate that integrated treatment for both conditions, combined with a brief program focused on adherence for primary care patients with Type 2 diabetes and depression can result in a significant improvement in clinical outcomes.”

“We hope the findings will encourage the adoption of adherence programs aimed at improving outcomes.”For the study, researchers randomly assigned volunteers to integrated care or usual care groups. Integrated treatment combined typical primary care with a brief medication adherence program.

Patients and primary care physicians worked with integrated care managers to identify and talk about possible potential medication regimen problems, such as the cost of medications, or a lack of social support.

Individualized programs were developed to improve adherence to antidepressants and diabetes medication. By attaching electronic monitors to pill bottles, researchers kept track of the precise date and time participants took their prescribed medications over the 12-week period.

In the end, 60.9 percent of subjects who received the integrated approach had improved blood sugar levels, compared to only 35.7 percent of patients who received only the usual primary care. Also, patients in the integrated care group were more likely to show fewer depression symptoms in comparison with patients in the usual care group (58.7 percent vs. 30.7 percent, respectively).

“Our study calls for a greater emphasis within healthcare systems on the development and promotion of clinical programs to enhance medication adherence, particularly among patients with chronic medical conditions and depression,” said Dr. Bogner.

“An integrated approach to depression and type 2 diabetes treatment may facilitate adoption in practices with competing demands for limited resources.”

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Employees with depression who are receiving treatment while they’re still working are significantly more likely to be productive, according to a study by the Centre for Addiction and Mental Health (CAMH). The study, which is published in The Canadian Journal of Psychiatry, is the first of its kind to examine a possible correlation between treatment for depression and workplace productivity.

Mental illness costs the Canadian economy an estimated $51 billion annually, with a third of that attributed to productivity losses. People who experience a depressive episode are significantly less likely to be highly productive, the study shows. This is not surprising, since depression has been shown to have adverse effects on comprehension, social participation and day-to-day-functioning, explained Dr. Carolyn Dewa, head of CAMH’s Centre for Research on Employment and Workplace Health. However, those “who had experienced a moderate depressive episode and received treatment were 2.5 times more likely to be highly productive compared with those who had no treatment,” she said. “Likewise, people who experienced severe depression were seven times more likely to be high-performing than those who had no treatment.”

Despite the positive results, the study also shows a troubling trend regarding employees’ willingness and/or ability to seek out help for mental illness. Among the study participants who had experienced a severe depressive episode, 57% did not receive treatment. Of those who had experienced a moderate depressive episode, 40% did not seek treatment.

“When we look at the success of workers in the sample who received treatment while still in the workplace, it really speaks to the importance of prevention and the need for employers to facilitate treatment and support,” said Dewa. “If people are able to receive treatment early, disability leave—which costs companies $18,000 per leave—may be avoided.”

People’s reluctance to seek help for mental illness may come down to stigma, discrimination and lack of support in the workplace, suggested Dewa. “It is crucial that employers offer mental health interventions to their employees and support them in engaging in treatment, as well as continuing to support them as they transition back into the workplace.”

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These days, trying to keep a healthy style of life is probably one of the biggest challenges ever. Although a lot of people still don’t look at depression as a health condition, it is the sort of illness that affects a staggering number of people. The worst part is that not even scientists are fully aware of the factors that can cause depression. But, one step at a time, the scientists will crack this too. A recent study shows that depression is linked to the lack of vitamin D.

The study, published in Mayo Clinic Proceedings, shows that there is a strong correlation between depression and low levels of vitamin D. UT Southwestern Medical Center psychiatrists have started the largest investigation on the matter with the help of the Cooper Center Longitudinal Study. Their findings may put an end to all the conflictual results previous studies have showed.

Dr. E. Sherwood Brown, professor of psychiatry and senior author of the study, declared: “Our findings suggest that screening for vitamin D levels in depressed patients – and perhaps screening for depression in people with low vitamin D levels – might be useful”. However, despite their findings so far, these scientists say they “don’t have enough information yet to recommend going out and taking supplements”.

The fact is that although they have noticed a correlation, scientists still have not determined the exact relationship. The uncertainty is linked to whether low vitamin D contributes to depression, or whether the depression affects the level of vitamin D in the body, by reducing it.

One thing is for sure, according to Dr. Brown. Vitamin D has the potential to affect neurotransmitters and inflammatory markers. So far, the levels of vitamin D in the body have been showed to be risk factors in autoimmune and infectious diseases, diabetes, several cancers, Alzheimer’s and Parkinson’s as well as general cognitive decline.

The study has examined the results of 12,600 participants from late 2006 to late 2010.  The main result is that higher vitamin D levels tend to be linked to a significant decreased risk of depression. Depression and vitamin D deficiency is a topic that has initiated a lot of debates over the past few years, so finally sorting that out will be an important breakthrough in medicine today.

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