When I heard that there were headlines saying fast food can trigger depression, I shrugged my shoulders. Oh well. I don’t eat fast food anyway. But wait! What’s this? The study also includes “commercial baked goods (doughnuts, cakes, croissants).” I practically live off those! From PsychCentral:
The results also showed that those participants who ate the most fast food and commercial baked goods were more likely to be single, less active and have poor dietary habits (eating less fruit, nuts, fish, vegetables and olive oil). It was also common for individuals in this group to smoke and work over 45 hours per week.
Well, yes, that does sound like a rather depressing way to live. Do they watch crappy TV too? Sigh.
Fast Food Linked to Depression [Psych Central]
liz | 12:01 PM | depression
When I was a kid, I was aware that my grandmother was frequently sick as a result of something called “sprue.” It meant she had a weird diet, and was very thin. Sadly, she also had no sense of smell, so the world of food was entirely unremarkable for her. No one else we knew had sprue, an autoimmune disorder, but it made sense because she had other autoimmune stuff going on too.
In 11th grade I went on a trip to what was then the Soviet Union. I made the mistake of eating something from a street vendor. I got very sick, and the sickness lasted through senior year. Regular ol’ tourist bacteria was quickly ruled out, but when the gastroenterologist found out my grandmother had sprue, he got excited: It skips a generation, he said, and might be the cause of my problems. I underwent endless tests and then a biopsy of my small intestine. The results were inconclusive. But a gluten allergy has very specific symptoms—very. Trust me, you don’t want to know what they are, because they’re related to poop, but they are pretty unmistakable and I had them. The doctor diagnosed sprue.
I was put on a gluten-free diet. In high school, that kind of sucks. It’s hard to go to pizza joints and Burger King with all your friends and be so limited. My parents took me to a celiac sprue support group, and I can only tell you that we laughed all the way home. This was 1985, remember, and the delicious! “cornbread” they served to prove that it wasn’t so bad to be gluten-free was not encouraging. The conversation was unintentionally hilarious.
The weird thing was, I got better. My symptoms disappeared. Then, at my high school graduation party, I unthinkingly plucked a piece of macaroni from a bowl of macaroni salad on the sideboard and popped it into my mouth. As soon as I realized it was gluten, I started to cry. What had I done? I told my mom in a panic and she said she thought it was okay. And it was. Gradually, I introduced gluten back into my diet. And you know what? Nothing happened. From that day to this I’ve been eating gluten and never had a problem again.
Nowadays the mysterious sprue is known as gluten allergy and it’s everywhere. It seems half the people I meet are allergic to wheat, and the allergy has spawned an industry of foodstuffs and cookbooks. (For a funny take on this kind of thing, check out the Allergy Pride Parade on the new season of Portlandia.)
Dealing with allergies of any kind can get you down, but when the allergies pertain to something we do every day—something as fundamental as eating—it can truly be a pain in the ass. Now a new study says it’s rather more serious than that for women. From MedPage Today:
In celiac disease, ingested gluten can damage the surface villi and impede nutrient absorption, but 37% of women with the condition met the clinical threshold for depression on the 20-item Center for Disease Studies Depression Scale, according to Joshua M. Smyth, PhD, of Pennsylvania State University in University Park, and colleagues.
Moreover, 22% also met the criteria for disordered eating assessed on a 29-item questionnaire, the researchers reported online in Chronic Illness.
Following a gluten-free diet is the usual recommended treatment for celiac disease, however, because of the near ubiquity of gluten in common foods, many patients with the immune disorder have difficulty keeping to their diet.
And even those who do adhere to the diet can remain symptomatic, which can interfere with normal functioning and lead to psychological difficulties.
Unsurprisingly, women who are forced to focus on food due to the disease can get consumed by the worry, and segue into eating disorders like anorexia and bulimia. Given that eating disorders are frequently about control issues, this makes sense—you have no control over your celiac diet but you exert control otherwise. Also, women who are on the celiac diet have excessive concerns about weight, according to the study. On the other hand, I don’t know one single woman who doesn’t worry about her weight.
Worse celiac symptoms were associated with poorer physical functioning and mental health (P<0.001 for both).
Correlations also were seen between different areas of psychiatric functioning, such as depression and stress (r=0.54, P<0.001), as well as stress and eating concerns (r=0.85, P<0.001).
The average level of depressive symptoms was 14.93, with a cutoff for clinical depression of 16.
The 65 women whose depression scores were at or above the cutoff had worse celiac symptoms (P<0.001), greater stress (P<0.001), lower dietary adherence (P<0.05), and worse quality of life for both physical and emotional domains (P<0.001 for both). ....
The study confirmed that women with celiac disease are at risk for psychiatric distress, implying that screening may be useful and that psychosocial support may be an important aspect to overall care for these patients, they observed.
Lesson to be learned from the study? Women who adhere to the diet and do not obsess about their weight are far less likely to experience depression.
The Chicago News Cooperative takes up the problem of Mayor Rahm Emanuel’s decision to cut six of Chicago’s 12 mental health centers. In Philly, that would be devastating, so I can’t imagine it’s any different there. Of course the government is saying that people will be taken care of somehow, but that’s the kind of thing they always say, right? They say they patients from the other centers can just go to the ones that will stay open. But, um, that would mean a 71 percent increase in patients for the remaining clinics and a 0 percent increase in resources. Sounds like a plan.
Go here to read the stories of the people whose lives will be impacted by the cuts. Interestingly, though you’d imagine they’re depressing, they’re actually stories of hope. People with these illnesses are so strong, they are such survivors. They’re remarkable, and they deserve better.
Over at Huffington Post (I know; clearly you can tell what I’ve been reading lately), Cara Santa Maria is doing a series called “DSM Diagnosis: How Do You Know If You Have Mental Illness?”
Isn’t she cute? I think she’s completely adorable, though I can’t wait until she grows out of the lip ring. She’s obviously trying to do a serviceable job here, and though I’m not entirely comfortable with the setup (invoking abnormal psychology), her explication of the DSM is solid enough. I think a lot of people are unaware of the way the axes work within diagnostic criteria and it makes a big difference to how they’re treated. (If your medical records are seen by more than one person — if you’re in the System for a long time — and that Axis II diagnosis included mental retardation in 1976, it probably included it in 2006, even if that diagnosis was a mistake due to your language barrier or hearing loss. I’ve seen that happen.)
Obviously, as with anything of this type, there are problems. Some of the imagery is a little goofy (note the photo of the schizophrenic person) but if you think about it, what else can you use? Santa Maria is going to be talking about this subject for a month, but you know how these things go: the real conversation is in the comments section. Please consider taking a minute or two and correcting some ill-informed opinions over there. People are saying really stupid shit and we should educate them.
The size of this headline right now on Huffington Post is huge:
There are things — books, movies, Journey songs — that help put things into context for me when I feel down. It’s usually about resetting time; I get very caught up in mulling over things that have happened in the past that have compromised the present. Or I’m thinking about the future in a way that makes me feel confounded and hopeless.
But recently I saw a documentary about a man, Joe Hutto, who raised 16 wild turkeys, and I was simply blown away by it. It was the most moving thing I’ve seen in many years, and it has absolutely become key to my understanding of staying in the present. In the film, Hutto says,
So many of us live either in the past or the future and betray the moment. And in some sense we forget to live our lives. … And wild turkeys don’t do that. They are convinced that everything they need, that all their needs will be met only in the present moment and in this space and the world is not better a half mile through the woods, it’s not better an hour from now, and its not better tomorrow. That this is as good as it gets. So they constantly reminded me to do better and to not live in this abstraction of the future which by definition will never exist. And so we sort of betray our lives in the moment so the wild turkeys reminded me to be present, to be here.”
Every time I find myself feeling frustrated or bored now, I think, “Don’t betray the moment,” and I look around to see what’s beautiful or special about the world around me. Right now, it’s how my dog has arranged the blankets with exceeding care so she could curl up in a circle and go to sleep. I can hear her little puffs of breath, and when she sleeps she smells like corn. I know that’s odd, but that’s the moment, and I have to appreciate it because, sadly, dogs don’t live forever. If I betray this moment by thinking about how bored I am or depressed or bloated (PMS?), I’ve missed seeing the world. And people don’t live forever either. It’s a gift to listen to and watch a little dog sleep.
This week has been kind to Deep Brain Stimulation (DBS) after the results of a study were published in the Journal of Neurosurgery. Headlines like “More Evidence DBS Effective for Severe Depression,” “Depression Symptoms Eased With Deep Brain Stimulation,” “Deep Brain Stimulation therapy helps fight depression,” etc. will give people with treatment-resistant depression new hope. But as with all study results, it’s best to be cautious about these.
The study included 21 patients who’d tried at least 16 medications without good results, had depression for 20 years and were unable to work due to the condition. The DBS device was implanted to target the subcallosal cingulate gyrus (natch), which had shown good responses to DBS at a single center before but researchers wanted to see if results could be replicated across multiple centers.
It seems that the issue with DBS at the moment is sustaining the improvement. From the study abstract:
Patients treated with SCG DBS had an RESP50 of 57% at 1 month, 48% at 6 months, and 29% at 12 months. The response rate after 12 months of DBS, however, increased to 62% when defined as a reduction in the baseline HRSD-17 of 40% or more. Reductions in depressive symptomatology were associated with amelioration in disease severity in patients who responded to surgery.
In a Medscape translation by Deborah Brauser, that means the study actually had mixed results.
Results showed that although 57% of the participants had a 50% reduction in HRSD-17 symptom scores at the 1-month follow-up, only 48% showed the reduction at the 6-month mark and only 29% showed it at the 1-year mark.
“The apparent drop in efficacy…is potentially worrisome but may be somewhat of an artifact of the data analysis,” write the investigators.
Brauser also points to an editorial in the journal that makes the headlines this research is getting even more misleading:
“[Principal investigator Andres M. Lozano] and his clinical collaborators have given us an interesting and important study,” writes Kim J. Burchiel, MD, from the Department of Neurological Surgery at Oregon Health and Science University in Portland, in an accompanying editorial.
However, Dr. Burchiel notes that because of its open-label design, the study “cannot be regarded as evidence of efficacy; only safety can be assessed to some degree.”
In addition, he calls the 29% 1-year improvement rate “modest,” adding that it may be consistent with a placebo response.[Emphases mine}
It also distresses me to learn that one of the study participants committed suicide, though I realize those things happen in such research trials. Was the suicide due to the implantation? An attempted suicide, Brauser writes, took place “between weeks 4 and 5, but this was thought to be due to a family matter.”
The reality is that even for those people who had a short-term benefit, they may have felt it was worth it after so many years of suffering.
An incredibly eloquent submission by Joe Gutstein.
Let’s imagine for a moment that you are long into the public mental health system. You have been in the hospital multiple times, in a couple of partial hospitalization programs, and have spent years in sheltered workshops and day programs. You’ve received the Prophecy of Doom, “Too sick for too long to get any better.” You’ve heard plenty of statements beginning with “You can’t, You won’t, and You will never.” You’ve been told endlessly that something is intrinsically (genetically) wrong with you and the only thing that will truly save you is a medication yet to be discovered. You’ve also been told that the most important thing you can do is get on SSI or SSDI in light of the prolonged and persistent nature of your illness. You’ve been told to engage in meaningful activities generally limited to walking, listening to music, and reading. You’ve been told countless times to avoid any stressors which might be associated with more rewarding activities and these stressors will doubtless lead to yet another hospitalization. You’ve been told so many things.
You’ve lived through several successive Eras: Psychosocial Rehabilitation, Evidence Based Practices, Transformation, Recovery and now Recovery and Wellness but the only thing that actually changed was your medication. You’ve been referred to as a patient, a recipient, a client, a consumer, a prosumer, a self advocate and now a “person with ….” but everything is the same at the hospitals, the sheltered workshops, the partial hospitalization programs and the very day program you now attend. You are now told pursuant to the Recovery model that you are suddenly empowered but what evidences your empowerment? What is it in your life that is now different? When did you last hold a meaningful job, live in decent housing, go on a date, attend to a party which wasn’t held at 3 pm or have friends over to your place? Has your health improved? Has your circle of friends and acquaintances changed? Has your income increased to provide for more options? What activities do you now engage in which you wouldn’t have before you were empowered?
Are you empowered? Not really, nothing has changed in your existence. What you do have is a familiar long standing delusion in which you are empowered. You imagine, it is part of your symptomatology, that you can provide anyone anything and everything with a CGI script. This is an empowering belief within your disempowering reality and among all the other folks at the day program it gives you a unique identity, a unique story where being unique in other areas might not be highly regarded. Fortunately, there is no impact on your role as a person in the day program unless you chatter away about it. (No more so than your peer who believes he is being watched by friends on another planet. After all, he is no longer alone all the time. Someone is watching over him where no one else might otherwise care about him.)
What is going to replace this powerful delusion and that which accrues to you by virtue of it? Let’s consider your options and the system of supports and services which will assist you in replacing it. Knowing that it is best not to ask for anything specific which might fall beyond the groups found at the day program, You say, “I want to be empowered.” The reply is “Of course, we can help you with this. Did you know that the day program has an Empowerment Group?” (You knew there was an Empowerment Group.) Consequently, you are signed up for the day program’s Empowerment Group. It meets in the same room as the Socialization Group which was going to help you get a date on Saturday night and the Pre-Vocational Group which was going to help you get a meaningful job. But you know the folks in the Empowerment Group. Not a one has become empowered. (The group meets weekly and all the chairs are in a therapeutic arrangement. There are handouts and members of the group so inclined read aloud from the handouts.)
So in the final analysis, you have the delusion and the Empowerment Group. The delusion is empowering but the Empowerment Group isn’t. Sadly, no one asked you the right question in the Era of Wellness & Recovery. Now – for the first time – the very question he or she would want to be asked in the same circumstances is being asked, “What do you need to thrive?” What is it that would lead you to hope for a life where the delusion has no value and might be patently detrimental. And for once you truly know that your answer shouldn’t be limited to something that happens in another group but involves real skills, fostered and facilitated in the real world with services and supports which promote a life. And just maybe you’ll now believe in the possibility of that date on Saturday night and a meaningful job for this new reality is more satisfying and empowering then any long held delusion.
In the recovery movement, which is the zeitgeist in the delivery of mental health services at this time, we are supposed to look past someone’s diagnosis. I am not “a bipolar” or “depressive” or “schizophrenic.” I have been diagnosed with such, but the relevance of that diagnosis is highly suspect. Because aren’t I just Liz? Liz who is addicted to Dunkin Donuts hazelnut coffee, Liz who likes chihuahuas in sweaters, Liz who tries to do gluteal exercises to increase her butt’s circumference — without success. So many things make up my Liz-ness, right? So who cares what some doctor said?
Generally speaking, I agree with this approach. For many years we have been labelling people in an attempt to treat them, and the results aren’t exactly stellar. So why not change protocols, DSM by damned?
Yet as a person who works on the frontlines of mental health care, I sometimes do find myself stymied by a person’s behavior, and a diagnosis can (infrequently) help. Because there certainly are definable characteristics of certain illnesses that can help me understand where a person is coming from. It also helps in distinguishing substance abuse from simple illness.
Here’s what I mean. Say I meet a guy who talks to me about his power over floating CGI-enhanced rabbit-shaped angels — who says he can get me anything I want by talking to them and persuading them. This is not true. By any measure we use to determine reality, the CGI-enhanced rabbit-shaped angel is clearly a fiction. But what if he slurs while he tells me this? What if he leaves that day and I have to understand what’s going on so I can advocate for him? Wouldn’t many people think, “That guy is on some serious crack.”
Now, we’d like to think a mental health professional would be more sophisticated than that, but then, you’d be assuming a level of knowledge that some MHPs simply don’t have (I say that with love). So if you look at this guy’s medical records and it says he has been diagnosed 10 times by 10 different doctors in the last 10 years as a person with schizophrenia, that might be good knowledge to have. Additionally, if his records state that he has never used drugs or alcohol, that’s also good to know.
I’m not saying that guy is only his diagnosis. I’m saying that hearing what psychiatrists have labeled him with for a decade might be useful information for me to have if I’m going to help him.
Similarly, the search for diagnosis can be a good road to travel. In today’s Washington Post, a mother asks Marguerite Kelly what her depressed daughter should do — meds or exercise? Kelly gives an answer that anyone should get in the absence of clinical assessment:
It’s time for your daughter to find an experienced board-certified internist who listens well and is curious enough to test her for viruses, low thyroid, high cortisol, candida and many other conditions that can cause depression. If she’s healthy, she then should be evaluated by a psychologist or a psychiatrist, who will ask her about any trauma or loss that she’s had, any history of depression in the family, any bad PMS occurrences or any sadness in the winter, all of which can trigger depression.
This is a good protocol in search of a diagnosis. That being said, my psychiatrist reminds me again and again he doesn’t care what my label is; he just wants to help me feel better. And it’s true that it doesn’t matter if you call it OCD or bipolar of DID or PPP (for Poo Poo Poo), if you’re counting every crack in the sidewalk, it’s probably time for some help.
These are my thoughts for today, messy though they are. I’d love to hear your thoughts.
A new study of heart patients suffering from depression is in itself depressing — at least if you were excited about the potential of omega-3 fatty acids to life your spirits. From the New York Times:
The patients were randomly assigned to a combination of sertraline, an anti-depressant, and either omega-3s or a corn oil placebo. After 10 weeks, there was “absolutely no difference” in depression remission rates between the 59 patients taking omega-3s and the 56 patients taking the placebo, said Robert M. Carney, lead author of the study, which appeared in the Oct. 21 issue of the Journal of the American Medical Association.
“It was very disappointing,” he said.
The trial was launched because patients with heart disease are at greater risk of dying if they are depressed, Dr. Carney said. Depressed patients are known to have low levels of omega-3s, which are a risk factor for heart disease, as well.
Now, with any study, there are multitudinous caveats. It’s a small sample. They had lower levels of omega-3s to begin with. Perhaps there were other factors (i.e., physical illness) that superseded the treatment of depression, yadda yadda.
And there has been other research to suggest omega-3s are useful for depression. USA Today broke down a different study in 2007:
The omega-3 fatty acid in some fish may be a “brain food” that helps ward off depression because it increases gray matter in three areas that tend to be smaller in people who have serious depression, a study suggests today.
The increase could help explain why past studies have found that the omega-3 acid DHA reduces symptoms of depression. The richest sources of DHA are fatty fish and fish-oil capsules.
Researchers gave magnetic resonance imaging tests to 55 adults. Participants also reported everything they ate for 24 hours on two randomly selected days, says study leader Sarah Conklin, a neuroscientist at University of Pittsburgh Medical School. She’ll report her findings at the American Psychosomatic Society meeting in Budapest.
The more DHA a person consumed, the more gray matter there was in three areas of the brain linked to mood: the amygdala, the hippocampus and the cingulate, Conklin says. Seriously depressed people tend to have less gray matter in these areas, she says.
For every yes in research, there’s a no. It’s really frustrating for people looking for answers. That’s why it’s best to just go with your gut: Try what feels right and if it works for you, great. If it doesn’t work for you, move on to something else. But remember: There is no magic bullet — oily or otherwise.