Seasonal affective disorder: Can winter really send you into a case of seasonal depression?

Original article in ABC News (June, 2016) by Selina Green and Kate Hill.

Has your mood plummeted with the temperature? Planning a beeline between the couch and fridge and not much else over winter?

For residents of parts of southern Australia, which suffer from high rainfall and long, dark days during winter, a simple case of the winter blues can turn into something more serious, according to Swinburne University Professor of Psychology, Greg Murray.

Seasonal affective disorder (SAD) is a genuine clinical condition believed to be caused by decreased light exposure in winter.

“It’s a condition where a person has recurrent episodes of diagnosable depression and those episodes fall in winter each year,” he said.

SAD was different to the general mood downturn that many people commonly experienced in winter months, said Professor Murray.

“A significant proportion of people in southern Australia do describe themselves as feeling a bit flat and lethargic in winter,” he said.

“Most of us want to sleep more, put on a bit more weight, are attracted to fatty foods, so there are some biological mechanisms that predispose us to being a little less motivated in winter than at other times of year.

“If your mood is having a marked impact on your ability to function or impacts on your thoughts and feelings about self, seek help.”

But how do you know when your winter blues have crossed the tipping point into full-blown SAD?

Professor Murray asks his patients this question — “Do you get the sense that you can find your way out of this?”

If the answer is no, then it is time to have a chat to a professional and perhaps seek treatment.

“If your mood is having a marked impact on your ability to function or impacts on your thoughts and feelings about self, seek help,” he said.

“It’s as serious as any other depression and needs to be dealt with quite assertively.”

According to Professor Murray, SAD cases in Australia were rare and he and other clinicians see a handful of cases each year.

“Our best bet in something like 1 in 300 people in Australia may warrant that diagnosis,” he said.

Professor Murray said treatment for the disorder could include those used for other types of depression, such as cognitive behavioural therapy, anti-depressant medication or bright light treatment.

Scepticism still surrounds SAD

First identified in the United States in the 1980s, SAD was known as a seasonal depression and became widely recognised by therapists worldwide.

However, Professor Murray said there had always been some scepticism about the existence of SAD, with some doubting over whether decreased light exposure could trigger changes in mood.

“People are starting to think that a very specific type of depression caused by lack of light in winter might be a bit of an overstatement,” he said.

In fact, there had always been interest into whether the fairer of the seasons — summer and spring — might trigger the same disorder, he said.

“In fact the bible of psychiatry, when it describes SAD, it says that the seasonal pattern can take any form. It could be spring, summer, autumn or winter.”

“One of the things that gets more difficult in winter is exercise and another is socialising.”

Sufferers may consider simply waiting out the winter months, but Professor Murray said any sort of depression warrants attention.

“Humans are normally self-correcting,” he said.

“If life gets us down in the dumps or gets a bit difficult, most of us, by the time we are adults, have coping skills for getting around that, whether it be have a swim, or have some mates around for dinner or have a chat to your partner about it.

“But depression, by definition, if it’s at diagnosable level, is where our system has adopted an unusual orientation and maybe we no longer have access to those constructive thoughts and behaviours that would normally see us through.”

As for those aware their mood plummets during colder months, Professor Murray said they could proactively plan for it while the sun was still shining.

“One of the things that gets more difficult in winter is exercise and another is socialising,” he said.

“Given that those two things are critical for most people’s mental wellbeing, once daylight savings drops away, plan how you’re going to keep up these activities up in winter.”

Making a commitment to socialise once a month with friends and taking out a gym membership over the colder months could help.

And when the sun does shine through the clouds, get out there and enjoy it, he said.

“Most of us can benefit from getting an hour or so of outdoor light every day. That may well address some of those biological processes.”

Can men get postnatal depression?

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.”

Nearly 80 genes linked to depression

Original article in SBS News (April, 2018)

Scientists have found 78 genes which could help explain what triggers depression and assist with the development of better treatments.

Scientists have pinpointed nearly 80 genes which they believe could help explain why some people are more susceptible to depression.

A team of experts led by the University of Edinburgh analysed the genetic codes of 300,000 people to identify areas of DNA which may be linked to the condition.

They found 78 genes which could help explain what triggers depression and assist with the development of better treatments.

Dr David Howard, lead author of the report, said: “This study identifies genes that potentially increase our risk of depression, adding to the evidence that it is partly a genetic disorder.

“The findings also provide new clues to the causes of depression and we hope it will narrow down the search for therapies that could help people living with the condition.”

Depression affects one in five people in the UK every year and is the leading cause of disability worldwide.

Life events such as trauma or stress can contribute to its onset but it has not been clear why some are more likely to develop the condition than others.

The scientists used information from a UK Biobank – a research resource containing health and genetic information for 500,000 people – to conduct their study.

Some of the genes discovered are known to be involved in the function of synapses, tiny connectors that allow brain cells to communicate with each other through electrical and chemical signals.

They then confirmed their findings by examining anonymised information held by personal genetics and research company 23andMe, with the donors’ consent.

Professor Andrew McIntosh, who leads the Edinburgh-based research group, said: “Depression is a common and often severe condition that affects millions of people worldwide.

“These new findings help us better understand the causes of depression and show how the UK Biobank study and big data research has helped advance mental health research.”

Australian readers seeking support and information about depression can contact Lifeline on 13 11 14.

What causes depression? What we know, don’t know and suspect

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.

Exercise can prevent depression, study finds

Original article in ABC News (May, 2018) by RN Drive and Mariella Attard.

Physical activity can prevent depression, across all ages and around the world, a new study has found.

You may have heard before that exercise can help with mental health.

Now, a big international study has the numbers to show it can actually prevent depression from developing in the first place.

The international team included researchers from The Black Dog Institute, UNSW Sydney and Western Sydney University’s NICM Health Research Institute.

They took data from 49 studies across the world, involving 266,939 people.

As Dr Joseph Firth from the University of Western Sydney explained, it is an exciting find.

“People who were sufficiently physically active were at 15 per cent reduced risk of developing depression,” Dr Firth said.

“Fifteen per cent is a huge number of people given the amount of cases of depression.”

‘The best type of exercise is the type you’ll actually do’
Dr Firth says these are long-term studies over seven or eight years, so the protective aspect of exercise comes from keeping active over the long haul.

“It’s not about going to the gym on time and have a tough session and doing something that you’ll never do again,” he said.

“It’s more about finding the type of exercise that you know you can really enjoy, that can help keep you physically active on a regular basis.”

Dr Firth said the minimum amount of exercise required to gain this benefit is not known, but it isn’t very much.

He said 150 minutes per week was associated with a 22 per cent risk reduction of depression, but that less than that could also lead to some benefit.

Dr Firth emphasised that exercise needed to be enjoyed, and was not necessarily linked to great skill and competitiveness.

“We should be helping kids enjoy sports even outside a competitive environment, just to find things they enjoy doing,” Dr Firth said.

He said while more support was needed to help with mental health issues, regular exercise was an easy change that individuals could self-manage.

“All the data suggests it could confer a massive protective effect and really improve the population health in terms of depression and other mental health conditions,” he said.

How does exercise help?

During exercise, certain chemicals are released in the brain which act like antidepressants, Dr Firth explained.

And that can be protective if there are other stressful things happening in our lives that might otherwise cause depression.

“We believe that physical activity and the chemical release actually provide a buffer from this and make you more resilient to developing depression,” he said.

Joel Thompson, who plays for Manly-Warringah in the National Rugby League, told the ABC’s RN Drive program he noticed a difference in his mood in the off-season.

He said while exercise was a big part of his job, he also saw it as a way to spend time with his family.

“We’ve had a tough start to the year with football and the best thing for me is to get out there and exercise with my family and do stuff like that,” he said.

It was a counsellor who suggested to Thompson that he use exercise as a coping strategy.

“It’s been a big part of staying on top of things,” Thompson said.

“If things get too much, I like going to the beach, going for a swim, or going for a walk with the kids — it’s been really good for me.”

As well as playing football, Thompson is also a mental health advocate whose family members have battled with mental illness, and who has lost a cousin to mental illness.

He said he was a big believer in the benefits of exercise in terms of mental health.

“Do something that you love and have fun,” he said.

The findings coincide with the Black Dog Institute’s Exercise Your Mood week, from April 30 to May 6, which encourages everyday Australians to improve their mental health through physical activity.

More than brain chemistry: Is society, not just serotonin, contributing to increasing rates of depression?

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.”

Throwing Off Your Body’s Biological Clock Could Put You at Risk for Depression

Original article in Men’s Health (May, 2018) by Melissa Matthews.

A new study says staying awake all night could be linked to mood disorders.

  • People who were more active at night were at increased risk of depression, according to a new study
  • Researchers believe that your internal clock is confused when you are more active at night
  • More studies are needed to determine the link between mood disorders and circadian rhythms

Night owls, here’s another reason to stop watching Netflix until 2 a.m.: a new study found a link between staying up late and depression.

Every biological process, from eating to sleeping, is controlled by the body’s circadian rhythms, or internal clock. These rhythms are regulated by the environment, so when it’s sunny, our bodies yearn to be awake; when it’s dark, our rhythms tell us it’s time for bed.

Irregular circadian rhythms confuse the body, and they’ve been linked to weight gain and diabetes. Now, a new study published in The Lancet Psychiatry says disrupting your natural clock could also increase your risk of mood disorders by up to 10 percent.

Researchers from the University of Glasgow studied 91,105 adults between 37 and 73 years old using activity monitors to determine when they were most active. People who were more active late at night, compared to during the day, were considered to have disrupted circadian rhythms.

They found that people who were more active at night were between 6 and 10 percent more likely to be diagnosed with a mood disorder, like depression or bipolar disorder. Scientists also discovered that night owls tended to be lonelier and more unhappy.

It’s important to note that the research is not saying that staying up all night causes depression — only that the two are linked. But Psychiatrist Daniel Smith, the study’s co-author, believes scientists should pay more attention to the link between circadian rhythms and depression.

“The study tells us the body clock is really important for mood disorders and should be given greater priority in research and in way we organize societies,” he told the BBC.

While we still can’t say for certain that being a night person is bad for your mental health, there is plenty of research about the benefits of being a morning person. Early risers eat a more balanced breakfast, are less likely to procrastinate, and are more successful at work — all of which are good reasons to go to bed early tonight.

How to handle the dark days of depression

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.

I Tried Transcranial Magnetic Stimulation to Cure My Depression. Here’s What Happened.

Original article from Men’s Health (May, 2018) by Jordyn Taylor.

According to the latest estimates, more than 300 million people worldwide are living with depression. Medication and talk therapy are effective treatments for most patients — but not all.

If first-line treatments don’t work, some people with depression turn to brain stimulation therapies. One such treatment is transcranial magnetic stimulation (TMS), which uses a pulsed magnetic field to stimulate nerve cells — or neurons — in the regions of the brain that regulate mood. When stimulated, the neurons release neurotransmitters like serotonin, which are otherwise depleted in people with depression.

“Serotonin is supposed to flow from the neurons to the front of brain and tell us, ‘This is a happy moment!’ But for a depressed person, that doesn’t happen,” explains Dr. Kalyan Dandala of Associated Behavioral Health Care, a network of treatment centers in the Northwest that offer NeuroStar TMS Therapy. “We’re waking up that part of the brain that’s been dormant.”

TMS has been used for more than a decade, and was approved by the FDA in 2008. It’s proven to be helpful for at least half of patients who complete several weeks of near-daily treatments, according to the National Institute of Mental Health. But it’s a major time commitment — and some patients experience relapses.

Benjamin*, 26, dealt with depression for years. He tried various types of medication, but none had the effects he was looking for. In March 2018, at the recommendation of his psychiatrist, Benjamin began TMS therapy. This is his story, as told to news editor Jordyn Taylor. This interview has been edited for length and clarity.

It started with anxiety, actually.

It came out of nowhere. After I graduated high school, I came to Seattle to learn how to be a restaurant cook. I was surprised at how well I was handling the stress — and then a couple of years later, stuff just started happening.

I was having panic attacks and feelings of, “I just can’t handle this.” I was working at my first restaurant job, and I can vividly remember having a mental breakdown while I was cooking during a rush. The order had all these different modifications, and I kept messing up. The anxiety kept building and building until it erupted, and I kind of lost it. I was trying to keep a calm face about it, but my coworkers could tell that something was going on. I felt embarrassed, but I had to be like, “Guys, I need help. I can’t get through this.”

I went to a psychiatrist, and I was given medications to help with the anxiety. I would use one, and then it would lose its magic a little bit, and we would go to something else. We tried two or three; there was one that kind of stuck, and the anxiety came into check.

But then the depression took over.

Anxiety is like, I can’t handle it. Depression is more like, I don’t care. The best way to describe it is just kind of wandering aimlessly through life with no enjoyment. I lost sight of myself. I couldn’t really figure out who I was anymore. I wasn’t enjoying the activities that made me me: I ran in high school, but I didn’t want to go outside or exercise. Music was also a huge part of my high school career, but I didn’t want to do anything.

I thought I was going to keep having to cycle through medications until I eventually hit the jackpot — and even then, would it still have worked? I definitely had a feeling of hopelessness, like, is this going to be me forever?

There was a point when my psychiatrist left to work somewhere else. She gave me a long prescription, but after a year, I was running low on my medication, and I decided I really needed to go back to somebody.

I was talking with my new psychiatrist about how my depression medication, Wellbutrin, hadn’t been working. She was like, ‘Okay, since you’ve tried different classes of medications and they haven’t been working, I think you qualify for this new treatment.’

She starts telling me about transcranial magnetic stimulation therapy, and I start laughing because I tell her I’ve heard about it. I had read about TMS therapy — I thought it was really cool and futuristic, but that I’d probably never do it in my lifetime.

One of my hangups was the daunting idea of going there for 30 minutes a day, five days a week, for six weeks. It’s a huge commitment. But beyond that, I was excited to try it, because I liked the idea of a non-medicated treatment.

They say the first day is always the hardest, and I can truly say that is is. Normally they’re 30-minute appointments, but the first appointment is an hour and a half. They need to take the time to find the area of the brain associated with depression, so they do the whole mapping process.

You’re basically sitting in a dentist’s chair. You have your arms on a rest, and you put your hand up: Your fingers are all spread out like you’re holding a football, and then your thumb’s pointed out like you’re trying to hitchhike. Then they use the machine — it’s a coil that kind of cups the top, back part of your head — to send these electromagnetic waves in. They’re trying to get a reaction from your thumb. [Editor’s note: the magnetic pulses are targeted at an area in the left upper part of your brain that controls your mood, which is a few centimeters in front of the area that controls your thumb.]

It feels like a tapping sensation; I joked that I want to look around and see this woodpecker sitting on the chair and poking at my head periodically. I would feel a tap, and then they would look at my thumb. If there wasn’t a reaction, they moved it and tried again until they got a good one.

Next, they calibrate the starting dose for you. That part was the hardest. They administer what the treatment will be like on a certain level, and they ask you, ‘Okay, how painful was this from 0 to 10?’ They did it for the first time, and I’m like, ‘Alright, that’s 1 or 2.’ They raised it up — it was a 3 or 4 — they raised it again — 5 maybe — but you know, the pain was bearable. They kept going up, and once it felt like 7 or 8, I was just like, ‘Nope, that’s way too much — let’s bring it down.’

It was also really hard because it triggered emotions for me. March 29 is when I went in there, and the whole month of March was really crappy for me and my family. You’d naturally get teary from the tapping, but I was also trying not to cry because it was bringing up all these emotions. It was a crazy trip, but what I really loved about this whole process was that from day one, the TMS specialist told me, ‘We care about you and your journey through this, so we’re here for you.’

The first day was incredibly tough, but it was a place of no judgement — everybody was there for me. I came back the next day and started everything.

Now, I only have four treatments left. The only side effects they told me I might experience is headaches or a sensitivity in the scalp at the area of the treatment, but I felt neither.

Going into this, I knew it wasn’t going to be a magical Cinderella transformation, but I definitely feel like a newer person. In the beginning, I started feeling more moments of happiness, but there were also some days where I didn’t know if it was working or not — but it could have been the depression talking. It really took a lot of my closest friends and family to start noticing these differences. I talk with my dad, and he’s like, “Your demeanor has changed. You just sound happier.” My best friend at work, she’s like, “Yeah, you just look better — even as far as your posture goes, just the way you carry yourself.” I’m feeling like myself again.

After these treatments, I feel like I’m more connected with myself and the world around me, and I can truly say that I’m happy with myself. I like me. It took a long time to get to that point, because throughout depression, I kind of hated myself. I hated life, and I hated who I was. Now I have a lot more clarity — I’m even thinking about my future.

Interestingly enough, I’ve been entertaining the idea of going into the mental health field. I don’t know exactly what I’d do, but I just like the idea of helping people with depression or other mental illnesses. I want to give people the hope that I was given — to tell people it’s okay, this isn’t a forever thing. You can overcome this.

*Last name has been withheld to allow subject to speak freely on private matters.

How your smart watch will monitor depression: Changes in activity data could flag an evolving episode.

Original article from Information Age (May, 2018) by David Braue

Exercise trackers and smartphones could flag psychological distress amongst mental health patients even when they’re not actively engaging with psychologists.

That’s according to Flinders University researchers who are recruiting more than 500 participants to follow on from a successful recent pilot study.

That study saw Dr Alissa Knight and Niranjan Bidargaddi – both researchers within the Personal Health Informatics program at the Flinders University College of Medicine and Public Health – collect data from 120 young adults’ smart watches and exercise trackers over the course of eight months.

Participants used the widely-adopted DASS-21 depression survey to rate their psychological state at regular intervals, and this was compared with patterns of exercise as recorded by the wearable devices and smartphones.

The analysis, Dr Knight told Information Age, correlated anxiety and other psychological changes with changes in the subjects’ normal activity and exercise patterns.

“Within a person’s typical physical activity behaviour, we found that those that had the most disruption had higher levels of physiological distress – particularly in anxiety.”

Continuous collection of activity data could potentially prompt a clinician to proactively reach out to subjects for support, even when they had not presented for in-office therapy for some time.

“Traditionally it has been difficult to get updates on someone’s mental health in between clinical sessions,” she said.

“People may be suffering silently, and those sorts of people may not be inclined to go to the clinic to be assessed.”

Better than self-reporting

Links between physical exercise and mental well-being have long been known.

However, researchers previously had to rely on patients to be accurate and diligent in tracking their exercise, and filling out clinical surveys such as the DASS.

With physical activity recognised as an important treatment tool for disorders such as major depression, fitness trackers offer an unprecedented way for researchers to monitor patient compliance.

One study last year found that Fitbits could improve body function satisfaction and decrease depressive symptoms in women that were otherwise sedentary.

The ability to correlate such evaluations with empirical data about patient activity has also been hailed as transformational in human physiology research, while others have welcomed the devices’ ability to drive gamification of exercise and fitness.

Another recent study found continuous activity monitoring to be a potentially important tool in managing depressed patients’ response to clinical treatment.

More data, more research

Data-driven research does require a degree of technological expertise.

Yet while accessing the devices’ proprietary data has sometimes been tricky in the past, maturing vendor APIs are facilitating researchers’ access to data via fitness-tracking ecosystems such as Apple HealthKit, Google Fit, the Fitbit Web API, and the Garmin Health API.

With the pilot study deemed a success, the Flinders team has already received ethical approval for a broader study that will recruit 500 or more patients to explore the predictive value of wearable devices.

Another larger, nationwide study is also in the works, and Dr Knight anticipates “some nice findings” by year’s end.

Fitness trackers are just one of many data sources that researchers are mining for new insights into their patients’ behaviour.

Another recent study, for example, found a correlation between Twitter activity, mental state, and exercise – concluding that those who exercise regularly posted significantly fewer tweets expressing depression or anxiety.

“People are generally happy to share their personal data in real time when it’s tracked by wearable technology,” Knight said, “and there are all sorts of different avenues that we can generate this data from that we wouldn’t have had access to even 10 years ago.

“It’s an exciting time to be in.”