Depression is a known risk factor for Alzheimer’s disease and other forms of dementia. Diabetes, too, has been linked to an increased Alzheimer’s risk. Now, a new study shows that having both diabetes and depression raises the risk of developing dementia even more.

The findings are important, since diabetes and depression are two of the most common ailments afflicting the elderly. Furthermore, both illnesses can be successfully treated or managed, which may help to ward off dementia and other complications.

Other studies have shown that having diabetes increases the risk of all kinds of dementia by 47 percent, and the risk of Alzheimer’s by 39 percent. Other reports estimate that having depression doubles the risk of developing Alzheimer’s or other forms of dementia.

The new report, part of the Diabetes and Aging Study, looked at more than 19,000 men and women of varying ethnicities who were part of a health care plan in Northern California. They ranged in age from 30 to 75. All had Type 2 diabetes, and 3,766, or nearly 20 percent, were also suffering from depression.

The study participants were followed for three to five years and given tests for memory problems and other signs of dementia. During that time, 238 developed dementia. Having depression along with diabetes resulted in a two-fold increase in risk of developing dementia, independent of other risk factors like smoking, cardiovascular disease, and obesity. A two-fold increase in risk translates to about a five-year earlier onset of Alzheimer’s symptoms, the researchers noted.

"Prior research has shown that both depression and diabetes are risk factors for dementia,” said study author Rachel Whitmer of Kaiser Permanente. “This study suggests that having both of these illnesses occurring together is associated with an even greater risk."

Particularly worrisome was that some of the younger people in the study, under age 65, were also at increased risk of dementia, which is uncommon in younger people. "Earlier onset of diabetes in patients with depression and greater risk of dementia in younger, compared to older patients, with depression and diabetes underscore the importance of evaluating the potential for early depression interventions to reduce the incidence of dementia," said lead author Dr. Wayne Katon, professor and vice chair of the University of Washington Department of Psychiatry and Behavioral Sciences.

It is important that anyone with diabetes and symptoms of depression be screened for the mental health disorder. Depression, of course, can make someone with diabetes less likely to comply with medications or to exercise regularly or watch their weight, all of which can worsen diabetes symptoms.

Other research suggests that effective treatment of depression and diabetes, as well as eating more fruits and vegetables, could potentially reduce dementia incidence by some 20 percent. Treatment of the depression may be particularly effective in reducing dementia risk.

"Since depression affects up to 20 percent of diabetic patients, it is critical to understand this relationship and further evaluate whether depression interventions have an impact on dementia risk in patients with diabetes," explained Andrew J. Karter, a co-author on the current report.

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Babies born prematurely are at a much greater risk for developing severe mental disorders including psychosis, bipolar disorder and depression, according to a new study. Researchers found that individuals born very prematurely (less than 32 weeks) were three times more likely to be hospitalized with a psychiatric illness at age 16 and older than those born full-term.

The scientists believe the increased risk may be due to small but critical differences in brain development if the child is born before the full 40-week gestation period. The risk varied with each condition. Psychosis was two and a half times more likely for premature babies, severe depression three times more likely, and bipolar disorder 7.4 times more likely for those born before 32 weeks.

Researchers also found smaller but significant increased psychiatric risks for infants born only moderately early, between 32 and 36 weeks. “Since we considered only the most severe cases that resulted in hospitalization, it may be that in real terms this link is even stronger,” said Chiara Nosarti from the Institute of Psychiatry at King’s College London, who led the research.

She stressed, however, that “the majority of individuals who are born prematurely have no psychiatric or cognitive problems, are absolutely healthy and well functioning.”Overall, the disorders affect between one and six percent of the general population, she said.

Nosarti worked with researchers at the Karolinska Institute in Sweden and analyzed data from 1.3 million medical records in Sweden between 1973 and 1985 to find all those admitted to a hospital with their first episode of a psychiatric disorder by 2002.  They then looked back to see if these people had been born either very or moderately prematurely.

“The strongest association we found was to mental health disorders known to have a strong biological basis, such as bipolar disorder,” Nosarti said. She said the results suggest that slight alterations in the developing brain of those born early may play an important role in mental health in their later years.

Earlier research has shown that preterm babies are at a greater risk for various health and developmental problems, but this study was the first to look in detail at the association between severe psychiatric disorders and premature births.

A United Nations-backed report in May reported that 15 million babies were born prematurely in 2010 and that rates of the phenomenon are rising around the world partly due to advances in medicine which allow even extremely premature babies to survive.

When asked whether this increase could be partly responsible for similar rises in mental illnesses and neurodevelopmental disorders such as autism, Nosarti said a small portion of these may be explained by premature births.

The research found that approximately six percent of people with severe depression and six percent of those with psychosis were born preterm, as were around 11 percent of people with bipolar disorder.

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The results, reported May 25 online in the journal Epidemiology, are good news for women who worry that their depression will harm their baby. Researchers also stress that women who take antidepressants during pregnancy should not be overly alarmed.

“Women did not ask to be depressed and yet they worry that their depression may affect their baby,” said Kimberly Yonkers, professor of psychiatry and of obstetrics, gynecology, and reproductive sciences. “This study tells them they should not worry that they are somehow compromising their pregnancy because they are depressed. And when considering whether to take medication for depression, women should understand that the risk of preterm birth is only one of many factors they should weigh.”

The study found that taking serotonin reuptake inhibitors (SRIs) during pregnancy significantly increased risk of what is called a late preterm birth. Late preterm birth is defined as at least 34 weeks after gestation but before 37 weeks. Antidepressant use is not associated with early preterm birth, which is much more
dangerous to the baby.

Yonkers said that several previous studies suggested depression itself might lead to premature birth. The Yale team studied almost 3,000 pregnant women, including those who were diagnosed as depressed during their pregnancy. After controlling for numerous variables such as health history, age, drug use, and socio-economic status, they found no association between depression and premature birth.

They did find a significant risk of preterm birth among women who were taking anti-depressants. So should depressed women not take antidepressants?

 “A woman should always consult with her doctor, but if she is symptomatic and suffering the use of antidepressants may be indicated,” Yonkers said. Kathleen Belanger of Yale was senior author of the paper. Megan V. Smith, Nathan Gotman and Haiqun Lin are other Yale-affiliated authors.

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The birth of a baby is usually a joyful time. However, one in eight women will suffer from postpartum depression. Instead of feeling elated about their new family member, they may feel depressed, anxious, irritable, worried and withdrawn.

A 30-minute DVD created by the local Prenatal/Postpartum Mood Disorder Task Force highlights the stories of three Humboldt County women who have experienced a postpartum mood disorder. The DVD, titled “Finding Your Way through Postpartum Mood and Anxiety Disorders,” also includes interviews with one woman's husband and a local doctor, a therapist and a certified nurse midwife. The public is invited to a free showing of the DVD on Wednesday from noon to 1 p.m. at the Community Wellness Center, 908 Seventh St. in Eureka. The presentation is one of several local activities that have taken place in May in conjunction with national Mental Health Month.

While many women experience mild, short-term mood changes right after the birth of a child, some experience more significant symptoms of depression or anxiety, according to the U.S. Department of Health and Human Services. Symptoms of PPMD can begin at birth or any time in the first year after childbirth.
”The goal of our DVD is to put a familiar community face with the message that PPMD does happen to many families, there are resources for support and there is hope,” said Mary Scott, director of Public Health's Maternal, Child and Adolescent Health program.

Scott also facilitates the Prenatal/Postpartum Mood Disorder Task Force, which includes representatives from the Department of Health and Human Services, local hospitals, Family Resource Centers, Paso a Paso, Northcoast Children's Services, United Indian Health Services and other organizations, as well as women and family members who have experienced perinatal mood disorders. Funding for the English language version of the DVD came from a Union Labor Health Foundation grant given to the task force. A Spanish-language version of the DVD is currently being completed, with funding from the Union Labor Health Foundation and St. Joseph Health System.
 

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The students who show signs of depression are more inclined towards using the Internet differently than those who show no symptoms of being depressed, a new study has revealed. Researchers at Missouri University of Science and Technology analyzed Internet usage among college students.

They used the actual Internet usage data collected from the university's network for the purpose of study.
The researchers recognized nine fine-grained patterns of Internet usage that may indicate depression.
They found that the students showing signs of depression tend to use file-sharing services more than their counterparts, and also use the Internet in a more random manner, frequently switching among several applications.

Dr. Sriram Chellappan, an assistant professor of computer science at Missouri S and T and the lead researcher in the study claimed that the findings provide new insights on the association between Internet use and depression compared to existing studies. "The study is believed to be the first that uses actual Internet data, collected unobtrusively and anonymously, to associate Internet usage with signs of depression", said Chellappan. He revealed that Previous research on Internet usage has relied on surveys, which are "a far less accurate way" of assessing how people use the Internet.

"This is because when students themselves reported their volume and type of Internet activity, the amount of Internet usage data is limited because people's memories fade with time. "There may be errors and social desirability bias when students report their own Internet usage," Chellappan said. Here, social desirability bias refers to the tendency of survey respondents to answer questions in a manner that will be viewed favorably by others. Chellappan and his fellow researchers gathered a month's worth of Internet data for 216 Missouri S and T undergraduate students.

The data was collected anonymously and unobtrusively and students involved in the study were assigned pseudonyms to keep their identities concealed from the researchers. However, before the researchers collected the usage data from the campus network, the students were tested to determine whether they showed signs of depression.

After this the researchers analyzed the usage data of the study participants. They found that students who showed signs of depression used the Internet much differently than the other study participants. Chellappan and his colleagues found that depressed students tended to use file-sharing services, send email and chat online more than their counterparts.

Such students also tended to use higher "packets per flow" applications, those high-bandwidth applications often associated with online videos and games, than their counterparts. Also they tended to use the Internet in a more "random" manner by frequently switching among applications, perhaps from chat rooms to games to email. Chellappan thinks that randomness may indicate trouble concentrating, a characteristic related to depression.

"Students showing signs of depression had high flow duration entropy, which means that the duration of Internet flows of these students is highly inconsistent," said Chellappan. At the beginning of the study, the 216 participating students were tested to determine whether they showed the symptoms of depression.

Based on the Center for Epidemiologic Studies-Depression (CES-D) scale, about 30 percent of the students in the study fulfilled the minimum criteria for depression. On a national level, previous studies have shown that between 10 percent and 40 percent of all American students suffer from depression.  Chellappan's study has been accepted for publication in a forthcoming issue of 'IEEE Technology and Society Magazine'.

The study will be titled as "Associating Depressive Symptoms in College Students with Internet Usage Using Real Internet Data. Kotikalapudi is the chief author of the paper and has received his Master of Science degree in computer science from Missouri S and T in December 2011. His co-authors for the paper are Chellappan; Dr. Frances Montgomery, Curators' Teaching Professor of psychological science; Dr. Donald C. Wunsch, the M.K. Finley Missouri Distinguished Professor of Computer Engineering; and Karl F. Lutzen, information security officer for Missouri S and T's IT department.

Chellappan is now aiming to use these findings to develop software that could be installed on home computers to help individuals determine whether their Internet usage patterns may indicate depression.
The software would unobtrusively monitor Internet usage and alert individuals if their usage patterns indicates signs of depression.

"The software would be a cost-effective and an in-home tool that could proactively prompt users to seek medical help if their Internet usage patterns indicate possible depression.""The software could also be installed on campus networks to notify counselors of students whose Internet usage patterns are indicative of depressive behavior," said Chellappan. Chellappan also believes that, the method used to connect Internet use and depression can be helpful help in the diagnosis of other mental disorders like anorexia, bulimia, attention deficit hyperactivity disorder or schizophrenia.

"We could also investigate associations between other Internet features like visits to social networking sites, late night Internet use and randomness in time of Internet use with depressive symptoms," he said.
"Applications of this study to diagnose and treat mental disorders for other vulnerable groups like the elderly and military veterans are also significant," he added. (ANI)

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"It might be good politics but it's not good policy," CEO Lewis Kaplan told AAP. "It's not good for the nation's health to not focus very much more strongly on the diabetes pandemic because it's going to send the system broke." He was speaking in Sydney at the launch of a major new study of 3338 Australians living with diabetes, which highlighted illnesses linked to the disease.

Mr Kaplan said he was disappointed that Federal Health Minister Tanya had been unable to attend the launch because of a prior engagement. "We wanted to have her in the real world, not in that policy bubble called Canberra," Mr Kaplan told the launch. "Unfortunately she had a more pressing engagement."

Diabetes Australia says at least one million Australians have been diagnosed with diabetes and 700,000 are undiagnosed. Up to 275 new cases are diagnosed every day. Experts predict that by 2016 it will be the leading disease burden in the country - costing the nation billions.

Mr Kaplan said the government should have forsaken the budget surplus and pumped money into diabetes healthcare. "If we don't do something about it, in 20, 30 years' time we won't be able to afford healthcare because there will be so many people with so many complications from diabetes," he added.

The Diabetes Miles Study launched on Monday found that 35 per cent of adults who use insulin to treat type 2 diabetes experience moderate to severe depression or anxiety. Adults with type 2 diabetes are also far more likely to report complications such as heart disease, sexual dysfunction and vascular disease.

Mr Kaplan said that with over 200,000 Australians with type 2 diabetes on insulin, the study sample could mean over 70,000 people are afflicted with depression. Black Dog Institute spokesman Will Bonney said stronger mental health was key to dealing with the challenge of diabetes.

"As someone who has lived with type 1 diabetes for 31 years and encountered the black dog a number of times along the way, I am pleased that attention is being brought to the interplay of depression and diabetes," he said.

Diabetes is caused when the pancreas cannot make enough insulin to convert sugar to energy. Type 1 is unpreventable but Type 2 diabetes, which affects 85-90 per cent of all sufferers, is greatly increased by lifestyle factors such as high blood pressure, obesity and poor diet. Symptoms include blurred vision, fatigue, mood swings and headaches.

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LONDON: Women who have inherited specific genetic variants may be at increased risk for postnatal depression, according to research presented at a conference in Italy this week. If confirmed, the investigators hope that their finding will result in a blood test being developed that will allow doctors to check a woman’s risk for the condition before giving birth.

“There are studies suggesting that women with postnatal depression appear to have abnormal hormonal responses to stress, especially responses of the hypothalamic pituitary adrenal axis, possibly due to differences in sensitivity to the steroid hormones of pregnancy,” said lead investigator Dimitris Grammatopoulos from the University of Warwick, in the UK, who presented the research this week at the International and European Congress of Endocrinology in Florence, Italy.

Nature versus nurture
“Our study provided the first evidence that specific variants of genes controlling the hypothalamic pituitary adrenal axis are associated with increased risk of postnatal depression,” he said. Postnatal depression is common in Western countries affecting around 1 in 7 women.

“If left untreated, postnatal depression has profound consequences on the quality of family life and social functioning as well as on the long-term emotional and cognitive development of the baby,” said Grammatopoulos.

Similarities between depression and postnatal depression
Mutations located in genes that regulate the hypothalamic pituitary adrenal axis have previously been linked to depression, but not specifically to postnatal depression.

The most significant risk factors for the condition that have been identified to date include having a past history of depression, psychological disturbance during pregnancy, a poor marital relationship, a lack of social support, and exposure to stressful life events.

As there are certain similarities between depression and postnatal depression, Grammatopoulos and colleagues decided to test a group of 140 pregnant women for five genetic variants known as single nucleotide polymorphisms (SNPs) previously linked with increased susceptibility to depression.

The women were tested for postnatal depression before and 2–8 weeks after giving birth using a psychological test called the Edinburgh Postnatal Depression Score, and 34 of the women developed the disorder.

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New data released today at the annual meeting of the American Psychiatric Association show that patients with unipolar, non-psychotic Major Depressive Disorder (MDD) receiving transcranial magnetic stimulation (TMS) with NeuroStar TMS Therapy® achieved significant improvements in both depression symptoms and in quality of life measurements.  Overall, 58 percent of patients achieved a positive response to NeuroStar TMS therapy, with 37 percent of patients achieving remission from their depression.

After an average of five weeks of NeuroStar treatment, the percentage of patients reporting extreme problems with anxiety and depression decreased by 42.2 percent, demonstrating a reduction in depression symptomatology. For overall treatment effect, the percentage of patients reporting no problems in performing usual activities improved by 30.5 percent.  

"The improvements we observed show that non-drug therapy with NeuroStar TMS not only reduces the symptomatic suffering of patients, but lessens the disability of depression with important implications for these individuals' ability to return to functioning effectively at home, in the workplace, and in the community," said Ian A. Cook, M.D., Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles.

In the open label study, which involved 307 patients receiving acute treatment with NeuroStar TMS, patients experienced statistically-significant improvement across physical and mental variables as measured by the Short Form 36-Item Questionnaire (SF-36).  The SF-36 is a multi-purpose, short-form health survey that evaluates functional health and well-being of disease among eight variables including physical functioning, role limitations due to physical problems, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems and mental health. After five weeks of acute TMS therapy, the most drastic improvement was seen in the mental component summary score, which more than doubled from 16.6 prior to therapy to 33.5 after therapy.

Similarly, self-reported quality of life measures significantly improved with TMS therapy compared to baseline according to the EuroQol Questionnaire (EQ-5D), a standardized instrument that was used to evaluate the effect of TMS therapy on the quality of life of patients.  At the end of acute treatment with TMS, the greatest improvements in EQ-5D dimensions were observed among patients who indicated no problems with "usual activities" (14.3 percent pre-TMS vs. 44.8 percent post-TMS), "anxiety/depression" (1.6 percent pre-TMS vs. 30.1 percent post-TMS) and "pain/discomfort" (39.4 percent pre-TMS vs. 52.8 percent post-TMS).  In other EQ-5D dimensions, 81.8 percent of patients reported no problems with "mobility" following TMS treatment vs. 68.7 percent at baseline; 87.1 percent of patients reported no problems with "self-care" following TMS treatment vs. 72.6 percent at baseline.

"These data reinforce the clinical efficacy of TMS Therapy as a viable option for patients living with major depression who have not achieved or maintained symptom improvement with oral antidepressants," said H. Brent Solvason, M.D., Stanford University Medical Center. "The most meaningful takeaway for patients is that TMS Therapy has the potential to make them feel better, in addition to potentially allowing them to experience a level of physical and social functionality they haven't had with their depression."

About Transcranial Magnetic Stimulation TMS is a non-invasive, non-systemic therapeutic device that delivers magnetic resonance imaging (MRI)-strength, pulsed, magnetic fields to induce an electronic current in a localized region of the cerebral cortex, the part of the brain that controls mood.  NeuroStar TMS Therapy is the first and only TMS therapy for major depressive disorder cleared by the U.S. Food and Drug Administration (FDA) that has been proven to achieve remission without systemic side effects in patients who have not found relief with antidepressant medication.

About Depression Depression is a serious illness that affects about 20 million Americans annually. People with depression may experience a range of physically and emotionally debilitating symptoms, including anxiousness, sadness, irritability, fatigue, changes in sleep patterns, loss of interest in previously enjoyable activities and digestive problems. It is estimated that about four million patients do not benefit from standard treatments for depression, even after repeated treatment attempts.

About the Study The clinical trial was a multi-site, naturalistic, observational study involving 307 patients receiving acute treatment with TMS therapy across 43 clinical practices.  All treatments were initiated using the NeuroStar TMS Therapy® System (Neuronetics, Inc., Malvern, PA, USA).  The study is posted on www.clinicaltrials.gov, listing number NCT 01114477.

About NeuroStar TMS Therapy® Neuronetics' NeuroStar TMS Therapy System was cleared by the FDA in October 2008 for the treatment of MDD. NeuroStar TMS Therapy is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly- focused MRI-strength magnetic field pulses. The treatment is typically administered daily for 4-6 weeks.

About Neuronetics Neuronetics, Inc. is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses. Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation. Neuronetics was created as a spin-out of The Innovation Factory, a medical device incubator in Duluth, GA.

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There are few disorders which can silently destroy the beauty of our being and gifts of our creation more than the multi faceted and diverse symptoms of depression.

Depression is, without doubt, the fastest growing illness in the U.K. Approximately 1 person in every 5 will become depressed at some point in their lives and one in 20 will be clinically depressed. Statistics suggest that women are more vulnerable to depression, but men generally find it harder to admit to or talk about their experiences. We should never try to dismiss the symptoms of depression and always take them seriously, they are never an inevitable part of growing up or growing old. It is possible to overcome depression, and to prevent its return.

If we are suffering from depression it means that our brain and nervous system has reached a point where it has slowed down. In most cases it will do this because it is confronted with too much stress.  Stress or imagined stress is very often the trigger for a panic attack. This stress may be related to current issues but far more likely an event has triggered a past experience which we have pushed down deeply within ourselves and which is not in our conscious self.

Many people suffering from mental problems will be prone to panic or anxiety attacks as depression is very often intertwined with these. It is often suggested that if we suffer from one of these problems we are likely to suffer from the other. In many cases depression has its roots in our shame, our sorrow and our hope.

When we are attacked by depression it seems impossible to function and to enjoy life as we should. Hobbies and friends don't interest us as they used to, we feel exhausted all the time and just getting through the day can be massively overwhelming. Although, when we are depressed, things may feel hopeless, with help and support we can get better. Firstly we need the right tools and learning about depression, recognising the signs, symptoms and causes, is the first step to beating this enemy.

I often hear the word "depression" being used to explain feelings of sadness, but sadness is a healthy reaction to events in our life. Depression is much more than just sadness. Depression can be described as like ‘living in a black hole' and carrying a sense of impending doom. But often depressed people don't experience sadness at all and instead can simply feel lifeless, empty, and apathetic.

Irrespective of the symptoms, depression is different from normal sadness as it can totally take over our day-to-day life, damaging our ability to function effectively in any capacity. We desperately look for relief from the intense and unrelenting feelings of hopelessness, helplessness, and worthlessness.

Depression has a number of different causes which will be different from person to person and can occur through a combination of factors. With the exception of manic depression, it does not seem to be inherited through genes although some of us are more prone to depression than others. This is because of the way we're made, or how our emotional system has responded to experiences or family background. Past experiences can have a profound effect on how we feel about ourselves in the present, and if those feelings are very negative, they can be the start of a downward spiral. In many cases, the first time someone becomes depressed, it will be sparked off by an unwelcome or traumatic event, such as losing a job, going through divorce, being physically attacked or raped. It's not just the negative experience that causes the depression, but how we deal with it. If the feelings provoked are not expressed or explored at the time, they fester and contribute towards depression. It's important to acknowledge and grieve over what we have lost in order to be able to move on successfully.

There is a major characteristic about depression that we must always be aware of when turning our minds to fighting and defeating it. Depression feeds on itself. In other words, we get depressed and then we get more depressed about being depressed. Negative thoughts become automatic and are difficult for us to challenge. Being in a state of depression can then, itself, become a bigger problem than the difficulties that caused it in the first place. We need to break the hold that the depression has on us.

Depression can manifest in many different ways and we don't always realise what's going on because the problems seem to be physical, not mental. Perhaps we tell ourselves we are simply feeling tired or affected by the weather. To recognise depression in ourselves, a friend or a loved one, read through the list below which are the most common signs. Identifying with more than three of these makes depression highly likely.

* Being restless and agitated.

* Having difficulty sleeping, or feeling tired and lacking energy.

* Realising that we are doing less and less.

* Self-harming or being occupied with thoughts of suicide.

* Developing physical aches and pains with no physical cause.

* Not deriving pleasure out of things which we usually enjoy doing.

* Blaming ourselves and feelings of guilt about day to day actions.

* Loss of self-confidence and a preoccupation with negative thoughts.

* Using tobacco, alcohol or other drugs more than usual.

* Not eating properly and losing or putting on weight.

* Noticing that we have started to cry a lot.

* Being unusually irritable or impatient.

* Loss of interest in sex.

* Finding it hard to concentrate or make decisions.

* A sense of feeling numb, empty, despairing or helpless.

* Having difficulty remembering things.

* Feeling low-spirited for much of the time, every day.

* Distancing ourselves from our friends and not asking for help.

* Taking a bleak, pessimistic view of the future.

 This list or parts of it can be found anywhere on the internet.  A very commonly searched phrase on Google is "Signs of depression". Many of these sites simply recycle the same familiar information about negative self-statements, affirmations and biochemical imbalances. A few might tell us something of value, but the vast majority are fundamentally commercial sites designed to sell us something. Perhaps online therapy, or for us to click on banner advertising to generate income for the website owner.

Encouragingly, there is no isolation here, below are just a few of the famous people who have been treated for depression: Winston Churchill, Jim Carrey, Woody Allen, Agatha Christie, Charles Dickens, T.S. Eliot, Nelly Furtado, Ernest Hemingway, Margaux Hemingway, Janet Jackson, John Keats, Beyonce, Hugh Laurie, Paul Merton, Brian May, Michelangelo, Gwyneth Paltrow, Diana, Princess of Wales, Rachmaninoff, Charlotte Rampling, John D Rockefeller, Mark Rothko, Robbie Williams, J.K. Rowling, Will Self, Brooke Shields, Britney Spears, Catherine Tate, Leo Tolstoy, Mike Wallace, Evelyn Waugh, Tennessee Williams, Owen Wilson, amongst countless others.

 Aaron Beck's work in the 60's and 70s created a far greater understanding towards depression and the benefits of ‘cognitive therapy'. His two seminal works, ‘Depression: Causes and Treatments' and some years later ‘Cognitive Therapy and Emotional Disorders' in my view moved away from empirical beliefs and moved much more towards an empathetic and a person centred approach.

There is no evidence to the popular rumour that depression is caused by a lack of chemicals in our brain. An increase of certain chemicals to our brain can, however, suppress many of the symptoms of depression. I believe there are only a very few situations where medication and therapy work well together. In many cases I have had examples where the client can fall back into depression after a few months. I do wonder whether the anti-depressants can darken that shadow between the knowing and the doing. At some point I believe the most effective work will be done in the absence of these medications, although there may well be a right and wrong time for that. Treatment simply through medication does no more than, at best, paper over cracks. When we do this the cracks just become bigger. We can not solve depression with a pill.  There are no easy answers.

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IN DECEMBER, The Economist warned that without dramatic intervention the euro zone could face a new depression. Soon after, the European Central Bank sprang into action, averting an immediate financial meltdown through heavy lending to banks. The resulting calm looked like an opportunity for euro-area leaders to seize the moment and escape, once and for all, from crisis. Instead, complacency set in. The ECB's financial anaesthetic has not prevented a steady economic deterioration that now threatens to engulf—and perhaps end—the euro zone.

Across the euro area, unemployment is worsening. The unemployment rate touched a new record high in March: 10.9%, up a full percentage point from the prior year. Of course, the pain is not evenly distributed. It is low and reasonably steady in the north but high and climbing in the south. Youth unemployment rates are staggering—over 50% in Greece and Spain, 36% in Portugal and Italy, rising sharply in all four. There is worse to come. Manufacturing activity is slowing sharply across the euro area, and the core is no longer immune:

The details of these reports are most worrying. April's decline was stunning, but new order inflows tumbled at the fastest pace since December. The job decline in manufacturing is now impacting Germany and France.

The picture is distressing. It is not surprising. The euro-zone economy is large and overwhelmingly driven by domestic demand. That demand has been steadily squeezed by a broad, sustained fiscal tightening. Monetary policy is providing almost no relief. The ECB raised rates last year, and while it has since unwound the 50-basis-point increase from 2011, it shows no interest in cutting rates further below the present 1% level. Quantitative easing looks out of the question. The ECB's extraordinary lending to banks seems to have stabilised bank-financing conditions; it does not appear to have prevented a sharp slowdown in lending to the private sector. There was no way to avoid a return to recession amid such circumstances.

Ordinarily, of course, policymakers would react to this deterioration by taking steps to stabilise the economy. What is most frightening about the euro-area picture is that this is not happening. For now, austerity remains the rule. Despite the nastiness of the economic picture, the ECB is widely expected to take no action at its meeting tomorrow. The euro area is walking, eyes wide open, into depression. Led by its periphery, which is already there.

Most everyone seems to have convinced themselves that this sort of thing isn't so bad, so long as a Lehman-like financial collapse is avoided. It isn't. Nothing good will come of a euro-zone depression.

If, when all of this is said and done, the euro zone descends into a chaotic, costly break-up, many people will write that such a thing was inevitable, unavoidable. They'll be wrong. We are watching causation this very moment: institutions that know how and why to prevent things from falling apart and which nonetheless sit back and do nothing.

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