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Original article in the Guardian (November, 2017) by Luisa Dillner.

More than a quarter of new fathers in a new study showed significant levels of depression – what are the causes, and what can they do about it?

Men don’t go through pregnancy or childbirth. Their hormone levels don’t nosedive. They don’t get sore nipples. What exactly have they got to be depressed about? Quite a lot, according to research from Sweden showing that, over the past 10 years, a significant number of men have struggled with the transition to fatherhood.

This latest research tries to quantify just how many men get postnatal depression. Previous studies have found between 4% and 10% of men, while, in this smallish sample of 447 Swedish fathers who volunteered (and may therefore not represent your average dad), a surprising 28% of men had symptoms that scored above mild levels of depression. Overall, 4% had moderate depression. Fewer than one in five fathers who were depressed sought help, even though a third of those had thought about harming themselves. While women in the UK are often asked a series of questions that screen for postnatal depression (which affects up to 13% of women), the mental health of fathers is rarely assessed.

The solution

The lead author of the Swedish paper, Elisa Psouni, from the department of psychology at Lund University, says the Edinburgh Postnatal Depression Scale (EPDS) used for both women and men is not so accurate in picking up depression in fathers. Her research showed higher levels of depression in dads because it added in a score more reflective of “male” symptoms of depression such as agitation, anger, irritability, working longer hours and drinking too much.

Depression in fathers may be rising not just because researchers are looking for it, but because more new dads are struggling. Psouni believes fathers increasingly face the same dilemmas that mothers do – including trying to combine parenthood with working. Fathers who got depressed often had external pressures, such as job issues, and if their partner was depressed, their own risk of depression doubled. Lack of sleep, having twins and conflict in the relationship can all contribute.

A depressed dad will play and smile less with his child. Children are deeply affected by paternal postnatal depression with studies showing poorer measures of wellbeing and more behavioural problems at the age of seven.

Fathers who sense they may be struggling and partners, relatives or friends who notice an increase in irritability and anxiety in a man in the first year of parenthood (paternal depression is more dispersed throughout the first 12 months) should consider the possibility of paternal postnatal depression.

Cognitive behavioural therapy can help, as can antidepressants. If the depression is not recognised, says Psouni, “one of most terrible things is that you catch up with yourself a year later and realise you have been really down and struggling – and the first year of your child’s life has gone.”

Original article in the Conversation (August, 2017) by Gordon Parker

The term and even diagnosis of “depression” can have different meanings and consequences. Depression can be a normal mood state, a clinical disorder, and even a disease.

If your favourite soccer team loses, you might feel emotionally depressed for a few minutes. If you were a player on the team and you brought about the loss, your state of depression and self-criticism might last much longer. Both can be viewed as normal “depressed mood” states.

Such states are common, with a study of university students finding that 95% of individuals had periods of feeling depressed, being self-critical and feeling hopeless every 6-8 weeks. So we should accept that a “depressed mood” is a universal and common experience. For most, the depressed mood is transient because the person will come to terms with the cause, or its cause will cease to exist over time, or be neutralised in some way.

There’s no precise boundary between “depressed mood” states and “clinical depression”, but differences lie in impairment, symptoms and duration. Clinical depression is associated with distinct impairment (such as “absenteeism” with the individual unable to get to work, or “presenteeism” where the individual gets to work but the depression compromises their performance). Symptoms common in clinical depression include loss of appetite, sleep and libido changes, an inability to be cheered up, an inability to experience pleasure in life and a lack of energy. Clinical depression generally lasts months or years if untreated.

Current formal classification manuals tend to view clinical depression as a single condition simply varying by severity (major depression versus a set of minor depressions, regrettably including normal depressive moods). For the sake of discussing the causes of depression, I’ll look at two distinct types of depression: melancholia and the situational depressions.

Biological and disease-like depression

The key “biological” depressive disorder is melancholia. For some 2000 years, this was more viewed as a movement disorder rather than a mood disorder due to it showing “psychomotor disturbance”. This means the individual is slow to move or speak, lacking energy and unable to be cheered up, or agitated - wringing their hands, pacing up and down and repetitively uttering phrases. In addition, those with melancholia lose the capacity to find pleasure in life or be cheered up. They also lack energy and experience appetite and sleep changes.

A small percentage of those with melancholic depression develop “psychotic depression”. This is where an individual experiences delusions or hallucinations, often of derogatory voices telling them they’re worthless and better off dead, or of pathological guilt. For those with a bipolar disorder, most depressed episodes are melancholic or psychotic depression in type.

Melancholia has a strong genetic contribution, with a study quantifying a three times greater history of depression in family members of those with melancholia. If one parent has melancholia, their child has a 10% chance of developing the same; if both parents have melancholia, the chance is approximately 40%.

Once termed “endogenous depression” as it seemed to come from “within” rather than being caused by external stressors, episodes are generally more severe and persistent than would be expected from depression caused by environmental stressors. It doesn’t respond to counselling or psychotherapy and requires medication (most commonly an antidepressant drug but also perhaps other drug types). The psychotic form requires an antipsychotic drug in addition to an antidepressant.

There are a number of differing classes of antidepressants. The SSRIs (selective serotonin reuptake inhibitors) are viewed as increasing levels of the neurotransmitter serotonin in the brain and so correct the “chemical” disturbance underlying many depressive conditions. However, in melancholia it’s thought that there are also disturbances in other neurotransmitters such as noradrenaline and dopamine. Melancholia is therefore more likely to respond to the broader action antidepressant drugs such as the serotonergic and noradrenergic reuptake inhibitors (SNRIs) and tricyclics (TCAs), with the latter targeting all three implicated neurotransmitters.

In recent years, studies have not only implicated dysregulation in brain chemicals (“neurotransmitters”), but also in brain network circuits in those with melancholia. Disruptions in the circuits linking the basal ganglia (situated at the base of the forebrain and associated with emotion) and the pre-frontal cortex (the brain region implicated in personality expression and social behaviour) result in depressed mood, impaired cognition and psychomotor disturbance. These are, in essence, the key features of melancholia.

Brain imaging studies have also identified disrupted function in circuits and networks linking the insula (a brain region associated with awareness of our emotions) to other regions in the frontal cortex. These indicative findings are being progressively advanced by highly technical brain imaging strategies, and so in future years should clarify the multiple functional and structural changes that occur in the brain for those with melancholia.

There’s no “test” to diagnose biological depression, with former methods falling out of fashion due to inaccuracy, so diagnosis relies on the doctor identifying its characteristic features, excluding environmental factors and weighting a family history of depression.

Psychological and social depression

Non-melancholic depression is generally induced by a social stressor. A diagnosis of “reactive depression” captures a clinical, non-melancholic disorder caused by the individual experiencing a social stressor that impacts and compromises self-esteem. This could be a boyfriend or employer berating a young woman to the point where she feels worthless.

In many ways, such scenarios are similar to a “normal” depressed mood state, but more severe. Here we would expect the individual to come to terms with or neutralise the stressor, or even spontaneously improve across all clinical parameters after weeks. A chronic environmentally or socially driven non-melancholic depression generally reflects an ongoing stressor that the individual cannot escape. An example would be a wife who lives with a constantly abusive husband, but is unable to leave him due to having a number of young children and no money of her own.

Other non-melancholic disorders are principally driven by psychological or personality-based factors - with actual episodes generally triggered by social stressors. Research has identified a number of personality styles that put people at risk:

1. those with high levels of general anxiety who are at risk of depression because of their worrying, catastrophising propensities, and their tendency to take things too personally
2. “shy” people who are often this way due to having been bullied or humiliated in their early years. They often view social interactions with others as threatening in comparison to the safety of their own company
3. those who are “hypersensitive” to judgement by others. This could be praise or feeling (perhaps inappropriately) they are being rejected or abandoned. These people often respond by sleeping more and craving certain foods that may settle their emotional dysfunction
4. “self-focused” individuals who are hostile and volatile with others, blame others when things go wrong and prioritise their own needs. When depressed, they tend to show a “short fuse” and create collateral damage for those around them
5. those who were neglected or abused in their early years and who therefore have low basic self-worth. They often repeat such cycles of deprivation and abuse in their adult relationships, and so readily become depressed
6. perfectionists who are prone to self-criticism and a loss of pride. They may also have a limited range of adaptive strategies to stress.

There are several brain regions implicated in these non-melancholic mood states and disorders. A key site is the amygdala (an almond-shaped region in the brain that processes emotional reactions) which shows a heightened response when an individual is depressed.

If there is “chemical” dysfunction in the non-melancholic disorders, serotonin is the most likely neurotransmitter implicated. We suspect serotonin has a role to play but we can’t be sure yet and further studies are needed.

So, we should reject a “one size fits all” model for considering “depression” and instead favour a “horses for courses” model. There are multiple types of depression (normal and clinical), with the latter reflecting differing biological, psychological and social causes and therefore requiring treatments that address the primary causal factor.

Original article in ABC News (February, 2018) by Mira Adler-Gillies.

Johann Hari was 18 when he swallowed his first antidepressant.

“The tablet was white and small, and as I swallowed, it felt like a chemical kiss,” he said.

It was only after the British author and journalist finished school, and left his home in the United Kingdom to travel the world, that he began to suspect the abiding unhappiness that had periodically overwhelmed him all his life was not in fact normal.

It was the late 1990s, the “Age of Prozac”, and depression and its chemical cure were everywhere.

After sobbing on the Matterhorn and breaking down in Kafka’s house, Hari had a realisation.

“There is a term for feeling like this. It is a medical condition.”

He soon found a doctor who told him that his diffuse sense of unhappiness and despair was the product of depleted serotonin levels.

His depression, the doctor explained, was a brain disease, and a new generation of drugs — Selective Serotonin Reuptake Inhibitors (SSRIs) — would cure him.

He started taking his medication and, for a time, found relief. But it was short lived. The sadness just kept creeping back.

Questioning the benefits

Each time his medication was increased and, with it, the zealotry of his belief in the cause of his disease and the efficacy of the cure.

“I liked this story. It made sense to me,” he said.

But a decade later, a depressed, overweight and anxious Hari felt unable to any longer avoid the contradictions, inconsistencies and glaring inadequacy of that story.

“There were two mysteries hanging over me. One was, ‘Why was I still depressed?’ The second mystery, the much more important one to me, ‘Why are so many people in our culture, becoming so depressed and so anxious?'”

His quest for answers to these questions drove him to research and write a book examining “the real causes of depression and the unexpected solutions”.

A global crisis

Hari is not alone, neither in his depression nor his embrace of a chemical cure.

Depression is a condition that only last century afflicted a tiny fraction of the population, but by 2017 the World Health Organisation had declared the leading cause of ill health worldwide.

In Australia, about 1 million people experience depression every year.

“One in five Americans will take a psychiatric drug in their lifetime. Australia has the second highest level of people taking chemical antidepressants in the world,” Hari said.

Yet we are told the “depression epidemic” is only getting worse.

Hari argues antidepressants offer temporary relief to the melancholy and malaise of urban populations, with the underlying cause remaining untreated.

“It’s not solving the problem for most people, it’s not lifting most people out of not feeling good, which is why we need to have a much deeper conversation about why we’re feeling so bad, why those reasons have been increasing and expanding the menu of options so we can deal with these deeper problems,” he said.

A bio-psychosocial problem

Psychiatrist and Professor of Youth Mental Health at The University of Melbourne Patrick McGorry agrees that where depression and anxiety are concerned we have narrowed our attention.

“Hari is trying to work out what is driving this level of depression in our society,” Professor McGorry said.

“It is a bio-psychosocial problem; there are biological factors and psychological and social factors. What Hari is talking about are the social drivers of depression.”

The reasons why the “serotonin theory” and its chemical cure had such immediate and universal purchase are complex.

Both Hari and Professor McGorry agree the pharmaceutical industry played a role.

“It’s good to challenge how the drug companies and the DSM and the FDA oversimplify not just depression, but all mental disorders,” Professor McGorry said.

“They try to reduce them and American psychiatry is really responsible for that; they turned away from psychoanalysis to biological psychiatry and regarded everything as just a brain disease.”

Hari says he is not on a crusade against antidepressants, big pharma or psychiatry.

Nor is he suggesting everyone should stop taking SSRIs, benzodiazepines or any other medication they have been prescribed.

Professor McGorry cautions against dismissing the benefits altogether.

“There are people who are very severely depressed and I believe, if you look at all the evidence, there is absolutely no doubt that antidepressants are lifesaving for them,” he said.

Nine causes

Both Hari and Professor McGorry suggest we need to widen our attention, to view depression as the World Health Organisation put it, as “socially produced”.

“There is scientific evidence for nine causes of depression and anxiety, none of which can be described as just a chemical imbalance in the brain,” Hari said.

Two of those causes are biological; the other seven have more to do with the social and cultural world in which we are embedded and from which so many of us feel alienated.

“Everyone has basic needs for food, water, shelter, clean air. There’s equally strong evidence that we have natural psychological needs. You need to feel you belong,” Hari said.

Those needs, he argues, are not being met.

He points to research by Australian social researcher and sociologist Hugh Mackay that has revealed an explosion in loneliness over the past 50 years.

Mr Mackay argues “the biggest contributor is social fragmentation”.

As the traditional bonds of social life dissolve, as community and interdependence give way to alienation and anomie, we have found ourselves living in a state of dangerous isolation.

“You aren’t a machine,” Hari said.

“You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future. You need connections to all these things.”

Original article in Nature (May, 2018) by Emily Sohn.

Mental illness can be devastating — but there are ways to fight it, say four researchers who have known those bleak times.

Mental illness is widespread in the sciences, and graduate students are particularly vulnerable. Building a strong support network and separating your sense of self from your job are crucial. Here, in the second of our three-part series on mental health in academia, four researchers share their stories and advice. Next week, we examine lab leadership and and how to improve the health of research groups.

ELYN SAKS: ‘Crazy thoughts’ Lawyer and psychoanalyst at the University of Southern California Gould School of Law, Los Angeles

It was 1982, and I was in my first semester as a student at Yale Law School. We had a paper due and I climbed onto a roof, singing, dancing, gesticulating and saying crazy things, like I had killed people with my thoughts. My friends called the student health centre and tried to get me there, but I wouldn’t go.

The next morning, I asked for an extension on the paper. I was still saying crazy things, and my professor took me to the emergency department. They committed me. I was hospitalized for five months, restrained, forcibly medicated, given very little privacy and locked up.

If you were withdrawn from Yale for psychiatric reasons, you had to be evaluated for readmission by the head of university health psychiatry. I looked this person up and found an article he’d written on exactly this topic — the questions that the evaluator should ask, and the answers to look for. I was totally prepared, and it unfolded exactly as he had laid it out.

Still, part of me felt like I would never get back on my feet. The guy advised me to become a cashier for two or three years. I asked myself how much more stressful it would be to stand at a cash register dealing with a long line of people waiting for change from their purchase. So I went back to Yale.

Feeling overwhelmed by academia? You are not alone
I was eventually diagnosed with schizophrenia, and it took me ten years to become reconciled to staying on medication. Once I did, my life got much better. In a work environment, it also helps if you have people who know what you’re going through. But some people will think you’re not up to the job or are dangerous or scary. You’ve got to pick your supporters carefully.

And stigma is a real scourge. When my memoir, The Center Cannot Hold: My Journey Through Madness, came out in 2007, an administrator on the staff at the University of Southern California Gould School of Law told me that she was glad she didn’t know I had schizophrenia when we started going to dinner together. She said she’d never have gone. I was stunned that a smart, kind, well-meaning person would have such a picture of mental illness that she wouldn’t have gone to dinner with me.

I’ve learnt that my mind is my best friend and my worst enemy. When I’m working, the crazy thoughts recede.

NATHANIEL BORENSTEIN: ‘My life sucked’ Veteran computer scientist and Internet pioneer in Greenbush, Michigan, who helped to create e-mail and the precursor to PayPal.

When I was in graduate school in the 1980s, studying the theory of computation, my adviser — who had been very encouraging — suddenly started indicating that he didn’t understand what I was doing. I got very depressed and almost left the programme. I didn’t perceive my reaction as symptomatic of an illness. I just thought that the whole world sucked, that my life sucked and that everything was wrong.

I get depressed a couple of times a decade, and my depressions tend to look the same. I spend a lot of time curled up in bed, not wanting to talk to anyone. Everything looks bad.

I’d whisper to my student self: you are not alone
I think that the better you know your pattern, the more likely you are, and the quicker you are, to recognize it. When I start to recognize my pattern, it’s comforting to know that the world is not completely horrible and that I’m just depressed. I immediately make an appointment with my therapist. I want to be open about this, so that when younger people read this, they can be spared that response. At least if they know it’s an illness, when they’re curled up in a ball, it’s better than thinking that the whole world sucks.

There is a tremendous resistance to taking psychiatric drugs, but I would encourage people who are struggling with depression to consider them. In the early 1990s, I started antidepressants and that was a godsend. Within a couple of hours, I was feeling better. And a few days after that, I met someone I totally clicked with professionally and we founded a new digital company, the predecessor to PayPal.

The times that you might think were my biggest triumphs, when you might have expected me to be dancing around and doing a jig — those are the times I’ve tended to get extremely depressed. It’s because I have accomplished this thing and it was a lot of work — but it was nowhere near what I thought I ought to have accomplished. I choose one path and look at someone who has gone down a different path, and I feel like I’ve fallen short.

My most recent episode was in January and February of this year. I went to the hospital with constant, extreme abdominal pain, which was making me very depressed, and was diagnosed with colitis. That was the first time I’d thought of suicide as a way to end the pain. Since then, I have got help and the pain is under control.

I’ve heard that depression is a gift, because it can help us to recognize when we need to change something. But if anyone had told me in 1981 that my depression was a gift, I would not have believed it for an instant. I once came this close to destroying my career.

ANONYMOUS: ‘Know your limits’ Male molecular biologist in the United States.

I was in graduate school in South America. I was frustrated there and had a period of depression. My principal investigator (PI) suggested I see a psychiatrist, who gave me medication for bipolar disorder, and it helped. I also realized that graduate school would be over soon and that I’d be able to move on to the next thing.

In January 2015, about six months before graduating, I started looking for a postdoc position and researched a lot of labs. I sent my CV to 40 or 50 places, along with detailed cover letters. And I had a really good publication record. But I was not getting any responses. I became despondent, fell into a debilitating depression and began drinking heavily. It was a black hole.

The whole time I was applying, my PI kept saying: “Why don’t you write a postdoc fellowship to stay in the lab here with me, in case things fall through?” So I did. And my fellowship application came through with high marks and got funded. But I didn’t stop looking for other postdocs, and began applying to a couple of places I didn’t tell my PI about.

Collection: Science careers and mental health
One didn’t ask for a recommendation letter, and when the people there saw my CV, they hired me on the spot. Only later did I discover that my PI had been sabotaging my career.

Academia has structural disadvantages for people with mental-health issues. To a great extent, your career path is decided by factors beyond your control. Confidential letters of recommendation are very important in the hiring process, particularly in science. You’re not going to know that someone threw your CV in the garbage because someone else said, “Hey, he’s depressed”. Those opportunities are lost for ever.

Unless there is a structural change in the system, that bias is not going away. My advice? Know your rights. Carefully document any instances of abuse or misconduct. And try to ensure that a former employer will have nothing to use against you that could affect your future career. This includes keeping your mental-health issues out of the workplace as much as possible, even if you have to keep odd hours in the lab to work around therapy.

Learn to carefully balance the needs of your job against your personal and mental needs. I take a mood stabilizer and can’t drink alcohol at all. And I know when I need to leave work. I think, “I’ve spent enough time here. I think I’ll swim in the pool.” You have to know your limits.

ANONYMOUS: ‘You’re not alone’ Female bioscientist in Europe.

When I applied to PhD programmes, I was accepted by two in the United States. One offered me funding and the other didn’t. But the one that didn’t was more prestigious, and I was misled into thinking that I would have no trouble getting teaching-assistant positions to help pay for the programme. So I decided to go there. I made a very big mistake.

I arrived in the summer and got a position as a teaching assistant — but I had to reapply for a new one every couple of months. On top of that, I got accepted as a research assistant in the lab of a famous professor, but he paid nothing. I was also taking a full load of courses and studying for qualifying exams.

The first semester was very difficult. I couldn’t focus. I was always lost. I was always sad. I had to drop a course. If only someone at that time had said: “You have depression and that’s why you can’t focus.”

The next semester, I took a lighter load. I thought it would be easy. But I got a low score. I also wrote an internal grant that got funded, but I never saw the money. At that point, I didn’t want to get up or out of bed. I started being absent from the lab. I couldn’t bring myself to walk to that place. The worst part is that I ended up with a C. My grade-point average crashed. Then, when exams came, I failed miserably. I worried about my teaching-assistant position and losing that money. I panicked. I was sitting there crying and thinking my world had fallen apart.

I called a counsellor and told them that I was considering self-harm. There is a law in that area that if you try to hurt yourself, they put you in the psychiatric hospital. The police came in and handcuffed me. I was just crying and repeating, over and over, “I got a C. I’m going to get kicked out.” In the hospital, I was monitored 24/7. After two days, I was still crying.

Ten days after my first hospitalization, I was handcuffed again and put in the hospital again. Each time I was put in the hospital by the police, I was charged more than US$100 — a huge expense for me. I contacted the other PhD programme to see if the people there would honour their funding offer from the previous year. They said no. I opened a bottle of pain medication and started popping the pills in my mouth. Then I stopped and called my psychologist. After a few weeks off from my PhD studies, another hospitalization and two failed exams, my position in the programme was terminated.

I started looking for other PhD courses and found one with a renowned scientist in Europe that would pay me enough, so I went there. But you can’t just say, “It worked out in the end.” For a year, I sat and stared at the wall. Even though the position is well paid, the culture still treats PhDs poorly and values unhealthy competition. I am leaving academia.

Tell the darkness not to take you today — not this moment, not this second. Take time off if you need to. Find the person you were before the darkness came. Reach out for help — surround yourself with people who will show you, in this darkness, that you will make it. As isolating and hopeless as it might seem right now, you are not the only one who has had to pass through this. You are not alone.