Here’s the thing about having a mental illness – you can’t always see it or hear it if you’re on the outside. Unlike other illnesses like the flu or cancer where the symptoms show up visually or you can hear it in the voice of someone who has been up coughing all night, you can’t always see or hear that someone is experiencing depression or anxiety. And despite the misconception that people who are depressed don’t get out of bed or can’t find the energy to participate in their lives consistently, the majority of people experiencing depression are functioning members of society. So what do you do when you’re too “functional” to be taken seriously for experiencing depression or anxiety?
Thoughts are simply ideas that we are conscious of. Thinking is the flow of thoughts. Thinking can be automatic (passive, habitual, effortless) or deliberate (active, volitional, effortful). Thoughts can remain private in our mind or be shared with others as speech or writing. There is much we don’t understand about what goes on under the hood – how pre-conscious brain activity generates thinking.
CNN reports on a study just released, that states 3.4% of the adult, non-elderly population suffer from serious psychological distress – symptoms typically captured under the diagnosis of depression. This is greater than a 10% increase over the past decade in the U.S. Individuals with serious psychological distress are much more likely to suffer from poor physical health and tragically, less able to afford health care.
Despite federal recommendations for depression screening, a new Rutgers study found that less than 5 percent of adults were screened for depression in primary care settings. The low screening rate suggests missed opportunities to identify individuals with depression and link them to care, according to study authors. The research was published in February in Psychiatric Services in Advance.
An estimated 13 to 16 percent of adults will experience symptoms of depression in their lifetime, and an estimated 4 to 8 percent experience major depression in a given year. Yet in primary care settings, depression goes unrecognized about half the time. Depression screening has been recommended since 2002 and it is generally covered by private insurance and Medicare.
A recent article on Raptitude, talked about how the majority of of difficult experiences in David’s life resulted from his desperate need to avoid difficult experiences. This need to avoid difficult situations, caused him to live a period of his life led by the need to avoid rather than confront or embrace.
Emotions can drive our behavior, at times without our conscious awareness. In this post, the focus is on the behavior of avoidance, and its driver – emotional experiences that were distressing. Thinking, which is called ‘rumination’ in this piece, is captive to the emotion – a post hoc rationalization, that is unproductive. Becoming aware of these patterns can lead to freedom – freedom to change. This can be in the form of therapy (behavior therapy specifically targets avoidance) or other approaches preferential to the individual. The important start is recognizing what is happening, leading to the option to change.
eMindLog™ is a tool to know where you are, so you can choose what to do. You can use eMindLog™ to track your daily experiences allowing you to see trends and triggers over time which can help you make better informed decisions about your life. To start using eMindLog™, sign up here.
According to the World Health Organization (WHO), more than 4 percent of the world’s population live with depression, and women, youth, and the elderly are the most prone to its affects.
As of 2015, an estimated 322 million people suffered from depressive disorders, a rise of 18.4 percent in a decade, as people live longer, the United Nations said in a report.
The global economic loss exceeded $1 trillion a year, referring to lost productivity due to apathy or lack of energy that lead to an inability to function at work or cope with daily life.
“Depression is the single largest contributor to years lived with disability. So it’s the top cause of disability in the world today,” Dr. Dan Chisholm of WHO’s Department of Mental Health and Substance Abuse told a news briefing.
He further went on to note that depression is 1.5 times more common among women than men.
A further 250 million people suffer anxiety disorders, including phobias, panic attacks, obsessive-compulsive behavior and post-traumatic stress disorder, the report said.
80 percent of those stricken with mental illness live in low- and middle-income countries. As Chisholm said, “That puts paid to the notion of these disorders being diseases of the rich or the affluent, that is not the case. In fact in many countries people who are affected by poverty, unemployment, civil strife and conflict are actually at higher risk of certainly anxiety disorders and also depression.”
There are three age groups that are particularly vulnerable to depression:
- Pregnant or post-partum women
- The elderly
“The pressures on today’s youth are like no other generation perhaps,” Chisholm said.
“Another target group is women who are pregnant or have just given birth. Depression around that period is actually extremely common, around 15 percent of women will suffer not just ‘the blues’, but a diagnosable case of depression.”
Retirees are also susceptible. “When we stop working or we lose our partner we become more frail, more subject to physical diseases and disorders like depression do become more common.”
An estimated 800,000 people die from committing suicide each year, a “pretty horrifying figure”, Chisholm said. “It is more common in males in higher income countries but more common in females in lower- and middle-income countries.”
The WHO is running a campaign to tackle stigma and misconceptions called “Depression: Let’s Talk”.
“We feel that is a key first step, that if we want to bring mental health, depression and other mental disorders out of the shadows, we need to be able to talk about it,” Chisholm said.
eMindLog™ measures stress, anxiety, and depression using self-reporting and allows patients to connect with their providers to engage in better informed care and to create a dialog between patient and provider enriching the diagnosis and treatment process. Users / patients can sign up here.
World Health Day is April 7, 2017. To learn more about World Health Day and Depression: Let’s Talk, visit WHO.
The most commonly prescribed antidepressants are Selective Serotonin Re-uptake Inhibitors (SSRIs). Skeptics argue that because it takes four to six weeks for these antidepressants to kick in, they don’t really work or that if they do, it’s not because the patient has low levels of serotonin in the brain.
Let’s start with a little background. Serotonin has multiple functions in the brain, one of which is keeping us calm and content. It is a neurotransmitter that works most effectively when it is outside of the brain’s neurons; although it doesn’t do anything good or bad if it is inside the brain’s cells. SSRIs work by blocking the serotonin transporter which results in more serotonin being outside of the neurons where it can do it’s job.
If there is too little serotonin active outside the brain’s cells, we become nervous, unhappy, or unable to feel any pleasure. By blocking the the transporter that inactivates serotonin, SSRIs can restore the brain’s active levels of serotonin returning us to a calm and content state. Skeptics of SSRI efficacy will return to the concept that the delayed effect means they don’t really work.
It is rather interesting that SSRIs don’t work after taking just one pill, especially considering that SSRIs are not the only drugs that block the serotonin transporter. Street drugs like cocaine and ecstasy also reportedly block the serotonin transporter. But it obviously does not take four to six weeks for cocaine and ecstasy to take effect.
Rather than assuming that the medication is not working, let’s consider an analogy. If you were to go to a dietitian to set up a meal plan to help you lose weight. You and your dietitian come up with a good plan that is likely to work. However, your refrigerator and kitchen are stocked with the items you already eat. Rather than wasting the food you’ve already purchased, you consume it and slowly begin restocking your kitchen with healthier items. Because of this transition time, your weight remains stable but about a month after you’ve begun, you start to lose weight. This is the time when the old foods in your kitchen have been replaced with healthier options.
More recent research suggests an analogous explanation of why SSRIs don’t kick in right away. The reason suggested is that SSRIs don’t target the serotonin transmitter directly. Although some SSRIs (like Lexapro) bind directly to the transporter, the direct binding is not the underlying mechanism of action. Instead antidepressants target our DNA, in particular the genes that code for the serotonin transporter. They make these genes less active causing there to be less transporter molecules available in the brain. This, the new research argues, explains the delayed action of antidepressants. As our brains already have plenty of transporter molecules when we begin taking antidepressants, it takes awhile for the suppression of genes coding for the transporter take effect in the brain.
When we start taking the medication, our brain is like the refrigerator, full of old food choices. It takes a few weeks to get through the old food and begin replacing it with healthier alternatives that can ultimately stabilize us and make use function normally.
eMindLog™ is a tool that you and your provider can utilize to monitor and track the effectiveness of medication. It can also be used to create a baseline for starting treatment. To learn more and see how it works, create your free account.
This article was originally posted on The Superhuman Mind by Berit Brogaard D.M.Sci., Ph.D.
Congratulations to Philip Ninan, M.D., eMind Science, Chairman and CSO who received the President’s Award for his services as Program Chair 2015-2016 at the annual meeting and scientific session of the North Carolina Psychiatric Association September 10, 2016.