For individuals with autism, learning to interact with first responders is critical. It is just as essential for first responders to understand autism and be prepared to respond effectively and safely to situations that arise involving individuals on the spectrum.

With that, here are 7 things people with autism want first responders to know…

“We know you are not our ‘friends’ and have a job to do, but treat us like your best friend. As individuals with autism, we will not comply well with aggressive tactics that will ultimately conjur a lifetime of memories involving bullying and exploitation. Remind us how things will be alright especially with our cooperation, and ask if there is anything you may do to make the process easier for us. Most importantly, ask if we have autism when you have the slightest inkling something may be a little ‘off.’ There have been numerous misunderstandings in society that have been resolved with no lingering trauma because the authority figures showed the mercy and compassion that had been denied by other citizens who were not on patrol that were guided by blind ignorance.”

– Jesse Saperstein

“Due to sensory issues from autism, when I am afraid or experiencing anxiety I may not respond to your questions like everyone else. I may shutdown completely or overreact. Typical people are wired neurologically like bottle water, not much happening. My neurological makeup is closer to carbonated Mountain Dew. When shaken, watch out!”

– Ron Sandison

“I would want first responders to know that sometimes, people with autism are very scared when first responders approach them because of the masks, suits, the yelling, and the disaster that’s happening. I would also want them to know that autistic people have a more sensitivity to our senses and because of that, we experience pain more or less than the average person does when they’re hurt. I also want them to know that we can tell if someone is stressed out and that it stresses us out. I think what would help us out a lot is if first responders approach us calmly and use gentle voices with us so we’re not so stressed out and scared. I also think what would help is first responders having a spare teddy bear, stress ball, or anything that we could squeeze or hug because it helps us calm down and release tension and stressed.”

– Taylor Orns

“Being on the autism spectrum can present plenty of challenges in everyday life, and these challenges can be even more intense when it comes to an emergency situation. First responders are often unaware of these challenges or how to handle them, which sometimes can lead to greater tragedy. Remember above all else that when you give instructions to an autistic person, we may be so overwhelmed by the emergency situation that we are unable to respond or signal understanding the way a neurotypical person would. But we are not purposely disobeying or resisting you; we are trying our best to cope with unbearable emotional and sensory overload.”

– Amy Gravino

“Autism is not a tragedy. Ignorance is the tragedy.’ For those first responders out there who educate themselves about those with autism to fight that ignorance in our society I’d just like to say thank you. When I present about growing up with autism I often say everyone you meet will have their own unique challenges but by being aware and accepting your impact will make a difference in our community.“

– Kerry Magro

Autism Speaks is committed to educating first responders about autism and best practices to help keep individuals on the spectrum safe in potentially dangerous situations through training, awareness and resources. To learn more, contact the Autism Response Team at 888-288-4762 or familyservices@autismspeaks.org.

By Támara Hill, MS, LPC

Do you know someone who looks and appears depressed but denies it when confronted? Do you believe their rejection of your assessment of them? Could it be that they are”hiding,” covering their true emotions, or simply telling the truth? Even as a trained therapist I have seem my fair share of clients, primarily men and adolescent males, proclaim over and over that they are not depressed even when they appear that way. I ended up second guessing myself and desperately searching for a term, diagnosis, or phenomenon that could help me make sense out of what appeared to be depression. Little did I know, it was pretty simple.

We live in a nation that fervently seeks for answers for behaviors that we do not understand or that do not meet a certain set criteria. For example, mental health professionals will often engage families in learning about depression when a adolescent exhibits traits and behaviors that seem to be depression. Rarely, if ever, will a trained mental health professional ignore other reasons for behaviors that seem like depression. We are all susceptible to mistaking certain behaviors for something way more serious than it actually is.

When I was beginning in my field in an inpatient child and adolescent residential facility of very troubled and ill youngsters, I began to feel very tired. Every other day I felt more and more tired. I loved the work I did and I felt honored/humbled to be as close to troubled, yet wonderful youths who were mistaken to be “tarnished.” There wasn’t a day that went by that I did not have crippling fatigue or migraine headaches. I found myself developing, because of mild burn-out symptoms, a pessimistic view of today’s youths and their future. This pessimistic view most likely caused others to question whether I was depressed or not.

Trying to identify differences between depressed mood and normal temperament can be a very big challenge, especially for family and friends. It is important to learn the signs of depression so that you can decipher what may or may not be clinical depression. Unfortunately, because depression can be so very similar to other disorders or difficult temperaments, it is important to understand what is and is not a symptom of depression. Some of the following “symptoms” may be more temperament than depression:

Isolation: Believe it or not, some people prefer to be alone. Why? Well, a few reasons may be that they “rejuvenate” through isolation (introverts), they prefer thinking over socializing, or they are avoiding social settings because of a history of social ostracism, discrimination/racism, or bullying. Some people believe isolation is not a bad thing, especially if isolating will keep them from having to be disappointment and uncomfortable in the social arena. Have you ever heard of the saying “the quietest people have the loudest minds.”
Maturity or serious behavior(s): Some individuals grow up fast while others take a bit more time to become “real adults.” People who “act mature” are often regarded by their peer group as “depressed,” “old,” or “pessimistic.” Mature behaviors or serious thinking styles can cause others to regard the individual as depressed or sad. Many mental health professionals come across as more serious than others at times which can appear to be depression or pessimism. For example, while completing my counseling psychology program in graduate school I often had fellow-classmates make statements about me such as “why don’t you ever joke around in class” or “you do know that therapists can have fun…right?”
Not easily amused or “moved” by things: Some people are simply calm about almost every single thing in their lives. Nothing moves them. “Laid-back” people are sometimes underwhelmed and may not react to certain things like others would. For example, a wedding announcement or baby-announcement may not move the “laid-back” person like it would someone who is more reactive. For me, I tend to be “laid-back” and will only naturally respond to events that truly moves me to respond. Individuals who tend to be underwhelmed may or may not be depressed. It is important to consider the natural mood of the individual before assuming they are depressed.
Emotional or reactive behaviors: As stated above, some individuals are reticent and laid-back while others are not. Individuals who are reactive are often viewed by others as positive or optimistic. Individuals who are thoughtful and tend to react only when necessary, are often viewed as depressed or pessimistic. I’ve heard families of some of my laid-back teen client’s say “OMG. Just tell me already. Don’t you have any thoughts or feelings about this?”
Irritability: One of the hallmark features of depression for men and adolescent males is irritability. For women, depression is often characterized by tearfulness, depressed mood, or mood lability (i.e., changeable moods). But some irritability is temperamental and not based on mood. Temperament is personality and an irritable personality or temperament is not depression.
Substance abuse and use of alcohol: Self-medication with drugs and alcohol is often a “symptom” of depressed mood. But there are some individuals who will use drugs and alcohol for social purposes (i.e., engaging with others or interacting at parties) or because they are addicted/dependent. Substance abuse/dependency does not always = depression.
Anhedonia or lack of motivation: As difficult as it may be to believe, some individuals are born unmotivated. Individuals who seem to “take things in stride” or “does not care” may not be depressed. Again, temperament is often a major influence of personality. It is important to understand that individuals who have a positive temperament will most likely lose motivation if depressed. An individual who has always been unmotivated does not have to be depressed.
Interest in “dark” subjects such as death/dying, life challenges, tribulation, or sorrow: Individuals who like to listen to depressing or “dark” music (or read dark/depressing books/articles, etc.) does not have to be depressed. As you know, some people enjoy topics that speak about life challenges, death, or depressed moods/attitudes. This does not always insinuate a depressed mood. While many of us are drawn to things that “speak” to our challenges, primarily when struggling with some aspect of life, other individuals gravitate toward this kind of stuff all of the time.

By Lauren Walters

According to https://www.psychologytoday.com/blog/anxiety-zen/201605/depression-7-powerful-tips-help-you-overcome-bad-moods, “There is no health without mental health. In the past decade, depression rates have escalated, and one in four Americans will suffer from major depression at one time in their lives. While there is no quick fix or one-size-fits-all for overcoming depression, the following tips can help you manage depression so it does not manage you.” Mental health is an integral component of one’s daily routine. Therefore, how do you manage your mental health? In particular, how do you alleviate symptoms associated with depression? This article will provide the reader with strategies to alleviate symptoms associated with depression.

Beware Of Rumination

According to https://www.psychologytoday.com/blog/anxiety-zen/201605/depression-7-powerful-tips-help-you-overcome-bad-moods, “Many ruminators remain in a depressive rut because their negative outlook hinders their problem-solving ability.” In other words, rumination occurs when individuals constantly overanalyze situations. This can lead to depression. However, how do you overcome rumination and become less depressed. According to https://www.psychologytoday.com/blog/anxiety-zen/201605/depression-7-powerful-tips-help-you-overcome-bad-moods, the following can be stated:

· Remind yourself that rumination does not increase psychological insight.
· Take small actions toward problem-solving.
· Reframe negative perceptions of events and high expectations of others.
· Let go of unhealthy or unattainable goals and develop multiple sources of social supports.

Therefore, focus less on rumination but rather problem-solving to overcome depression.

Focus On What You’re Doing Right

It is easy to discount the positive and focus on the negative. When you focus on the negative, your self-esteem and confidence level can drastically decrease. This can result in depression. The question remains how do you focus on the positive as opposed to the negative. According to https://www.psychologytoday.com/blog/anxiety-zen/201605/depression-7-powerful-tips-help-you-overcome-bad-moods, the following can be noted:

At the end of the day, write down three things you did well. No need to over think this, and no act of taking the high road is too small. For example, “When my coworker emailed the budget proposal, he forgot to cite a source. Rather than get upset, I spent two minutes researching the answer and added the information myself.”

Therefore, it is always essential to look at a situation from a positive perspective as opposed to a negative perspective. As a result, you will become less depressed.

Conclusion

With that said, there are many ways to alleviate symptoms associated with depression. This article has provided the reader with two of them, including being aware of rumination, as well as focusing on what you’re doing right, as opposed to what you’re doing wrong in a situation or an event.

By Rick Nauert PhD

New research finds significant benefit in the use of mindfulness-based cognitive therapy to reduce the risk of depression relapse.

The mindfulness-based cognitive therapy approach was compared to usual care with the results comparable to other active treatments, as measured over a five month period.

Recurrent depression is a serious issues as it causes significant disability. Interventions that prevent depressive relapse could help reduce the burden of this disease.

A growing body of research suggests mindfulness-based cognitive therapy (MBCT) is efficacious.

In the study, researchers reviewed the results of analyses of individual patient data from nine published randomized trials of MBCT. The analyses included 1,258 patients with available data on relapse and examined the efficacy of MBCT compared with usual care and other active treatments, including antidepressants.

From the review, Willem Kuyken, Ph.D., of the University of Oxford, England, and coauthors report MBCT was associated with reduced risk of depressive relapse/recurrence over 60 weeks compared with those who did not receive MBCT.

Investigators also discovered that the technique is robust as it is equally effective for a variety of groups regardless of sex, age, education, or relationship status.

The treatment effect of MBCT on the risk of depressive relapse/recurrence also may be larger in patients with higher levels of depression symptoms at baseline compared with non-MBCT treatments. This finding suggests that MBCT may be especially helpful to those patients who still have significant depressive symptoms.

Nevertheless, the authors acknowledge study limitations related to the availability of the data within the studies.

“We recommend that future trials consider an active control group, use comparable primary and secondary outcomes, use longer follow-ups, report treatment fidelity, collect key background variables (e.g., race/ethnicity and employment), take care to ensure generalizability, conduct cost-effectiveness analyses, put in place ethical and data management procedures that enable data sharing, consider mechanisms of action, and systematically record and report adverse events,” the authors conclude.

The study and accompanying editorial appear in JAMA Psychiatry.

Editorial: Mindfulness-Based Cognitive Therapy, Prevention of Depressive Relapse

“Mindfulness practices were not originally developed as therapeutic treatments. They emerged originally in contemplative traditions for the purposes of cultivating well-being and virtue. The questions of whether and how they might be helpful in alleviating symptoms of depression and other related psychopathologies are quite new, and the evidence base is in its embryonic stage.

“To my knowledge, the article by Kuyken et al is the most comprehensive meta-analysis to date to provide evidence for the effectiveness of MBCT in the prevention of depressive relapse.

“However, the article also raises many questions, and the limited nature of the extant evidence underscores the critical need for additional research,” writes Richard J. Davidson, Ph.D., of the University of Wisconsin-Madison.

Source: JAMA Psychiatry

By Margarita Tartakovsky, M.S.
Sadness. Hopelessness. Loss of interest. Loss of energy. Difficulty sleeping. Difficulty concentrating. Low self-esteem. Weight gain. Weight loss. Suicidal thoughts.

These are some of the symptoms listed for a depressive episode (also called bipolar depression) in bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders. But these clear-cut signs don’t exactly capture the complicated course of bipolar disorder or the palpable anguish that people with bipolar depression really feel. They don’t capture the angst or fear or confusion.

“The unpredictable nature of cycling through mood states, being unsure of what symptoms may envelop you next, typically creates underlying anxiety,” said Colleen King, LMFT, a psychotherapist who specializes in treating individuals with bipolar disorder, depression and anxiety. People with bipolar disorder can experience mixed states or dysphoric mania, she said. This is when you feel agitated and angry — furious at everyone and everything.

You might be especially curt with others and feel like no one understands your experience, said Louisa Sylvia, Ph.D, associate director of psychology at the Bipolar Clinic and Research Program at Massachusetts General Hospital and author of The Wellness Workbook for Bipolar Disorder: Your Guide to Getting Healthy and Improving Your Mood. You might lash out and not want to interact with anyone, she said.

During a depressive episode, King’s clients tell her that they feel broken or don’t care about anything anymore. They don’t have the motivation or passion for anything except sleep. They cry all the time. They feel frustrated and helpless. They fear they’ll never feel normal again.

“For me, depression feels like I have been robbed of my cognitive, emotional and physical abilities,” said King, who also has bipolar disorder. She feels as though she’s walking through a river of waist-high molasses while fog surrounds her. “There is minimal visibility and it’s challenging to move around.”

It takes King a lot of cognitive energy to pay attention to and understand what others are saying or what she’s reading or writing. It’s hard to create cohesive sentences during conversations. Sometimes, she says the opposite of what she’s thinking. Sometimes, she can’t remember the words for common objects. Sometimes, multi-step tasks take days to complete.

Depressive episodes are physically exhausting. “I feel as though I’m moving against all the forces of nature, fighting as hard as I can, to keep functioning,” King said. Episodes go beyond feelings of sadness to guilt, shame, anxiety and fear. They shatter a person’s self-identity. “Self-worth rattles like glassware in an earthquake, swaying with the shifting earth that is my mood state,” King said.

Of course, everyone is different and will experience different symptoms during their depressive episode. But whatever the specific symptoms, bipolar depression tends to have one thing in common: It’s overwhelming.

Because the depression may come after a manic or hypomanic episode, it can feel like a big crash, Sylvia said. It can feel especially devastating, because when your energy and mood are so high, you naturally have further to fall. For instance, during a manic or hypomanic episode, you might not need much sleep and perceive yourself as more productive, Sylvia said. When depression strikes, and you may feel like you want to cancel all your plans and need 16 hours of sleep, you might feel utterly worthless, she said.

Navigating Bipolar Depression

Sylvia works with clients on creating separate plans for preventing or minimizing manic and depressive episodes. The first step is to become aware of what you’re experiencing, she said. Pay attention to your own unique warning signs and symptoms. As Sylvia said, what does tired mean to you? What does loss of energy look like for you? How many hours do you typically sleep when you’re starting to feel depressed? What are the first signs of a depressive episode for you?

Sylvia also stressed the importance of prioritizing a healthy lifestyle, which can be summarized with the acronym MEDS: medication, exercise, diet and sleep. Similarly, she emphasized building a routine — and adapting it when new situations arise. (For more, check out The Wellness Workbook for Bipolar Disorder and The Bipolar II Disorder Workbook: Managing Recurring Depression, Hypomania and Anxiety, which is co-authored by Sylvia).

For instance, Sylvia worked with a woman who became a caretaker for her sick friend. Because her friend lived several hours away, the client’s routine was completely disrupted, triggering a whole lot of stress and feeling overwhelmed. In response, Sylvia and her client created new morning and evening habits. Instead of getting up and getting right into her car, the client started waking up earlier. She’d eat breakfast at home and walk her dog. To make her drive more enjoyable, she’d listen to books on tape and to her favorite music. She found an activity — gardening — that she enjoyed at her friend’s house. Sylvia also helped the client rethink her trips: As a caretaker, she was actually doing wonderful work.

When King experiences a depressive episode, she also has a plan in place. This includes: making sure her psychiatrist and therapist know what’s going on; turning to loved ones for support; regulating her sleep; eating nutritious foods; meditating; and moving her body. It also means: reducing obligations; focusing on immediate priorities; and practicing nourishing activities, such as being in nature, creating art and spending time with her wife.

King uses coping skills that she teaches to her own clients, including mindfulness and cognitive-behavioral techniques. She socializes less but doesn’t completely withdraw from others, and she practices self-compassion. “Acknowledging the enormity of energy it takes to manage a depressive episode helps me to be gentle and kind to myself. When the self-doubts assault my identity and worth, I repeat self-compassionate mantras.”

This plan isn’t easy or linear. It takes hard work. It’s very likely that you’ll have to force yourself to eat something nutritious, to take a walk, to talk to a friend and to grieve your old expectations, King said. This is when turning to a support team—of loved ones and professionals — is so powerful.

“Depression tricks us into believing that it’s going to last forever. It seems like it does when you’re in it.” King reminds herself that she’s endured depressive episodes and cycling before — and she’s regained her health and stability. Sylvia also reminds her clients that these episodes end. “It won’t last forever, and it won’t last at its highest peak forever.”

King tells herself that she’ll remember joy and feel whole, again. And, with treatment, you will, too. “Do not give up.”

By Lauren Walters

Introduction

You may have heard of Major Depressive Disorder. However, individuals who experience depression may not necessarily have a diagnosis of Major Depressive Disorder. Instead, they may have a diagnosis of Dysthymic Disorder. You may be wondering what Dysthymic Disorder is. This article will explain this. In addition to explaining the criteria for a diagnosis of Dysthymic Disorder, this article will also describe the specifiers of Dysthymic Disorder.

What Is The Criteria For Dysthymic Disorder?

According to http://www.allaboutdepression.com/dia_04.html#1, the following is the criteria for a diagnosis of Dysthymic Disorder:

A person has depressed mood for most the time almost every day for at least two years. Children and adolescents may have irritable mood, and the time frame is at least one year.
While depressed, a person experiences at least two of the following symptoms:
Either overeating or lack of appetite.
Sleeping to much or having difficulty sleeping.
Fatigue, lack of energy.
Poor self-esteem.
Difficulty with concentration or decision making.
Feeling hopeless.
A person has not been free of the symptoms during the two-year time period (one-year for children and adolescents).
During the two-year time period (one-year for children and adolescents) there has not been a major depressive episode.
A person has not had a manic, mixed, or hypomanic episode.
The symptoms are not present only during the presence of another chronic disorder.
A medical condition or the use of substances (i.e., alcohol, drugs, medication, toxins) do not cause the symptoms.
The person’s symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.
What Are The Specifiers For Dysthymic Disorder?

According to http://www.allaboutdepression.com/dia_04.html#1, there are three specifiers for Dysthymic Disorder, including early onset, late onset, and with atypical features. According to http://www.allaboutdepression.com/dia_04.html#1, on the basis of the early onset specifier, “Dysthymic symptoms begin before the age of 21. This may increase the likelihood of developing later major depressive episodes.” According to http://www.allaboutdepression.com/dia_04.html#1, on the basis of the late onset specifier, “Dysthymic symptoms begin after the age of 21.” According to http://www.allaboutdepression.com/dia_04.html#1, on the basis of the atypical features specifier, “symptoms are experienced during the last two years.”

Conclusion

This article has provided the reader with the criteria of Dysthymic Disorder and the specifiers for Dysthymic Disorder. On a final note, to have a diagnosis of Dysthymic Disorder, as oppose to a diagnosis of Major Depressive Disorder, symptoms must be present for an extended period of time, specifically for at least two years or more.

By Rick Nauert PhD

New research suggests the more time young adults use social media, the more likely they are to be depressed.

Investigators from the University of Pittsburgh School of Medicine believe the findings could help clinical and public health entities better care for depression. The study does not, however, establish causation.

Depression is expected to become the leading cause of disability in high-income countries by 2030. The research, funded by the National Institutes of Health, is available online and is forthcoming in the journal Depression and Anxiety.

Researchers explain that this was the first large, nationally representative study to examine associations between use of a broad range of social media outlets and depression.

Previous studies on the subject have yielded mixed results, been limited by small or localized samples, and focused primarily on one specific social media platform, rather than the broad range often used by young adults.

“Because social media has become such an integrated component of human interaction, it is important for clinicians interacting with young adults to recognize the balance to be struck in encouraging potential positive use, while redirecting from problematic use,” said senior author Brian A. Primack, M.D., Ph.D.

In 2014, Dr. Primack and his colleagues sampled 1,787 U.S. adults ages 19 through 32, using questionnaires to determine social media use and an established depression assessment tool.

The questionnaires asked about the 11 most popular social media platforms at the time: Facebook, YouTube, Twitter, Google Plus, Instagram, Snapchat, Reddit, Tumblr, Pinterest, Vine, and LinkedIn.

On average the participants used social media a total of 61 minutes per day and visited various social media accounts 30 times per week. More than a quarter of the participants were classified as having “high” indicators of depression.

Investigators discovered a significant link between social media use and depression whether social media use was measured in terms of total time spent or frequency of visits.

For example, compared with those who checked least frequently, participants who reported most frequently checking social media throughout the week had 2.7 times the likelihood of depression.

Similarly, compared to peers who spent less time on social media, participants who spent the most total time on social media throughout the day had 1.7 times the risk of depression.

In the study, researchers were careful to control for other factors that may contribute to depression including age, sex, race, ethnicity, relationship status, living situation, household income, and education level.

Lead author Lui yi Lin, B.A., emphasized that, because this was a cross-sectional study, it does not disentangle cause and effect.

“It may be that people who already are depressed are turning to social media to fill a void,” she said.

Conversely, Ms. Lin explains that exposure to social media also may cause depression, which could then in turn fuel more use of social media. For example:

Exposure to highly idealized representations of peers on social media elicits feelings of envy and the distorted belief that others lead happier, more successful lives;
Engaging in activities of little meaning on social media may give a feeling of “time wasted” that negatively influences mood;
Social media use could be fueling “Internet addiction,” a proposed psychiatric condition closely associated with depression;
Spending more time on social media may increase the risk of exposure to cyber-bullying or other similar negative interactions, which can cause feelings of depression.
The findings will encourage clinicians to ask about social media use among people who are depressed. Moreover, the knowledge of the relationship could be used as a basis for public health interventions leveraging social media.

Some social media platforms already have made forays into such preventative measures. For example, when a person searches the blog site Tumblr for tags indicative of a mental health crisis — such as “depressed,” “suicidal,” or “hopeless” — they are redirected to a message that begins with “Everything OK?” and provided with links to resources.

Similarly, a year ago Facebook tested a feature that allows friends to anonymously report worrisome posts. The posters would then receive pop-up messages voicing concern and encouraging them to speak with a friend or helpline.

“Our hope is that continued research will allow such efforts to be refined so that they better reach those in need,” said Dr. Primack, who also is assistant vice chancellor for health and society in Pitt’s Schools of the Health Sciences and professor of medicine.

“All social media exposures are not the same. Future studies should examine whether there may be different risks for depression depending on whether the social media interactions people have tend to be more active vs. passive or whether they tend to be more confrontational vs. supportive. This would help us develop more fine-grained recommendations around social media use.”

Source: University of Pittsburgh/EurekAlert

By Rick Nauert PhD
A new study has discovered that meditation and aerobic exercise together reduce depression.

The Rutgers University study found that this mind and body combination, done twice a week for only two months, reduced the symptoms for a group of students by 40 percent.

Researchers believe the study shows that an individual, personal intervention can relieve depression at any time and for no cost.

The study has been published in the journal Translational Psychiatry.

“We are excited by the findings because we saw such a meaningful improvement in both clinically depressed and non-depressed students,” said lead author Dr. Brandon Alderman, assistant professor in the Department of Exercise Science and Sport Studies.

“It is the first time that both of these two behavioral therapies have been looked at together for dealing with depression.”

Researchers believe the two activities have a synergistic effect in combating depression.

Alderman and Dr. Tracey Shors, professor in the Department of Psychology and Center for Collaborative Neuroscience, discovered that a combination of mental and physical training (MAP) enabled students with major depressive disorder not to let problems or negative thoughts overwhelm them.

“Scientists have known for a while that both of these activities alone can help with depression,” said Shors. “But this study suggests that when done together, there is a striking improvement in depressive symptoms along with increases in synchronized brain activity.”

Researchers followed men and women over an eight-week program. Participants included 22 suffering with depression and 30 mentally healthy students.

At the end of the study, group members reported fewer depressive symptoms and said they did not spend as much time worrying about negative situations taking place in their lives as they did before the study began.

This group also provided MAP training to young mothers who had been homeless but were living at a residential treatment facility when they began the study. The women exhibited severe depressive symptoms and elevated anxiety levels at the beginning of the study.

However, by the end of the eighth week, they too, reported that their depression and anxiety had eased. The women also reported feeling more motivated, and were able to focus more positively on their lives.

Depression, a debilitating disorder that affects nearly one in five Americans sometime in their lives, often occurs in adolescence or young adulthood.

Until recently, the most common treatment for depression has been psychotropic medications that influence brain chemicals involved in regulating emotions. Cognitive behavioral therapy or talk therapy can also reduce depression but the intervention takes considerable time and commitment on the part of the patient.

Rutgers researchers say those who participated in the study began with 30 minutes of focused attention meditation followed by 30 minutes of aerobic exercise. They were told that if their thoughts drifted to the past or the future they should refocus on their breathing, enabling those with depression to accept moment-to-moment changes in attention.

Shors, who studies the production of new brain cells in the hippocampus — part of the brain involved in memory and learning — says even though neurogenesis cannot be monitored in humans, scientists have shown in animal models that aerobic exercise increases the number of new neurons and effortful learning keeps a significant number of those cells alive.

The idea for the human intervention came from her laboratory studies, she says, with the main goal of helping individuals acquire new skills so that they can learn to recover from stressful life events.

By learning to focus their attention and exercise, people who are fighting depression can acquire new cognitive skills that can help them process information and reduce the overwhelming recollection of memories from the past, Shors says.

“We know these therapies can be practiced over a lifetime and that they will be effective in improving mental and cognitive health,” said Alderman.

“The good news is that this intervention can be practiced by anyone at any time and at no cost.”

Source: Rutgers University

By Traci Pedersen
Around 10 percent of primary care patients who are prescribed antidepressants for depression or anxiety have undiagnosed bipolar disorder, according to a new UK study published in the British Journal of General Practice (BJGP).

Bipolar disorder is a mental illness characterized by strong fluctuations in a patient’s mood, energy, activity levels, and the ability to carry out everyday tasks. Approximately eight percent of the population suffers from recurring depression, and about one percent suffers from bipolar disorder.

Bipolar disorder can be difficult to diagnose initially as many patients tend to seek help for the troubling symptom of depression first. Patients who have experienced symptoms of mania (such as increased energy and activity, increased confidence, over-talkativeness, or being easily distracted) often don’t recognize these symptoms as significant or problematic and therefore don’t mention them to their doctor.

This often leads to inappropriate treatment, such as the prescription of antidepressants without mood-stabilizing medication. Many bipolar patients respond very poorly to antidepressants alone as they can intensify mania and worsen the disorder. When bipolar disorder is diagnosed, drug treatment should include a mood-stabilizing drug such as lithium, with or without an antidepressant.

The study, conducted by researchers from Leeds and York Partnership NHS Foundation Trust and the School of Medicine at the University of Leeds, involved young adult patients from general practices.

The researchers discovered that among patients aged 16-40 years who had been prescribed antidepressants for depression or anxiety, around 10 percent had unrecognized bipolar disorder. This was more common among younger patients and in those who reported more severe episodes of depression.

These findings suggest that health care professionals should review the life histories of patients with anxiety or depression, particularly younger patients and those who are not responding well to medication or treatment, for evidence of bipolar disorder.

“Bipolar disorder is a serious problem, with high levels of disability and the risk of suicide. When it is present in depressed patients it can easily be overlooked. Under-diagnosis and over-diagnosis of illnesses bring problems,” said Dr. Tom Hughes, consultant psychiatrist at Leeds and York Partnership NHS Foundation Trust and the University of Leeds.

Hughes added that he hopes these new findings will help doctors and patients better recognize bipolar disorder, which he calls an “important and disabling condition.”

Source: University of Leeds

By Traci Pedersen

Cannabis use is linked to an increase in both manic and depressive symptoms in people with bipolar disorder, according to a new study by Lancaster University.

The study is the first to examine the use of cannabis in the context of daily life among people with bipolar disorder. In the U.K., where the study took place, around two percent of the population suffers from bipolar disorder, with up to 60 percent of those using cannabis at some point in their lives.

Research in this area is limited, however, and reasons for this high level of use are unclear.

Clinical psychologist Dr. Elizabeth Tyler of the Spectrum Centre for Mental Health Research at Lancaster University led the study with Professor Steven Jones and colleagues from the University of Manchester, Professor Christine Barrowclough, Nancy Black, and Lesley-Anne Carter.

“One theory that is used to explain high levels of drug use is that people use cannabis to self-medicate their symptoms of bipolar disorder,” said Tyler.

For the study, the researchers evaluated people diagnosed with bipolar disorder who were not experiencing a depressive or manic episode during the six days the research was carried out. Each participant reported daily on their emotional state and drug use at several random points over a period of week. This enabled people to log their daily experiences in the moment before they forgot how they were feeling.

Here are a few comments from the daily reports:

“I do smoke a small amount to lift my mood and make myself slightly manic but it also lifts my mood and switches me into a different mind-set.”
“I do not use weed to manage depression as it can make it worse, making me anxious and paranoid.”
“I have found though that if I have smoked more excessively it can make me feel depressed for days afterwards.”

The researchers found that the odds of using cannabis increased when individuals were in a good mood. Cannabis use was also associated with an increase in positive mood, manic symptoms and paradoxically an increase in depressive symptoms, but not in the same individuals.

“The findings suggest that cannabis is not being used to self-medicate small changes in symptoms within the context of daily life. However, cannabis use itself may be associated with both positive and negative emotional states. We need to find out whether these relationships play out in the longer term as this may have an impact on a person’s course of bipolar disorder,” said Tyler.

The study is published in the journal PLOS ONE.

Source: Lancaster University

By Traci Pedersen

Taking certain antidepressants for depression is linked to a greater risk of subsequent mania and a new diagnosis of bipolar disorder, according to a new study published in the online journal BMJ Open.

The strongest link was found with serotonin reuptake inhibitors (SSRIs) and the dual action antidepressant venlafaxine, according to the findings. These drugs were associated with a 34-35 percent increased risk of being later diagnosed with bipolar disorder and/or mania.

For the study, researchers analyzed the medical records of more than 21,000 adults who had been treated for major (unipolar) depression between 2006 and 2013 at a large provider of inpatient and community mental healthcare in London. They also looked at subsequent diagnoses of bipolar disorder or mania following an original diagnosis of major depression.

The overall yearly risk of a new diagnosis of mania and bipolar disorder between 2006 and 2013 was 1.1 percent. Prior treatment with certain antidepressants was linked to a greater risk of a subsequent diagnosis of bipolar disorder and/or mania, the yearly risk of which ranged from 1.3 percent to 1.9 percent.

The risk was particularly high after patients had received treatment with SSRIs or venlafaxine. These drugs were associated with a 34-35 percent increased risk of being diagnosed with bipolar disorder and/or mania. The findings remained strong even after taking account of potentially influential factors.

Since this is an observational study, no firm conclusions can be drawn about cause and effect. The researchers suggest that the findings may be explained by latent bipolar disorder rather than any effects of drug treatment.

“However, regardless of underlying diagnosis or aetiology the association of antidepressant therapy with mania demonstrated in the present and previous studies highlights the importance of considering whether an individual who presents with depression could be at high risk of future episodes of mania,” say the researchers.

Risk factors include a family history of bipolar disorder, a depressive episode with psychotic symptoms, young age at first diagnosis of depression, and depression that is unresponsive to treatment.

“Our findings also highlight an ongoing need to develop better ways to predict future risk of mania in people with no prior history of bipolar disorder who present with an episode of depression,” they write.

The researchers also note that the absolute risk of developing bipolar disorder is still low and that antidepressants are typically safe and effective treatments for depression and anxiety. They advise that patients not stop their treatments suddenly as this could result in withdrawal symptoms.

By Janice Wood

A new study has found that adults over the age of 30 are not as happy as they used to be, but teens and young adults are happier than ever.

For the study, a research team led by San Diego State University professor Jean M. Twenge analyzed data from four nationally representative samples of 1.3 million Americans between the ages of 13 and 96 taken from 1972 to 2014.

What they discovered is that after 2010, the age advantage for happiness found in prior research vanished. There is no longer a positive correlation between age and happiness among adults, and adults older than 30 are no longer significantly happier than those ages 18 to 29.

“Our current culture of pervasive technology, attention-seeking, and fleeting relationships is exciting and stimulating for teens and young adults, but may not provide the stability and sense of community that mature adults require,” said Twenge, who is also the author of “Generation Me.”

Data showed that 38 percent of adults older than 30 said they were “very happy” in the early 1970s. That shrunk to 32 percent in the 2010s. In the early 1970s, 28 percent of adults ages 18 to 29 said they were “very happy,” versus 30 percent in the 2010s.

Over the same time, teens’ happiness increased, according to the researchers — 19 percent of 12th graders said they were “very happy” in the late 1970s, versus 23 percent in the 2010s.

“American culture has increasingly emphasized high expectations and following your dreams — things that feel good when you’re young,” Twenge said. “However, the average mature adult has realized that their dreams might not be fulfilled, and less happiness is the inevitable result. Mature adults in previous eras might not have expected so much, but expectations are now so high they can’t be met.”

That drop in happiness occurred for both men and women, Twenge noted.

“A previous study in 2008 got quite a bit of attention when it found that women’s happiness had declined relative to men’s,” she said. “We now find declines in both men’s and women’s happiness, especially after 2010.”

The study was published in Social Psychological and Personality Science.

Source: San Diego State University

By Rick Nauert PhD

New research may help to explain how early life stressors can so dramatically affect mental health in adulthood.

The discovery is important because stress during the formative years, including abuse or emotional neglect, increases the risk for adult depression by nearly two-fold.

Scientific research into this link has revealed that the increased risk following such childhood adversity is associated with sensitization of the brain circuits involved with processing threat and driving the stress response.

Emerging findings are now demonstrating that in addition to the stress sensitization, there may also be diminished processing of reward in the brain. This deficit may diminish a person’s ability to experience positive emotions.

In the new study, researchers at Duke University and the University of Texas Health Sciences Center at San Antonio looked specifically at this second phenomenon in a longitudinal neuroimaging study of adolescents. Their intent was to gain a better understanding of how early life stress contributes to depression.

They recruited 106 adolescents, between the ages of 11-15, who underwent an initial magnetic resonance imaging scan, along with measurements of mood and neglect. The study participants then had a second brain scan two years later.

The researchers focused on the ventral striatum, a deep brain region that is important for processing rewarding experiences as well as generating positive emotions, both of which are deficient in depression.

They discovered that over a two-year window during early to mid-adolescence, there was an abnormal decrease in the response of the ventral striatum to reward only in adolescents who had been exposed to emotional neglect.

Emotional neglect is a relatively common form of childhood adversity where parents are persistently emotionally unresponsive and unavailable to their children, explains first author Dr. Jamie Hanson.

“Importantly, we further showed that this decrease in ventral striatum activity predicted the emergence of depressive symptoms during this key developmental period,” he added.

“Our work is consistent with other recent studies finding deficient reward processing in depression, and further underscores the importance of considering such developmental pathways in efforts to protect individuals exposed to childhood adversity from later depression.”

This study suggests that, in some people, early life stress compromises the capacity to experience enthusiasm or pleasure. In addition, the effect of early life stress may grow over time so that people who initially appear resilient may develop problems later in life.

“This insight is important because it suggests a neural pathway through which early life stress may contribute to depression,” said Dr. John Krystal, Editor of Biological Psychiatry.

“This pathway might be targeted by neural stimulation treatments. Further, it suggests that survivors of early life trauma and their families may benefit from learning about the possibility of consequences that might appear later in life. This preparation could help lead to early intervention.”

By John M. Grohol, Psy.D.

Lots of people walk through life trying to hide their depression. Some people with hidden depression can conceal their depression like pros, masking their symptoms and putting on a “happy face” for most others.

People with concealed depression or hidden depression often don’t want to acknowledge the severity of their depressive feelings. They believe that if they just continue living their life, the depression will just go away on its own. In a few cases, this may work. But for most folks, it just drags out the feelings of sadness and loneliness.

Dealing with the black dog of depression through concealing one’s true feelings is the way many of us were brought up — we don’t talk about our feelings and we don’t burden others with our troubles. But if a friend or family member is going through something like this — trying to hide or mask their depression — these signs might help you discover what they’re trying to keep concealed.

6 Signs of Concealed Depression

1. They have unusual sleep, eating or drinking habits that differ from their normal ones.

When a person seems to have changed the way they sleep or eat in significant ways, that’s often a sign that something is wrong. Sleep is the foundation of both good health and mental health. When a person can’t sleep (or sleeps for far too long) every day, that may be a sign of hidden depression.

Others turn to food or alcohol to try and quash their feelings. Overeating can help someone who is depressed feel full, which in turn helps them feel less emotionally empty inside. Drinking may be used to help cover up the feelings of sadness and loneliness that often accompany depression. Sometimes a person will go in the other direction too — losing all interest in food or drinking, because they see no point in it, or it brings them no joy.

2. They wear a forced “happy face” and are always making excuses.

We’ve all seen someone who seems like they are trying to force happiness. It’s a mask we all wear from time to time. But in most cases, the mask wears thin the longer you spend time with the person who’s wearing it. That’s why lots of people with hidden depression try not to spend any more time with others than they absolutely have to. They seem to always have a quick and ready excuse for not being able to hang out, go to dinner, or see you.

It’s hard to see behind the mask of happiness that people with hidden depression wear. Sometimes you can catch a glimpse of it in a moment of honesty, or when there’s a conversation lull.

3. They may talk more philosophically than normal.

When you do finally catch up with a person with masked depression, you may find the conversation turning to philosophical topics they don’t normally talk much about. These might include the meaning of life, or what their life has amounted to so far. They may even open up enough to acknowledge occasional thoughts of wanting to hurt themselves or even thoughts of death. They may talk about finding happiness or a better path in the journey of life.

These kinds of topics may be a sign that a person is struggling internally with darker thoughts that they dare not share.

4. They may put out a cry for help, only to take it back.

People with hidden depression struggle fiercely with keeping it hidden. Sometimes, they give up the struggle to conceal their true feelings and so they tell someone about it. They may even take the first step and make an appointment with a doctor or therapist, and a handful will even will make it to the first session.

But then they wake up the next day and realize they’ve gone too far. Seeking out help for their depression would be admitting they truly are depressed. That is an acknowledgment that many people with concealed depression struggle with and cannot make. Nobody else is allowed to see their weakness.

5. They feel things more intensely than normal.

A person with masked depression often feels emotions more intensely than others. This might come across as someone who doesn’t normally cry while watching a TV show or movie suddenly breaks out in tears during a poignant scene. Or someone who doesn’t normally get angry about anything suddenly gets very mad at a driver who cut them off in traffic. Or someone who doesn’t usually express terms of endearment suddenly is telling you that they love you.

It’s like by keeping their depressive feelings all boxed up, other feelings leak out around the edges more easily.

6. They may look at things with a less optimistic point of view than usual.

Psychologists refer to this phenomenon as depressive realism, and there’s some research evidence to suggest that it’s true. When a person suffers from depression, they may actually have a more realistic picture of the world around them and their impact on it. People who aren’t depressed, on the other hand, tend to be more optimistic and have expectations that aren’t as grounded in their actual circumstances. Non-depressed people believed they performed better on laboratory tasks than they actually did, compared to people with depression (Moore & Fresco, 2012).

It’s sometimes harder to cover-up this depressive realism, because the difference in attitude may be very small and not come across as something “depressing.” Instead of saying, “I really think I’ll get that promotion this time!” after having been passed over it four previous times, they may say, “Well, I’m up for that promotion again, but I doubt I’ll get it.”

By Rick Nauert PhD

The Difference between Depression and Premenstrual Dysphoric DisorderA new study addresses premenstrual dysphoric disorder (PMDD), a severe mood disorder which affects five to seven percent of all women of reproductive age in the United States.

Unfortunately, the disorder is often misdiagnosed as major depression or other mood disorders.

In the study, PMDD is determined to be a biologically different form of premenstrual syndrome. Women with PMDD who have experienced depression may make up a subset.

The findings are important because they give physicians more reason to search for a more specific diagnosis and could possibly lead to more precise treatments. There currently are few good choices, said Susan Girdler, Ph.D., professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine. Girdler led the study.

“PMDD is not garden-variety premenstrual symptoms. PMDD causes severe impairment in quality of life, equivalent to post-traumatic stress disorder, major depressive disorder and panic disorder, that continually cycles on a monthly basis. Some women spend half their lives suffering from this disorder,” said Girdler.

In a study published in the journal Biological Psychology, Girdler and her colleagues measured biological responses to stress and pain.

Previous studies demonstrated that women with chronic major depression have a heightened biological response to stress and release more stress hormones, such as cortisol.

Girdler and her group previously have shown that women with PMDD respond conversely, with blunted stress responses.

The current study is the first known head-to-head comparison of the two groups and confirmed earlier findings.

“We found the greatest weight of evidence that PMDD and major depression are really two distinct entities in terms of biological response to stress and with respect to pain sensitivity and pain mechanisms,” Girdler said.

But more important, Girdler said, was the finding that women with PMDD who also had experienced depression in the past looked different from PMDD women who had never been depressed. Only the PMDD women with prior depression had lower cortisol and greater sensitivity to pain compared to non-PMDD women with prior depression. These differences between PMDD and non-PMDD women were not seen in women who had no depression history.

“So while the study shows that PMDD is biologically different from major depression, a history of depression may have special relevance for women with PMDD with respect to stress hormones and pain response,” Girdler said.

Current treatments for PMDD are effective in only about half of women. But, Girdler says, gathering more biological clues about PMDD could expand the treatment options.

Source: University of North Carolina

By Jessica Ward Jones, MD, MPH

According to Dr. Kathleen R. Merikangas from the National Institute of Mental Health and her colleagues, “Nearly 40 percent of people with a history of major depressive disorder report periods of hypomania that just miss the threshold for a bipolar diagnosis.”

Bipolar disorder, formerly known as manic depression, is a mental disorder characterized by alternating “highs” (what clinicians call mania) and “lows” (depression). Bipolar disorder affects about 2.6 percent of the U.S. population, according to the National Institute of Mental Health. People with bipolar disorder are generally diagnosed with one of several types: bipolar I, bipolar II, or cyclothymia. Bipolar I disorder patients have more severe mood swings, with periods of mania alternating with depression. Bipolar II patients experience alternating periods of depression and hypomania (a milder version of mania). People with cyclothymia have mood swings as well, but not severe enough to be diagnosed with bipolar disorder. Clinicians and researchers are becoming aware that there is a spectrum from major depression to pure mania.

To assess how often people with depression have subtle, undiagnosed bipolar symptoms, Merikangas and her team examined 9,282 people people surveyed in the National Comorbidity Survey Replication (NCS-R).

“The NCS-R is a nationally representative face-to-face household survey of the U.S. population conducted between February 2001 and April 2003. Lifetime history of mood disorders, symptoms, and clinical indicators of severity were collected using version 3.0 of the World Health Organization’s Composite International Diagnostic Interview,” writes Merikangas.

The team found that of the 9,282 people in the survey, 5.4 percent met criteria for major depressive disorder alone over the prior 12 months and 10.2 percent had a history of depression.

2.2 percent had major depression with subthreshold hypomania over the prior 12 months, and 6.7 percent had a lifetime history of depression with subthreshold hypomania.

Bipolar I disorder affected 0.3 percent of the respondents over the prior 12 months and 0.7 percent over their lifetime; bipolar II affected 0.8 percent, and cyclothymia 1.6 percent, respectively.

Added together, the bipolar spectrum conditions were nearly as common as major depression alone.

Almost 40 percent of people with a history of depression described periods with hypomanic symptoms that were just below the threshold for a diagnosis of bipolar disorder. These individuals tended to be younger when symptoms began, have more episodes of depression, have more anxiety, substance abuse, behavioral problems, and higher rates of suicide than those without subtle hypomanic symptoms. However, the severity of their illness was lower than those diagnosed with bipolar II.

In addition, those with a history of subthreshold hypomania had a family history of mania at the same rate as those diagnosed with mania themselves.

Those with subthreshold hypomanic symptoms and those with depression alone received treatment at the same rates.

Although subthreshold mania is not a diagnosis in the current edition of the Diagnostic and Statistical Manual of Mental Diseases (DSM-5), a revision is due in 2013. Merikangas suggests that adding subthreshold bipolarity could be beneficial. “These findings demonstrate heterogeneity in major depressive disorder and support the validity of inclusion of subthreshold mania in the diagnostic classification. The broadening of criteria for bipolar disorder would have important implications for research and clinical practice,” write the authors.

“Such an expansion of the bipolar concept would likely lead to important changes in the treatment of patients who are undiagnosed or misdiagnosed despite elevated morbidity and mortality rates.”

These results are important not only for researchers, but for clinicians. In evaluating patients with major depression, clinicians can be aware of the possibility of subthreshold hypomania, and the tendency for these patients to have a poorer outcome than those with depression alone. Merikangas’s group suggests that enquiring about family history of mania can be especially helpful in evaluating this group. Furthermore, some of these patients may benefit from the addition of a mood stabilizer in addition to antidepressant therapy.

Dr. Merikangas’s results can be found in the August online edition of the American Journal of Psychiatry.

Source: American Journal of Psychiatry

By Janice Wood

The pressure to be constantly available and respond 24/7 on social media can cause depression, anxiety, and reduce sleep quality for teenagers, according to a new study.

For the study, presented at a British Psychological Society conference, researchers Dr. Heather Cleland Woods and Holly Scott of the University of Glasgow provided questionnaires to 467 teenagers regarding their social media use overall, as well as at night time.

A further set of tests measured sleep quality, self-esteem, anxiety, and depression.

The researchers also measured the teens’ emotional investment in social media, which relates to the pressure felt to be available 24/7 and the anxiety around, for example, not responding immediately to texts or posts, they explained.

“Adolescence can be a period of increased vulnerability for the onset of depression and anxiety, and poor sleep quality may contribute to this,” Cleland Woods said. “It is important that we understand how social media use relates to these. Evidence is increasingly supporting a link between social media use and wellbeing, particularly during adolescence, but the causes of this are unclear.”

An analysis of the collected data showed that overall and night-time specific social media use, along with emotional investment, were related to poorer sleep quality and lower self-esteem, coupled with higher anxiety and depression levels.

“While overall social media use impacts on sleep quality, those who log on at night appear to be particularly affected,” Cleland Woods said.

“This may be mostly true of individuals who are highly emotionally invested. This means we have to think about how our kids use social media, in relation to time for switching off.”

Source: The British Psychological Society

By Kirstin Fawcett
Ian Anderson was only 5 years old when he began to lose interest in activities he once loved. He experienced mood dips and withdrew from his peers. His school performance suffered. And his mind was plagued with thoughts of suicide.

Anderson’s mother took him to a family therapy session, and he was diagnosed with depression. Soon after, Anderson started regularly going to therapy. At age 10, he was prescribed antidepressants.

“It’s hard to say whether [my depression was spurred] by genetics and a chemical imbalance in the brain, or whether it was because my parents had just divorced,” says Anderson, a 29-year-old retail manager who lives in the District of Columbia. “But it was clear that that I was showing very classic symptoms” of the illness.

Many people mistakenly believe depression is only diagnosed and treated in adolescents and adults. After all, kids don’t fully understand major life stressors or have the self-awareness and maturity to feel anything more than a shallow sense of sadness. Right?

Wrong. In recent years, experts say, the medical community has started to focus more on the diagnosis and treatment of pediatric depression – spurred by increased awareness of mental health conditions, as well as a growing body of research in the discipline.

According to pediatric psychiatrists, approximately 5 to 8 percent of children and adolescents suffer from depression at any given time. But while the numbers peak in adolescence – teens ages 13 to 16 are more likely to receive a diagnosis – physicians do report cases of depression in children as young as 2 years old.

Parents might want to wait for their kid to “snap out of” or “outgrow” their depression, mental health professionals say. But according to studies, early onset depression often persists into adulthood, and can signal that the child will experience more frequent and severe episodes in adolescence or adulthood.

“A child who experiences a major depressive episode probably has at least a 50 percent chance of having another episode in the next five years,” says Dr. John Huxsahl, a psychiatrist who specializes in child and adolescent psychiatry at the Mayo Clinic in Rochester, Minnesota.

Early diagnosis, intervention and treatment are key, experts say. Childhood depression is just as serious as adult mental illness – and should be treated as such.

Identifying Depression in Kids

Say your child isn’t sleeping well, or he is complaining of stomach aches, irritable bowel or migraines. He used to love going to the playground, but now barely leaves the couch. Kids who can talk will start expressing negative thoughts or sentiments; those who can’t will exhibit temperamental or reactive behavior. You take your child to a primary care or family physician for a screening. You’re looking for something, anything – a thyroid condition, low blood sugar – that might explain your once active, happy child’s mysterious symptoms.

Your kid might lack the vocabulary or emotional savvy to explain what’s going on in his head. Adding to your confusion? A depressed child might act – and feel – slightly differently than his older counterparts with the same condition, Huxsahl says. Sure, they’ll share some symptoms – a loss of appetite, sleeping too much or too little, withdrawing from the world – but there are subtle distinctions.

For instance, kids with depression might not appear “sad” to others, nor will they be able to tell you they feel down. They might, however, act more irritable and angry than normal, or be prone to more arguments and temper tantrums.

Ahedonia – the inability to experience pleasure or joy – is another tell-tale symptom that your child might be depressed, Huxsahl notes.

“Children are generally happier than adults, and more spontaneous with their happiness,” Huxsahl says. “When young children are clinically depressed, you notice it’s like someone grabbed a thermostat that regulates their ability to regulate pleasure and dialed it down 20 degrees.”

Another common feeling associated with pediatric depression is guilt, says Dr. Timothy Wilens, chief of the division of child and adolescent psychiatry at Massachusetts General Hospital in Boston. “Some adults report guilt as part of their depression, some don’t. But a lot of kids [with depression] will feel guilty about everything,” Wilens says. “They’ll feel guilty they’re not having fun, or that they’re holding their family back. They’ll feel guilty that they’re not doing anything. There’s guilt for a whole lot of reasons. You’ll see that more often with kids than you do adults.”

Psychosomatic complaints – a stomach ache, a headache – can be common among children with depression. And while adults with the illness often suffer in work performance, a kid with depression might start underperforming in school – not completing homework or assignments, doing poorly on tests and not paying attention in class.

Also, keep in mind that life circumstances often play a role in the development of depression in children, says Dr. Abby Schlesinger, an assistant professor at the University of Pittsburgh School of Medicine who specializes in child and adolescent psychiatry. One of the most significant risk factors is a family history of mental illness. Kids with histories of abuse or neglect – physical and/or emotional – are also at a greater risk for developing depression, as are kids who experience traumas ranging from bullying or a major life change, such as a move, death or divorce.

“Negative, stressful life events in general can be triggers – particularly for children that are biologically sensitive because of their genetics,” Schlesinger says. Keep a close eye on whether the child also has any chronic illnesses, an anxiety disorder, attention deficit hyperactivity disorder or other conditions.

Reluctant to attribute your child’s recent behavior to depression? Think it might just be growing pains or a “phase?” Consider the duration and severity of the symptoms before writing them off, says Dr. Leslie Miller, an assistant professor of child and adolescent psychiatry at Johns Hopkins University School of Medicine in Baltimore, Maryland.

“You want to look at how long [the symptoms] have been going on for, and you want to look at impairment,” Miller says. “Is this a kid who used to have a lot of peer interaction and now they’re withdrawing? Is this a kid who pretty much followed rules for the most part but is now having a tantrum every day? Are they barely passing their classes, or not able to get their homework in? Every kid has tantrums, and that’s normal and fine. But you have to look at patterns” to determine whether there’s something more serious going on.

One clear – and serious – indicator of pediatric depression is suicidal thoughts or behavior, Schlesinger says. Kids are more emotion-driven than adults, and don’t necessarily understand the finality of suicide. They’re less likely to plan it, and more likely to end their lives in an unpredictable manner. Although suicide in young children is rare – and a child isn’t necessarily going to end his life if it crosses his mind – it does happen.

According to the American Foundation for the Prevention of Suicide, suicide is the third leading cause of death in adolescents ages 15 to 24, as well as the sixth leading cause of death in children ages 5 to 14. Experts say a good psychiatric evaluation should include questions about suicidal thoughts or behaviors. And if a child has expressed suicidal thoughts to a parent, or shown warning signs – for instance, saying things like “I wish I were dead” – it’s important for the family to have a plan on how to handle worst-case scenarios.

“Children are impulsive by nature,” Schlesinger says. “If they have a strong negative emotion [and] they don’t have a plan how to manage it, then they’re at risk.” If your child has expressed suicidal thoughts, she advises parents to stay calm and supportive. Instead of freaking out, let the child know he or she can talk to you if he or she needs help. Plan coping strategies you child can utilize to make himself or herself feel better in the event of suicidal thoughts.

By Traci Pedersen

People who suffer from major depressive disorder (MDD) may experience relief through synchronized transcranial magnetic stimulation (sTMS) therapy, according to a new study that tested the safety and efficacy of low-field magnetic stimulation using the new NEST® device on adult patients with MDD.

The findings are published in the Elsevier journal Brain Stimulation.

For the study, more than 200 participants were evaluated from 17 leading academic and private psychiatric institutions in the United States; enrollment included both treatment naïve and treatment-resistant patients as previous exposure to antidepressant medication was not a requirement for inclusion into the trial.

“The study found sTMS therapy to be significantly more effective than sham when administered as intended, supporting the hypothesis that low-field magnetic stimulation improves depressive symptoms,” said principal investigator Andrew Leuchter, M.D., professor of Psychiatry in the Semel Institute at University of California, Los Angeles.

“Additional analyses found subjects who failed to benefit from or tolerate prior antidepressant treatment in the current episode were most likely to demonstrate significant benefit from sTMS therapy compared to sham.”

When delivered accurately and consistently, sTMS therapy was successful in relieving depression symptoms in 34.2 percent of participants who had not responded to drug treatment, compared to 8.3 percent of those treated with an inactive device.

In addition, NEST® appeared safe and tolerable, with no significant differences seen between active and sham treatment in the rate or severity of negative events. There were no device-related serious adverse events in this study.

“These promising results indicate that sTMS is a promising novel technology for the treatment of depression,” said co-author Mark S. George, M.D., Distinguished Professor of Psychiatry, Radiology and Neurology at the Medical University of South Carolina, and the Editor-in-Chief of Brain Stimulation.

“This technology is revolutionary in two ways over the current FDA-approved forms of TMS. First, this device tunes the stimulation to the patient’s own brain rhythms. By stimulating at each patient’s individual resonant frequency, sTMS may be able to achieve therapeutic success using lower energy. Second, this device is safe, easy to use, and portable, which would allow use in a wide variety of treatment settings.

“sTMS may expand the options we have for treating serious depression.”

“We are very pleased with the outcome of this trial and what it could mean for those with MDD, particularly those who have failed to achieve adequate improvement from prior antidepressant treatment,” said Kate Rumrill, president and CEO of NeoSync.

By Rick Nauert PhD

New research suggests that even when depressed people have the opportunity to decrease their sadness, they don’t necessarily try to do so.

The finding is somewhat perplexing given that depression is characterized by intense and frequent negative feelings, like sadness. Consequently, it might seem logical to develop interventions that target those negative feelings.

But the new findings, published in the journal Psychological Science, suggests this may not always be an appropriate plan of action.

“Our findings show that, contrary to what we might expect, depressed people sometimes choose to behave in a manner that increases rather than decreases their sadness,” said the study’s first author, Dr. Yael Millgram of the Hebrew University.

“This is important because it suggests that depressed individuals may sometimes be unsuccessful in decreasing their sadness in daily life because, in some sense, they hold on to it.”

Millgram and colleagues couldn’t find any research that had examined the direction in which depressed people try to regulate their emotions, perhaps because it seems logical to assume that they would try to decrease their sadness if they could.

The researchers set out to conduct their own series of studies to find out whether this was actually the case.

In the first study, 61 female participants were given a well-established screening measure for symptoms of depression. Participants who scored on the very low end of symptoms were classified as “nondepressed” for the study, while those who scored in the middle to high end of the range and who were also diagnosed with a major depression episode or dysthymia were classified as “depressed.”

All of the participants were then asked to complete an image selection task — on each trial, the participants saw a particular image and could press one key to see it again or a different key to see a black screen for the same amount of time. The images were presented in random order and were drawn from a group of 10 happy images, 10 sad images, and 10 emotionally neutral images.

Comparing across the three types of images, the data showed that both depressed and nondepressed participants chose to see happy photos again more often than they chose to re-view the sad or neutral photos.

But, when the researchers looked specifically at how the groups responded to the sad images, they found that participants who were depressed chose to view those images again more often than the nondepressed participants did.

These findings were confirmed in a second study involving music selection. Again, the researchers found that depressed participants were more likely to choose sad music to listen to later in the study than happy or neutral music. The sad music clip was chosen by only 24 percent of the nondepressed participants but by 62 percent of the depressed participants.

“Depressed participants indicated that they would feel less sad if they listened to happy music and more sad if they listened to sad music, but they picked the sad music to listen to,” said Millgram.

“We were surprised that depressed participants made such choices although they were aware of how these types of music would make them feel.”

And a third study showed that when participants were taught how to use cognitive reappraisal as a strategy for increasing or decreasing their emotional responses to stimuli, the depressed participants chose to increase their emotional responses to sad images more often than the nondepressed participants did.

Researchers discovered that these efforts were effective: The more participants chose to use reappraisal to increase their emotional reactions to sad images, the more their sadness increased.

The findings suggest that developing effective tools isn’t enough to help people regulate their emotions in beneficial ways; they also have to be motivated to use those tools.

“The most urgent task for us is to try to understand why depressed people regulate their emotions in a manner that increases rather than decreases sadness,” said Millgram.

The researchers also plan on investigating the real-world implications of choosing to increase sadness as people respond to stressful events in their daily life.

Source: Association for Psychological Science

By John M. Grohol, Psy.D.

According to the Center for Collegiate Mental Health 2014 annual report, anxiety is the number one concern of college students’ mental health needs today, with depression placing second. As college counseling centers continue to deal with ever-expanding workloads and needs of the college students they serve, it’s concerning that so many students are facing serious mental illness, such as anxiety and depression.

University counseling centers were originally setup to help students primarily with academic and relationship concerns, as well as just the issues that arise from living on your own for the first time in your life. But in the past two decades, these centers — whose services are usually provided at little or no cost to students, covered by their student fees — have begun serving more and more students with serious mental illness.

The most recent data comes from a survey that was conducted in 2013-2014 and included over 101,000 college students seeking services from 2,900 clinicians providing services at 140 college and university counseling centers.

In the survey, clinicians identified that for clients who sought out counseling services, anxiety was the top-most concern of nearly 20 percent of all college clients. Nearly 16 percent of students complained of depression, while another 9 percent came to the counseling center for a relationship issue.

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Stress was the top issue for nearly 6 percent of college students, while nearly 5 percent of students complained that their academic performance was their main issue. Family, interpersonal functioning, grief/loss and mood instability rounded out concerns expressed by more than 3 percent of college students seeking services.

The New York Times also covered the story, noting the rise of anxiety concerns among students:

Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C.

Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.

“A lot are coming to school who don’t have the resilience of previous generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying, and they don’t have the ability to soothe themselves.”

The good news is that due to mental illness stigma becoming more and more of a non-issue amongst younger generations, more young people have no problem seeking out services for these concerns. The bad news is that we live in a society where providing coordinated and integrated care for mental illness remains firmly stuck in the past.

College counseling centers are usually not well-integrated within their local community of care. And students often are reluctant to seek care away from their university, since such care might only be affordable by using insurance — usually, their parents. Despite the reduction in stigma and uptick in those seeking care, there still are limits on what a person might want to share with their parents, including their mental health battles.

Counseling centers are equipped (and funded) only to offer fairly short-term treatments. Yet more and more students are turning to these under-funded centers for their care, resulting in long wait lists, or less-than-ideal short-term care.

In an effort to cater to the rise in the number of students seeking services, more colleges are offering workshops (for psychoeducation) and groups to help treat these rising numbers. It’s no wonder — the students coming to them are more informed and better-educated about mental health treatments than at any previous time in history. As the Times article notes, “Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication.”

We hope universities continue to expand their services and get creative in better serving their young adult students. After all, these are some of the most important, formative years for the students.

By Brian Cuban
I am just one guy out of many men and women who struggles with Body Dysmorphic Disorder( BDD), a condition that often begins in adolescence and affects as many as 1–2% of the population. For potentially millions of Americans, depression, addiction, steroid abuse, eating disorders, and broken relationships are common byproducts.

So what is the down and dirty of BDD? Experts characterize BDD as a condition marked by sometimes disabling preoccupation with imagined or exaggerated defects of physical appearance. Many experts consider BDD a form of obsessive-compulsive disorder, or OCD. The disorder is fairly common, affecting as many as 2% of the population, and has been known to psychiatric experts for over a century.

Is there an exact point in life that I can point to and say “this is when my thought process changed, this is when I developed BDD?” No, I can’t. I was bullied as a child. I grew up in a family sometimes in conflict, with a pattern of verbal abuse on my mother’s side, passed through generations. I was a fat kid. I was the middle child and shy to begin with as a matter of biology and genetics. Psychologists, psychiatrists, and other treatment professionals will tell you that there is no one cause.

What does it feel like? Here are some of the behaviors that have defined my struggle with BDD. To a casual observer some of these may seem narcissistic, “quirky,” or eccentric. They may sound familiar to others at risk for BDD:

The shower inspection. I have been doing it as far back as I can remember—a detailed inspection of the areas of “concern” on my body when I shower. I know I am doing it, but it has become integrated into my daily routine. Like breathing, I just can’t stop. With the palm of my hand I press down on my stomach and try to flatten it. Of course it always bounces back, but I feel like I can actually measure if there has been any increase in my waist size.

Verifying body defects through touch. I do it all the time. I rarely notice it. Primarily my chest area. This is a remnant of a past steroid addiction. I could be walking down the street, in a mall, sitting at dinner. For a split second I will touch my chest. It may even cause concern among those around me if it occurs more than once in a short period—I have had that happen. The person will ask if I am okay. They may think I am having chest pain, on the verge of a heart attack.

The pants carousel. Women are stereotyped as trying on numerous outfits before they go out. It’s part of their mystique and what we love about them. And we all want to look good in what we wear. No big deal. But is it common for a guy to try on numerous outfits before he goes out at night? What about before he leaves the house in the morning? What about trying on every pair of pants in the closet to make sure they all still fit as a daily routine while getting ready for work?

A love-hate relationship with mirrors. Don’t we all have that? Nothing out of the ordinary. The difference is that growing up, I traditionally did not see my reflection. I saw over-exaggerated love handles. A receding hairline seemed completely bald. The reflection in the mirror showed scarring that did not exist in real life. My chest seemed deformed and unattractive. I was even able to “see” stupidity. I saw a monster.

The hanging shirt. I hate to tuck in my shirts. Fortunately it has become kind of a style statement so it does not seem too weird. For me, however, the un-tucked shirt is not an attempt to be stylish. The very act of tucking the shirt and creating less space between my stomach and my clothes is stressful for me.

Fear of crowds/Social Anxiety. This could be going to a party, nightclub, bar, or anywhere else that I expect people to be sizing each other up. Any situation where in my mind the entire scene is about judging and comparing my looks and “defects” to other people, forging romantic relationships, or being scrutinized based on looks has always been a terrible problem for me. And the way I’ve coped with social anxiety has sometimes been worse than the anxiety itself. In the past, I’d always be drunk or high before the event.

Plans to artificially fix the “defects.” Any other BDD sufferers out there who have contemplated lap band surgery even though they are not medical candidates for it? When the Bariatric Weight Loss commercial comes on the tube, I quickly think, “Will Lap Band be okay for me or do I need a gastric bypass?” What? I weight 220 lbs at 6 foot 2 inches! Of course I don’t need that. My mind for a split second says something different.

Inner critic; outer-critic. I would see flaws not just in myself, but in everyone I met as well. When I was at my worst, this was a terrible problem for me and hurtful to others. When you obsess over defects in yourself, zooming in 10X on even the most minute flaws, you tend to do the same when you look at others. When I was younger, this sometimes turned me at times into what I despise—a bully.

One Word: Plastics. Multiple visits to the plastic surgeon are common for BDD sufferers. I am no exception. As of the writing of this book, I have had four hair transplants, one liposuction, and lasik at a total cost of about twenty thousand dollars. Not too extreme by BDD standards, but the only reason I did not have more procedures is because I could not rack up any more debt to get them.

Self-medication. Using drugs to try to change how you feel about yourself, how you see yourself, how you perceive others seeing you. I excelled in this. Alcoholic. Cocaine Addict. Abuse of weight loss drugs laxatives and anabolic Steroids. All of them gave me a brief self-image high the moment I took them, but in the end they all led toward vicious cycles of destructive behavior.

Disordered Eating Behaviors. Eating disorders are something that many BDD sufferers are intimately familiar with. I am not an exception here, either. About thirty percent of those with BDD will also develop and eating disorder.

Depression. Depression has always gone hand in hand with my BDD, and when it’s at its worst, depression has robbed me of the will to live. To make my life better and put an end to self-destructive habits.

Suicidal thoughts. I am very lucky to be above ground to write this book. I had a Spanish made .45 automatic. I almost wasn’t. Some are not.

Am I cured? The climb out was a long, slow, hard process. It started with putting one small step forward. There were setbacks. There were times when it seemed easier to go backwards than forwards. There were times when simply giving up was within hand. I now have the strength to face my path in life independant of what I see in the mirror? What do I see? I see something I did not see for so many years. I see Brian. Heavy, thin, bald, pimples, love handles and all. It’s ok. I am enough.

Today, I am addiction free except for my daily Starbucks Vente Blonde coffee. (In the world of addiction, the Vente seems a good trade-off from my old routine of coffee with a cocaine chaser to get going in the morning. or jabbing a steroid needle in my butt) I can face the world of people and social interaction—with some stress, yes, but not life-disabling stress, without the need to artificially change the image in the mirror. I love and have loved. I have been rejected. I have let go. I have forgiven. I am alive. I am okay. You can be as well. Take that step forward. It all starts with dropping that wall of shame and allowing yourself to be helped.

Resources: The Broken Mirror by Dr. Katharine Phillips.

By Támara Hill, MS

Last week I wrote about 8 Symptoms that should not always be labeled a mental illness. Life is life. We are all going to experience the worst of it and the best of it. We should not be so quick to label ourselves “disordered” until we evaluate every aspect of what could be happening to us. Clinicians and mental health professionals should also be careful not to quickly pathologize every client that comes through their doors. But sadly, there are way too many people in the world, including some mental health professionals, who either downplay or exaggerate mental health symptoms. There is often no in-between. Although we all would like to maintain the idea that most people are mentally healthy and well adjusted, we cannot ignore the fact that there are millions of people (children, adolescents, adults) who are struggling with mental health symptoms every single day of their lives. They are struggling with mild, moderate, and severe symptoms that seem to make their future grim. This article will discuss symptoms that should never be ignored or downplayed and possibly be evaluated by a mental health professional.

Unfortunately, the field of psychiatry and psychotherapy lacks a manual that would provide concrete direction on how to identify mental illness. Of course, we are all familiar with the DSM (and ALL of its many versions and revisions) but this is certainly not enough for the perplexities of life. The DSM provides minimal guidelines to help guide mental health professionals and to help them communicate, using a common language, more appropriately. But the manual does not provide the concrete answers many people seek about their lives and their health. Making a diagnosis using the DSM often includes a mediocre process of elimination. Sometimes this process is completely on point, while at other times is is completely off point. As a result, determining when a symptom (or constellation of symptoms) is a problem, can take a lifetime. For those individuals who are insightful about their psychiatric and emotional needs, deciding to pursue mental health treatment is often an easy process. But for those individuals who are often in denial, struggle with acceptance of reality, or lack a great deal of insight into themselves, pursuing mental health treatment is not something they are willing to do or even talk about. That’s why it’s important that others (family, friends, spouses, etc.) become knowledgeable about the symptoms and behaviors that signal that there is a very big problem.

Because it’s very difficult for many of us, primarily those without a clinical background, to identify when a symptom or behavior might indicate that psychiatric treatment is needed, I have compiled a list of symptoms and behaviors that should always prompt us to either seek treatment ourselves or encourage another person to seek treatment. This list is a list I often provide to parents and families who see me. Some of the problematic behaviors and symptoms include:

Frequent and dangerous sexual acting out: I have previously worked with juvenile delinquents within a mental health/juvenile agency. Most of these youths presented with high levels of anxiety, extreme traumatic histories, and frequent sexual acting out. Sadly, the children weren’t the only individuals sexually acting out. Many of their parents also engaged in similar behaviors such as sending nude pictures of themselves using their cell phone or Facebook accounts (“sexting”), prostituting, entertaining multiple partners, or maintaining an open marriage or relationship (without boundaries or sexual precautions). Although we are human beings who should not be ashamed of our sexuality, we must be appropriate, respect ourselves, and have some insight into how our sexuality affects our lives. For individuals who lack insight, there is a problem. The problem could be psychological (looking for approval, feeling rejected, etc), emotional (looking for love or companionship), or trauma-based (the result of a traumatic and abusive past).
Physical/Verbal aggression that is frequent: Some individuals are born with a difficult temperament that causes them to be easily triggered by minor things. Some individuals also have bad tempers that they just cannot control. However, an individual who frequently lashes out at others without considering the consequences of their behavior(s), puts others in harms way, is abusive (verbally, physically, or sexually), and jeopardizes their employment or living conditions, has a problem. There is something going on under the surface that causes the aggression. A mental health professional would be able to provide what is called a bio-psycho-social assessment to look at all aspects of the individual’s life. Biological/genes, social components, and psychological factors would all be assessed.
Self harm or suicidal thoughts with a plan and intent: Sadly, many of our youths today engage in self-injurious behaviors which include but are not limited to: cutting their arms, legs, thighs, or stomach with blades, knives, or other sharp object as a stress releaser or a way to fit in with others. Other kids engage in verbalizing a great deal of suicidal threats such as “I will kill myself,” “I want to leave this place,” or “I would be better off dead.” These kind of statements are known as passive death wishes because no mention of a plan has occurred and level of intent may be low. ALL suicidal statements should be taken seriously and evaluated, but the most severe form of suicidal thoughts are those that include a high degree of intent (on a scale from 1-10; 10=highest, an “8”) and a plan such as jumping off of a bridge tomorrow at 5:00 when people are too distracted to notice. If an individual (primarily children and teens) express both intent and give you an example of how they would complete the suicide, mental health attention is medically necessary. This is sufficient information to have this person 302’d or hospitalized.
Extreme fatigue or depressed mood: Life is hard and sometimes it simply gets you down. For many people in today’s fast-paced society where competition and callousness seems to have taken over, depression is likely to occur. Sleep and appetite disturbance, low self-esteem, hopelessness and helplessness, low mood, lack of interest in activities once enjoyed, irritability, weight loss or weight gain, and poor concentration are all symptoms of depression. Symptoms that interfere with daily life, result in job or relationship loss, and makes each day feel harder to navigate, will require therapy and possibly medication management. A mental health evaluation that screens for depression will be helpful.
Intense migraine headaches or bodily aches and pains: Some mental health disorders affect all aspects of our bodies. In many cases, mental health conditions can trigger medical conditions and vice versa. A mental health evaluation can help rule out psychological conditions so that you can focus on what the true issue is. For example, depression often triggers a lot of physiological symptoms such as headaches, bodily aches and pains, weight loss or weight gain, nausea or vomiting, arthritis or fibromyalgia, etc. However, some medical conditions such as thyroid disease can trigger depressed mood as well. So being able to get a mental health screening or evaluation will be important to ruling out conditions that may not be affecting your symptoms.
Extreme preoccupation with physical appearance, sex, money, or crime: Today’s society has become extremely narcissistic and self-focused. Most modern and popular movies, music videos, and songs include money, sex, crime, or some other illegal and immoral activity. Despite this fact, it’s important to understand when narcissism has turned into full blown clinical narcissism that interferes with daily life as a result of impulsivity (which can lead to risky sexual behaviors, substance abuse, gambling, infidelity, etc), immaturity, extreme vanity (which includes a lack of empathy for others and extreme preoccupation with physical appearance and self-importance), and a sense of grandiosity that appears delusional and unrealistic. Many of my previous colleagues worked with narcissism and anti-social personality disorder (sociopathy) and found that many of these clients have a delusional view of themselves which includes an unrealistic self-importance and grandiose perception of life in general. Someone like this can truly jeopardize your safety or harm you in some fashion. A mental health evaluation will help rule out any other mental health disorders that may be contributing to the behavior (such as oppositional defiant disorder for youths, ADHD, or bipolar disorder) and provide some direction on where to seek therapeutic intervention.
Terrible nightmares/night terrors or flashbacks: For young children, having nightmares (sometimes nightly) is not abnormal. Their little minds are hard at work trying to re-organize the world and make sense out of everything in life. But for individuals, including children and teens, who have experienced a traumatic history (abuse, neglect, rape, etc) or witnessed a traumatic event, flashbacks and nightmares are likely to occur. Flashbacks can feel very real to the person and affect the body and mind as if the trauma were happening all over again. Research studies have shown that during Eye Movement Desensitization and Reprocessing (EMDR) the individual who previously experienced a trauma will begin to show physiological signs of re-experiencing the trauma. The heart rate increases, the eyes may frequently blink, the body begins to shake, thoughts begin to race, and the person shows symptoms of not being able to tolerate the flashback or EMDR experience. Anyone can experience flashbacks or what is known as secondary trauma. You do not have to have a trauma history or be a veteran to experience flashbacks or nightmares/night terrors. A single incident such as witnessing your aging mother fall down the stairs, sustain a concussion, and struggle to recover can be traumatizing enough. Any of the above symptoms should be evaluated by a mental health professional who can rule out PTSD (Post Traumatic Stress Disorder) or secondary trauma.
Emotional lability, changeable moods, risky behaviors, and intense emotional reactions: Individuals who exhibit frequent changes in mood, struggles with emotion regulation and distress tolerance, engages in high risk behaviors and (substance abuse, gambling, infidelity, refusing to take necessary medications, sexually inappropriate behaviors, shallow and unstable romantic relationships, etc.) can all be possible signs of either borderline personality disorder or bipolar disorder. It’s important, because both disorders are identical in some ways, that a mental health evaluation be pursued so that a correct diagnosis and treatment can be obtained.

Sadly, it isn’t until a behavior, action, or symptom has gotten WAY out of control that psychiatric treatment is ever considered. This is mainly because of a fear of stigma, but the other piece of this puzzle involves a fear of reality. Some people think “Really…? How could this be me? I have always been active, strong, and self-sufficient. I couldn’t be depressed.” Others say things such as “My mother has worked all her life and is a very strong woman. How could she have borderline personality disorder?” Because of our habit of going into denial when it comes to mental illness, we miss the signs and symptoms that are often right in front of our faces screaming for us to pay attention.

All of the categories above must interfere in some way with daily life and prevent healthy social interactions. Can you think of a few “symptoms” or behaviors that might signal that there is a need for a psychiatric evaluation, medication management, or therapy? If you were to recommend psychiatric treatment or suggest that someone attend therapy, what symptoms would you point out? What would make you think the person would need professional intervention?

By RICK NAUERT PHD Senior News Editor

A new review finds that people suffering from depression appear to experience time differently than healthy individuals.

Although the perception of time is subjective and usually depends on the relevant situation, the discovery that time appears to pass more slowly for depressed individuals is significant.

Many of us experience a different sense of how fast or slow time is passing relative to whether we are waiting for something or if a deadline is approaching. The new study, however, finds that depressed individuals often perceive that time seems to pass extremely slowly or even stands still.

Psychologists at Johannes Gutenberg University Mainz (JGU) collated relevant studies on the subject to analyze them in a so-called meta-study.

They discovered that although depressed individuals perceive slow time passage, when asked to judge the duration of a specific time interval, such as two seconds or two minutes, their estimates are just as accurate as those of healthy subjects.

Sven Thönes and Dr. Daniel Oberfeld-Twistel of the Institute of Psychology at Mainz University looked at the results from 16 individual studies in which 433 depressed subjects and 485 non-depressed control subjects participated.

“Psychiatrists and psychologists in hospitals and private practices repeatedly report that depressed patients feel that time only creeps forward slowly or is passing in slow motion,” reported Oberfeld-Twistel.

“The results of our analysis confirm that this is indeed the case.”

In the second part of their meta-analysis, Thönes and Oberfeld-Twistel examined subjective estimates of how long events last.

In these studies, the subjects were asked, for example, to estimate the duration of a movie in minutes, press a button for five seconds, or discriminate the duration of two sounds. The results obtained for the depressed subjects were exactly the same as those for the healthy ones without any relevant statistical difference.

“We found strong indicators that in depressed individuals the subjective feeling of the passage of time differs from the ability to assess the actual duration of external events,” concluded Oberfeld-Twistel, summarizing the findings.

Thönes and Oberfeld-Twistel identified several aspects of the relation between depression and time perception that have not yet been investigated adequately.

Little is actually known about the effects of antidepressants and psychotherapy, or how patients with bipolar disorders compared to non-bipolar depression assess the passing of time.

Researchers believe future studies are needed to clearly differentiate between the subjective perception of the passage of time and the ability to estimate the length of precisely defined time intervals.

By TRACI PEDERSEN Associate News Editor

Cannabis use is linked to an increase in both manic and depressive symptoms in people with bipolar disorder, according to a new study by Lancaster University.

The study is the first to examine the use of cannabis in the context of daily life among people with bipolar disorder. In the U.K., where the study took place, around two percent of the population suffers from bipolar disorder, with up to 60 percent of those using cannabis at some point in their lives.

Research in this area is limited, however, and reasons for this high level of use are unclear.

Clinical psychologist Dr. Elizabeth Tyler of the Spectrum Centre for Mental Health Research at Lancaster University led the study with Professor Steven Jones and colleagues from the University of Manchester, Professor Christine Barrowclough, Nancy Black, and Lesley-Anne Carter.

“One theory that is used to explain high levels of drug use is that people use cannabis to self-medicate their symptoms of bipolar disorder,” said Tyler.

For the study, the researchers evaluated people diagnosed with bipolar disorder who were not experiencing a depressive or manic episode during the six days the research was carried out. Each participant reported daily on their emotional state and drug use at several random points over a period of week. This enabled people to log their daily experiences in the moment before they forgot how they were feeling.

Here are a few comments from the daily reports:

“I do smoke a small amount to lift my mood and make myself slightly manic but it also lifts my mood and switches me into a different mind-set.”
“I do not use weed to manage depression as it can make it worse, making me anxious and paranoid.”
“I have found though that if I have smoked more excessively it can make me feel depressed for days afterwards.”
The researchers found that the odds of using cannabis increased when individuals were in a good mood. Cannabis use was also associated with an increase in positive mood, manic symptoms and paradoxically an increase in depressive symptoms, but not in the same individuals.

“The findings suggest that cannabis is not being used to self-medicate small changes in symptoms within the context of daily life. However, cannabis use itself may be associated with both positive and negative emotional states. We need to find out whether these relationships play out in the longer term as this may have an impact on a person’s course of bipolar disorder,” said Tyler.

By RICK NAUERT PHD Senior News Editor

Emerging research suggest an association between low levels of vitamin D and depression in otherwise healthy young women.

Oregon State University (OSU) researchers found that young women with lower levels of vitamin D were more likely to have clinically significant depressive symptoms over the course of a five-week study.

The results were consistent even when other possible explanations, such as time of year, exercise, and time spent outside were considered, says lead author David Kerr.

“Depression has multiple, powerful causes and if vitamin D is part of the picture, it is just a small part,” said Kerr, an associate professor in the School of Psychological Science at OSU.

“But given how many people are affected by depression, any little inroad we can find could have an important impact on public health.”

The findings were published recently in the journal Psychiatry Research.

As most are aware, Vitamin D is an essential nutrient for bone health and muscle function. However, deficiency has also been associated with impaired immune function, some forms of cancer and cardiovascular disease, said co-author Adrian Gombart, an associate professor of biochemistry and biophysics, and an international expert on vitamin D and the immune response.

People create their own vitamin D when their skin is exposed to sunlight. When sun is scarce in the winter, people can take a supplement, but vitamin D also is found in some foods, including milk that is fortified with it, Gombart said.

The recommended daily allowance of vitamin D is 600 IU per day. There is no established level of vitamin D sufficiency for mental health.

Although experts have suspected that vitamin D and depression are connected, scientific research to support the belief is lacking, says Kerr.

Accordingly, the new study was designed to support the association between Vitamin D deficiency and depression.

“I think people hear that vitamin D and depression can change with the seasons, so it is natural for them to assume the two are connected,” he said.

According to Kerr and his colleagues, a lot of past research has actually found no association between the two, but much of that research has been based on much older adults or special medical populations.

Kerr’s study focused on young women in the Pacific Northwest because they are at risk of both depression and vitamin D insufficiency.

Past research found that 25 percent of American women experience clinical depression at some point in their lives, compared to 16 percent of men, for example.

OSU investigators recruited 185 college students, all women ages 18-25, to participate in the study at different times during the school year. Vitamin D levels were measured from blood samples and participants completed a depression symptom survey each week for five weeks.

Perhaps as a surprise, many women in the study had vitamin D levels considered insufficient for good health. Moreover, the rates were much higher among women of color, with 61 percent of women of color recording insufficient levels, compared to 35 percent of other women.

In addition, more than a third of the participants reported clinically significant depressive symptoms each week over the course of the study.

“It may surprise people that so many apparently healthy young women are experiencing these health risks,” Kerr said.

As expected, the women’s vitamin D levels depended on the time of year, with levels dropping during the fall, at their lowest in winter, and rising in the spring.

Depression did not show as a clear pattern, prompting Kerr to conclude that links between vitamin D deficiency and seasonal depression should be studied in larger groups of at-risk individuals.

Researchers say the study does not conclusively show that low vitamin D levels cause depression.

A clinical trial examining whether vitamin D supplements might help prevent or relieve depression is the logical next step to understanding the link between the two, Kerr said.

A follow-up study on vitamin D deficiency in women of color has already been instigated by OSU researchers. In the meantime, researchers encourage those at risk of vitamin D deficiency to speak with their doctor about taking a supplement.

“Vitamin D supplements are inexpensive and readily available.” Kerr said. “They certainly shouldn’t be considered as alternatives to the treatments known to be effective for depression, but they are good for overall health.”

Source: Oregon State University

By MARGARITA TARTAKOVSKY, M.S.
There are many articles about things you can do to improve your depression. But what about staying away from those things that can make it worse?

“There are many things a person who lives with depression needs to be mindful of for better well-being,” according to Deborah Serani, Psy.D, a clinical psychologist and author of the valuable book Living with Depression.

Below, she shared six triggers that can exacerbate depression — and what you can do to minimize or cope with them.

1. Stress.

A surplus of stress spikes the hormone cortisol, Serani said. “Cortisol keeps us in an ‘emergency ready’ state, with states of arousal and irritability that tax our already fatigued body and mind.” To minimize stress, Serani suggested delegating tasks, dividing projects into digestible parts and learning to say no. “Above all, resist the tendency to take on too much at home, work or school,” she said. Check out these other articles on shrinking stress:

5 Ways to Stress Less
6 Ways to Stress Less at Work
10 Practical Ways to Handle Stress
Therapists Spill: The Best Ways to Shrink Stress & Anxiety
2. Sleep.

The relationship between sleep and depression is a complicated one. People with depression tend to have disrupted sleep. And people with sleep disorders – specifically insomnia — seem to be more susceptible to depressive symptoms. Too little or too much sleep can aggravate depression.

“Making sure the architecture of your sleep cycle is predicable and sound will help keep depression symptoms from worsening,” Serani said. Consistency is key in enhancing sleep quantity and quality. Go to sleep and wake up around the same time every day, she said. And if you take naps, make sure they don’t sabotage nighttime sleeping, she added.

3. Food.

The relationship between food and mood also is complex. But some studies have suggested that certain foods are associated with depression. For instance, this prospective study found a link between trans unsaturated fatty acids and depression risk. Foods high in sugar or simple carbohydrates can spike glucose levels and mess with mood, Serani said. Alcohol and too much caffeine can make you more irritable and also boost blood sugar levels, she said.

4. Toxic people.

Serani described toxic people as “negative and corrosive.” They don’t grasp how depression actually affects your life, she said. Avoid interacting with these individuals altogether, or at least try to have others around who can temper their toxicity, she said.

And focus on having great people in your life. “Part of living with depression requires you to learn how to reframe negative thoughts into positive ones, so having people in your life that are affirmative, nurturing and accepting of who you are will help ground you in a better healing environment,” Serani said.

5. Media.

Upsetting and disturbing news and stories can exacerbate depression. “I know that my depressive symptoms worsen if I’m exposed to horrifying news, startling stories or dramatic films,” Serani said. She keeps up with current events by reading selective stories. Figure out what medium you’re most comfortable with. And learn your own signs that you’ve absorbed enough information, she said.

6. Anniversary reactions.

Around or on the date of a past traumatic event, some people experience the same distressing symptoms they originally felt. Events that might trigger an anniversary reaction include anything from a loved one’s passing to a stressful doctor’s appointment, Serani said.

She suggested readers “take a look at the dates on the calendar to raise awareness of any emotional days that may be coming up.” Knowing these days are coming up will help you better prepare for them, she said. For instance, let your loved ones know about potentially problematic days, she said. “See if they can check in on you or offer support in some way.”

?What tends to aggravate your depression?
What helps you minimize or cope with that trigger?

By TRACI PEDERSEN Associate News Editor

Employees who sit for long periods of time are at greater risk for psychological distress, according to an Australian study published in the journal Mental Health and Physical Activity.

Specifically, employees who reported sitting for longer than six hours per day had higher rates of anxiety and depression compared to those who sat for less than three hours a day.

Furthermore, going to the gym after work doesn’t appear to protect workers from the effects of prolonged sitting. When study participants were sedentary for most of the work day, even if they were physically active and getting exercise outside of work, they still showed relatively higher rates of anxiety and depression symptoms than did workers who sat for less than three hours a day.

For the study, researchers analyzed data from 3,367 state government employees as part of a broader health outreach program.

Participants were asked to fill out a short psychological assessment on their symptoms of anxiety and depression during the last four weeks. They were also asked to rate their current levels of physical activity, leisure-time activity, and general satisfaction with the workplace.

The results showed a significant relationship between rates of psychological distress and sitting. Employees who reported sitting for longer than six hours per day had increased prevalence of moderate symptoms of anxiety and depression compared to those who reported sitting for less than three hours a day.

There were also differences based on gender, with women reporting higher rates of sitting-related psychological distress than men. On average, male workers reported sitting for nearly five hours a day while women reported sitting for about four hours per day.

“Since men and women in our sample reported similar estimations of work stress, unmeasured factors such as work-family conflict and incorporation of work and parenting roles could be differentially affecting women,” writes psychological scientist Michelle Kilpatrick, Ph.D., of the University of Tasmania and colleagues in the journal Mental Health and Physical Activity.

“Consequently, individuals may be meeting recommended levels of health promoting physical activity, yet their physical and mental health may remain at risk if they are also sedentary for prolonged periods,” writes Kilpatrick.

Previous research has shown a link between prolonged sitting and a number of serious health issues ranging from Type II diabetes to heart disease. Although there was a strong association between long-term sitting at work and moderate levels of psychological distress, sitting was not associated with extreme levels of anxiety and depression.

Source: Association for Psychological Science

By PSYCH CENTRAL STAFF

borderline-personality-disorder-symptomsThe main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive, oftentimes demonstrating self-injurious behaviors (risky sexual behaviors, cutting, suicide attempts).

Borderline personality disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person’s self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person’s emotions and feelings.

These individuals are very sensitive to environmental circumstances. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician’s announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this “abandonment” implies they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Relationships and the person’s emotions may sometimes be seen by others or characterized as being shallow.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Specific Symptoms of Borderline Personality Disorder
A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

Frantic efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance, such as a significant and persistent unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Transient, stress-related paranoid thoughts or severe dissociative symptoms

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Borderline personality disorder is more prevalent in females (75 percent of diagnoses made are in females). It is thought that borderline personality disorder affects between 1.6 and 5.9 percent of the general population.

Like most personality disorders, borderline personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

Details about Borderline Personality Disorder Symptoms
Frantic efforts to avoid real or imagined abandonment.

The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.

Unstable and intense relationships.

People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficient supports or as cruelly punitive. Such shifts other reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.

Identity disturbance.

There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

You can also learn more about the detailed characteristics of borderline personality disorder.

How is Borderline Personality Disorder Diagnosed?
Personality disorders such as borderline personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose borderline personality disorder.

Many people with borderline personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for borderline personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Borderline Personality Disorder
Researchers today don’t know what causes borderline personality disorder. There are many theories, however, about the possible causes of borderline personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Borderline Personality Disorder
Treatment of borderline personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see borderline personality disorder treatment.

Borderline Personality Test: http://psychcentral.com/quizzes/borderline.htm

Youth who enter puberty ahead of their peers are at heightened risk of depression, although the disease develops differently in girls than in boys, a new study suggests.

Early maturation triggers an array of psychological, social-behavioral and interpersonal difficulties that predict elevated levels of depression in boys and girls several years later, according to research by led by psychology professor Karen D. Rudolph at the University of Illinois.

Rudolph and her colleagues measured pubertal timing and tracked levels of depression among more than 160 youth over a four-year period. During their early teenage years, the youth in the study completed annual questionnaires and interviews that assessed their psychological risk factors, interpersonal stressors and coping behaviors. Parents also reported on their children’s social relationships and difficulties.

Published online by the journal Development and Psychopathology, the study is one of the first research projects to confirm that early puberty heightens risk for depression in both sexes over time and to explain the underlying mechanisms.

“It is often believed that going through puberty earlier than peers only contributes to depression in girls,” Rudolph said. “We found that early maturation can also be a risk for boys as they progress through adolescence, but the timing is different than in girls.”

Youth who entered puberty ahead of their peers were vulnerable to a number of risks that were associated with depression. They had poorer self-images; greater anxiety; social problems, including conflict with family members and peers; and tended to befriend peers who were prone to getting into trouble, the researchers found.

Levels of depression among early-maturing girls were elevated at the beginning of the study and remained stable over the next three years. These adverse effects were persistent in early maturing girls, who remained at a distinct disadvantage, even as peers caught up to them in physical development, Rudolph said.

“In girls, early maturation seems to trigger immediate psychological and environmental risks and consequent depression,” Rudolph said. “Pubertal changes cause early maturing girls to feel badly about themselves, cope less effectively with social problems, affiliate with deviant peers, enter riskier and more stressful social contexts and experience disruption and conflict within their relationships.”

Early maturation did not appear to have these immediate adverse effects on boys, who showed significantly lower levels of depression at the outset than their female counterparts. However, these differences dissipated over time, such that by the end of the fourth year, early maturing boys didn’t differ significantly from their female counterparts in their levels of depression.

“While early maturation seemed to protect boys from the challenges of puberty initially, boys experienced an emerging cascade of personal and contextual risks – negative self-image, anxiety, social problems and interpersonal stress – that eventuated in depression as they moved through adolescence,” Rudolph said.

Although the study examined the risk factors as independent measures, it’s possible that these elements mutually reinforce each other over time, the researchers said.

“But it’s important to note, as we find in our work, that only some teens are vulnerable to the effects of early maturation, particularly those with more disruption in their families and less support in their peer relationships,” Rudolph said.