Raising an Optimistic Child: A Proven Plan for Depresion-Proofing Young Children--for Life
(McGraw-Hill, 2006) by Bob Murray and Alicia Fortinberry

Creating Optimism:
A Proven Seven-Step Program for Overcoming Depression
(McGraw-Hill, 2004) by Bob Murray and Alicia Fortinberry

March 25, 2002

We present the results of recent studies focussing on depression: the effectiveness or otherwise of antidepressants and herbal remedies such as St John's Wort; links to eating disorders and weight issues; and how each gender copes with, and is affected by depression.

• Psychiatrists Admit Down Side of Antidepressants
  The professional body for psychiatrists has conceded that antidepressant pills such as Prozac may only have a 50% success rate in treating depression.
• Depression Leads to Overeating for Women, But Not Men
  Women are far more likely than men to drive into the Hagen-Daz because they're depressed; men tend to overeat just because they like the food.
• Antidepressants May Protect Against Neuronal Loss in Mood Disorders
  Animal studies suggest that antidepressants and mood stabilisers are neuroprotective and may even lead to neurogenesis in selected brain regions.
• New Report on Women and Depression
  More than 19 million Americans suffer from depression yearly and women are twice as likely as men to experience a major depressive episode.
• The Web May Attract Compulsive Gamblers
  Internet gamblers may be more likely to have a serious gambling problem than other gamblers, say researchers.
• Midnight Eating Due to Depression and Stress
  The reason some people raid the fridge at night may have nothing to do with their insatiable appetite. Researchers believe that it is more likely to be down to their inability to deal with stress.
• Gender Difference, Cancer and Depression
  Recent studies show that the sexes have profound differences in they way they cope with cancer and depressive responses.
• Fatigue May Cause Postnatal Depression
  A simple questionnaire on fatigue could, if given after childbirth, identify women who are at an increased risk of developing moderate to severe postnatal depression, say US researchers.
• One in Six "Considers Suicide"
  Almost one in six UK adults have contemplated suicide at some point in their lives, according to a survey.
• New Research Throws Doubt on St John's Wort
  One of the active ingredients in the herbal remedy for mild depression, St John's Wort, is contained in such small quantities in some brands of the drug that they are ineffective, according to US research. And doubt continues over which active ingredient is responsible for the potential benefits of the remedy known technically as Hypericum Perforatum.

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Psychiatrists Admit Down Side of Antidepressants

The Royal College of Psychiatrists, which represents around 10,000 psychiatrists, has withdrawn previous advice that said "six or seven in every 10 depressed people will get better on antidepressants." Based on the most recent research, new draft advice says that between only 50% and 65% "will be much improved" if they take antidepressants.

For the first time, the new advice also concedes that herbal remedies made from the flower St Johns Wort are "about as effective as antidepressants in milder depression."

The college's old advice said that antidepressants are not addictive. "There is no evidence that antidepressant drugs caused dependence syndromes," it said. The new study acknowledges that there is a debate on the subject and points out that "up to a third of people experience withdrawal." It says withdrawal "seems to be greatest" with Seroxat, the biggest selling antidepressant in the UK which, like Prozac, works by boosting the levels of the brain chemical serotonin.

Withdrawal symptoms included nausea, flu-like symptoms, anxiety and sweating. In the last few years, prescriptions for antidepressants have more than doubled in England, from 9m in 1991 to 22m in 2000, due largely to the increase of drugs such as Seroxat and Prozac, known technically as selective serotonin reuptake inhibitors, or SSRIs. One of the reasons for this sharp increase was the view that SSRI were effective and relatively problem free, a view brought into question by the RCP's new advice.

The study comes after a report by Health Which?, published by the UK Consumers Association, claiming that official advice on antidepressants was misleading. Health Which? also pointed out that recent research suggests a link between suicide and SSRIs. The draft RCP guidelines claim that "suicidal thoughts will pass once the depression starts to lift."

Separately, scientists are finding interesting interactions between SSRIs (selective serotonin re-uptake inhibitors) such as Prozac and Paxil and certain form of cancer.

John Gordon, professor of immunology at Birmingham University, writing in the journal Blood has found that these drugs may stimulate the growth of brain tumours by blocking the body's natural ability to kill cancer cells. Gordon and his colleagues found evidence to suggest cancer cells can be killed by "positive thinking," which could be blocked when people take Prozac.

The study, to be published in the journal Blood next week, examined the effects of Prozac and other antidepressants on a group of tumor cells growing in a test tube. The researchers found that the drug prevented the cancer cells from committing "suicide," thereby leading to a more vigorous growth of the tumours. Although an increased risk of cancer has not so far been detected in Prozac patients, the latest findings could lead to a global re-evaluation of the drug's long-term safety.

On the other hand Prof Gordon's work has also shown that SSRIs may also provide some protection against other forms of cancer: "An exciting property of serotonin is that it can tell some cells to self-destruct. We have found that serotonin can get inside the lymphoma cells and instruct them to commit suicide, thereby providing the potential for an effective therapy," Professor Gordon said.

In newspaper stories the professor was also quoted as saying that people should not suddenly stop taking SSRIs on the basis of his findings.

Persistent studies have also tied Prozac to suicide. The main problem with antidepressants is that they do not deal with the underlying relationship causes of depression which researchers are coming to see as the main factor in the disease. BM

Read more in The Guardian

Read more in Health Which?

Read more in the journal Blood

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Depression Leads to Overeating for Women, But Not Men

That is according to University of Minnesota psychologist Robert Jeffery. His year-long study of 1,800 obese men and women looked at gender differences in the eating behavior of overweight adults. "Moods don't seem to be driving men's eating, but depression is a key driver for women," said Jeffrey, speaking at the American Psychosomatic Society meeting in Barcelona.

At the start, everyone rated how difficult they found it to resist food in varied situations -- at parties, when watching TV, etc. -- or while experiencing certain emotions. Participants also took a depression test and were asked about their medical histories. Women were nearly twice as likely as men to have a history of depression. "Body weight is not a big issue for men," Jeffery says, "but a lot of these women might be depressed because they're overweight, and the social consequences of this for women are much greater."

Women's depression around weight apparently prompts even more weight gain. For women, depression was strongly tied to trouble controlling eating behavior. Depression correlated with the women's inability to resist foods even more than their body weight did. For men, the heavier they were, the less confident they felt about controlling their weight; depression had no bearing on that confidence.

But could men just be denying that food is a crutch for them? Jeffery thinks not, because the relatively lighter men voiced more confidence about resisting food, and the heavier men said they had more trouble.

A year later, after receiving counselling in a weight-loss program, women who weren't depressed lost more than twice as many pounds as the depressed women who said they had trouble resisting food. For men, neither mental health nor confidence about controlling eating predicted weight loss.

Men usually have to be much more overweight than women before they'll enter weight-loss programs, Jeffery says. Women dominate group programs, "and programs with a lot of women ought to be addressing depression." Men, he says, "tend to be a lot more naive than women" about what puts on the pounds. "Eating is kind of a knee-jerk thing for them." An informational approach might work best for men, he says.

Read more in American Psychological Association and USA Today

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Antidepressants May Protect Against Neuronal Loss in Mood Disorders

According to Dr L Trevor Young, from McMaster University in Ontario, studies have shown that in the rat hippocampus and cerebral cortex, long-term treatment with antidepressants -- including selective seratonin reuptake inhibitors, tricyclics and monoamine oxidase inhibitors -- increases the expression of several target genes such as brain-derived neurotrophic factor (BDNF) and enhances neurogenesis.

Furthermore, long-term treatment with lithium and anticonvulsants increases the expression of several neuroprotectant factors in rodents. There are increasing reports of cell loss, both neuronal and glial, in key cerebral cortex regions in patients with mood disorders. Changes in the size of brain areas such as the hippocampus and amygdala have also been reported.

Postmortem studies suggest that antidepressant treatment may increase BDNF levels in the hippocampus and that lithium treatment may lead to small, but potentially relevant, increases in grey matter volume in patients with bipolar disorder. Dr Young said, "Enthusiasm and excitement about the neuroprotective effects of these psychotropic drugs is warranted, but more evidence is needed before clinicians can use this data to influence practice."

Researchers (especially those funded by the drug companies) are forever looking for new uses for antidepressants as the reality of their lack of effectiveness becomes more widely recognized. However the real point here is that depression, especially when it is due to early childhood trauma, causes a stunted development of certain areas of the brain and mis-wiring in others. Neurogenesis, the creation of new neurons (brain cells), thought impossible only a few years ago, is now seen as the great hope. Professional observers of our Uplift Program believe that the phenomenal success of the program can be explained by its ability to canalize the process of neurogenesis. BM

Read more in theJournal of Psychiatry and Neuroscience

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New Report on Women and Depression

These findings are among those summarized in a new report, "Summit on Women and Depression: Proceedings and Recommendations," just published by the American Psychological Association, and reflecting the research reviewed by 35 internationally renowned experts from a variety of disciplines who contributed papers to the Summit.

Major depression can impair a person's social and physical functioning even more severely than serious medical conditions such as hypertension, diabetes or arthritis, and can result in disability and significant loss of income, according to the research cited in the report. Furthermore, a World Health Organization Report examining "The Global Burden of Disease" found that "depression presents the greatest disease burden for women when compared with other diseases."

Among the major causes of depression in women the report singled life stress and trauma. Case-control and community-based studies have shown that more than 80 percent of major depression cases were preceded by a serious adverse life event. Traumatic events, such as childhood sexual abuse, adult sexual assault, male partner violence and physical illness also can lead to depression. Initial research has suggested that early trauma has a greater impact on risk for depression than later occurring trauma. Research has also indicated that women may be more likely than men to experience depression in response to a stressful event.

The report also outlined current research that has demonstrated that relationships are more paramount to women's self-concept than for men's. It also stated that women are more likely to experience stress in response to adverse events occurring in the lives of others and place their needs secondary to those of others. These interpersonal orientations illustrate major psychological differences between men and women that may help account for differences in vulnerability to depression.

Once again it is gratifying to have our long-held beliefs authenticated. BM

Read a summary of the report on the APA website

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The Web May Attract Compulsive Gamblers

A new study warns that the explosive growth of the Internet will lead to more on-line betting opportunities -- and thus increase the risk of more people suffering from the health and emotional difficulties associated with compulsive gambling. These can include substance abuse, circulatory disease, depression and risky sexual behaviours.

Psychologists Dr George Ladd and Dr Nancy Petry, of the University of Connecticut Health Center, US, surveyed the gambling behaviors of 389 people. They found nearly 11% were problem gamblers and over 15% met the criteria for pathological gamblers.

The most common forms of gambling reported by the participants were lottery (89%), slot machines (82%) and scratch tickets (79%). Next came card-playing forms of gambling (71%), sports betting (57%), bingo (56%) and animal betting (53%).

Internet gambling was reported by just over 8%, or 31 of the participants. Fourteen of those people reported gambling on the Internet at least weekly. Although Internet gambling was the least common gambling activity of the study's participants, the study found that a majority of those with Internet gambling experience had the most serious problems with addiction.

Only 22% of the participants without any Internet gambling experience had problems, compared with 74% of those who used the web. Internet gamblers were also more likely to be unmarried and younger. They also tended to have lower education and income levels.

Writing in the journal Psychology of Addictive Behaviors, the researchers said: "The availability of Internet gambling may draw individuals who seek out isolated and anonymous contexts for their gambling behaviours. Accessibility and use of Internet gambling opportunities are likely to increase with the explosive growth of the Internet."

Paul Bellringer, director of GamCare, an organisation in the UK dealing with the social impact of gambling, agreed: "We recognize that Internet gambling has the potential to push up the prevalence of problem gambling. It is relatively easily to get logged on to a hard gambling activity which is repeated time and time again and to get totally absorbed by it."

Mr Bellringer said that, in common with other forms of gambling, young people were potentially most at risk. It is estimated that people under the age of 25 are up to three times more likely to become problem gamblers.

Mr. Bellringer said: "Problem gamblers cease to be doing it for entertainment value or, despite what they might think, to win something. They simply want the gambling activity to last for as long as possible because it makes them feel powerful, they get a buzz from it or it helps them to escape."

GamCare is negotiating with Internet gaming companies to include the following:

• natural pauses between betting sessions
• customer limits on spending
• socially responsible messages about the dangers of gambling
• a helpline number

Read more from GamCare

Read more in Psychology of Addictive Behaviors

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Midnight Eating Due to Depression and Stress

The scientists, from the University of Tromso, Norway, believe "night-eating syndrome" may also be linked to a number of other harmful psychological and physical disorders.

The body's 24-hour clock is regulated by a complex pattern of hormones, which also play a role in how the body responds to stress. The researchers set out to test the theory that a compulsion to eat at night indicates a disruption of this hormone pattern -- and consequently an inability to deal with stress.

They compared five women with night-eating syndrome with five women who had no such compulsion to eat at night. The women with the syndrome ate at least half of their daily intake of food after 8pm, and snacked at least once during the night. Tests revealed that the night eaters had significantly higher levels of the stress hormone cortisol in their blood.

Similar findings have been recorded in people with other disorders, such as obesity, fatigue syndrome, anorexia nervosa, insomnia and depression. However, it is not yet clear whether these disorders are all caused by the same disruption to hormone patterns.

One wishes the researchers had also asked about the participants' experiences in childhood. Could it be that certain traumas, such as sexual abuse and parental fights, happened after the children were put to bed? One of my patients, who suffered from night eating for many years, remembered that her father used to wake her up late at night when coming home drunk from parties and behaved inappropriately. Subsequently, any night-time noise would wake her up, and often she sought solace and safety in food. When she became anorexic, she found herself eating at night when her defences against doing so were low. AF

Read more in BBC News

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Gender Difference, Cancer and Depression

According to psycho-oncologist Alexander Kiss, gender plays a big role in the way people respond to cancer, how they are treated by the medical fraternity and their survival prospects. He and his team from the Universities of Basel, Switzerland and Vienna, Austria, studied people suffering from breast (women) and prostate (men) cancers.

Sex and coping mechanisms

They found that gender differences are evident not only in the physical impact of the illness but also on sex, quality of life, psychosocial differences, coping, and patients' partners.

The most striking difference between the sexes is that whereas women are open to talk about their condition and their treatment with their friends, men are not. This difference may have its root in how men view themselves. According to the researchers: "If you ask men (colleagues or patients) what masculinity means for them, most are astonished, some make jokes, and you seldom get a consistent answer. How men are socialized and act as men is seldom discussed but constantly revealed in social interaction. It is influenced by beliefs and behaviour such as acting hard and strong."

Masculinity has close links to potency, not only in the biological sense but also in the social sense. Surprisingly, however, there is little awareness of, or research into, the effect of prostate cancer on male gender identity. Research on men has been limited to the fact that 80% of men who have been treated for prostate cancer by the traditional methods have been unable to maintain an erection sufficient for vaginal penetration after 55 months.

By contrast, the effect of surgical techniques (mastectomy versus lumpectomy) on femininity has been investigated extensively. 30-40% of women say that the procedure has negatively affected their sex lives but since their self-view is more social, emotional and relationship-centered this has not had nearly the same effect on their lives.

Although quality of life measures have been routinely incorporated into studies of treatments for breast cancer since the late 1980s, they were rarely included in studies of prostate cancer. The much earlier research into quality of life issues in breast cancer may be partly due to public concern about breast cancer stimulated by the feminist movement in the 1970s and 1980s. Public concern about psychosocial issues in prostate cancer has emerged only in the 1990s and has been restricted mainly to North America. The lack of information on the effect of quality of life of different treatments for prostate cancer makes it more difficult for men to decide about treatment.

Even now, the researchers claim, there is no randomised trial comparing the effect on quality of life of different treatments for localised prostate cancer (surgery, brachy therapy, and external beam therapy).

Depression and support

The diagnosis of cancer is distressing, and between 20% and 30% of cancer patients continue to be depressed or anxious six months after diagnosis. Disease stage, uncontrolled pain, and absence of social support correlate more with psychological distress than cancer site. Again more data are available for breast cancer than prostate cancer. Being depressed is "in contradiction" with the core issues of male gender identity. Certain symptoms of male depression may be gender specific, for example,:stress intolerance, low impulse control, alcohol misuse, and aggressive behavior.

During stressful times most women with breast cancer want to talk about it and share their feelings with others. Most men with prostate cancer would rather not. Clinicians involved in psychosocial research in cancer think that gender affects how people cope with cancer, but there is little empirical research on this issue. The authors of a recent study of men after prostatectomy concluded: "Most men with prostate cancer avoided disclosure about their illness where possible and placed great importance on sustaining a normal life. Factors related to limiting disclosure included men's low perceived need for support, fear of stigmatization, the need to minimise the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others."

Support groups for patients with breast cancer have a longer tradition than those for men with prostate cancer, and more women than men attend support groups. Men in support groups prefer to share information, whereas women prefer to share emotion. These gender differences are even found in Internet cancer support groups. Support groups for men are more common in North America than the rest of the world. More is known about the efficacy of group intervention in breast cancer than in prostate cancer.

However what is known, from this and other studies, is that the survival chances are much higher for non-depressed patients with a supportive family and friend network.

Urologists just don't get it

Although psychological distress in cancer patients is high, according to the researchers, doctors are poor at detecting depression (a separate study two years ago found that only about 50% of UK doctors recognized the symptoms of depression).

Psychological distress is often discounted as a normal consequence of having cancer. This lack of recognition of psychological distress means that many patients do not receive treatment.

Nevertheless, treatments such as antidepressant drugs, counselling, and supportive intervention are effective in cancer patients. However a recent study found that radio-oncologists' recommendation for supportive counselling did not correlate with patient distress or the amount of perceived social support by patients but rather with progressive disease and less denial behaviour. Oncologists increasingly realise the importance of communication skills, and training has been shown to improve their ability to detect and treat psychological distress. However, many urologists are not aware that there is a problem, and training has been lacking.

Wives more distressed than husbands

Partners are the most important emotional and social support for cancer patients. To support and care for others is a core feature of female, but not male, gender identity. A recent study found that female partners possessed a more accurate understanding of their husband's experience with prostate cancer than male partners had of women's breast cancer experience.

In the few studies comparing psychological distress of patients with prostate cancer and their wives, the wives seemed to be more distressed than the husbands.

Reported in the British Medical Journal

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Fatigue May Cause Postnatal Depression

In their study, the Pennsylvania-based team distinguished between "postpartum blues," which affects 50 to 80 percent of new mothers, and "postpartum depression," which affects only 15 to 20 percent of women. The "very dangerous mental illness," postpartum psychosis, affects less than a half percent of new mothers, according to the researchers from Penn State University.

Postpartum problems classified as "depression," rather than "blues" or "psychosis," can last from two weeks to one year and are linked to reported fatigue after the first week and fortnight following birth, their research suggests.

Women were visited within 24 hours of giving birth and subsequently on day 7, 14 and 28. "Women with high levels of fatigue on days 7 and 14 were significantly more likely to report symptoms of depression on day 28 than women with low levels of fatigue," said Ingrid Bozoky, one of the researchers who visited mothers at Pennsylvania's Center Community Hospital.

Dr Elizabeth Corwin, assistant professor at the university's school of nursing, told delegates at the Scientific Session of the Eastern Nursing Research Society that fatigue after childbirth is "normal." But she said the study suggested that depression is more likely in those mothers who do not experience a "fall off" in fatigue in the first 28 days after delivery.

Dr Corwin suggested that a questionnaire about fatigue used on the 14th day after birth could be administered as a matter of course on the baby's first visit to a paediatrician or other healthcare provider. "There certainly is some connection between fatigue and postpartum depression. Mothers should remember that they need to take care of themselves after giving birth."

Read more in Health-News

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One in Six "Considers Suicide"

According to researchers, as many as 4% had considered taking their own life in the past year. The survey, conducted by the Office of National Statistics, found that such suicidal thoughts were more likely among women and younger adults. Tony Blair's government has set a target of reducing suicides by 5% by 2010. Last year, however, the rate actually increased by 1%.

The ONS survey also revealed that suicidal thoughts were more common in divorced people, lone parents, and people who rented rather than owned their homes.

Increased rates of suicidal thinking were also found among those with mental disorders, who were dependent on alcohol or drugs, or who had experienced several stressful life events.

A total of more than 8,000 people were questioned for the survey. They were asked whether they had ever thought that life was not worth living, or whether they felt they would be better off dead. The sample was also asked whether they had ever attempted suicide, or if they had deliberately harmed themselves in any way but not with the intention of committing suicide.

Just over 4% of people questioned said they had attempted suicide -- about half a percent in the past year. Some 2% of those taking part had deliberately tried to harm themselves -- but without suicidal intent. Of those currently suffering depression, a quarter had at one time attempted suicide compared with 2% of those with no current mental disorder.

Psychosis was the factor which had the highest relevance to the likelihood of suicidal thoughts, followed by the number of stressful life events endured by the person. Schizophrenia is one illness which can lead to psychotic episodes -- as can Alzheimer's Disease or manic depression.

Richard Brook, chief executive of the mental health charity Mind, said: "Revelations that as many as 15% of adults have at one time or another considered suicide come as no surprise to Mind. We would hope that highlighting the fact that someone they know well could be affected by suicidal thoughts will help tackle the stigma of mental health problems, and make people more sympathetic to those experiencing problems."

Read more in BBC News

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New Research Throws Doubt on St John's Wort

Gerlie De Los Reyes and colleagues at the University of Southern California draw attention to research suggesting that hyperforin, rather than hypericin, may be the active component of the medication.

"Hypericins isolated from the extract have been shown to be virtually inactive as psychotropic agents in animal models," say the researchers.

The team looked at eight commercial brands of St John's Wort and found wide variations in the amount of hyperforin that they contained. Only two of the products tested contained enough to be clinically therapeutic, they concluded. And although recent literature suggests that hyperforin is an active antidepressant, it is not routinely used to standardize St John's Wort products because it degrades under ambient conditions.

Gerlie De Los Reyes said, "It's essential that manufacturers standardize and list the content of hyperforin on St John's Wort labels. Consumers must have this information to make informed decisions about the medications they are taking."

Read more in American Journal of Health-System Pharmacy

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